The purpose of this session is to share knowledge about depression and useful/helpful responses to it (and questions about it.)
We have listed below some common questions/misunderstandings/myths/oversimplifications/problems to get the conversation started. If you have any others that you think should be added let us know.
If time allows TBAT will edit this post while the thread is active in order to incorporate questions/answers/suggestions that arise in the comment thread. The final document will be kept in a "101/useful information" section of the website.
Remembering that "every (depressed) person's experience is different" is important. Some people don't need meds, others do. For some people, the depression ends; for others, it doesn't.
MYTHS ABOUT DEPRESSION
- Depression isn't really an illness. People are just feeling sorry for themselves.
- If people who said they were "depressed" made more of an effort to cheer up they would get over it.
- a. Anti-depressants are just "happy pills" and people who take them just want to avoid feeling what the rest of us do.
- b. Anti-depressants turn you into a zombie and subdue your real personality.
- c. Anti-depressants are just pushed by Big Pharma to make a profit.
- d. Antidepressants are interchangeable so it doesn't matter if one's health insurance plan will only cover particular medications or demands that that you take "generic equivalents."
- If people just (exercised more/ ate differently / read different books / watched different movies) they would get over it.
- All depressions are caused by experiencing abuse--if the depressed person tells you that nothing "caused the depression" or "they had a happy childhood" they are lying or in denial.
- Depression is just a women's thing.
- Depression is less severe than other mental illnesses.
- Clinical depression is worse than situational depression.
- Needing a therapist/psychiatrist to overcome depression means that person is weak.
- Depression is the same as Bipolar Disorder (Manic-Depression), and people who suffer from Bipolar Disorder "enjoy" their "up" periods.
- Depression is an expected prerequisite / consequence of a "creative" personality or lifestyle.
- Children can't get depressed.
- You should stop taking anti-depressants as soon as possible so you don't get addicted.
- You can't be depressed, I've seen you act happy.
- Good Christians don't get depressed.
- You can't take antidepressants if you're breastfeeding. Don't be so selfish.
- You're not suicidal if you're not actually planning to kill yourself.
- People who talk about suicide never actually kill themselves; they're just being manipulative.
- People who survive a suicide attempt are always glad.
- If you can get out of bed, you aren't depressed!
Depression is a physical illness that causes damage to the brain. Emotional pain and/or numbness is a symptom of it, just as physical pain is a symptom of other illnesses.
Depressed people generally are making a considerable effort: when you're depressed, it's very hard to make it through the day at all. It is not, however, possible to simply will away an illness. This applies to mental illnesses as much as to physical ones.
A depressed person is not feeling 'what the rest of us do': the experience of depression is not like the normal stresses and strains of life. Likewise, anti-depressants don't actually make you happy. (It's notable, for example, that there's pretty much no street trade in them. This is because if you're not depressed, they don't make you experience anything beyond the side effects.) Their exact effect is something of a 'black box' in medicine - that is, more is known about their end result than how they work - but their main function is to stop the destruction depression is wreaking in someone's brain. They don't stop a depressed person feeling what everyone else does; they make a depressed person capable of feeling more 'normal' emotions.
Before tricyclics and SSRIs, the only way to treat depression was with sedatives, which would indeed just dope someone. Modern anti-depressants, however, don't sedate people. Rather than subduing someone's personality, when properly prescribed, they give the real personality a chance to resurface after being buried under depression.
The pharmaceutical industry can indeed be an aggressive marketer, and anti-depressants have been sold as a 'cure' for a wider and wider range of illnesses. How effective they are for those illnesses is a matter of debate. However, the fact that a medication is sometimes wrongly prescribed doesn't mean it's always wrong to prescribe it. While they aren't a cure-all for every problem, if the right anti-depressant is prescribed for someone depressed, they are an appropriate medication, and sometimes a life-saving one.
Sometimes it takes more than one try to figure out what medication(s) work(s) for a particular person. The side effects are also important to consider. When one of our authors first started on the medication zie is on now, zie come back from class (zie was in college at the time) and sleep for hours at a time. The medication was only accepatable worked because zie was in school and had a schedule that accommodated random napping. Another of our authors got relief only from a medication that also caused tinnitus and dehydration so severe zie had trouble swallowing and hir skin would rip.
WARNING: Other medications can seriously interact with (to the point of negating their effects) anti-depressants. The medication that one is prescribed for something such as strep throat could have a serious impact on medications one routinely takes including birth control pills AND anti-depressants.
Exercise can have an anti-depressant effect, and a healthy diet is good for anyone. The fact remains that depression is a genuine illness that causes organic damage to the brain, and many people cannot recover from it without medical intervention, either by medication or counselling or a combination of the two.
