When it comes to matters of mental health, it’s not always easy finding the help you or your loved one need.
It’s not that simple to just open up to a complete stranger about your problems. If you or a loved one is suffering from depression, you may feel alone, like no one understands you, and there’s no one to answer your pressing questions. And while the anonymity and sea of information offered by the Internet has it’s clear advantages, sometimes it’s hard to cut through the noise to find answers to your specific depression questions.
We’re here to try to help. Help for Depression recently hosted a live depression questions & answers session with clinical psychologist and depression expert Dr. Rob Dobrenski. The recorded version, divided by question, follows:
1. What is depression?
Dr. Rob: Let’s just start with what is depression. I’ve got that countless times here on the forum. In many ways, it’s really quite simple. It’s just a group of symptoms that mental health professions have kind of grouped together to call depression. It’s what we call a social construct meaning that it’s just a term that professionals can use back forth so that we have sort of a general idea of what we’re talking about so we don’t have to describe in detail every single symptom in the person that we’re talking about. Now, some people can try to come up with sort of a universal singular understanding of depression. There was this idea that it was purely just a deficit in serotonin, which is a neurotransmitter in the brain.
Others came up with psychological theories that it was a form of what they call learn learned helplessness. There was this idea that we’re taught over time that there are situations that we can’t escape from or are proven positive and we get depressed because of it. There are also tons of Freudian theories that have been around for decades. All of them have their place, but none of them have been able to fully capture what depression is for everyone. So we’re still looking at a really kind of a still a flawed system. We’re still learning a lot about depression. So I still kind of think of it and I explain it to everyone who I treat, it’s really just a cluster of symptoms.
2. What are the symptoms of depression?
Dr. Rob: Now, what are the symptoms, which is the next set of questions that came in? What you’re going to find based on what I’ve seen now is that it’s a very, very idiosyncratic and highly individual disorder. There are a lot of symptom combinations. Now, if you’re familiar with the DSM, which is the Diagnostic and Statistical Manual, that’s sort of the bible that mental health people use. What’s required is you have to have one of two things. You have to have a depressed or down or sad mood, basically, all day every day for at least two weeks or you have to have a loss of interest in nearly all pleasurable activities, which is different in each particular individual in what he or she finds pleasurable. That has to occur all day, every day for at least two weeks.
So when you think about it, it’s kind of interesting that you don’t actually have to have a depressed mood per se to get a diagnosis of depression and most people do, but it’s not actually mandatory. Now, in addition to those symptoms, you have to have four ups, okay? And even these are a little bit convoluted. So you could be looking at some people have significant weight gain. Some people have significant weight loss. That’s one symptom. Some people are unable to sleep and have very poor sleep. Some people sleep too much and it’s called hypersomnia.
So, again, it’s completely different. Another symptom is sort of physical agitation while other people report almost like a cognizant slowing, which is this sort of like just the information that they’re told, everything just seems to be moving a little bit more slowly. Not really a positive way to feel – out of sync with the real world. Fatigue is another symptom, feelings of worthlessness, decreased concentration, which is really important because we’re going to get into some concentration and memory stuff, hopefully, at some point in the talk and recurring thoughts of death and suicide.
That last one’s particularly important because some people reports just passing thoughts about what it would be like to be dead and things like that. With depression, it’s usually much more extreme and it occurs much more frequently. It’s usually very, very intense and it can be very scary. People can sort of be thinking about ways that they might injure themselves and there’s no better reason to be seeking professional help at that point. That’s, by far, the best. So I hope you’re getting kind of an appreciation for just how idiosyncratic depression can be. Unfortunately, the treatments, though, don’t change all that much even though you can look at all these different combinations
3. Natural / alternative treatments for depression?
Dr. Rob: Now, a lot of people have asked here about alternative therapies. Somebody specifically mentioned natural healing methods. Depending on what you mean by natural, I don’t really recommend herbs and things like that. The evidence for those things…if you remember ten years ago they talked a lot about St. John’s Wort and people reported some good results and I think it lost a lot of popularity because it wasn’t regulated all that well and I don’t think everybody found it to be sort of this miracle natural cure. I don’t recommend too many of those things just because I haven’t enough effectiveness. I haven’t seen it recorded very much. Well, like if we’re thinking natural beyond anything that’s not medication, I’m saying that therapy can be very, very helpful. Really, a track record, especially with cognitive behavioral therapy for depression, some people like these self-help books.
