AAMFT
Consumer Update
Depression
The mental
health profession categorizes depression as a mood disorder, but also
recognizes that its symptoms can vary widely from one person to another.
It is also accurate to think of depression as a complex problem that
can affect many different aspects of the sufferer’s life. It can affect
the body, and generate such physical symptoms
as insomnia, fatigue, appetite disturbances, diminished sex drive, and
anxiety. It can affect the mind, interfering with the ability to think clearly, notice and
remember details, and make good decisions. It can affect emotions, causing feelings of sadness, despair,
guilt, worthlessness, and apathy. It can affect behavior, leading to alcohol or drug abuse,
suicide attempts, and other socially or self-destructive behaviors. It
can affect interpersonal (social and family) relationships, leading to aggression, withdrawal,
or marital and family distress.
The main forms of depression
are: major depressive disorder, also called "unipolar"
for its affecting only one end of the mood continuum -- depression; and
bipolar disorder, formerly called manic-depressive
illness, ("bipolar" for its affecting both ends
of the mood continuum -- depression and euphoria, or mania.) Depression
can also present itself as dysthymia, a less intense and more chronic
form of depression. Major depression is far more common than bipolar
disorder, and has a much wider range of contributing factors.
What are depression’s effects on personal and family life?
The symptoms of depression
described above make it clear: To be depressed is to suffer. The hopelessness
and helplessness that people experience when they are depressed is more
than just a frame of mind at such times -- it is an entire way of being.
People stop trying, they stop caring, they withdraw from life, and of
course, this makes them feel even worse. Their lives deteriorate, and
it affects others as well. Family members are not immune to the depressive’s
negativity -- the never-ending complaints, the steady stream of criticisms,
the lack of emotional closeness, and the loss of the ability to have
fun together. Spouses can feel hurt and alienated, and children may feel
guilty, resentful, and as if they are to blame. In turn, family relationships
can also exacerbate depressive symptoms.
How do you know when to seek help?
As a general answer,
you should seek help when depression is starting to affect your life (your family,
your job, your outlook) in negative ways, and you are not very clear
about what you need to do to prevent things from getting worse. You should seek help
-- for yourself, loved ones, or both -- long before things get really
bad.
To be more specific,
take into account the following factors when deciding to seek professional
treatment.
- Suicidal thoughts
or feelings: Suicide is a terrible and irreversible solution to specific problems.
The depressed person and his or her family need to think preventively,
and get help immediately if someone is suicidal.
- Acute depression
turning chronic: Before settling into "life as a depressed person," the
depressed person, and family if possible, should do all they can
to resolve it early on. Every day spent suffering is too costly.
- Lifestyle disruption:
The depressed person, and his or her family, can prevent bad circumstances
from getting worse by acting quickly. The depressed person does not
have to ignore his or her health, lose a job, or hurt or alienate family
and friends.
- Reality testing: If a family and their depressed
member do not have someone good to talk to, someone with whom they
can share their private thoughts, then how will they know whether what
they are thinking makes sense? A good therapist is a valuable partner
for "reality testing."
What kinds of treatments are commonly used?
Psychotherapy and antidepressant
medications are the two most commonly used treatments for managing depression.
Many people use a combination of the two. People’s responses vary, of
course, but these approaches hold good promise for providing relief.
Most people have already
heard of the popular antidepressant medication, Prozac. It is only one
of the many "newer generation" medications that do, in fact,
help the majority of people who take them. Medication is a valuable tool
for reducing symptoms and "raising the floor" on depression.
Speaking to a psychiatrist about the use of medications in your particular
case is the best way to explore whether medications are viable for you.
A psychotherapist can also help you with this decision.
Psychotherapy is an non-drug
alternative that is generally as effective as medication, and in some
ways is even superior (though not quite as fast-acting). For example,
people who receive therapy tend to have a lower relapse (recurrence)
rate, and tend to feel better as an active participant in the recovery
process. Psychotherapy can help individuals and families who are dealing
with depression. The most effective psychotherapies are called cognitive therapy (which teaches how to identify and
correct distorted thinking), behavior therapy (which teaches how to behave more
effectively), and interpersonal therapy (which teaches relationship skills). All of these are
short-term therapies, and all focus on changing things in the present.
The fact that long-term
research shows the effectiveness of medication and psychotherapy for
treating depression can be wonderfully reassuring for depression sufferers
and their families. Depression is highly responsive to good treatment,
and good treatment is available from a variety of sources.
References and Resources
American Association for Marriage and Family Therapy
Annotated bibliography of
readings in intimacy and depression
Depression Awareness, Recognition,
and Treatment (DART)
National Institute of Mental Health
5600 Fishers Lane, Room 10-85, Dept. GL
Rockville, MD 20857
(800) 421-4211
Feeling
Good Handbook,
by David D. Burns. NAL/Dutton (1990). This book includes techniques
that enable readers to cope with a range of everyday problems such
as depression. Presents ideas of cognitive therapy through exercises,
self-tests, and forms.
Mind
Over Mood.
By Dennis Greenberger and Christine Padesky. Guilford (1995). This
treatment manual draws on the authors’ extensive experience as clinicians
and teachers of cognitive therapy to help readers successfully understand
and improve their moods, alter their behavior, and enhance their relationships.
The Shelter
of Each Other.
By Mary Pipher. Ballantine (1996). Offers thoughtful, practical strategies
to reach families and help them call upon their reserves of mutual
nurture and support in the face of societal, cultural, and economic
pressures. Challenges readers to find the courage to nurture and revive
the families they cherish.
Hand-Me-Down
Blues: How to Stop Depression from Spreading in Families. By Michael Yapko. St.Martins (1999).
Describes the role of the family system in developing depression for
both biological and developmental reasons, and teaches specific strategies
for helping families reduce and even prevent depression in their members.
Breaking
the Patterns of Depression. By Michael Yapko. Random House/Doubleday (1997). A comprehensive,
"user-friendly" book that recommends an active, skill-building
approach to self-help. Includes nearly 100 structured activities to engage
the reader in learning the skills to overcome depression.
The text for this brochure was written by Michael D. Yapko, Ph.D. (www.yapko.com)