The causes of depression are complicated and still not fully understood. As far as current understanding goes, some people seem genetically predisposed to be more vulnerable to it than others; likewise, stressful experiences (including abuse) can precipitate it. These stressful experiences can vary widely, though, and some people simply come down with depression for no very clear reason.
Depression may be more commonly reported in women than men; however, a great many men suffer from depression. There is, in fact, some discussion of 'male depression', also referred to as 'covert depression'. While some women show typically 'male' symptoms and vice versa, in a society where women are socialised to be passive and men active, depressed women commonly present as weepy, self-hating and inert while depressed men commonly present as aggressive, angry and antagonistic. This 'angry' presentation can often lead to men being diagnosed with other problems or treated as antisocial; many depressed men develop substance abuse problems because in the absence of a proper diagnosis they resort to alcohol or drugs as a form of self-medication. Women are also at risk for substance abuse. Depression is a human problem, not a female one, and men and women both suffer when men go undiagnosed because of stereotypes.
Depression is in many cases more treatable than some other mental illnesses, but that doesn't mean it's less severe.
Depression is a life-threatening illness. People with severe depression often kill themselves: it is a potentially fatal disease. 'Potentially fatal' is about as severe as diseases get. Even when not suicidal, depressed people can become unable to work, to take care of their families, even to take care of themselves. And even in survivors, its potential to destroy quality of life is just as powerful as other mental illnesses.
In the first place, drawing a distinction between the two is very difficult. What causes the depression is no guide to how bad the depression will be. Some clinical depressions are relatively mild; some situational depressions are very severe. It varies from individual to individual. Someone who experiences situational depression for a long enough time will likely become clinically depressed. Even when it can be drawn, situationally depressed people can become suicidal, or unable to work, take care of themselves, etc. just as easily as clinically depressed people.
This is a common belief of people with depression (and other mental illnesses) who do not want to seek help. Depression is an incapacitating illness that needs treatment, and seeking out help isn't weak, any more than it's weak to seek out a physiotherapist if you injure a muscle. If someone breaks their leg, we do not regard them as weak for needing someone to set the bone, for wearing a cast, or using crutches. We see these as the logical steps to take when a leg is broken. We would look askance at someone who claimed they were going to fix the leg “on their own.” Depression is an illness, for all it occurs in the head instead of the body, and it requires treatment just like any other illness or malady.
A good therapist is a person who helps the patient find their own strength and become independent.Therapy itself can be a challenging and uncomfortable experience that requires a lot of courage to go through, and likewise it takes courage to defy the stigma attached to seeing a therapist in the first place.
There are many different approaches to therapy, and you have to find a therapist who works for you and with you. For example, one might have to choose between therapist who adhere to the (often competing) schools of thought of psychotherapy and CBT (Cognitive Behavioral Therapy). Most therapists use a mix. Again, it often depends on the person, and the approach that works for one person may not work for another--a bit like the diet and exercise thing.
Bipolar is an affective disorder, which is to say it deregulates the emotions. So is depression, which is also known as unipolar depression. They are not, however, the same illness: their impact on the sufferer's life can be very different, and they require different medication and treatment. While some bipolar sufferers experience the "up" period as an enjoyable high, for others the "up" period is a nightmare of emotional chaos, just as dark as the "down".
Some creative people suffer from depression. So do a lot of people who aren't particularly creative; depression is a common illness. There is no evidence to support the idea that creativity and depression are connected, any more than there's reason to suppose that TB and creativity are connected - an idea that the myth of the 'consumptive artist' used to advance. Stress can bring on depression, and artists are often poor, which is stressful; it's just as likely that the connection is as simple as that. Depression is not an inspiring experience: it slows down thinking and numbs out feeling, and many artists with depression have killed themselves, putting an end to the possibility of any further creations. Likewise, many artists with depression become too sick to work, leading to unproductive years that, had they been well, could have been spent creating more beautiful works. Depression doesn't cause creativity; it eats it. Artists who produce great work are just as likely to have produced it despite their depression as because of it.
Not true. Depression is no respecter of age, and children are psychologically vulnerable. A person whose depression begins in childhood is most at risk for having their illness mistaken for a personality trait, which can cause lifelong problems for them.
While people going off anti-depressants can experience 'discontinuation' symptoms, most modern anti-depressants are not addictive. This is an issue discussed in the medical community; what is not questioned is that going off anti-depressants too soon brings a serious risk of relapse. The minimum recommended period for taking anti-depressants is six months followed by a gradual decrease of dosage; doctors generally advise that you should continue to take anti-depressants at least six months after you stop experiencing any depressive symptoms. Some people go off anti-depressants comfortably; some people - usually people who were depressed for a long time before they were diagnosed - need to take anti-depressants for many years, or even for the rest of their lives, in the same way that people with high blood pressure may need to stay on medication. If that's what's medically necessary, there's nothing wrong with it.