There’s two that I tend to recommend and these are both in the vein of a cognitive behavioral approach to therapy, but it’s good for people if cost and time is an issue and want to try the self-help route. One book that I recommend is called Mind Over Mood. That’s by two authors – Greenberger and Padesky. That is a workbook, actually. You write in it. It’s a structured kind of treatment. The pros of it as I’ve been told by my patients who have used it are that it’s very user-friendly and it takes you through it step-by-step-by-step. Some of the criticisms I’ve heard is that it might be a little too simplistic almost. Some people wanted to kind of speed it up and they found themselves getting far too basic information.
The other book that’s extremely popular…let’s see if we can add the link to the broadcast later for those coming to read the text. One second here. Here it is. Yeah, we’ll add this link. It’s the Feeling Good Handbook and there are a lot of different versions of this by Dr. Burns – very, very popular. I think there was a formal workbook. There’s also more of a page turner that you just sit and read – very, very popular. I’ve heard really, basically, just good things about it from my patients and one criticism is that the main text is actually quite large and some people thought it a little daunting, but the material is fantastic. Okay, let’s move on here. Let’s see what else we got.
Oh, sorry. Going back to some alternative therapy, I forgot to mention the light box. I actually have one here so let me get it on the screen for you. Light therapy is usually considered an adjunct to other types of treatments. The idea is, essentially, you know when they first made it you had to, basically, stick your face inside this box for 20 minutes at a time. Now, like a little box like the one I have here, you just turn it around and you just kind of have it pointed at you while you’re on the computer or surfing the internet and the idea is that it stimulates serotonin production and things like that.
4. What are the different types of depression?
Dr. Rob: Are there different types of depression? Well, hopefully, we covered that at least to some degree. You saw all the different combinations of depression and just the way it can play out with the loss/gain – weight loss or gain – agitation or cognitive slowing. It’s all over the place. If you go into the DSM, they’re big on breaking it down to mild depression, moderate, severe and, actually, sometimes depression gets so severe that people actually have psychotic incidents. They can begin to hallucinate and really start to lose touch with reality. Obviously, those people are in desperate need of getting professional help at that point.
Now, you’ll also hear about a disorder call dysthymia, dysthymic disorder, which is a low grade depression. It’s not as severe and it tends to not impact people as intensely, but it’s a very long duration. You need to have this sort of blah state – as they call it – for at least two years before you can even get that diagnosis. It’s just considered not as debilitating, but it is a form of depression, as well.
5. I've been struggling with depression since 2008. My husband has a very difficult time dealing with my depression. I've been very communicative. Is there anything else I can do?
Dr. Rob: Question: I’ve been struggling with severe depression since 2008. My husband has a very difficult time dealing with my depression even though I’ve been very communicative. He refuses to participate in marriage counseling. Is there anything else I can do?
Well, one thing I would recommend for someone like this is to give your partner some of the material we talked about. Not everyone that reads the self-help books has to be the person who has the depression. The more they can understand about it, the easier it is to deal with. You don’t necessarily have to do marital counseling. I always think it’s a very good idea when one person is struggling with depression. Not just from an educational standpoint, but because it really helps to open up the lines of communication, so that you’re able to discuss what you need while you’re dealing with depression and also so you’re partner knows how to deal with it and can also, in this case, express his needs around dealing with your depression, but the information can really, really be helpful. So I definitely recommend one of those books for your partner.
Someone else asked the opposite situation. They are not depressed, but their partner is. What I would recommend is do a little search. You just type in ‘what do I do when my partner suffers from depression.’ The first thing that pops up is a link to my website, which is called shrinktalk.net and I wrote most specifically on that that there are multiple things to consider when you’re trying to push your partner to seek help.
It’s very difficult because people who are depressed are – sort of like the very definition – very vulnerable and being sort of hyper-critical and demanding can sort of exasperate that depression. So the goal is to be very, very empathic, but also challenging them to get the help that they need. So it goes into that a lot more on the website. You might want to take a look there for that.
