Unless you have experienced the sense of desolation that comes with major depressive disorder it is difficult to describe. Feeling lost and depressed for days, weeks, or months on end can have devastating effects on a person’s life. Depression isn’t something that can be willed away with pep talks or daily affirmations. Its roots are deeply engrained in brain chemistry, taking hold of our joy and sense of control in our lives.
One of the most concerning aspects of depression is the impact it can have on all areas of our lives. No realm is sparred, with the disorder affecting our professional life, our family life, and our relationships. In addition, depression can have a negative affect on our physical wellbeing as well. Curbing the fallout of depression due to impairment in functioning is a central goal of treatment.
While in the throes of major depression, feelings of despair and hopelessness begin to crowd out any aspect of joy or pleasure, making happiness itself seem like a distant memory. The energy required to even get out of bed in the morning can become too much, with the resulting solitude and inactivity leading to feeling lost and depressed with no end in sight.
Depression is a complicated mental health disorder with, as of present, still undiscovered causes. Science continues to explore the possible biological and genetic sources of the complex disorder, but until this is discovered we are limited as to what our treatment options are. Treatments that work for one person may not be effective for another. For this reason, an integrated approach offers the best opportunity for symptom relief.
About Major Depressive Disorder
Most healthy individuals experience fluctuations in mood, but when feelings of despair and sadness persist for most of the day and for a period of two weeks or more, they may be suffering from clinical depression. According to the DSM-5, symptoms of major depressive disorder might include:
- Fatigue and decreased energy
- Impaired concentration
- Persistent sadness
- Loss of interest in activities once enjoyed
- Irritability and restlessness
- Feelings of worthlessness and guilt
- Sleep disturbances, such as insomnia or excessive sleeping
- Recurring thoughts of death or suicide
- Over eating or loss of appetite
Depression can take different forms. The various types of depression include:
- Major depressive disorder (MDD)
- Persistent depressive disorder (PDD), also referred to as dysthymia
- Postpartum depression
- Premenstrual dysphoric disorder (PMDD)
- Seasonal affective disorder (SAD)
- Bipolar-related depression
- Psychotic depression
Potential Causes of Depression
While the exact causes of depression have not yet been pinpointed, certain factors that are said to play a role in developing depression have been identified. These possible causal factors include:
- Genetic and biological factors: First-degree relatives of people with severe depression are more likely to also suffer from this mental health condition than the general population. Biologically, various areas of the brain are likely involved. Neuroimaging of the brain of a depressed person reveals a smaller or less active amygdala, hypothalamus, and anterior cingulate cortex.
- High stress life events: Significant events, both positive and negative, can trigger distress, including starting a new job, moving, marriage or divorce, having children, or retirement, to name a few.
- Long-term illness: Although it is a physical illness, being bedridden or having physical activity severely limited can trigger depression.
- Traumatic past events: Physical, emotional, or sexual abuse can contribute to a depressive illness sometimes years after the traumatic event occurred. Also, being raised in a dysfunctional home environment where substance dependence, neglect, or mental illness was present can also cause latent depression.
- Being female: The reproductive and hormonal fluctuations that women experience via the menstrual cycle, pregnancy, and childbirth are key contributors to mood shifts.
- Age: Hormonal fluctuations are more pronounced in young people, making them more vulnerable to developing a depressive disorder. Also, seniors may also develop depression due to the ending of their career, loneliness after loss of a spouse, or deteriorating health.
- Co-occurring substance abuse: Depression often coexists with a substance use disorder. When the substance use disorder is primary, the negative consequences of the chemical dependence can lead to depression.
Different Settings for Depression Treatment
When considering treatment for depression, the level of care that is appropriate based on the severity of symptoms or length of history of the depression is an important factor. There is a wide range of treatment options available for treating depressive disorders, including:
- Psychiatric private practice. The primary care practitioner is often the first stop in getting help for depression. This is a necessary first step as the physician can first rule out a medical condition as the reason for the depression symptoms. He or she will usually then prescribe antidepressants, or will refer the individual out to a psychiatrist who can provide a more focused treatment protocol, including psychotherapy and medication.
- Outpatient programs. An outpatient program will provide the same services as a private practice doctor, but with added services such as support groups and referrals to outside social services if needed. Outpatient programs typically provide the individual with a couple of sessions per week, individual and/or group therapy.
