Do I Have a “Biological” Depression?
Debates about whether some depressions are biological and others psychological miss the point and are not useful for guiding therapy. All depressions are ultimately biological. They are associated with changes in sleep, appetite and energy levels and, in the more severe forms, with disturbances in thinking, memory and concentration. These biological changes do not distract from the fact that most depressions have a psychosocial context and that a person’s mood can be markedly affected by changes in their relationships with others. There may be either a real change in the situation which was upsetting; or a change in the person’s perception of the situation; or a change in the person’s ability to cope with the situation.
Help can be found with medication or psychotherapy. The decision to use medication should be based on the severity of the patient’s symptoms, a history of recurrence and the patient’s wishes. A patient with psychotic or delusional depression or bipolar disorder should first be considered for medication. There is also a need for non-pharmacotherapeutic alternatives in the treatment of depression. Many depressed patients do very well with psychotherapy as the only treatment. For some patients, combined medication and psychotherapy is the most helpful.
I’ve Been Chronically Depressed!
In some cases, a severe episode of depression (including sleep and appetite disturbances) may be superimposed on a long-standing depression that had only mild symptoms and a pessimistic way of viewing the world and dealing with others. Sometimes, when this severe depression is resolved, the on-going mild symptoms disappear, because they were merely a reflection of a long-standing, previously untreated depression. Also, when you are acutely depressed, you can expect to be at your worst: dependent, pessimistic, negative and irritable; when you no longer experience the symptoms you may feel very differently. However, if the chronic symptoms still remain, a longer or different form of treatment may be necessary. You and your therapist will make this evaluation.
Is My Depression Incurable?
When you are acutely depressed, it is common to feel that the symptoms will last forever. However, with proper treatment, about 80% of patients will be symptom free in 4-6 weeks. Once the sleep and appetite problems begin to resolve, you will find that your mood is better. It is important to remember that there are many different types of effective treatments for depression. IPT is just one of them. There is a range of other types of psychotherapies and a range of medications that can be used. Therefore, if one treatment does not work, your therapist and you should seek alternatives.
Give the treatment enough time (at least six weeks) to work. Don’t let the hopelessness of depression discourage you from continuing.
What If I Have Suicidal Thoughts?
The symptoms of depression can be overwhelming and invade all parts of your life. You may feel that your life is out of control. Suicidal thoughts are symptoms of depression. You may experience suicidal feelings, i.e., feeling life is 5 not worth living, wishing you were dead or perhaps thinking about a suicide attempt. If you feel this way, you should let your therapist know and you should request that you have more frequent contacts with the therapist. The therapist’s availability during these crises can be through daily phone calls or more frequent consultations.
DO NOT KEEP SUICIDAL THOUGHTS TO YOURSELF.
I Can’t Accept What I Really Want
Many depressed patients have trouble accepting their own wishes and are unwilling to act upon them because they feel that their needs are unacceptable or unlikely to be fulfilled. For example, a woman may meekly (but resentfully) accept domination by her husband if she does not believe that a different type of relationship is legitimate, appropriate or possible.
To counter the tendency to suppress or deny needs or wishes, you should try to work on expressing what these wishes or needs are. Discuss them with your therapist and decide what is reasonable. Work actively in treatment to try to bring them about, to understand your role in the behavior and to make realistic changes.
I Am to Blame for My Family Problems
Many depressed patients blame themselves for situations over which they have only partial control. Self-blame is part of depression. There may be unrecognized family or group pressure on you to take the blame. This is a good topic to bring up during the therapy so that you can learn to avoid being made the scapegoat if that is what is happening in your family.
Can I Drink My “Blues” Away?
Some depressed people think that alcohol will relieve their symptoms. After all, alcohol can help sleep, at least in the short-run, and will dull painful memories and current experiences.
Alcohol is a bad “treatment” for depression. In the long-run it disturbs sleep and is a mood depressant. It can make you more depressed. Moreover, it diminishes your ability to cope, creates additional problems in family and work, interferes with your treatment and increases risk for suicide.
IF YOU ARE DRINKING, TELL YOUR THERAPIST AND ASK FOR HELP.
What about “Under the Counter” Drugs?
The same problems, as with alcohol, occur with use of illicit drugs or abuse of legal drugs – and they can even be worse.
IF YOU ARE HAVING A PROBLEM WITH DRUG ABUSE, TELL YOUR THERAPIST AND ASK FOR HELP.
Can I Give Depression to My Children?
Depression is a family affair. If you are depressed, your children are at 2 – 3 times greater risk for becoming depressed, when compared to children of parents who have never been depressed. Put another way, if the normal rate of depression is 3%, the risk to children of depressed parents is 6 – 9%. The good news is that most of the children won’t get depressed. We don’t know the mechanism by which depression is transmitted in families, whether it is through genes, learning, stress produced by a parent’s depression or some combination.
If you are depressed and your children also seem to be having similar problems, pay attention, take it seriously, talk to them about it and get them help.
Is Seeking Treatment a Defeat?
Many depressed patients see the need for treatment as just another sign of their weakness or defeat. An alternative way to look at the situation is that seeking treatment is a constructive and courageous move to try to make changes in your life. It is an effort to take your situation in hand and actively do something about it. Seeking treatment for your depression is a positive first step out of depression.
Mastering Depresion Through Interpersonal Psychotherapy, A Patient Workbook. By Myrna M. Weissman, Oxford University Press, 1995