6. How can I get help for depression?
Dr. Rob: How can I get help for depression? Today, help is more readily available than ever. I mentioned the self-help. I’ve mentioned the light box. If you have private insurance, if you call them, they can direct you to multiple providers in your area. A simple web search with your zip code will find tons of therapists in your area. You can also consider University-based hospitals because a lot of times as training for their psychiatrists, they will often provide free treatment or sometimes you can look for drug studies. They can also provide free treatment in exchange for being part of the study and for people also with financial issues you can also look for University-based psychology training programs. They often have low-fee or free treatment in exchange you’re being treated by students who are in sort of a learning process. That can be very effective, as well.
So there are many, many, many choices out there. There are private therapists who are extremely expensive to very affordable therapists who are just as good. That’s another thing we should add is that a lot people say, “How do I find the best treatment possible?” I tell everyone there really is no best. It’s what’s best for you. Psychiatry and psychology, there’s a certain part to it and someone who is a great therapist for one person is not necessarily going to be a great therapist for another person. So you want to find who the best person for you.
A lot of what I encourage people to do is if time and resources are there, you might want to do a little therapy shopping. People will maybe sit down with two or three different therapists or doctors and say, “What can you offer me. Let’s see what’s going on,” and they see if they would be a good kind of therapeutic fit.
Some people, depending on if you go to their web pages – most providers have websites – you can ask questions and they’ll answer them, which might give you a feel for what’s going on, but I never encourage people to go simply see someone because someone else said he or she was the best or to use things even like the cost of the therapy because that’s not an indicator of how good it is or even years of practice because there’s not really any research that supports the idea that the longer you’ve been doing it that the better your results are going to be. Young therapists and new therapists tend to be just as good as people who have been doing it a long time. So, again, when you’re looking for something, think what’s best for me not just what someone told me is the best or what I should be looking for.
7. What is the Hamilton Depression Rating Scale?
Dr. Rob: What is the Hamilton depression rating scale? My guess is someone who wrote this then has probably read some research study because the Hamilton depression rating scale is just a self-report, pencil and paper scale. You check off the symptoms and how severe they are. It’s commonly used in research studies to help get a rough measure of how people are improving. So people fill out the measure before and then at various points throughout the treatment and then they look at how the numbers breakdown.
8. Can anxiety medication help depression?
Can anxiety medication help depression? Again, I’m not a psychiatrist. What I have seen is some people will take anxiety medications. Some of those are benzodiazepines. You might know them as Xanax, Valium or Klonopin. Again, if you have a very agitated type of depression doctors may prescribe that, which will lower the anxiety, which would, in turn, boost somebody’s mood. So it would be sort of an interactive way to treat depression. That would sort of be the front line way of doing it.
Now, the SSRIs that I mentioned, while those are traditionally antidepressant, those are also used for certain anxiety conditions like social phobia, generalized anxiety disorder, so some people can maybe take something that is an SSRI not necessarily for depression, but it treats depression. You can also use it for anxiety. So, as you can see, we don’t know enough about how exactly how all these things work, but the good news is that the medicines in them are working anyway. That’s the beautiful of it. And as time goes on, we’re seeing that they’re, basically, very safe medicines.
9. I have alternating bouts of anxiety and depression. What can I do?
Dr. Rob: I have alternating bouts between anxiety and depression. What should I do? Well, depending on how much it bothers you and I’m guessing since you’re writing in, probably a lot, you need to get some help for it, plain and simple. You can consider the self-help route, but anxiety and depression, they’re not character flaws, as I still like to say. They’re illnesses. They’re not weakness. They need to be treated and both of those have great track records of treatment whether it’s medicine and therapy. Again, a combination of both is always going to be preferred, but someone who is bouncing back and forth between depression and anxiety, they need to consult a professional, find out what’s going on, exactly what the diagnosis is and what the best course of treatment is. That’s what I highly recommended for something like this.