- Partial hospitalization programs. The PHP, also referred to as a day program, involves a higher level of care. The program may provide up to 30 hours per week of programming, including individual therapy sessions, group therapy, life skills classes, dual diagnosis treatment, family therapy, suicide prevention, and additional therapies such as ketamine therapy.
- Residential mental health treatment. A residential, or inpatient, mental health program offers a step up from the PHP, providing round the clock support and supervision. A residential program offers the individual an opportunity to disengage from their usual home and workplace settings to focus their time and energy on overcoming the depression. A residential setting allows for a more customized and intensive approach to treatment.
- Hospitalization. In some instances, it may be necessary to admit a loved one into a hospital setting where they can receive the highest level of care. Signs that someone may need hospitalization include the presence of violent behaviors, psychosis, deteriorating health due to the depression, or suicidal thoughts or actions. The psychiatric hospital setting provides acute stabilization services, and once stabilized, the individual will transition to a residential mental health program.
Comprehensive Depression Treatment
When someone experiences feeling lost and depressed to the point that his or her daily functioning is impaired, it is essential that they reach out for help. Depression is highly treatable and should never be ignored. Too many attempt to ride out the depressive episode, only to find their symptoms worsen along with their quality of life.
Depression treatment focuses on modulating brain chemistry through the use of antidepressants, and thought/behavior patterns through the interventions of a psychotherapist:
- Medication. There are four categories of antidepressant drugs on the market, including SSRIs, SNRIs, tricyclic medications, and MAOIs. These medications each vary slightly in how they function in the brain. Often, there is a need to trial a few different drugs before the best fit is determined.
- Psychotherapy. Psychotherapy modalities are selected based on the specific issues underlying the depression. Psychodynamic therapy is a longer-term approach that delves into childhood issues that might be factors in the depression, and cognitive behavioral therapy (CBT) can help the patient identify irrational thinking that leads to depressive symptoms. There are also exposure therapies for helping those with depression who have experienced trauma.
The Role of Holistic Therapy
One of the major trends in psychiatry in the past decade is the inclusion of holistic methods into the overall treatment plan for mental health disorders. Complementary holistic therapies can enhance the effects of the clinical therapies, resulting in a more satisfactory treatment result. These holistic or experiential activities help the individual to regulate stress while improving overall wellness. Some holistic therapies that can aid depression treatment include:
- Yoga. Yoga integrates breath work with purposeful movements and postures that help lead to relaxation while strengthening the body.
- Mindfulness. The practice of focusing attention on the present moment is called mindfulness, or being fully aware of the sensory stimuli and emotions experienced.
- Exercise. One of the fastest ways to improve mood is through establishing a consistent exercise routine, particularly engaging in cardio or aerobic activities.
- Acupuncture. This ancient Chinese practice uses needles to target acupoints that alleviate depression, such as Quchi, Shugu, Taixi, Hegu, and Guanyuan.
- Equine therapy. Being assigned a horse to care for, including grooming, feeding, and exercising, can provide improved self-worth, confidence, and mood.
- Massage. Through the manipulation of muscles and soft tissues, massage therapy can help ease muscle tension, reduce stress, increase blood flow, and improve mood.
Alternative Therapies for Depression
In a significant number of people, conventional and/or holistic therapies may not be effective in reducing the symptoms related to the depression. These individuals are diagnosed with treatment-resistant depression, leaving them to explore alternative methods for managing the effects of the depressive disorder. These alternative options might include brain stimulation techniques, such as:
- TMS therapy. Transcranial magnetic stimulation is a noninvasive brain modulation technique that requires no surgery or anesthesia and can help rebalance brain chemistry, leading to depression symptom relief.
- Deep brain stimulation. Involves brain surgery where electrodes are implanted and the individual uses a neurostimulator to activate the electrodes.
- Vagus nerve stimulation. Involves a surgical procedure to implant a stimulation device that has a wire to the vagus nerve in the back. The device stimulates the vagus nerve, which sends signals to the brain.
- Electroconvulsive therapy. Involves electrically induced seizures while under general anesthesia.
When feeling lost and depressed has negatively impacted your life, getting the professional help you need to reclaim your joy is imperative. Depression is a treatable mental health condition that can be managed and overcome with the right interventions. Medical Concierge Recovery is here to help.