Depression

Depression, whether mild or serious, is very common. Everyone has felt down at times. Losing a loved one, financial changes, family events, career moves, health issues and sometimes even for unclear reasons can precipitate a longer period of sadness or grief. When sadness interferes with the ability to function, becomes relentless and persists, it turns into a health hazard. It may be misinterpreted as laziness, becoming demented, being uncaring. It is the source of embarrassment, feeling like a failure with no hope for change.
Let’s review some definitions:
The American Psychiatric Association’s diagnostic and statistical manual of mental disorders, 5th ed. DSMV criteria for major depressive episode are:

1. 5 or more of out of 9 symptoms ( including at least one of depressed mood and loss of interest or pleasure) in the same 2-week period. Each of the symptoms represent a change in previous functioning, and needs to be present every day.
   -Depressed mood ( subjective or observed; can be irritable mood in children and adolescents, most of the day;
   -Change in weight or appetite. Weight 5 percent change over one month.
   -Insomnia or hypersomnia.
   -Psychomotor retardation or agitation (observed);
   -Loss of energy or fatigue.
   -Worthlessness or guilt.
   -Impaired concentration or indecisiveness; or
   -Recurrent thoughts of death or suicidal ideation or attempt.
2. Symptoms cause significant distress or impairment.
3. Episode is not attributable to a substance or medical condition.
4. Episode is not better explained by a psychotic disorder.
5. There has never been a manic or hypomanic episode. Exclusion e) does not apply if a ( hypo) manic episode was substance- induced or attributable to a medical condition.

The World Health Organization’s International classification of diseases and related health problems, 19th revision defines a depressive episode as follows:…..

Major depression along with other presentations like: dysthymia, which is a chronic state of sadness; grief, which can last for years untreated and be associated to losing people, pets, status and changes like retirement or relocation; postpartum depression are amenable to treatment.
It is important to consider the following:
1. Above all, be safe. If you have thoughts of hurting yourself or someone, get immediate help. The information on this page does not constitute treatment or individual medical advice.
2. Time heals. Sad events feel different later. We adjust to broken dreams.
3. You need to fight it, even when your energy is low, do your best and congratulate yourself for it. Go out of the house. Exercise. Get some sun. Stay busy.
4. Stop your sad thoughts. It is tempting to recreate events of a breakup for example. Is important to recognize as such and not allow oneself to be consumed by them. Sometimes setting time apart to cry and grieve gives a sense of normalcy and saves energy for the rest of your day.
5. Depression saps one’s energy. Is not laziness. When you have bursts of energy, use it, enjoy it and build your confidence again.
6. Pay attention to your health. Depression is sometimes the first sign that something may not be right with our bodies.
7. Depression is not easily understood by others. People around may try to cheer you up or not know how to act around you. Aim to keep your relationships. We are not meant to be alone. Bonding helps even when it may be a big effort. Isolation is not your friend.
8. Life happens: births, wedding, graduations, growing up, promotions, career, money, relocations…and we are not made of stone. Even good things can cause depression. Learning to cope, forgive oneself, enhance one’s potential, get a better understanding of our interior life and how we react to things, are aims of psychotherapy.
9. Depression can run in families. That being said, it can be addressed through treatment. Psychotherapy and if necessary, wise use of medications, can change one’s life.
10. Depression has a high price: decreased productivity, deterioration of relationships, isolation, decline in health, letting oneself go, undermined self-confidence. Seek help. There is no one size fits all. Consider your treatment as an investment.

Major Depression

Major depression, or major depressive disorder, is probably what most people think of when they hear depression. Major depression is characterized by the symptoms listed below, and you should have at least five of these symptoms and experience them more days than not for over two weeks.

• Weight gain or weight loss or a change in appetite
• Insomnia or oversleeping
• Unusually tired or lacking energy, fatigue
• Frequent feelings of sadness, restlessness, or irritation
• Problems concentrating or making decisions
• Lack of interest or enjoyment in things you used to like
• Feelings of guilt or worthlessness
• Thoughts of self-harm or suicide

Major depressive disorder can be treated and managed with therapy and medication.

