Depression

 

Statistics

• Although estimates vary, approximately 17% of adult Canadians will experience depression at some point in their lives.
• According to Health Canada and Statistics Canada around 5% of adults will be depressed in a given year.
• Of those who develop depression, only about 20 percent will receive adequate treatment.
• Depression is one of the most treatable illnesses: 80-90% find relief.

Dr. Habke says:

In our practice, depression is one of the most common reasons why people come to see us.  It is often complicated by difficulties in other areas of life, like relationship distress or work stress. In fact, depression often results in an escalating spiral – depression makes it more likely your relationship will not function well and that relationship dysfunction creates depression which in turn further impacts the relationship.  However, it is also possible to have depression as a ‘stand alone’ issue.

Most of my clients come in thinking one of two ways.  Either they feel that their situations have completely generated the depression (this happens when there is a significant loss but also when there are general life stressors), or they feel guilty about being depressed because everything in their life is ‘okay.’  They feel that they have no ‘right’ to be depressed because others are suffering a lot more.   It can take some time to convince them that the suffering of others doesn’t change their own suffering in any way.

When we first meet, I typically will do a depression screen.  This consists of a history, but also an assessment of the common symptoms of depression. I will ask about their energy levels, sleep (waking early in the morning and not getting back to sleep is a common symptom, but so is too much sleep), their appetite (a lack of appetite is significant but so is “comfort” eating), and their ability to concentrate or pay attention to things.  These, along with short term memory problems, have to be separated out from how the person is normally.  (Some people ALWAYS have trouble concentrating). Finally, I ask about suicidal thoughts.  It is not uncommon to have people say they have had the thought that it would be easier to not be alive, and less common (thankfully!) to hear them say that they feel they might act on suicidal thoughts.

The issue of drugs and alcohol also comes up in the first session.  It can be a tricky one because a lot of people don’t understand that although recreational drugs (marijuana most typically) and alcohol feel like a way to cope with depression, they often make depression worse through the way they impact either the biochemistry in the brain (for example, alcohol impairs the quality of your sleep – it may put you to sleep but you won’t sleep well) or your ability to make changes that might get you out of the depression.

With all the information together, I then will talk with my clients about their depression.  I explain that depression typically has two components – the physical and the situational.  The physical has to do with the biochemistry of the brain  and the situational is about what is happening in their life.  Think about it like the treble and bass adjustments on a stereo.  You can have a lot of bass (physical/biochemical problems) and lots of treble (situational stresses) and every combination in between.  As I mentioned before, some people have no stresses in their life but still are depressed. 

When we look at treating depression, we need to treat both sides of the equation.  There are some common things we discuss around the physicical side of depression – we know that there are some biochemical changes attached to these, although they can also affect the psychological (the “frame of mind”) so they are important for anyone who is depressed.   They include:

1) Exercise

2) Sleep

3) Meditation

4) Medication

Many people are really upset and/or anxious about taking medication.  There is a lot of information out there on side effects and bad reactions so I don’t blame them!  However, I have also seen medication work wonders and I believe it will speed up recovery from a depressive episode.  So, if the depression is high in the moderate range or above, I will encourage a consultation with the client’s family doctor around an antidepressant.  (A psychologist is trained in the management of psychological issues but is not a medical doctor – a general practitioner or psychiatrist must prescribe medication).  

When a depression falls in a lower range, I think it is reasonable to allow a client some time to try and do what they can to improve without medication (however, I don’t recommend trying more than about a month, and will change my position if the depression worsens).  

The more purely psychological side of depression can be related to two things.  First, clients will talk about specific situations in their life (“My marriage is in trouble,” “My work is too stressful”).  Secondly, clients will talk about the thoughts that they are having; some of these are related to the specific sitations they are dealing with (“I am a terrible husband,” “I am doing a lousy job at work”), some are more general.  For example, we often see people who feel bad about themselves generally (low self-esteem).

Every psychologist or mental health professional will use different approaches to therapy even if we are using the same principles, the techniques will vary.  Most psychologists will use some Cognitive Behavioural Therapy (CBT) techniques in addressing depression, although they may or may not give formal homework exercises.  These days, we also have a practical view to finding solutions in a relatively short period of time (you may hear this discussed as Solution-Focused Therapy). 

In my experience, there are a couple of recurring themes coming from people with depression.  First, it’s around inertia.  “I can’t get started on anything,” “I know exercise would help but I can’t get started,” or “I know we talked about looking for another job but I can’t seem to get started.”  Once we ascertain that there isn’t a bigger reason (they don’t actually believe it would help for example), then it becomes about the behavior itself.  I believe that my depressed patients focus so much on the final goal that it is overwhelming.  It’s like standing at the bottom of a mountain and looking at the top saying I’ll never get there.  So, we start to talk about the steps.  Rather than the goal, what is the most you can do right now (sometimes I’ll ask them what is the least that they can do so they get the idea).  ALWAYS:  Something is better than nothing. 

Secondly, I see clients “shoulding” on themselves.  “I should be able to do this,”
”I shouldn’t feel depressed,” “I should be a better person,” are all examples of this.  I will talk with clients about substituting another truth that is not so harsh (and I don’t mean “ought to” or “must”).  Thinking even “I would like to… ” or  “I hope to…” is still true but with less judgement. 

A lot of times, clients will want to know how long they will need to come and see me.  This is such a hard question, as it depends on how hard they work at the things we talk about, whether they are on medication and how it works for them, whether difficult situations in their life can be resolved and how severe the depression is in the first place.  However, MOST clients will find at least partial resolution of the depresssion in 4-6 weeks, although we often do follow-up on a monthly basis for a while.