Depression flattens out the emotions, but it doesn't mean someone is always in the exact same mood. A depressed person is still a human being, and human beings react to things around them. It's not so much that depression locks you in one mood; it's more that it makes it harder and harder to feel and/or sustain positive emotions: a depressed person may feel happy for a while, but then the depression drags them back down. In addition, there's a social expectation that people should act pleasantly to one another; a person who acts happy may be putting on a brave face because they fear rejection if they tell people honestly how they're feeling. Finally, if someone has been suffering from undiagnosed depression for a long time, they may simply assume that everyone feels the way they do and describe themselves as 'happy' on days when they only feel pretty bad instead of terrible. A depressed person doesn't always act in a stereotypically 'depressed' way, any more than a person with a cold sneezes with every breath.
Depression is not an infallible sign of backsliding, sinfulness, insufficient faith, or an inadequate prayer life, any more than cancer or influenza is a sign of sinfulness.
Small quantities of antidepressants can get into the milk, which will be passed on to the baby. If the baby is premature or has a low birth weight, this may be a factor to consider. However, if the baby is healthy, small quantities of antidepressants are very unlikely to harm hir: the UK's NHS website on depression states that all tricyclics except doxepin and the SSRIs paroxtene and sertraline can be safely prescribed, and other antidepressants may be continued if the woman has been taking them with good effect before.
Like most issues in parenting, there's a balance to be struck, and what shouldn't be forgotten is this: it does a baby no good at all to have a severely depressed mother. Such a mother will have less energy to take care of hir, will be modelling unhappier facial expresses and affect, can be less inventive in finding ways to stimulate the baby, may have less patience in dealing with hir, may cuddle less because she takes less pleasure in physical contact, will be more easily overwhelmed, and generally speaking will be giving the baby a different and less joyful experience of being mothered. This is as likely to affect the baby as antidepressants in the milk.
A new mother suffering from depression needs to find a sympathetic doctor who doesn't write off the problems she faces and take a rigid view of what's 'best for baby'. If she's severely depressed, taking antidepressants is not selfish: she's upping her game and making herself a better parent, which benefits the baby as well as herself.
In addition, a new mother with depression will be feeling full of guilt and inadequacy as it is. Calling her selfish or implying she's neglecting her responsibilities to her baby is a terrible thing to do.
When a doctor asks if someone is 'feeling suicidal', they don't necessarily mean 'Are you in the process of arranging your own death?' There's a spectrum between 'not suicidal at all' and 'a day away from death'. Many depression sufferers are haunted with what are known as 'suicidal ideations': thoughts of death or wishes to die that might, but do not necessarily, turn into an active plan.
It's very common, for instance, for someone depressed to think such thoughts as: 'I wish I could just go to sleep and not wake up tomorrow,' 'I can't think of a solution to this except just dying,' and 'Everyone would be better off without me.' These are suicidal thoughts even if they don't go any further than thinking, and are a sign that someone's seriously sick.
There may be people who use threats of suicide to manipulate others, but if someone depressed is telling you that they feel suicidal, they are almost certainly not trying to manipulate you. If they're depressed enough to be feeling suicidal, in fact, they're probably too punch-drunk to make the kind of clear plans than manipulating somebody involves. A person revealing suicidal thoughts is trying to express how bad they feel and asking for help - sometimes clearly, sometimes confusedly, but asking for help nonetheless. And if they're thinking suicidal thoughts, there's a non-negligible risk they may later make a suicide attempt. The myth that talking about and attempting suicide don't go together is just that: a myth.
Some people may be. Others may wake up filled with despair that they're still alive. The fact is, many people who commit suicide have already made several previous attempts. The fact that someone has attempted suicide is not reason to assume they'll never try again; in fact, common sense as well as statistics suggest that if someone feels bad enough to try and kill themselves they're more likely to try again if they survive the first attempt than someone who feels perfectly all right.
(As a side-note, psychologists recommend avoiding the phrases 'successful' and 'unsuccessful' when talking about suicide attempts. The reason is that someone attempting suicide is usually filled with despair and shame, and the idea of a survived attempt being 'unsuccessful' just reinforces the belief that they had better make absolutely sure they die so they don't wake up hearing that they 'failed' to even kill themselves properly. 'Completed suicide attempt' is the suggested alternative to 'successful'.)
Very few people have the option of not getting out of bed. The ability to drag oneself out of bed and out of the house in order not to starve is not in itself an indication of mental health.
FAMILIES OF THE DEPRESSED
- It is your fault that your child/parent/sibling/significant other is depressed.
