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Thanks to reader “Citizen” who posted the following question on my “Labor Pains” post:
How do you distinguish depression from ordinary feelings, if it isn’t as obvious as what you have described?
Separating clinical depression from the sadness and normal anxiety caused by life’s unpleasant moments must be a bit like distinguishing cow manure from horse compost. Although I’m not a farmer, I suspect it’s not easy or fun. (I’ll stick to writing about both on Beyond Blue.)
The First Noble Truth according to the Buddha is that life is suffering. To live is to suffer. Suffering is unavoidable. And M. Scott Peck began in classic “The Road Less Traveled” with these words: “Life is difficult. This is a great truth, one of the greatest truths.” So then how can shrinks tease apart depression from normal responses to life’s difficulties and challenges?
Some would say not very well.
“Drawing the line between normal and abnormal suffering has long been controversial in psychiatry,” writes Shankar Vedantam in a “Washington Post” article about new guidelines for the diagnosis of depression, “because people who have no disorders often experience the same symptoms as those who do, but their reactions typically are less prolonged and intense. Where to draw the line involves a degree of subjective judgment: If the criteria are too strict, some people who are depressed may not receive help.”
And if the line is drawn too broad, lots of people walk away with prescriptions they don’t really need, and pharmaceutical share prices rise (thus, the $12 billion-a-year U.S. market for antidepressants).
“The cost of not looking at context is you think anyone who comes under this diagnosis has a biological disorder, so should more or less automatically get antidepressant medication, and everything else is superfluous,” says Jerome Wakefield, the lead author of a new study suggesting that up to 25 percent of people whom psychiatrists would presently diagnose as depressed may just be reacting to stressful events in their lives, such as divorce, the death of a loved one, or losing a job.
I can understand Wakefield’s concerns because, even to this pro-medication person, it does seems like an awful lot of people are taking SSRIs (Selective Serotonin Reuptake Inhibitors). On the other hand, I know a few who should be taking them and aren’t (in my humble opinion).
In my psychotherapy sessions and in group therapy at the hospital, we often talked about situational depression versus bio-chemical depression. Depression is situational if it was triggered by an event such as a breakup, job loss, or trauma of any kind. If it doesn’t lift on its own, it can worsen into clinical depression.
During several months of my depression–especially as I tried different medications and holistic remedies but didn’t get better–I thought that my depression was situational: that my REAL problem lay with being a stay-at-home mom–with little or no intellectual stimulation, ugly Teletubbies on TV, 500-piece dinosaur puzzles to assemble, and hours of arts and crafts I should do with the kids if I was a good mom (according to parenting magazines).
“Maybe my problem is that I’m forcing an immense square peg into a minuscule round hole. If I got the right job, and worked full time, maybe then I wouldn’t be depressed,” I told my therapist.
“To work full time, you have to be able to not cry,” she said. (It was a good observation, given that I spent most of hour together bawling.) “Yes, you can work at integrating more intellectually stimulating activities into your life, but I really believe you’ve got to get on top of your bio-chemical depression before you can start to do that.”
A friend of mine presently buried in the Black Hole told me that she was afraid that her marriage was causing her depression.
“I’m wondering if I would feel depressed if I were in a more supportive relationship,” she said.
“Did you have these concerns when you were feeling good?” I asked, a question my therapist told me to ask myself whenever I came across another “solution” (like get a full-time job) to my depression enigma (which was never an enigma to her).
“No. I’m relatively happy with our marriage when I’m not depressed.”
“Now isn’t the time to go there, then,” I said, playing therapist (a favorite hobby of mine).
I know many friends who have struggled through situational depressions–their symptoms mimicked many of clinical depression. But, in time (in less than a year usually), the darkness lifted, and they were able to move on. I, on the other hand, was stuck–incapable of moving anywhere without a lot of intervention. And then some more intervention.
