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In-Depth: Living with Depression

Living with depression is like living with a 40 ton weight on your chest — you want to get up and move, but you just feel like you can’t.
– David J.

After coming out the other side of depression, I felt like a part of my life was stolen from me. I will never get those 3 years back.
– Julie P.

After receiving a diagnosis of major depression, you might feel relieved to have a name for your emotional pain and you might feel overwhelmed about the treatment at hand. However, you’re not alone. Between 10 and 25 percent of women and 5 to 12 percent of men will have a major depressive disorder in their lifetime. And, though it might seem impossible at first, depression is effectively treated and your mood and life will improve.

Here’s a rundown of what you can expect from treatment, how to boost your chances for effective treatment and general tips for reaching relief and recovery.

Diagnosis

Before understanding how treatment works, it’s important to ensure you received the right diagnosis through a comprehensive evaluation. This typically consists of a careful interview, including questions about symptoms and current stressors, a standardized questionnaire (such as the Patient Health Questionnaire or PHQ; Beck Depression Inventory or BDI) and suicide assessment. The practitioner also might conduct related blood tests to rule out a medical condition.

Common Misconceptions

Even though depression is extremely common, misconceptions still abound. These are some common myths:

  • Depression isn’t a serious condition. Many people mistakenly view depression as a “moral failing,” said Allen J. Dietrich, M.D., co-chair of the MacArthur Foundation Initiative on Depression & Primary Care, whose goal is to help primary care physicians diagnose and treat depression. Others also view being depressed as a weakness, said Christopher Martell, Ph.D, depression researcher and clinical psychologist in Seattle.

    Nevertheless, depression is a serious clinical disorder “characterized by a complex integration of biological and environmental vulnerabilities, life events and patterns of thinking and behaving that lead to the clinical presentation,” said Martell. The cause can vary for each person. But whatever the contributing causes for your depression, all practitioners agree that depression requires treatment.

  • “I should just toughen up and take it.” It’s important to realize that “depression isn’t a natural consequence of living life; it’s an aberration that doesn’t have to be tolerated,” said Steven D. Hollon, Ph.D, clinical psychologist and depression researcher at Vanderbilt University.
  • “I’ll snap out of it.” Letting depression go untreated in hopes that it’ll go away can actually exacerbate the episode, make it last longer and increase the risk for suicide.
  • “I’ll be like this forever.” The biggest misconception patients have is that their depressed feelings, fatigue, irritability, inability to concentrate and loss of interest will last forever; that there is no relief in sight, said Rosalind S. Dorlen, Psy.D, ABPP, New Jersey clinical psychologist and New Jersey public education coordinator for the American Psychological Association. Fortunately, however, thanks to effective treatment, patients do find relief and recovery.

Telling Others about Your Diagnosis

Many people wonder how much they should disclose about their depression to everyone from loved ones to co-workers. “The level of intimacy in answers is an individual decision,” said Mark E. Oakley, Ph.D, director and founder of the Center for Cognitive Therapy in Beverly Hills, California.

You can reveal more details to loved ones who are supportive. For co-workers or anyone who’s less supportive, you can simply say that you’re “going through a difficult time,” and feel free to provide “as little information as possible,” said Martell. You also might want to say that you’re working on the problem. Sometimes people feel that they need to make suggestions about what you should do. Saying that you’re getting help or working through your problems might minimize that response, he said.

What To Expect from Treatment

Treatment can consist of medication, psychotherapy or a combination of the two. Various practitioners, including psychologists, psychiatrists, licensed professional counselors and social workers, and primary care physicians can treat depression. Which professional and which treatment you choose is up to you.

“In our experience, fully half of patients can be managed exclusively in primary care. Many others would benefit from mental health consultation and some may need or prefer to be managed in mental health,” Dr. Dietrich said. Taking medication “can work on its own, is more accessible to many people and may require less frequent visits,” he said.

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However, as Hollon points out, medication doesn’t correct the underlying propensity for depression or address the negative thinking and behavior. This can be especially problematic for patients with chronic depression.

Whatever the limits of medication and psychotherapy, each is effective in reducing depression symptoms. Some research has shown that a combination of the two is particularly powerful.

Psychotherapy

There are many types of psychotherapy; however, not all approaches are created equal. So it’s important to understand what approach your therapist is going to use. Whereas generic talk therapy has not been proven effective in treating depression, research consistently shows that cognitive-behavioral approaches and interpersonal therapy are successful.

