8 Reasons Why Your Depression May Not Be Getting Better

Psych Central Article Here

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You’ve been to four psychiatrists and tried over a dozen medication combinations. You still wake up with that dreadful knot in your stomach and wonder if you will ever feel better.

Some people enjoy a straight path to remission. They get diagnosed. They get a prescription. They feel better. Others’ road to recovery isn’t so linear. It’s full of winding bends and dead-ends. Sometimes it’s entirely blocked. By what? Here are a few impediments to treatment to consider if your symptoms aren’t improving.

1. The Wrong Care

Take it from the Goldilocks of mental health. I worked with six physicians and tried 23 medication combinations before I found the right psychiatrist who has kept me (relatively) well for the last 13 years. If you have a complex disorder like I do, you can’t afford to work with the wrong doctor. I would highly recommend that you schedule a consultation with a mood disorders center at a teaching hospital near you. The National Network of Depression Centers lists 22 Centers of Excellence located across the country. Start there.

2. The Wrong Diagnosis

According to the Johns Hopkins Depression & Anxiety Bulletin, the average patient with bipolar disorder takes approximately 10 years to receive the proper diagnosis. About 56 percent are first diagnosed incorrectly with major depressive disorder, leading to treatment with antidepressantsalone, which can sometimes trigger mania.

In a study published in the Archives of General Psychiatry, only 40 percent of participants were receiving appropriate medication. It’s pretty simple: if you’re not diagnosed correctly, you won’t get the proper treatment.

3. Non-adherence to Medication

According to Kay Redfield Jamison, Ph.D., Professor of Psychiatry at Johns Hopkins University and author of An Unquiet Mind, “The major clinical problem in treating bipolar illness is not that we lack effective medications. It is that bipolar patients do not take these medications.” Approximately 40 to 45 percent of bipolar patients do not take their medications as prescribed. I’m guessing the numbers for other mood disorders are about that high. The primary reasons for non-adherence are living alone and substance abuse.

Before you make any major changes in your treatment plan, ask yourself if you are taking your meds as prescribed.

4. Underlying Medical Conditions

The physical and emotional toll of chronic illness can muddy the progress of treatment from a mood disorder. Some conditions like Parkinson’s disease or a stroke alter brain chemistry. Others like arthritis or diabetes impact sleep, appetite, and functionality. Certain conditions like hypothyroidism, low blood sugar, vitamin D deficiency, and dehydration feel like depression. To further complicate matters, some medications to treat chronic conditions interfere with psych meds.

Sometimes you need to work with an internist or primary care physician to address the underlying condition in tandem with a mental health professional.

5. Substance Abuse and Addiction

According to the National Institute on Drug Abuse (NIDA), people who are addicted to drugs are approximately twice as likely to have mood and anxiety disorders and vice versa. About 20 percent of Americans with an anxiety or mood disorder, such as depression, also have a substance abuse disorder, and about 20 percent of those with a substance abuse problem also have an anxiety or mood disorder.

The depression-addiction link is both strong and detrimental because one condition often complicates and worsens the other. Some drugs and substances interfere with the absorption of psych meds, preventing proper treatment.

6. Lack of Sleep

In a Johns Hopkins survey, 80 percent of people experiencing symptoms of depression also suffered from sleeplessness. The more severe the depression, the more likely the person will have sleep problems. The reverse is also true. Chronic insomnia creates a risk for developing depression and other mood disorders, including anxiety, and interferes with treatment. In persons with bipolar disorder, inadequate sleep can trigger a manic episode and mood cycling.

Sleep is critical to healing. When we rest, the brain forms new pathways that promote emotional resilience.

7. Unresolved Trauma

One theory of depression suggests that any major disruption early in life, like trauma, abuse, or neglect, may contribute to permanent changes in the brain. According to psychiatric geneticist James Potash, M.D., stress can trigger a cascade of steroid hormones that likely alters the hippocampus and leads to depression.

Trauma partly explains why one-third of people with depression don’t respond to antidepressants. In a study recently published in Scientific Reports, researchers uncovered three subtypes of depression. Patients with increased functional connectivity between different brain regions who had also experienced childhood trauma were categorized with a subtype of depression that was unresponsive to selective serotonin reuptake inhibitors like Zoloft and Prozac. Sometimes, then, intensive psychotherapy needs to happen alongside medical treatment in order to reach remission.

8. Lack of Support

review of studies published in General Hospital Psychiatry assessed the link between peer support and depression and found that peer support helped reduce symptoms of depression. In another study published by Preventive Medicine, teens who had social support were significantly less likely to become depressed after experiencing work or financial stress in early adulthood than those without support. Depression was identified among conditions affected by loneliness in a paper published in the American Journal of Public Health. Persons without a support network may not heal as quickly or as completely as those with one.