Postpartum Depression

PDD can start during the first year after birth. It can include sadness, feelings of inadequacy, crying spells, moodiness, self-doubt, and exhaustion.

Hormonal changes in addition to the learning curve that encompasses being a new mom can present an unexpected demand which requires support.  With the arrival of a new member of the family, everyone’s roles change, at least temporarily. With the passage of time, the growth of the baby and the right treatment, PPD resolves.

Tips to Manage Post-Partum Depression

1. Get treatment sooner rather than later. Moms usually tell me they wished they had started earlier and not suffered as much.
2. Dads and relatives will need to know how they can help best. Tell them. Sometimes it can be giving you time alone, preparing meals, offering you a ride or driving you, if you are too tired or have not slept.
3. Get all the sleep you can, every time you can.
4. Take walks and get some sun exposure.
5. Fight isolation. Being away from work, while the rest of the people you know is still working, is at best disconcerting. This gets compounded by being too tired to get out and socialize.
6. PPD is accompanied by increased exhaustion. Start small with walks and build yourself up to increase your well- being and fitness.
7. Eat well. Eat better. Do the best you can.
8. You will hear lots of advice. Pick what makes sense to you. There is no “one size fits all”.  We are all different. There are many kinds of mothering. Find your niche.
9. Follow your own heart. It is very common to experience self-doubts at the beginning of this journey. You and your baby will learn from each other and bond.
10. If you have ideas of hurting yourself or the baby, do not stay alone with the baby and go to the emergency room. Do not keep it to yourself.
11. Embarrassment and shame are common in PPD. Is more common than anyone thinks. You are not alone. When I ran support groups, this is the one feeling that got addressed the most.
12. It will pass. Get support. Get help.

Please note that these statements do not replace medical advice. If you have an emergency go to the nearest emergency room and get help.

Grief

Loses can be about people, but extend beyond that: pets, retirement, relocation, illness, loss of function, selling the house, children growing up and moving can be some examples.

The understandable sadness upon a loss can last months or years. It can go unnoticed even by the griever who often reports “ I should be over it by now”. Sometimes people are integrating the new reality and adapting to the loss, when they encounter reminders: a birthday, holidays, anniversaries. At those times, they become sad, see no hope in the future and feel as if the loss just happened. It is important in therapy to be reminded that these events are part of the grief process and indeed, necessary to maintain one’s strength along the way. Over time, we come to realize that loved ones do leave, but we keep a lot of them with us in our memories. As time passes and the symptoms continue, it becomes less understandable for those around the grieving person. At this time, education in the subject is very important. It is at this time that one needs not to be alone and friends and family are essential. Treatment addresses those issues.

The process of grief demands mental energy, which otherwise would be available to meet daily demands. Examples of such are becoming irritable, isolating from family and friends, partner, spouse; procrastinating, fatigue, inability to exercise, finding no joy in life, struggling with what came easy in the past. Over time, no one can tell how this started, since it is assumed that grief should be finished and it is a thing from the past. Over prolonged periods of this kind of stress, the body is not the same. Some people gain weight, some suffer from exacerbations of previous illnesses, fatigue, loss of libido. Relationships can suffer, as emotional unavailability and painful states of mind recur every time triggers are encountered. Treatment involves supportive therapy, education, medications when needed.

Job performance can be affected by insomnia, inability to focus, low energy, irritability and decreased ability to relate to others. A goal in treatment, besides relieving symptoms is to help preserve functioning and prevent further loses.
Sometimes substance use becomes another complexity added. This needs to be addresses in a non-judgmental and supportive way.

When treating, addressing just one aspect of the problem, leaves the others uncompensated. Modalities include psychotherapy, medications if needed, education, involvement of others designated by the patient and coordination of medical care.