Up Close With Dr. E

Tips for understanding clinical depression


In this column, three questions about clinical depression will be answered:

1. What is it?

2. What causes it?

3. How is it treated?

As you gain a better understanding of clinical depression, you will be surprised to learn that despite great advances in treatment, CD, for the most part, continues to be an untreated disorder. How so, you ask? Strong barriers to care continue to stop suffering patients from receiving treatment. By far, the strongest obstacle to care has been labeled, “The Hidden Prejudice,” by Michael Perlman, an expert on mental disability law. The “Hidden Prejudice” is another term for raw discrimination — just as potent as racism or sexism -— against any woman, man or child who suffers from CD (or any mental illness, for that matter). Discrimination against a person who suffers from CD goes like this: “If you are depressed, it is your own fault. You are a morally defective person whose bad behaviors have caused you to suffer. Your depression is a sign of deep flaws in your character, and is un-curable.” Wow! What an uplifting belief. The best antidote for poisonous discrimination is knowledge.

Clinical depression is neither a decision, nor a choice, made by depressive individuals. It is a brain-based medical illness. Why is it that your stomach can ache, your lungs can become inflamed, your kidneys can have an infection, your back can hurt, but, your brain can never be ill?

The final barrier which prevents people from seeking professional care is truly shocking: Most individuals, who are, at this moment, suffering from an active CD, have no idea that their daily battles to go to work or school, or care for their kids, or just do all those demanding jobs of living, are all due to a serious brain-based disorder. No, since the depression has been in their lives for so long, it, like a toxic dye, has seeped deep inside and stained their hearts and minds, convincing them that their life-long struggles are just a reflection of their own inadequacies. Their CD has become a key part of how they relate to themselves. That is, their depression has now become a part of their identity.

So, what causes CD? The best explanation for understanding what causes CD can be found in this model: The two-hit theory of depression. (Steven Stahl, 2002, “Essential Psychopharmacology”). Hit one is a genetic vulnerability, inherited and passed down in certain families. Hit two is a specific event, or stressor (childhood trauma or abuse, exposure to viruses, toxins or disease, highly stressful events such as a hostile divorce or assault). The first hit (genetic risk factors) is not enough to produce a CD. Nor can the second hit (a severe stressor), alone, cause a CD. It is only the combination of the two which causes CD. Measuring your genetic risk for depression will be part of the next breakthrough in treating and preventing depression.

We now come to the last question, how is CD treated? There are three standard treatments for CD: Antidepressant medication, psychological therapy and combination treatments (psychological therapy plus medication). However, it has been my experience that patients want, and need, much more than what these treatments can offer. Here are three statements I have consistently heard for over 20 years from patients who have been treated for CD:

1. “My anti-depressant medication helped me to function — to sleep, and get my energy back. But, my thinking patterns stayed negative.”

2. “My counseling helped me realize that my depression was the reason I had suffered. But my daily life did not change much. I was still in the same rut.”

3. “I am not just looking for my symptoms to go away. I want to understand how I became depressed. I want to get well and learn how to keep my life healthy.”

I believe that an essential part of treatment for CD is a skill-based program, where each patient is taught how to take responsibility for their mental health by making appropriate, life-long changes. This means that traditional treatment for CD (counseling and/or medication) needs to be strengthened by an individually tailored program where “new tools” for living are taught. This broader, comprehensive CD treatment would include the following: Understanding the role of good nutrition, developing an exercise program, building stronger bonds with family and friends, finding healthy ways to recover from stress, such as recreation and building spiritual and/or religious activities to connect us to fundamental life values.

The content of this article is for educational purposes only, and should not be used as a substitute for treatment by a professional.


Dr. Richard Elghammer contributes his column each week to the Journal Review.


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