 

On The Days Depression Makes You Feel Nothing At All

Author Article

Today is a blah day. It isn’t that there is anything terribly wrong today. There are issues looming, yes, but there are always issues of late. There is nothing pressing, though.

It is just a blah day, a day where I lay in bed, struggling to find a reason to get up. I’ve had to pee for a couple hours now. Yet, the dull ache in my bladder is not enough to pull me from under my covers. I should probably brush my teeth. Maybe get dressed and get a bite to eat. I have been awake for more than five hours now, even before the sun rose. Yet, here I still lay.

I feel blah. While the world around me continues with its hustle and bustle, I have no motivation, no desire to do anything. Nothing seems interesting or important. Nothing is pressing enough to pull me from this funk.

I would go back to sleep if I could, call in sick from life itself. I feel like nothing, not myself. I feel numb.

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Days like this are common with depression. Those who have never struggled often assume that depression is all bouts of random sadness and tears. Yes, I have those days, too, and it is draining when everything and anything feels heart-wrenching and makes me want to cry. Yet, even worse, perhaps, than the days when I feel everything too strongly are the days I feel nothing at all.

On these days, I have trouble pulling myself up or doing anything. I’m not being lazy. I just don’t see the point. I am pulled into a gray abyss, where there’s no purpose, no joy, no motivation, no will to live. It isn’t that I’m suicidal and actively want to die, either. I just have no will to live. The emptiness is all-consuming.

People suggest I should just “try” to be happy or to be positive. If only it were this simple. Again and again, the “should be” and “could be” options roll around in my mind but I’m numb to them all. Deep down, I know I should be getting up, doing something, living life.

Yet, my brain has me in a death lock. “What’s the sense?” and “Why bother?” it parrots to me again and again. Its voice is booming and deafening. I can hear nothing else. I would love to just smile, think a happy thought and have it vanish away like a puff of smoke but it’s solid and real to me. It takes the form of four solid walls, caging me in, holding me hostage, refusing to budge or listen to reason.

Those blah days are the worst because I feel trapped in this numbness. I cannot escape. I never know whether it will last one day or one week. There is never an end in sight, never a scheduled sweet release.

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Blah days drag on and on until at some point I begin to feel everything too strongly again. On blah days, I would welcome the tears, the anguish, the pain and the struggling just to feel anything at all.

It has been more than hours now, and I’ve barely managed to write a few paragraphs. Yet, those feel like a tremendous accomplishment. I call it a victory. I have done something, which is more than I am able to achieve on most blah days. I still have to pee, though the dull ache has grown into a steady cramp. Breakfast time has come and gone, and lunch time has arrived. Yet, I still don’t have any desire to eat anything, let alone get up.

There are calls I should make and things I should be doing. Yet, my depression still echoes in my head that I shouldn’t bother, that nothing is worth the effort. It tells me to stay in bed, just let this day drift on by, that it doesn’t matter.

Nothing matters. It is all I can hear. It is deafening. I am adrift in a sea of hopelessness and emptiness. I feel paralyzed.

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I swear I am not being lazy. I’m just trapped in a battle with my own mind. I feel lost and alone. I feel trapped in this emptiness. I feel nothing. I feel numb. I feel blah. This is what depression feels like.​

This Comic Sums Up Exactly What It’s Like Living With Depression

CLICK TO VIEW (16 IMAGES)

Samantha Maffucci

Editor

Health And Wellness

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This article was originally published at The Mighty. Reprinted with permission from the author.

How Familiar with High-Functioning Depression Are You?

Author Article

Amanda Leventhal who is an undergraduate student at the University of Missouri has recently explained in an article how depression is underdiagnosed and overlooked in high functioning individuals. Her article has inspired a host of online discussions regarding the complex nature of depression and why it is so important to talk about this epidemic problem. Even in today’s societies, the causes of depression remain unknown and mental disorders such as manic-depression (bipolar disorder) are still unfairly stigmatized making mental health still a taboo topic that needs to be clarified and brought to light.

What is Depression?

Most guidelines today define depression as a mental disorder marked by low mood, aversion to activity and that also affects a person’s thoughts, behavior, and well-being. The exact causes of depression are unknown but possible triggers are stress, trauma, low self-esteem, chemical imbalances in the brain, prolonged illness, loneliness, and lack of light. Brain scans of depressed persons show that certain regions of the brain such as the frontal and temporal cortex, the insula, and the cerebellum are hypoactive. Furthermore, a growing number of studies have found a link between illness-caused inflammation and the development of depressive symptoms. What this means is that depression can no longer be considered an invisible illness but a very much palpable disorder that definitely requires treatment.

