National Depression Education & Awareness Month

You don't need to wait until depression is crippling before you get help

I have struggled with depression throughout my life, but I didn't know what it was for a long time. Growing up in the 90s and early 2000s, mental health wasn't a topic anyone spoke about openly. The narrative at that time was that teenagers with frequent mood swings were moody, ornery if consistently irritable, lazy if they couldn't muster the motivation for schoolwork, or slept the days away. These symptoms look similar in adulthood and can include habitually being late, lacking motivation at work, or having difficulty getting out of bed. Some people experience extreme sadness, guilt, or even unexplainable digestive issues. Today these symptoms are more commonly acknowledged as potential signs of depression or markers of suffering mental health.

I began my battle with depression in my teenage years. While I wrote angsty poetry, I also struggled with suicidal ideations and cutting, yet I didn't think of my struggle with these things as medically significant - I was just sad. It wasn't until I attempted suicide that I began to get help.

My diligence towards my mental health care began in college when I started therapy and medication. Though these efforts drastically improved my approach towards my mental health, I still struggled to cope with my depressive symptoms. I remember the first time I learned my diagnosis-Major Depression with Psychotic symptoms. Identifying it came with a weight I hadn't expected. I wondered what it meant for my life and if it categorized me as permanently damaged. I had avoided treatment my Junior year but redoubled my efforts the following year, finding an excellent therapist and psychiatrist. That year quickly passed by, and I found myself without health insurance again.

I spent the next decade focused on building my career and went without therapy or medications. For a while, it felt like I had turned a corner with my depression, but I continued struggles with irritability, insecurity, shame, and self-isolation.

After ten years, I went back to my primary care physician and asked for help. I restarted a medication regimen, but it wasn't until the COVID-19 pandemic I took a hard look at myself. I still felt isolated, was having panic attacks, and crying nearly every day. I considered what I had already overcome at that point and reminded myself I had survived too much to falter now, so I took a leap of faith and began virtual therapy. This decision was a pivotal point in my mental health journey.

Over the last two years, I have grown and healed immensely, and I attribute that to leaning on my support network. I remained committed to therapy for two years straight and learned it wasn't as uncommon as I believed it to be growing up. Friends and former colleagues share they also saw a therapist and that it helped regulate their lives. I began to let go of my shame and started treating my depression as I imagined someone might manage their diabetes. My "diet" was regular therapy sessions. My "insulin" was a carefully thought out prescription from my psychiatrist. I finally understood these things (along with coping skills, family, and having faith in my support network) were ways to take care of my mind and body – and it's my dream for everyone to approach mental health struggles this way.

While I still have hard days and heavy feelings, I know this is the healthiest path forward. I'm happier, able to handle stressors better, and have a better general outlook on life. The topic of mental health has gained momentum and even normalized, but the stigmas around therapy and medication have not fallen off the wayside. My hope in sharing my story is to show others suffering that there is treatment and that it works! If you or someone you know is struggling with depressive symptoms, remember, there's help.

Depression doesn't look the same on everyone

Have you had trouble feeling good about yourself, managing your daily activities, or trouble thinking clearly or positively, persistently, for two weeks or more? You might be struggling with depression. Depression can impact your ability to work, enjoy activities, and lead to suicidal ideations and death. It can also appear comorbidly with other diagnoses or symptoms such as an eating disorder, psychotic disorders, or anxiety disorders.

The National Institute of Mental Health (NIMH) 1 states if you have the following symptoms persistently for two weeks or more, you may have a diagnosis of Depression.