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Previous Posts
Rewire Your Brain For Love: An Interview with Marsha Lucas, Ph.D.
posted 6:00:56am Feb. 14, 2012 | read full post »
Love Deeply ...
posted 6:00:28am Feb. 13, 2012 | read full post »
Therapy Thursday: Sweat
posted 6:01:57am Feb. 09, 2012 | read full post »
Scrupulosity: What It Is and Why It's Dangerous
posted 6:17:35am Feb. 07, 2012 | read full post »
The Treasures of Darkness
posted 6:06:40am Feb. 06, 2012 | read full post » |
posted May 31, 2007 at 1:36 pm
Hi, You managed to hit two of my pet peeves about being bipolar today. 1) Weight gain. I took Depatcote for years complaining about the weight issue until after 5 years and 90 pounds I was taken off. I have arthritis and the weight gain makes things so much more painful. I immediately lost 20 and took 10 off more slowly. I still have 60 to go and just the idea of dieting for so long makes me want to eat chocolate. I have never liked vegetables and making myself eat them is like pulling teeth. all this gives my depression so much gist for the mill. 2) You can’t get a job when you are crying. Why the hell not. Why aren’t there jobs you can keep when you are miserable? There must be something one can do and cry at the same time. Maybe I am not too pleasant to be around but I could do something all by myself. Why does depression mean unemployed? Just working would improve my self esteem. I can work at home but when I am depressed I have no self discipline. If I get the dishes done and dinner on I am doing good. It is fortunate my floors are wood as they don’t show the dirt. Besides I need the money. Money issues are making my life unmanageable all by themselves. We ended up with $30.00 for groceries this week.I d like some relief from my actual problems so I can know that I will need to come up with something new for my next depression LOL Nora
posted June 27, 2007 at 9:29 am
Nora — It sounds like a vicious cycle you are in. I would imagine that your life is rather isolated. You are home alone a great deal and have a lot of time on your hands. I am certain that your problems seem overwhelming and leave you feeling hopeless. I, too, suffer from depression, though not bi-polar disorder. During the summer when I am not teaching, I have way too much time on my hands and getting a summer job for the six to eight weeks I am available is pretty impossible. This has worked for me so far this summer: I’ve set myself some boundaries. My weakness is the internet; I use it for my work, but also for escape. In that way, it is a lot like food. I have to access it every day, but my time on it can quickly get out of control. My first boundary is that I eat breakfast and spend fifteen minutes or so reading Scripture and praying before I allow myself any ‘net time. I also get out of the house walking every day. I am not particularly quick, nor do I walk for more than twenty minutes, but it gives me time to think outside of the four walls. It is amazing how much there is to experience in a rather boring neighborhood. Sunrise, fog, birdsong, sunsets, they can all be appreciated whether you live in a city or the country. If you are blessed with a variety of gardens to pass, you can enjoy them without the labor. And all this is free for the taking.
Getting out of the house and volunteering on a regular basis could open many new doors. First, being around people will lift your spirits. I usually think I want to be left alone and don’t want to see people, but when I do, I always feel better. I can’t think of any organization that has too many volunteers. Volunteering may also help put your own life into perspective. It seems to me that being needed is a basic requirement of a healthy life. If you feel like the world is no different because of your existance, it is a pretty depressing thought. So think about volunteering in an area that interests you. You may ultimately make the sort of connections you need for employment.
If you are at all like me and most other people, getting out of your comfort zone is a very threatening thing. The misery we know is so much more predictable, than the unknown around the corner. But I would encourage you to take small steps outside your comfort zone — they don’t have to be earth-shattering changes. I think that you will be able to take some pride in these small steps, which will be an encouragement to greater things.
Remember that God has plans for you. Jeremiah 29:11 For I know the plans I have for you, says the LORD, plans for welfare and not for evil, to give you a future and a hope.
Barbara
posted June 5, 2008 at 12:23 pm
Depression is a fact of life. But, like in my case & others, some need medication & therapy to handle their depression. I do agree some Doctors over medicate their patiences. I’ve got a friend that’s taken too meds for her depression. But, she says the Doctor wants her to take them for a bunch of reasons. But, she still seams depressed some of the time. The funny part with all the meds she’s on she’s losing weight but with me just being a couple of meds I can’t lose anything but a few lbs then I gain it back + more. Which makes me more depressed.