Depression in High-Functioning Individuals

Depression, just like the majority of all illnesses manifests with many symptoms. The most common symptoms of depression are low mood, apathy, a lack of motivation, troubles concentrating, problems with memory, sleepdisturbances, etc. The symptoms of depression tend to affect almost every aspect of a person’s life making this illness quite debilitating. An article published in the Canadian Journal of Psychiatry found that 79% of people with depression report that their illness has interfered with their ability to function at work. Since depression is considered a disorder that affects a person’s ability to function in life, we have to wonder if it is possible for people to be high-functioning and depressed at the same time? The short answer is yes as there are different types of depression. According to Harvard Health Publications, there is such a thing called dysthymia which is low-grade depression that lasts five years on average. The disorder is not as crippling as major depression but is a risk factor for episodes of major depression and it is probably under diagnosed in the general population.

The Stigma of Mental Illness and Why It Is a Problem

The stigma of mental illness causes a great deal of suffering and missed opportunities for those afflicted. Unfortunately, the invisibility of mental illness makes it harder for people to emphasize with a person suffering from mental disorders such as schizophrenia, major depression or manic-depression, and many often see the illness as made up or all in their head. The stigma may make it harder for people with mental illness to find employment, housing, and build secure relationships. People struggling with depression are very well aware of the stigma that surrounds mental illness and those going through depression may ignore their symptoms believing they have everything under control. This creates a problem that could lead to depression becoming worse with time and leading to poor health and even suicide if left untreated.

What You Can Do

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Knowing the nature of depression can help friends and family recognized atypical symptoms in loved ones. High functioning depressed persons may be better at hiding their symptoms, but behavioral and personality changes are usually good indicators something is going on. Irritability, anger, and a morose attitude is a good sign a person is depressed. Another sign could be increased sleepiness, weight gain, moodiness, and excessive fatigue. Asking the person that you believe is depressed about how they feel may help them understand that their behavior and mood is not normal but a result of depression. We have to understand that depression tends to skew a person’s view of themselves and the world and they may not recognize this as a sign of illness but rather as a normal reaction to a seemingly gloomy reality.

Conclusion

Although we tend to associate depression with low levels of functioning, some people may develop atypical symptoms of depression that can make it harder for them to believe they need help. The problem with mental illnesses such as major depressive disorder and manic-depression is that they often go unrecognized until a person develops severe symptoms that interfere with everyday functioning. The stigma attached to mental illness complicated matters further by making people already struggling with their mental disorder deal with feelings of shame and guilt. The result is often missed opportunities and low quality of life. Recognizing the symptoms of depression even in high-functioning individuals is something we need to take notice of today.

It’s pretty scary when you are in a stage what I call the “Blah Factor.” I say this because when you don’t feel anything you become numb to nothing. You don’t care and with a mental disorder like manic depression that blah blah feeling can lead to despair. What to do when you are face with the black factor? Hello, I’m Sunny Larue blogger, writer, storyteller, music lover and martini admirer. My blogs are about self-discovery with a positive vibe. My stories are about love and loss inspired by real life events. And this is the Blah Factor.

via THE BLAH FACTOR — Sunny Larue

The Most Dangerous Form of Depression Hides Behind a Smile

Author Article

The term “smiling depression”—appearing happy to others while internally suffering depressive symptoms—has become increasingly popular. Articles on the topic have crept up in the popular literature, and the number of Google searches for the condition has increased dramatically this year. Some may question, however, whether this is actually a real, pathological condition.

While smiling depression is not a technical term that psychologists use, it is certainly possible to be depressed and manage to successfully mask the symptoms. The closest technical term for this condition is “atypical depression.” In fact, a significant proportion of people who experience a low mood and a loss of pleasure in activities manage to hide their condition in this way. And these people might be particularly vulnerable to suicide.

It can be very hard to spot people suffering from smiling depression. They may seem like they don’t have a reason to be sad—they have a job, an apartment and maybe even children or a partner. They smile when you greet them and can carry pleasant conversations. In short, they put on a mask to the outside world while leading seemingly normal and active lives.

Inside, however, they feel hopeless and down, sometimes even having thoughts about ending it all. The strength that they have to go on with their daily lives can make them especially vulnerable to carrying out suicide plans. This is in contrast to other forms of depression, in which people might have suicide ideation but not enough energy to act on their intentions.

Although people with smiling depression put on a “happy face” to the outside world, they can experience a genuine lift in their mood as a result of positive occurrences in their lives. For example, getting a text message from someone they’ve been craving to hear from or being praised at work can make them feel better for a few moments before going back to feeling low.

