Here is the tragedy; when you are the victim of depression, not only do you feel utterly helpless and abandoned by the world, you also know that very few people can understand, or even begin to believe, that life can be this painful. There is nothing I can think of that is quite as isolating as this. – Giles Andreae
Do I Need Depression Treatment?
Many people seek depression treatment because they feel low or lethargic, have been told they look depressed or wonder if they “suffer from depression.” If you are like most people who come to see me, you are not quite sure what any of that means. You may be aware of feeling sad, blue, lost, empty or even dead inside. Perhaps someone around you has told you that you seem withdrawn or irritable, or you have been experiencing unexplained physical symptoms and wonder whether these are symptoms of an underlying depression.
It is not important that you know what you feel (or what you “have”) before you seek depression treatment. You just need to know that something seems off and be open to the possibility of getting help sorting it out. Our first task is to take seriously that something important is happening to you and going on inside you and that we are going to try to understand what’s going on collaboratively.
We begin by trying to get as clear a picture as possible of what you are subjectively experiencing. Is it a feeling of disquiet, a physical sensation, difficulty concentrating or changes in your sleep or appetite? We also want to know how long it has been going on, how much it fluctuates, how severe it is and how it affects you. And we will want to explore what might be triggering your symptoms of a possible depressive episode.
Loss And Depression Treatment
More often than not, during depression treatment we will be able to identify some experience of loss preceding your symptoms. The loss can be of a valued relationship, career, talent or capacity. Alternatively, the loss can be of a situation that you thought you had, or always hoped you would have at this point in your life. Perhaps you thought that by now you would be married and have kids or be at a certain point in your career. If you haven’t measured up to a milestone that you have been attached to, you may start to feel powerless and adrift – as if your destiny is beyond your control. This situation can easily lead to depression. In any case, there is often a subjective experience of loss that is registering as internal pain or as some disruption in your usual way of being.
If we are able to identify a sense of loss, one of our tasks will be to help you grieve. This part of depression treatment entails getting a clearer picture of what you had, in what way you have lost it and what the loss means to you. You may feel confused about what happened, ashamed about being unable to keep what you (thought you) had or guilty about having caused your loss. Any or all of those feelings and attitudes are often part of grief and depression. Understanding the whole of your experience—in an atmosphere of acceptance, patience and empathy—can be extremely helpful to you as you work through the distress you have found yourself in. One additional form of psychotherapy for depression is ketamine-assisted psychotherapy, which I describe on another page entitled Ketamine-Assisted Psychotherapy.
Grief vs. Major Depression
For some people, feelings of grief, shame, guilt and confusion are very difficult to put into words. Or, even as we find the words and develop an understanding of what is happening inside you, you may find that your symptoms remain untouched. You may feel like your emotional pain and accompanying physical symptoms have a life of their own and have little hope that things will get better, even if the external situation triggering your depression were to improve. Thoughts of suicide may have entered your mind. In such situations, we have to consider that you may be suffering from a major depressive disorder. If so, you owe it to yourself to consider the possibility that, along with our continuing effort to understand your internal life, additional tools may be helpful to you. One such tool is antidepressant medication.
Antidepressant Medication And Depression Treatment
The first issue to consider is the goal, or target, of antidepressant medication. Realistically, we would not use medication to eliminate all feelings of sadness. After all, being able to feel sad is part of being a healthy human being. But if your feelings of sadness are part of a syndrome that includes sleep and appetite disruption, loss of energy, difficulty with memory and concentration or loss of interest in life, you may be in a situation that is not healthy for you. We have to be particularly concerned if you are finding yourself unable to take care of yourself or if you are having suicidal thoughts.
If we come to see that you are suffering from a major depressive disorder, we can discuss the possibility of using an antidepressant as part of your treatment. Antidepressant medications are typically taken every day and usually take several weeks to begin to work. Their use requires added patience because most side effects appear before the benefits. Fortunately, most side effects of these medications are not serious, but they can be unpleasant and interfere with your functioning. If these side effects do occur, they can sometimes be managed with certain strategies or with the passage of time. However, we do need to remain vigilant to more serious side effects that infrequently occur, such as medication-induced mania.
Mania in some ways looks and feels like the opposite of depression – euphoria, racing thoughts, increased energy, less need for sleep and increased risk-taking. It may sound appealing to you while you are depressed, but it can cause major problems for you and also result in more severe depression. Mania is more likely to occur if you or a family member has ever experienced it before, so we would want to look carefully at your history. For people who have an increased risk of mania, the use of mood-stabilizing medications, either alone or in combination with antidepressants, needs to be part of our conversation.
There are many choices in antidepressant and mood-stabilizing medications these days. In general they all have the same effectiveness but may be more or less effective for each individual. They also differ in their typical side effects and interactions with other medications. If the possibility of a particular side effect is especially unsettling to you, we can begin with a medication that is less likely to cause that particular side effect. My goal will always be to take your hopes and concerns seriously, collaborate with you and support you as you seek relief of your distress.