- Why are you complaining -- you are not the person who is depressed, what difference does it make to your life?
- All they need to cure them is love/support.
- They'll feel better if their life situation improves. Have you tried...?
- Depression always destroys the sex drive.
Nobody knows for sure what causes depression. Sometimes it just happens. Blaming people is neither accurate nor fair. In fact it is potentially harmful to both the person without depression and their relation with depression.
When you blame someone for hir brother's or mother's depression it means that person cannot count on you for help or support for hir and hir family. Depending when this comment is heard, it can put long-lasting strain on the non-depressed relation. If you overheard as a child that you were the cause of your mother's depression, you might have taken it to heart and felt horribly guilty that "you" were somehow causing your mom so much pain.
Also, there's a good chance that the person with depression will hear about the comment and, depending on the person and disease, blame themselves for their non-depressed relation being blamed, attempt to hide their depression from others and the non-depressed relation, or agree with the comment. The first two put more emotional pressure on the person suffering from depression by adding guilt or the attempt to seem "normal." The last two make it harder for the depressed person to get treatment, by either hiding their need for it or blaming their depression on the non-depressed person instead of getting help.
Best-case scenario, the difference it makes is the difference between seeing a much-loved person well or dangerously sick. Depressed people suffer terribly, and some depressed people kill themselves. The relation is going to grieve and worry, just as they would if a loved one had any other painful and life-threatening disease. Worst-case scenario, the relation has to deal with all this and with mistreatment from the depressed person. Among the possible symptoms of depression are anger, irritability, hypersensitivity, aggression and negativity. While this is the symptom of a disease rather than a deliberate behaviour, a depressed partner or parent can be an abusive partner or parent. Emotional, verbal and even physical violence can be going on behind closed doors. This isn't a universal reaction, but it can be a factor, and if it does happen, it can be very difficult for the family member to talk about it; if they sense that the abuse is being caused by pain and sickness, they can fear that others will write off the depressed person if they talk about it.
We pick up on the moods of people around us. It's not at all unusual for the partner of a depressed person to come down with depression themselves. Even if they don't, they're dealing with an extremely difficult and frightening problem affecting someone they care about. Depression in families is a serious thing.
Someone suffering from depression does indeed need love and support, just like any sick person. But that support has to be the foundation for more effective treatment, just as for any other disease. We can't love away depression any more than we can love away cancer. Telling someone that all their family member needs is support is effectively making them responsible for an illness that's not under their control, which puts them in a position of helplessness while putting the depressed person in a position of dependence, which does neither party any favours.
There's a difference between feeling 'depressed' in the colloquial sense, meaning discouraged and fed up about something. A change in life circumstances can fix that. But while clinical depression can be triggered by bad circumstances, and may be harder to fight as long as the circumstances remain bad, it is not the natural and healthy response to circumstances that colloquial 'depression' is. Changing the circumstances won't cure the illness. And in fact, the more depressed someone is, the more likely to be incapacitated or self-destructive they are, so in many cases it's the other way round: they need to fix the depression before they have the energy, concentration, or emotional balance to be able to fix their life circumstances in any way that lasts.
For many people, depression destroys all interest in sex, which can be hard on partners. However, some depression sufferers use sex to self-medicate, turning to pornography in an attempt to get their libido kick-started, committing infidelities in the hopes that a new person will help them feel something, or insisting on sex with their partners in an attempt to kick-start feelings of love and connection that they're struggling to feel. This last can also be very hard on partners, especially if the depressed person is suffering from numbed empathy and hence is having difficulty treating their partner well and reacts badly to the idea of rejection. Some partners of a depressed person can end up feeling sexually neglected; others can end up sexually betrayed; others still can end up feeling pressured and objectified. These are all consequences of the disease rather than bad character, but all can be very harmful to spouses.
The National Institute of Mental Health has information pages on the subject of, depression among men and depression among women, both of which include links to other resources on the subject.
Information about bipolar disorder is available online: The National Institute of Mental Health's online booklet about bipolar disorder
Suicide prevention hotlines:
United States, the National Suicide Prevention Helpline (with a sub-line for veterans and soldiers) 800-273-8255, Trevor (for LGBT youth) 866-488-7286.)There are also numerous local helplines (NSPH routes you to the nearest one in your area, actually).
In the United Kingdom (dial 08457 90 90 90) and the Republic of Ireland (dial 1850 60 90 90) people in distress can contact the Samaritans
Befrienders Worldwide provides links to local help resources in countries around the world..
--Co-authored by the Slacktiverse Community
The Board Administration Team
(hapax, Kit Whitfield and mmy)
(hapax, Kit Whitfield and mmy)