Other symptoms of this condition include overeating, feeling a sense of heaviness in the arms and legs, and being easily hurt by criticismor rejection. People with smiling depression are also more likely to feel depressed in the evening and feel the need to sleep longer than usual. With other forms of depression, however, your mood might be worse in the morning and you might feel the need for less sleep than you’re normally used to.

Smiling depression seems to be more common in people with certain temperaments. In particular, it is linked to being more prone to anticipate failure, having a hard time getting over embarrassing or humiliating situations, and tending to ruminate or excessively think about negative situations that have taken place.

Women’s Health magazine captured the essence of smiling depression—the façade—when it asked women to share pictures from their social media and then to recaption them on Instagram with how they really felt in the moment they were taking the picture. Here are some of their posts.

Burden and treatment

It is difficult to determine exactly what causes smiling depression, but low mood can stem from a number of things, such as work problems, relationship breakdown, and feeling as if your life doesn’t have purpose and meaning.

It is very common. About one in ten people are depressed, and between 15% and 40% of these people suffer from the atypical formthat resembles smiling depression. Such depression often starts early in life and can last a long time.

If you suffer from smiling depression it is therefore particularly important to get help. Sadly, though, people suffering from this condition usually don’t, because they might not think that they have a problem in the first place—this is particularly the case if they appear to be carrying on with their tasks and daily routines as before. They may also feel guilty and rationalize that they don’t have anything to be sad about. So they don’t tell anybody about their problems and end up feeling ashamed of their feelings.

So how can you break this cycle? A starting point is knowing that this condition actually exists and that it’s serious. Only when we stop rationalizing away our problems because we think they’re not serious enough can we start making an actual difference. For some, this insight may be enough to turn things around, because it puts them on a path to seeking help and breaking free from the shackles of depression that have been holding them back.

Meditation and physical activity have also been shown to have tremendous mental health benefits. In fact, a study done by Rutgers University in the US showed that people who had done meditation and physical activity twice a week experienced a drop of almost 40% in their depression levels only eight weeks into the study. Cognitive behavioral therapy and learning to change your thinking patterns and behavior is another option for those affected by this condition.

And finding meaning in life is of utmost importance. The Austrian neurologist Viktor Frankl wrote that the cornerstone of good mental health is having purpose in life. He said that we shouldn’t aim to be in a “tensionless state,” free of responsibility and challenges, but rather we should be striving for something in life. We can find purpose by taking the attention away from ourselves and placing it onto something else. So find a worthwhile goal and try to make regular progress on it, even if it’s for a small amount each day, because this can really have a positive impact.

We can also find purpose by caring for someone else. When we take the spotlight off of us and start to think about someone else’s needs and wants, we begin to feel that our lives matter. This can be achieved by volunteering, or taking care of a family member, or even an animal.

Feeling that our lives matter is ultimately what gives us purpose and meaning—and this can make a significant difference for our mental health and well-being.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

 

What’s It Like to Be Suicidal? This Is My Experience, and How I Got Through It

Author Article

How we see the world shapes who we choose to be — and sharing compelling experiences can frame the way we treat each other, for the better. This is a powerful perspective.

At times, I’ve struggled with suicidal thoughts, even on a weekly basis.

Sometimes I’m able to ignore them. I might be driving to meet a friend for brunch and briefly think about driving my car off the road. The thought might catch me off-guard, but it quickly passes through my mind and I go about my day.

But other times, these thoughts stick around. It’s like a huge weight is dropped onto me, and I’m struggling to get out from underneath it. I suddenly get an intense urge and desire to end it all, and the thoughts can start to overwhelm me.

In those moments, I’m convinced I’ll do anything to get out from under that weight, even if it means ending my life. It’s like there’s a glitch in my brain that’s triggered and my mind goes haywire.

Even if that glitch is actually temporary, it can feel like it will last forever
With time, though, I’ve become more aware of these thoughts and found ways to manage when things get tough. It’s taken a lot of practice, but simply being aware of the lies my brain tells me when I’m suicidal helps to combat them.

If this last year has taught me anything, it’s that no matter what depression tells you, there’s always hope.
Here are four ways my suicidal ideation shows up, and how I’ve learned to cope.

1. When it feels impossible to focus on anything other than my pain, I look for a distraction
When I’m suicidal, I struggle to listen to reason — I only care about relief. My emotional pain is intense and overwhelming, so much so that it’s hard to concentrate or think about anything else.

If I find that I can’t focus, I sometimes turn to my favorite TV shows, like “Friends” or “Seinfeld.” They bring me a sense of comfort and familiarity that I need in those times, and it can be a great distraction when reality gets to be too much. I know all of the episodes by heart, so I’ll usually lay there and listen to the dialogue.

