Depression and Bipolar Disorder
Usually, people have reasons to feel depressed and although medication is often helpful to stabilize your mood, it is best to combine it with at least once-weekly psychotherapy for a long-lasting change.
Consulting with a professional in a trusting, safe and accepting relationship is the first step in feeling better and living a happier, more fulfilling life.
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Signs and Treatment of Depression
Depression is one of the most common mental health conditions that bring people to therapy. Similar to anxiety, a diagnosis of depression tells us little about the person coming to see us, about their life or about the reasons behind the depression. Also, just like with anxiety, it is common for people to feel depressed under special circumstances such as losing a loved one, going through a divorce or undergoing a drastic change in life. Usually, we don’t even call it depression because it doesn’t warrant professional intervention and we somehow manage to get out of it using our innate resources.
Signs of depression
What we refer to as clinical depression, however, is different and includes a number of other, observable symptoms and behaviors for a prolonged period of time, typically longer than six months:
- poor or increased appetite,
- drastic fluctuations in weight
- lack of motivation,
- feeling apathetic or lethargic and/or “heavy”
- social withdrawal/limited social interactions
- unwillingness or inability to engage in productive activity, missing out on school, work or family events
- feeling hopeless and/or helpless
- thinking about death or suicide; wanting to just put an end to it, end the pain
- suicide intent and/or suicide attempt – In extreme forms of depression, the risk of suicide can be severe and it is our number one priority in therapy to make sure that our clients stay safe. This is usually the point in treatment when the treating psychiatrist will prescribe medication to ensure that the person’s mood stabilizes and the risk for impulsive, self-harming behavior is reduced.
Depression is a (psychoanalytic) symptom
As I explained elsewhere, from a psychoanalytic point of view, depression is a symptom; a symptom of something else that has not been put into words, has not been expressed and is finding a way out through our body, making us depressed. That something could be years of childhood abuse and/or neglect; other traumatic experiences, including war, loss, death, rape, violence, or any kind of physical, emotional or political hardship; hurtful family or personal events; living with an abusive parent or a partner, etc.
It is impossible to name all circumstances that could lead to depression and honestly, it would be fruitless. Every person is unique and what may be traumatic and leading to depression for one person may not have the same psychological impact for another. What’s important is that we recognize that something is off and that we need help to address it.
The cure is in the therapeutic process
As psychoanalytic psychotherapists, we are not just interested in treating the symptom of depression but rather, we want to find the cause of the symptom, the reason why you are depressed. However, simply naming the reason for the depression is not enough to overcome it either.
The therapeutic process itself, which goes hand in hand with the therapeutic relationship, is what brings about change, not so much the facts named or spoken about. As human beings, therapists cannot change what happened to people even if we wanted to. But we can change the way people are treated, the way they think about themselves and the ways they allow themselves to feel about themselves and others in their lives.
It takes time
With some forms of depression, this takes time, sometimes years. The more severe the depression, the longer it takes to overcome it. Relationships are often impacted by the devastating effects of depression and regaining a sense of trust in people cannot happen with medication alone and outside of a therapeutic relationship.
I wish I could say it is easy to cure depression but unfortunately, I can’t. Nothing really comes easy in life but one thing is for sure, those who haven’t tried, haven’t succeeded.
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Top 3 Signs That Someone is Depressed and Needs to See a Professional
Before I jump into listing the signs, I want to emphasize that often people, who struggle with severe depression, may not find the willpower or desire to seek professional help on their own, and it is extremely important for people in their life to notice their pain and do something about it before it’s too late. We have all had a friend or family member experience depression for one reason or another and it can be confusing, scary and inhibiting to watch them suffer.
Elsewhere, I spoke about how psychoanalysis understands depression and listed the common symptoms associated with the diagnosis. Here, I want to give you the clinical presentation of how a person, struggling with depression, will appear to others around them and how can you, the observer, recognize the signs of depression when you see them and possibly do something about it.
Here are the top three signs that the occasional blues have turned into a clinical depression:
1. Extreme social withdrawal and isolation – if the person used to be socially engaged, went to work or school and all of a sudden, s/he is struggling to fullfill basic responsibilities, this is a sign that they are lacking motivation, have no interest in social activities, spend most of their time alone, in front of the TV or sleeping, all of which point to depression.
