Fighting Depression that Won't Let Go

Fighting depression is a daily battle for some people who have "tried everything". Certain forms of depression have been labeled "Treatment Resistant" and "Chronic" because they simply refuse to let go for any real length of time.

Usually depression is a highly treatable condition. The majority of us have or will have experienced an episode of major depression in our lives. The most notable effect is a loss of energy.

There is a common misconception that depression always comes with feelings of sadness. Many times irritability is the primary emotional component. This is especially true with depression in men and frequently with children and teenagers.

Most psychiatrists and therapists will start by "ruling out" a medical problem before beginning therapy for depression. This is most often accomplished by a trip to your family doctor for a physical exam... Fighting depression takes teamwork.

Some medical problems to look for...

• Diseases such as Lupus, allergies, Epilepsy, Mononucleosis, and Alzheimer's to name a few

• Hormonal conditions such as hyperthyroidism (over-active thyroid) or hypothyroidism (under-active thyroid) can cause depression or bi-polar disorder

• Genetics - Major Depression and Bipolar Disorder are known to run in families... However, there seems to be no way of knowing how much of this is due to heredity and how much due to environmental factors such as the emotional climate in the home, role modeling, and fulfillment of dependency needs.

Clinical Depression Symptoms

The standard diagnostic manual, the DSM-IV, outline the following criteria for a Major Depressive Episode.

A. At least five of the following nine symptoms must be present during the same two week period. A minimum of five symptoms and must include either of the first two symptoms.

• Depressed mood for most of the day, nearly every day... In children and adolescents it may be irritable mood

• Diminished interest or pleasure in almost all activities of the day, nearly every day

• Significant weight gain or loss when not dieting, and increased or decreased appetite nearly every day... in children and adolescents consider failure to make expected weight gains.

• Insomnia (not able to get enough sleep) or hyersomnia (sleeping too much) nearly every day

• Abnormal restlessness (psychomotor agitation) or a drop in physical activity (pscyhomotor retardation) nearly every day

• Fatigue or loss of energy nearly every day

• Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach of guilt about being sick)

• Diminished ability to think or concentrate, or indecisiveness, nearly every day

• recurrent thoughts of death (not just fear of dying) recurrent suicidal ideation (thoughts) without a specific plan, or a suicide attempt or a specific plan for committing suicide

B. The symptoms do not meet criteria for a mixed episode (mania and depressed mood)

C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

D. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication)or a general medical condition (e.g. hypothyroidism)

E. The symptoms are not better accounted for by Bereavement, such as a reaction after the loss of a loved one

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NOTE: The above criteria are symptoms of a Major Depressive Episode and do not alone constitute a diagnosis of a Major Depressive Disorder. Nor does this information substitute for professional evaluation and/or treatment. It is presented for informational purposes only. If you even suspect you may have depression please seek professional help as soon as possible.

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Fighting Depression - Treatment-Resistant and Chronic Depression

When depression responds to treatment all is well and good. However, when it doesn't respond to treatment the fight begins. Professional helpers like to help... being human they can get frustrated too when everything they try fails to resolve the problem.

When fighting depression becomes an all out war someone is going to lose and it's not usually the depression. Symptoms are our friends, they tell us where to look for problems. Depression is usually a symptom of something deeper.

For example...

• Depression may be what leads to the discovery of a medical problem that needs attention.

• Depression may be a signal of unfinished emotional business that needs attention

• Depression may be the "steady-state" or a highly developed neural network that was established as a result of growing up in an abusive or otherwise less-than-nurturing-family.

Fighting depression when it may be trying to tell us something is like throwing the baby out with the bath. Therefore it is important to listen to your symptoms as you proceed in therapy.

If all avenues have been explored, all medicines have been tried, all personal archeology completed, and all interventions exhausted and yet the depression remains it may be time to consider that it has simply become a chronic steady-state.

If this is the case then homeostasis is the likely culprit and fighting depression will required a new plan. One that requires daily commitment and hard work... something that is hard to ask from someone suffering from depression but none-the-less necessary.

Fighting Depression When it's a Steady-State

A good way to tell if you have a "treatment-resistant" depression, also known as "chronic" depression, is that you will notice an internal resistance to reading this information.

If you haven't noticed it yet, some part of you will begin to rise up on the inside and say things to you like...

• "Why waste your time reading this?"
• "This will be like everything else - nothing works!"
• "He doesn't know what he's talking about, just like all those other people who failed to help me."
• "Why bother, your not worth it anyway".

If you are familiar with this kind of self-talk you are at the right place... I congratulate you for reading this far.

It may be a struggle but you can force yourself to read on and even consider some of the suggestions here to create your own plan for fighting depression.

Since depression is an illness of isolation...and according to most, exacerbated by a lack of healthy connection to others, creating a support network is a required part this new plan for fighting depression.

There are many ways to create a support network. Friends and family can be a great source of support...or they can be part of the problem.

If you are fighting depression that is chronic or long-term, chances are they've tried everything they know to help but are as frustrated as everyone else. They may even accuse you of not wanting to get better.

If your family and friends remain supportive... that's great! But for this plan you also need a network of people who really know what you are dealing with, who have been there and done that, who have found a way out... and most importantly people who won't try to do it for you. More on this in a moment.

Also if depression has become a chronic steady-state, then it has its roots in unmet childhood dependency needs. If you have not yet read all four parts of the "Iceberg" it would be good to do so now.

Treatment resistance is about self-sabotage, usually at a subconscious level... It's like the neural network for chronic depression has a boundary around it...a firewall if you will...protecting it and keeping it's steady-state intact.

There are a multitude of ways to sabotage yourself...

Self-Sabotage Screening

If you find that you are a "self sabotager" the following outlines an action plan for recovery.

Recommended Plan of Action

• Begin by making a commitment, knowing full well that the more serious you are about fighting depression the stronger the resistance will become.

• Read Anne Katherine's book When Misery IS Company - End Self Sabotage and Become Content

• Read all four parts of the "Iceberg" and make notes about exactly where and how you relate to what you read in each part.

• Build a support network by finding a group of people who are in recovery from the same condition. I recommend any of the following 12-step groups as a place to start:
  • Self-Sabotagers Anonymous - They have two telephone conference call meetings every week on Thursdays and Saturday Mornings

  • Adult-Children of Alcoholics - Sometimes an ACA group adds "and other Dysfunctional Families", other times there are "Adult Children of Dysfunctional Families" groups... Check you local paper or call the operator for a local phone number to find out meeting times

  • Overeaters Anonymous - Check you local paper or call the operator for a local phone number to find out meeting times

  • Codependents Anonymous - Check you local paper or call the operator for a local phone number to find out meeting times

• Seek professional help from someone who knows Twelve Step Recovery and how to help Adult Children of dysfunctional families. This work will take time to uncover your core issues and a counselor with this knowledge and skills will be necessary.

• Explore all of the pages on this website to get an understanding about the neural network and steady-state of chronic depression. Know what you are up against if you are going to continue fighting depression.

• Contact me if you have questions.