It can help me pull back from my suicidal thoughts and refocus on getting through another day (or just another hour).

Sometimes all we can do is wait for the thoughts to pass and then regroup. Watching a favorite show is a great way to pass the time and keep ourselves safe.
2. When I’m convinced that everyone would be better off without me, I challenge those thoughts
My loved ones would never want me to die by suicide, but when I’m in crisis, it’s hard for me to think clearly.

There’s a voice in my head that tells me how much better off my parents would be if they didn’t need to support me financially, or if my friends didn’t have to take care of me when I’m at my worst. No one would have to answer the late-night calls and texts or come over when I’m in the midst of a breakdown — isn’t that better for everyone?

But the reality is, I’m the only one that thinks that.

My family wouldn’t recover if I died, and my loved ones know that being there for someone when things get tough is a part of life. They would rather answer those late-night calls than lose me forever, even if I struggle to believe that in the moment.

When I’m in this headspace, it usually helps to spend some time with Petey, my rescue dog. He’s my best friend and has been there through it all this past year. On most mornings, he’s the reason I get out of bed.

I know he needs me to stick around and take care of him. Since he was already abandoned once, I could never leave him. Sometimes that thought alone is enough to keep me hanging on.

Challenge your thoughts about loved ones being better off without you by not only thinking through the reality, but spending time with loved ones — pets included.
3. When I struggle to see my other options, I reach out to my therapist — or I go to sleep
Being suicidal is, in some ways, a form of total emotional exhaustion. I’m tired of having to force myself out of bed each morning, having to take all of these medications that don’t seem to be working, and crying constantly.

Struggling with your mental health day in and day out is very tiring, and when I’ve reached my limit, it can feel as though I’m just too broken — that I need a way out.

It helps to check in with my therapist, though, and be reminded of all of the progress I’ve made so far.
Instead of focusing on the step backward, I can refocus on the two steps forward I took just before that — and how other forms of treatment I haven’t tried yet can help me get back on my feet again.

On the nights when the ideations are most intense and it’s too late to check in with my therapist, I take a couple of Trazadone, which are antidepressants that can be prescribed as a sleep aid (Melatonin or Benadryl can also be used as sleep aids, and purchased over-the-counter).

I only take them when I feel unsafe and don’t want to make any impulsive decisions, and it helps to ensure that I make it through the night. In my experience, those impulsive decisions would’ve been the wrong choice, and I almost always wake up the next morning feeling a little better.

4. When I feel completely and utterly alone, I push myself to reach out
When I’m dealing with suicidal ideations, it can feel like no one understands what I’m going through, but I also don’t know how to articulate it or ask for help.

It’s hard enough to try and explain to someone why you feel the desire to die, and sometimes, even opening up just leads to feeling misunderstood.

Even if it can feel awkward or scary at first, it’s important to reach out in these moments and keep yourself safe
If I’m feeling suicidal, I know the worst thing I can do is try to go it alone. It took me a long time to work up the courage to call someone when I was feeling this way, but I’m glad I did. Calling my mom and best friends has saved my life multiple times, even if in the moment I wasn’t convinced it would.

Sometimes you have to ignore the part of your brain that tells you it isn’t worth it, and pick up the phone anyway
Now when I’m feeling suicidal, I call a friend I trust or my parents.
If I don’t feel like talking, just having someone on the other side of the phone can still be comforting. It reminds me that I’m not alone, and that I (and the choices that I make) matter to someone.

If you don’t feel comfortable talking to a friend, text the crisis hotline by texting HOME to 741741. I’ve done this a few times, and it’s nice to just get my mind off things by texting with a compassionate person.

When you’re in a depressed state, you’re not in a position to make permanent decisions, especially when there’s no one there to offer perspective. After all, depression doesn’t just affect our moods — it can affect our thoughts, too.

Suicidal ideation can be extremely scary, but you’re never alone and you’re never without options.

If you’ve run out of coping tools and you have a plan and an intent, please call 911 or go to the nearest hospital. There’s absolutely no shame in that, and you deserve to be supported and safe.

If this last year has taught me anything, it’s that no matter what depression tells you, there’s always hope. No matter how painful it can be, I always find that I’m stronger than I think I am.

And chances are pretty good that if you’ve made it this far, you are, too.

Why Does Depression Make Me Want to Be Alone?

Author Article

Xavier Lalanne-Tauzia

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Welcome to Coping, Episode 21.

