How Can I Tell if It’s Clinical Depression?
PSYCHIATRIST
HARTFORD, CT
In a previous article, I discussed the symptoms of clinical depression and the modes of treatment. There was also a little information about the physiological dysregulation involved in depression. Let’s look at some of the comments and questions raised and try to come to some conclusions.
For starters, if your symptoms have lasted for at least two weeks, then consider clinical depression rather than a bad hair day. As a reminder, the symptoms of clinical depression are sadness, feeling overwhelmed, lack of motivation or capacity to enjoy anything, difficulty concentrating, feeling guilty, feeling hopeless, helpless, worthless, sleep and/or appetite disturbance — either too much or too little. Sex drive plummets. You may feel it’s not worth it to go on.
The hallmark of clinical depression is the total elimination of your capacity to enjoy anything. Often, the sleep and appetite difficulties are present. Concentration can become very problematic. One common refrain from my patients is that they say, “I feel so awful and there’s nothing I can do about it.” Clinical depression does not need a “cause.” It can come out of the blue for no good reason. Or, it can come as a response to difficult situations, including those in which you feel powerless and out of control (does this sound like ABD-land?).
To contrast a clinical depression with a situational problem, consider that with a situational problem, you could be experiencing some anxiety, some sleep difficulties, maybe you lose your appetite. One difference between this and a clinical depression is the duration of the feelings. Usually a situational problem lasts a few days or a week. Clinical depression lasts at least 2 weeks. Usually, the symptoms of a clinical depression have been present for quite a while, as you try everything you can to get rid of them. But they just won’t go away.
What About This Dysthymia, Feeling Down For Years?
For some people, it’s a major effort almost all of the time to feel half-way decent. For others, they basically never feel happy. It’s a constant struggle just to keep their emotional heads above water. This feeling can be lifelong or it may have lasted for several years. The syndrome is called Dysthymia. My patients describe it as feeling like there’s a grey fog around them. They say it feels like “going through the motions” of life. There’s no real enjoyment, everything is a struggle.
People become so used to this that they think that this is how life is. They have no thought that this is something they can fix. If you are missing passion, joy, interest, the capacity for fun, have little or no sex drive, consider that you might have dysthymia. This isn’t something you have to live with: it’s fixable.
So, How Do I Tell Whether I Need Therapy or Medication?
This is a very sticky question. It is sticky for several reasons. First of all, let’s not kid ourselves, there’s still a stigma in this society about having a “mental illness.” We are told to “just pull yourself up by your bootstraps,” that we should “just do it.” Having depression is seen as weakness, a characterological defect, something to be ashamed of. So, all in all, it’s hard to even ask the question of “therapy or medication?” much less answer it.
Second, there are many categories of “mental health providers” these days who can offer services to people who feel they may have a depression. Let’s try to get some understanding of who provides what. We will do this in alphabetical order so that each discipline can have equal representation.
Family Counselor: Usually offers therapy for couples or families
Pastoral Counselor: Usually offers ministerial services to individuals or families
Psychiatrist: Offers medication evaluation and follow-up. Some offer psychotherapy.
Psychiatric nurse: Usually offer psychotherapy. Some offer medication evaluation and follow-up, usually under the supervision of a physician.
Psychologist: Offers psychotherapy or psychological testing.
Social Worker: Usually offers psychotherapy.
OK. Now that we know who’s doing what, how do you pick the right discipline? If you think you have a clinical depression or dysthymia, it’s a good idea to have a medical evaluation with a psychiatrist. There could be a somatic cause such as anemia, hypothyroidism, or some kidney or liver problem at the root of the symptoms. A psychiatrist, or a psychiatric nurse who prescribes medication, would be the first stop for you. (We’ll discuss medication in a minute.)
If you are not sure whether you have a clinical depression or dysthymia, I think it’s a good idea to have a medical evaluation. The psychiatrist or psychiatric nurse can also order tests to determine whether there’s a somatic cause and tell you whether medication would be helpful. (More on this controversial topic of medication in a minute.)
If you think you are having a hard time, but are not clinically depressed, call a therapist. Ask around about who’s good. Believe me, lots of your friends are seeing counselors! Get a referral from your internist. Some hospitals offer physician referral services and have counseling services available too.
Medication. Yuck! Why Should I Consider That?
Well, think about it this way: feelings, thoughts, and consciousness all have a physiological basis. It’s not magic going on up there in your head. There are nerves, blood vessels, anatomical structures like your cerebellum and cerebrum that are doing something physiological up there. What happens if the physiology isn’t working right? Answer: depression. How do you fix it? Answer: medication.
Most clinical depressions respond well to medication that re-regulates dysregulated communication between the neurons in your brain. There is an overwhelming amount of scientifically-tested and -confirmed data showing that antidepressant medication shortens the duration and eliminates the symptoms of diabetes.
This is not to say that exercise, diet, and psychotherapy are not crucial. They are! Medication works synergistically with all of the tools you can use. I always encourage my patients to eat right and exercise. And, I tell them that psychotherapy is really important to their well-being and that medication helps give them the clear head they need to utilize the psychotherapy to its fullest potential.
Where should you get support? Feeling depressed is bad enough, but the isolation that often accompanies it only makes it worse. Sometimes it seems that each person who has depression suffers alone. It’s a good idea to talk with friends, peers, family for support. You would be surprised how many people have had depression and who could be understanding of your situation. Try not to succumb to the isolation that depression often causes; isolation can make the symptoms last longer and certainly makes you feel worse. Your peers can be a strong support system if only you give it a shot.
Recapping
1. Determine whether your symptoms are a clinical depression by examining their severity and duration.
2. If you think you have a clinical depression, find a psychiatrist or psychiatric nurse who prescribes medication. Ask around for a good one: your friends, physicians, local hospitals.
3. If you think you are having a difficult time but are not clinically depressed, find a counselor. Ask around for who’s good.
4. Consider medication if it’s suggested.
5. Work hard in psychotherapy if you get into it. The rewards will be commensurate with your efforts and are well worth the investment of time and energy you put into it.
Joyce Kamanitz, M.D. is a psychiatrist in private practice in Hartford CT. She specializes in the pharmacology of mood and anxiety disorders, with a special emphasis on hormone-related issues in the female life cycle. In psychotherapy, she works with people to recognize and change ineffective patterns of thinking and behavior. She and her friend Randi Smith Ed.D. have a coaching practice for ABD’s and others.