• Persistent sad, anxious, or "empty" mood
• Feelings of hopelessness, or pessimism
• Irritability
• Feelings of guilt, worthlessness, or helplessness
• Loss of interest or pleasure in hobbies and activities
• Decreased energy or fatigue
• Moving or talking more slowly
• Feeling restless or having trouble sitting still
• Difficulty concentrating, remembering, or making decisions
• Difficulty sleeping, early-morning awakening, or oversleeping
• Appetite and/or weight changes
• Thoughts of death or suicide, or suicide attempts
• Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment

The Depressing History of Depression

Historically, mental health and depression were categorized as afflictions of the spirit or attributed to demons2. A person suffering from psychotic depression, where severe depression has some form of delusion or hallucination, might receive an exorcism or be labeled a witch and burned at the stake. Fortunately, not all doctors subscribed to that way of thinking. "A Persian doctor named Rhazes (865–925 CE), however, did see mental illness as arising from the brain. He recommended such treatments as baths and a very early form of behavior therapy which involved positive rewards for appropriate behavior. 2"

Through the ages, doctors began adopting similar mindsets. Robert Burton's "Anatomy of Melancholy" suggested social and psychological causes of depression and made suggestions like music therapy, travel, diet, and exercise as treatments for depression in 1621! Unfortunately, these weren't necessarily common beliefs, and many still held executions or witch hunts for the mentally ill.

By the 18th and 19th centuries, a new stigma set in. The depressed or mentally ill were inherently degenerate and should be shunned or locked away. The turn of the 19th and early 20th centuries weren't much better. In the early 1900s, treatments included lobotomizing, or surgically removing parts of the brain, which had adverse side-effects like poor judgement, personality changes, or death. However, by the 1950s, doctors noted a particular tuberculosis medication had beneficial effects for some depressed individuals; thus, the understanding of depression as a purely psychological affliction evolved, and pharmaceutical remedies developed.

What treatment options are available?

Today, depression is one of the most common mental health disorders in the United States, and it is more understood than it once was. NIMH states, "Depression, even the most severe cases, can be treated. The earlier that treatment can begin, the more effective it is." There are many treatments for depression, including medication, psychotherapy, brain stimulation therapies, and even some evidence for psychedelics[3] to alleviate depressive symptoms.

I asked for additional insight from ERC Pathlight Clinician, Alex Harrison, LCSW, about depression.

What is your professional recommendation for someone struggling with depressive symptoms?

Don't do it alone. Make sure there's someone in your support system who knows you and knows how you're struggling, someone who can check in with you honestly.

You don't need to wait until depression is crippling before you get help.

Find a therapist who can help you find tools to work through depression and keep an open mind to the idea of collaborating with a therapist and prescribing psychiatrist if medication is recommended. 

Recognize that when you're depressed, your instinct might be towards isolation, but that's the opposite of what you truly need. Staying connected to community is so important. Your inner mind will also likely tell you, "I'm a burden...nobody wants to be around me if I'm depressed."..... that's also not a thought that will serve you. A good therapist will help you observe and understand your thoughts around your depression and help you navigate them so that you're more likely to keep moving your life in a valued direction.

When should Depression be treated with psychiatric attention or medication?

I'm saying all of this from my own clinical experience working with adults both in a treatment setting and in private practice: I'm a fan of using medication in conjunction with sound therapy. I say this often: medication is not meant to be a replacement for therapy. Rarely is medication alone the element that fixes depression (or anxiety) in the long term. Medication, however, can be incredibly valuable in "rounding off/softening the edges" of our depression so that our brains are in a more malleable place to engage in the work of therapy fully (be it behavioral or insight-oriented). Working through depression takes a willingness to take action and do differently... that's why behavioral therapy is so helpful for those struggling with depression. However, depression is also really powerful, a heaviness that makes taking action feel like trudging through deep, wet mud. Meds can lighten the burden to the point where we can see our options more clearly and have a little more energy or resolve to take action.   

Citations:

1: National Institute of Mental Health. (n.d.). NIMH Depression. National Institute of Mental Health. Retrieved October 4, 2021, from https://www.nimh.nih.gov/health/topics/depression.

2: Schimelpfening, N. (2020, February 25). When were the earliest accounts of depression? Verywell Mind. Retrieved October 4, 2021, from https://www.verywellmind.com/who-discovered-depression-1066770.

3: Hamilton, J. (2020, November 4). Rigorous study backs a psychedelic treatment for major depression. NPR. Retrieved October 4, 2021, from https://www.npr.org/sections/health-shots/2020/11/04/931377532/rigorous-study-backs-a-psychedelic-treatment-for-major-depression.