“Depressed patients typically make specific errors in thinking and engage in unproductive behavioral patterns that lead to, maintain and can worsen depression,” said Oakley. When they walk in the door, clients typically have lots of evidence that they’ve screwed up in life and tend to blame themselves, said Hollon. It is these errors and evidence that cognitive behavioral approaches address.

Contrary to popular belief, these therapies don’t focus on the power of positive thinking. “I’d much rather see people be realistic instead of falsely optimistic,” said Hollon.

A large part of cognitive-behavioral approaches is investigating patients’ slew of negative evidence. “Patients learn how to examine the accuracy of their own beliefs, so they don’t get stuck with self-fulfilling prophecies,” said Hollon. For instance, instead of saying, “I didn’t get into college because I am stupid,” a patient examines the evidence and might realize that he didn’t get accepted because he only applied to one school or didn’t correctly complete the application.

Length of treatment ultimately depends on the severity of the depression, but cognitive-behavioral therapy (CBT) typically lasts from 12 to 24 sessions. “Patients can usually expect to see incremental changes in mood usually by the 12th session,” Oakley said.

In Hollon’s experience, patients typically start feeling better after a week or two, though the gains aren’t lasting. If Hollon doesn’t see “good improvement between four to six sessions” (if the depression isn’t severe or chronic), he wonders what’s missing. If you aren’t getting better, always ask why and don’t blame yourself, said Hollon. “It might be that your therapist isn’t pushing you forward.”

Overcoming Common Obstacles in Psychotherapy

Various hurdles can hinder progress in therapy. Here’s how to overcome them.

  • Be honest. Though it’s tough opening up to someone you don’t know about your innermost feelings, being honest with your therapist helps you make progress. If you aren’t comfortable disclosing information to your therapist, ask yourself why. If it’s the therapist who makes you uncomfortable, you might want to see someone else.
  • Be willing. It’s important to enter therapy with an open mind. For instance, even though you might experience a loss of interest in all activities, your therapist will encourage you to experiment with “things that previously brought joy, a sense of meaning or accomplishment,” said Oakley. Be willing to try these and other activities.
  • Remember you’re a team. Successful treatment involves both the patient and the therapist; it’s a collaborative process. “Patients assume an active participation in treatment, and assignments that are designed to build skills are an integral part of effective treatment,” said Oakley.
  • Speak up. A common obstacle to CBT is when patients don’t complete their assignments between sessions. “If your therapist is suggesting homework that seems like too much, discuss this with your therapist, who will most likely be open to the feedback and will work with you to make the between-session work manageable,” said Martell.
  • Consider your belief system. For some people, an ingrained belief system can impede treatment. For instance, an individual might feel that he’s doomed to a life of depression because of a family history of the disorder.
  • Remove mood from the driver’s seat. A common trap for depressed individuals is that they aren’t motivated to participate in activities that improve their mood. They become inactive and withdrawn, which worsens and maintains their depression, Oakley said. This is where it’s key not to let your feelings dictate what you do, he added.

Medication

Research shows that antidepressants are effective in reducing depression symptoms. But it’s important to understand that medication doesn’t work instantly or produce dramatic results. Most people will feel a positive impact in one to two weeks, but they won’t experience the full impact for one to two months, said Dr. Dietrich.

In the meantime, while you wait for the medication to start working, Dr. Dietrich suggests disciplining yourself to do the activities you used to enjoy. For instance, if you enjoyed visiting with friends before your depression, commit to inviting a friend over. He added, “You don’t need to be overly ambitious, but just get back in your groove.”

Keep in mind that the first medication you try may not be the right one for you. “Most people who start on one hypertension medicine will need to take a different or an additional medication. It’s not that much different for depression,” Dr. Dietrich said. In fact, trying several antidepressants and adjusting dosage is something doctors expect. So it’s important not to get discouraged if the first medication doesn’t work.

In-Depth: Living with Depression


Margarita Tartakovsky, M.S.

Margarita Tartakovsky, M.S. is an Associate Editor and regular contributor at Psych Central. Her Master's degree is in clinical psychology from Texas A&M University. In addition to writing about mental disorders, she blogs regularly about body and self-image issues on her Psych Central blog, Weightless.

APA Reference
Tartakovsky, M. (2020). In-Depth: Living with Depression. Psych Central. Retrieved on September 30, 2020, from https://psychcentral.com/lib/living-with-depression/
Scientifically Reviewed
Last updated: 17 May 2020 (Originally: 17 May 2016)
Last reviewed: By a member of our scientific advisory board on 17 May 2020
Published on Psych Central.com. All rights reserved.