I never realized how little I knew about depression until I became depressed. I didn’t know, for instance, how depression can snatch away your sex drive, leaving you feeling newly—and involuntarily—asexual. I didn’t know that depression attacks your attention span, your energy, and your ability to finish things. During a recent bout, I had trouble finishing magazine articles and movies. The number of emails I sent plummeted. Everyday errands felt like Herculean tasks.

But perhaps most surprising was the emotional numbness. Nothing about hearing the word “depression” prepared me for having a moment of eye contact with my two-year-old niece that I knew ought to melt my heart—but didn’t. Or for sitting at a funeral for a friend, surrounded by sobs and sniffles, and wondering, with a mix of guilt and alarm, why I wasn’t feeling more.

Tonic writer Phil Eil goes on to explore depression-induced numbness here.

Ask the therapist

Q: Why does my depression make me want to distance myself from other people?

A: This is a confusing, very real, phenomenon: I don’t want to be alone… but leave me alone.

I like to think of depression as an entity, separate from you, and as something that grows and shrinks. There are certainly many behaviors that help depression grow: isolating yourself, over-sleeping, staying indoors, not eating, eating unhealthily, neglecting hygiene, etc. These are likely not behaviors you would engage in on your own without depression, but depression can creep into your brain and make you want to only do these things. It tells you it’s all you’re capable of doing, and then doing them worsens your mental state and keeps you depressed for longer.

The other part of my answer is that absolutely nothing is wrong with you for wanting to distance yourself from other people. It could very well be that you’re not feeling yourself, and just showing up feels like it won’t work or will be too exhausting. But if you can, you should fight these feelings, because sometimes your brain snaps out of its depressed state, even just for a little while, when you’re involved with people you care about.

Here’s my best tip: When you’re depressed, do the opposite of what your body is telling you to do. So if you feel like sleeping till 2pm, force yourself to go for a walk outside instead. If you feel like ordering takeout or eating chips for dinner, organize yourself enough to cook a simple meal. The more often you can take a moment to identify whether what you are about to do will grow or shrink your depression, the more you can separate yourself from the thoughts and behaviors that depression brings on.

Michelle Lozano is an Associate Marriage and Family Therapist and member of the ADAA.

10 Things People Get Wrong About Living With Depression

Huffington Post Article
Nicole Pajer

There are many stereotypes surrounding depression, from being unable to get out of bed to crying at all hours of the day. But those living with the condition will tell you that the illness comes in many forms, and often looks far different than what we’ve learned over the years from movies and the media.

Because of these misconceptions, people who haven’t had a personal tryst with depression often don’t fully know the ins and outs of the disorder. For instance, depression is not something that you can “snap out of.” You can recover from it and manage it, yet it still can easily come back. And it’s entirely possible to be depressed but also experience joy in the company of friends.

Curious what other things people frequently get wrong about living with depression? Experts and people who live with the condition break them down below:

You can be depressed and not appear sad.

CAIAIMAGE/PAUL BRADBURY VIA GETTY IMAGES

“It’s a misconception that depression is all about constant sadness. Yes, persistent sadness is a symptom, but it’s just one of a range of emotions, or lack thereof, that someone living with depression can feel,” said Helena Plater-Zyberk, co-founder of Supportiv, an anonymous peer support network for people with struggles like depression. She added that many would be surprised to know that people with depression are also to experience an array of emotions, including joy.

Mike Veny, an author and keynote speaker who often speaks about his own depression, agreed. “People get confused when they learn that someone who is confident and smiling all the time struggles with depression,” he said. He added that just because a person appears positive and upbeat, doesn’t mean that they aren’t struggling to hold it together inside.

You can’t flip a switch to flip to feel better.

“The biggest misconception about being depressed is that you can just ‘snap out of it,’” said Samantha Waranch, a publicist in Los Angeles who lives with the condition, noting that it’s frustrating when people imply that being depressed is “all in your head” and can be warded off by “thinking happy thoughts, being around people or hitting the gym.”

“While things like exercising can help, I think people who have never experienced depression don’t understand that it is an illness, a chemical imbalance that is beyond your control,” she added.

Depression isn’t merely triggered by stressful situations.

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“People think depression is because of a trigger or that something bad had to have happened to be depressed,” said Katie Leikam, owner of True You Southeast, who has dealt with depression herself. “Yes, depression can come from things like grief, but sometimes you just wake up one morning depressed and you cannot point to a solid reason.”

Dr. Melissa Pereau, medical director and psychiatrist at the Loma Linda University Behavioral Medicine Center, said that depression can be a highly genetic disease involving chemical neurotransmitters in the brain. Depressive episodes that last weeks or months can also often occur without any cause.

“Asking a person who is living with depression, ‘Why are you depressed?’ is sometimes just as frustrating to them as saying, ‘You should try to be more positive,’” Pereau said.