2. Complete or partial neglect for personal hygiene and change in physical appearance – this is a very obvious sign that the person has stopped caring about how they look, smell or appear to others that is easily noticeable by family members and friends. When it becomes a regular occurance and the person no longer cares to clean their home or their body, it is clear that depression has set in deeply and an intervention may even save that person’s life. At that point, they may be thinking about or planning suicide, feeling hopeless, helpless and utterly desperate. Changes in their physical appearance such as gaining or losing a lot of weight may also be observed.
3. Changes in personality – if you find yourself thinking that the person you once knew is no longer there and they seem to have neglected their appearance or completely altered their way of relating to other people, this is a sign that something painful is going on internally, resulting in depression. In order to cope with the pain, the person may be drinking excessively or abusing other susbtances to the point of blacking out, forgetting or letting it impact their personal, social and occupational functioning. Frequent arguments, bursts of anger or sadness, impulsive and risky behavior may accompany this personality change.
If you or someone you know is experiencing any of these changes in mood and behavior, this may be an indication that they are depressed and need to see a professional.
How to recognize the signs of childhood depression
Similarly to how it manifests uniquely during adolescence versus adulthood, depression looks differently in early childhood as well. It is important to recognize the signs of childhood depression and to distinguish them from normal developmental milestones and behaviors. By the time you are finished reading this post, I hope that you’ll be able to identify the signs that your child may be depressed and to separate them from typical childhood behaviors.
Beforehand, I do want to open big brackets here: [I want to emphasize that the best way to know for sure if someone is depressed is to seek professional evaluation either by a therapist or by a psychiatrist. If you are concerned for your child or another family member, this post should only serve to orient you; it is not intended to replace the diagnostic process.]
So, what are the signs of childhood depression?
The first and most obvious sign that a kid is depressed is a general and overpowering sense of sadness. If your kid is crying a lot and cannot really explain why or just seems generally sad and gloomy, that’s a sign that they are hurting.
Another way to notice the sadness is to observe your child’s willingness to engage in spontaneous play either alone or with other kids, something they would usually engage in with ease, considering they’ve had proper rest and adequate nutrition.
A lack of interest in play, sometimes accompanied by a change in appetite or eating habits, would indicate that something may be wrong. This lack of interest in play may also come with feelings of tiredness, sleepiness and low energy.
However, for some kids, sadness may be masked by other behaviors or affective states such as:
- irritability – the kid is easily frustrated, annoyed and generally unhappy. They may struggle with following direction or enjoying themselves when they are out with family and friends.
- temper tantrums – if the child is older than the “terrible two’s” when temper tantrums are expected and part of normal development, melt downs may be a sign of something more serious happening with your child.
- angry outbursts – this happens with a little older kids, those nearing middle school, pre-adolescents and adolescents. A common way for sadness to mask itself is through manifestations of anger.
- physical aggression – when the aggression feels out of control and the kid bursts in tears afterwards, this may indicate an underlying condition of depression.
- physical complaints and frequent illnesses – this is probably one of the most common, yet unrecognized signs of childhood depression. Because children cannot verbalize their feelings as well as adults can, what they are feeling emotionally often expresses itself through their bodies in the form of frequent illnesses, stomach pains, unexplained headaches or other forms of the body “hurting.”
- regression in developmental progress – what do I mean by this. Let’s say that your kid is toilet trained and, all of a sudden, they start having accidents again. Sometimes, this happens but if it continues beyond once or twice, it may be a sign of something more going on.
This kind of understanding of childhood behavior and emotion is practical psychoanalysis at it’s core. As I have mentioned before, psychoanalysis listens beyond the obvious and looks for the meaning of symptoms beyond their face value.
What is the meaning of this or that behavior? Is there a reason why the child is acting this way? What are they trying to communicate to us without words but through their bodies and with their behavior? These are the questions we address in psychoanalytic psychotherapy with children and adolescents.
Are you worried about your child or someone you know? Leave a comment below or email me and I’ll do my best to help.
For more articles on common mental health issues affecting you and your family, subscribe to Mental Health Digest and get the latest issue emailed to you today by leaving your name and email address in the contact form here.
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Depression in adolescence: 5 insights every parent needs to know
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