Isolation isn’t always best.

Dr. Don Mordecai, the national leader for mental health and wellness at Kaiser Permanente, noted that checking in on a loved one who is suffering can go a long way in showing that you care.

“You can say things like, ‘I’m here for you. What can I do to support you?’ or ‘Depression is a real health issue that can be treated. Have you talked to your doctor about this?’” he said, adding that in having these conversations, you may be surprised to learn how much the people that you care about appreciate the opportunity to share how they are really feeling.

It looks different for everyone.

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“Depression looks different in people,” said Tameka Brewington, a psychotherapist and owner of Real Talk Counseling. “For instance, some people will want to sleep all the time, while others are not getting enough sleep. Some people will isolate and withdraw while others will engage in a hostile or aggressive manner.”

Since depression manifests itself in different ways, Brewington said it’s important to know that each and every person suffering from the mental illness will have different needs.

Medication takes time to work.

Medications can certainly help to ease the symptoms of depression, but they won’t instantly make everything better. It takes time. “Chronic diseases require chronic treatment,” said Dr. Michael Genovese, a clinical psychiatrist and chief medical officer of Acadia Healthcare.

Even when the medication does help, it’s important to continue on with your prescribed dosages until your doctor gives you the green light to back off. “I’ve seen many patients over the years that will start taking their prescribed antidepressants, and as a result of the medication, they will feel better. This can lead to patients abruptly stopping their medication, which is a mistake,” Genovese added.

He advised patients to work with their physicians on a long-term plan. “Evaluate your options after you have committed significant time to your treatment plan,” he said.

It’s easy to overlook.

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In addition to sadness, depression can also manifest itself in physical ways. For instance, people with depression may suffer from sleep and appetite disturbance, low energy, lethargy, difficulty concentrating, poor memory or low libido.

“Often these symptoms are misattributed to other illnesses and people suffer from undiagnosed and therefore untreated depression for years,” said Zainab Delawalla, a licensed clinical psychologist in Atlanta.

Not being properly diagnosed can be frustrating and people who live with the condition may end up bouncing from doctor to doctor before finally getting the proper help they need.

Having depression doesn’t make you weak.

The idea that only “strong” people don’t have a mental health condition is one of the biggest misconceptions about mental illness, said Kelan Kline, who runs the lifestyle blog The Savvy Couple with his wife and lives with depression.

“I consider myself a very strong person ― super happy-go-lucky all the time,” he said, noting that “depression can hit anyone at any time, no matter how strong you are.”

L’Tomay Douglas, a life coach and founder of Brand Me Beautiful Inc., added that people are misinformed when they think that people living with depression are lazy.

“As a person diagnosed with clinical depression since 2003, I often had people saying things to me like, ‘Your problem is you need to get up off the couch and do something,’” Douglas said. “What they didn’t know was I was living, I was still breathing despite the darkness that tried to suffocate me and tell me to end it all.”

Medication is not the only treatment option.

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Sydney Williams, who writes about her experiences of recovering from sexual assault on her website, Hiking My Feelings, said there’s more to managing depression than taking medication.

“Not everyone wants to take medications to manage their disease and some folks don’t have access to medications,” said Williams, who stressed the importance of exploring a variety of treatment options. This can include talk therapy, lifestyle changes (for Williams, that meant hiking) and more.

There is no time frame for depression.

“Depression is not a now/later or here/gone thing,” said Lynn R. Zakeri, a licensed clinical social worker based in Illinois. In fact, she added that “people often say that because they experienced it, they feel much more at risk of returning to that and even feel it is a faster route right back down to the bottom since it is now a familiar route.”

Leikam added that clinical depression lasts for at least two weeks at the time, but “you can go through periods where you are fine and then it can come back through circumstances or coming off of medication.”

At work the other day, a sickening howl came out of an office near mine. It was guttural. Primal. Unfortunately familiar. A few years ago, it was me making that sound at work and I had made it many times before. It is the howl of those left behind after a suicide. It is a […]

via Silent Screams – Suicide Facts and Help — Queen Bee Living

If You’re Often Angry Or Irritable, You May Be Depressed

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Registered nurse Ebony Monroe of Houston recently went through a period of being quick to anger about every little thing. She didn’t realize then what it might mean for her health.

“If you had told me in the beginning that my irritability was related to depression, I would probably be livid,” Monroe says with a laugh. “I did not think irritability aligned with depression.”

She’s not alone. Many people — including physicians — associate depression with feelings of hopelessness, sadness and a lack of motivation or concentration, but not anger. Some researchers say that’s a problem, given that there appears to be a strong link between irritability and depression.

If you pick up what is often called the “bible of psychiatry,” the Diagnostic and Statistical Manual of Mental Disorders, you’ll find that the list of core symptoms for major depression doesn’t include anger.

“It’s not included at all in the adult classification of depression,” says Dr. Maurizio Fava, a psychiatrist at Massachusetts General Hospital and a professor at Harvard Medical School.

But he points out that irritability — a reduced control over one’s temper that results in angry outbursts — is listed as a core symptom of depression for children and adolescents. It has never made sense to him that it’s not included for adults. “Why would someone who happens to be irritable and angry when depressed as an adolescent suddenly stop being angry at age 18?” he asks.

Anger is an emotional and physical feeling that makes people want to warn, intimidate or attack a person who is perceived as threatening. Fava says a depressed adult with lots of anger is often assumed to have bipolar disorder or a personality disorder.

“We see in our clinics patients who are labeled as having other diagnoses because people think, ‘Well, you shouldn’t be so angry if you are depressed,’ ” says Fava. The diagnosis matters because it affects the kind of treatment people get.

Back when he was trained decades ago, Fava says, he was taught that in depression, anger is projected inward — that depressed people would be angry at themselves but not at others. That didn’t match what he was seeing in a lot of his patients with depression.

“I would say 1 in 3 patients would report to me that they would lose their temper, they would get angry, they would throw things or yell and scream or slam the door,” says Fava. Afterward, these people would be filled with remorse.

Fava thinks these “anger attacks” may be a phenomenon that is similar to panic attacks. His research found that this kind of anger subsided in the majority of patients treated with antidepressants.

Psychiatry has carefully studied how anxiety and depressed mood are experienced by patients, notes Fava, but anger has been relatively neglected. “I don’t think that we have really examined all the variables and all the levels of anger dysregulation that people experience,” he says.

That view is shared by Dr. Mark Zimmerman, a professor of psychiatry at Brown University. “The field has not sufficiently attended to problems with anger,” says Zimmerman.

“The most frequently used scales to evaluate whether or not medications work for treating depression don’t have any anger-specific items,” he notes.

Yet Zimmerman says clinicians frequently see increased anger in people who come to doctors seeking help. “Irritability is not that much less frequent than sadness and anxiety in patients who are presenting for psychiatric treatment,” he says.

Zimmerman and some colleagues recently surveyed thousands of patients who were making their first visit to the Rhode Island Hospital’s outpatient psychiatric practice. All were asked about the level of anger they had felt or expressed in the preceding week.

“Two-thirds of individuals reported notable irritability and anger,” he says, “and approximately half reported it at a moderate or severe level.”

Another large study by a different research group looked at more than 500 people who had been diagnosed with major depression. It found that more than half showed “overt irritability/anger,” and that this anger and irritability appeared to be associated with more severe, chronic depression.

Monroe, the nurse, was lucky enough to have a concerned friend who gently suggested that maybe she should talk to someone. “The way that she approached me decreased that wall of anger and anxiety,” says Monroe, “and that’s when I decided to seek the help.”

Monroe came to realize that traumatic events from her childhood had left her depressed and full of unresolved anger. With nowhere for that anger to go, she was lashing out at loved ones like her sister and husband. “So they caught the back end of my irritability when, in fact, they had nothing to do with the source of it,” she says.

After about a year of counseling, her life has improved a lot, Monroe says. She now works with a group called Families for Depression Awareness to help others recognize the signs of depression. Its list of symptoms that families should watch for includes “picking fights, being irritable, critical, or mean.”

Still, people with depression can have a hard time recognizing this in their own lives.

When I called up the Depression and Bipolar Support Alliance to ask about anger, I reached its communications person, Kevin Einbinder. He initially thought to himself, “I’m sure somebody else certainly deals with anger, but I don’t have anger issues associated with depression.”

Then he started reflecting on his life with depression over the past three decades. “I thought of all the people in my life who have interacted with me — my family, the counselors, psychiatrists, even employers, significant others,” he says, “and I realized that anger was an underlying factor in all those relationships.”

For example, he used to use caustic, sarcastic humor to put people down. “This really drove people away,” says Einbinder. He also recalls sending angry emails late at night after lying awake and ruminating about things that had happened during the day. A counselor helped him see why this wasn’t such a good way to handle problems.

Overall, though, he and his caregivers never focused on anger.

In hindsight, he says, he really wishes they had.

“I think that would have provided a tremendous amount of context for what’s adding to my depression and in helping me, early on in my life, with more effective coping mechanisms,” Einbinder says.

With medication and therapy, he is doing much better now. Einbinder hopes that sharing his experiences will help people understand that if they’re dealing with depression and anger, “they’re not alone and there’s loads of resources out there.”