10. Is there any relationship between scleroderma and depression?
Dr. Rob: Interesting question came in – is there any relationship between scleroderma and depression? Scleroderma is a hardening of the skin, sort of an unusual hardening and thickening of the skin. I think it’s an autoimmune disorder. A quick look – my understanding is that about half the people who have some sort of condition like that have depression, but it’s just a correlation. I’m not saying that the condition causes depression or anything like that. They’re just associated, but all those people tend to respond just as well as everybody else to traditional depression treatments.
So, in other words, I don’t think if you’ve got something like scleroderma and depression comes on, it needs to be treated any differently. You don’t need to think about yourself any differently than someone who doesn’t have that type of condition.
11. How do I know when it is safe to stop depression therapy?
Dr. Rob: How do you know when it’s safe to stop your depression therapy? Now, I’m assuming that this person means from a medical standpoint in terms of antidepressants. That’s a decision between you and your doctor. Depending on how you’re feeling, if you’re feeling great, that could be a sign that that’s what the medicines supposed to be doing and maybe you should stay on it. Depending on what’s going on in your life and how long you’ve been on it, it could be time to taper it off.
My understanding is every doctor has a specific way to taper off a particular medicine. You never want to just stop those because of the possible effects of withdrawal and things like that, but that’s something that I never encourage someone to make that decision solely on their own. Not to take away the power of your individual choice, but because depression sometimes has a subtle group of behaviors that other people may notice. A lot of people told me when they come to see me for therapy, they say, “You know, at first, I didn’t even really notice anything. My spouse, my kids said you seem a little bit down. You seem cranky. You seem irritable. You’re not sleeping well. What’s going on? And then that’s when I realized that I needed something.”
So I never encourage people to just kind of make unilateral decision about medication or their therapy. Talk to your therapist or talk to your doctor. Talk to your friends and family. What do they know as far as what’s improved. Make a very informed choice as opposed to a knee-jerk reaction of, “Oh, I’m feeling better.” Let me make sure I stop my medicine because I feel better; definitely not a good idea.
12. Are depression symptoms in men women and children different?
Dr. Rob: Are depression symptoms in men, women and children different? In my experience I haven’t seen too much regarding gender differences and age differences. You can find some in literature, but they seem to be very, very subtle. You see in kids a little bit more of an irritability instead of an overt sadness.
Stereotypically, you might see men being a little bit more aggressive and irritable or women might be a little bit more sad, but that’s really all. I haven’t seen too many differences regarding sleep, weight loss and things like that. That seems to be kind of open season really for everyone. For kids, like I always say, I’m not a child psychologist, but during my training when I did work with kids, all of the experts kind of say look freely. Don’t necessarily look for sadness because you’ll miss what’s going on then.
13. Does a therapist have the right to demand someone can be medicated?
14. Are there quality depression rating scales online?
Dr. Rob: Just type in into a Google search ‘depression rating scale.’ You can fill out these forms and get a kind of very rudimentary idea of where you might fall on the depression scale, but what I tell people is except for those who are really just intellectually curious, if you’re filling out one of those then that probably means there’s something going on. Whether you need formal criteria for depression or not isn’t really all that important. Most people who are filling those out are not feeling so great and probably can stand to get some help. So, sure, fill out the forms. The ones online seem to be great. Just remember what they are – they’re just guidelines. They’re not really going to give you anything more than that.
15. Can memory loss be caused by depression and anxiety?
Dr. Rob: Can memory loss be caused by depression or anxiety? Yes, actually, that’s very true. A lot of times when I have people who come in with depression, even very people, they start thinking about losing my memory. I can’t remember new information. Maybe I have Alzheimer’s,” things like that. A lot of times is what depression does is it impacts memories. Keep in mind, one of the symptoms is decreased concentration. It’s very hard to remember something that’s not getting in. Memory is three things. Memory has to get in. It has to be stored and then it has to be retrieved.
So a lot of times in people with depression, it’s the information’s not getting in the same way. It’s not being stored the same way. So, therefore, when it’s time to retrieve it, it’s just not there. So I tell people to try not to freak out too much with the memory problems. Obviously, you want to tell your provider about it and see what can be done with it, but usually what happens is as the depression improves, the memory loss tends to go away. So that’s the good news about it.
16. What is your opinion of ECT therapy (electroshock therapy)?
Dr. Rob: I’d like to hear your opinion on ECT. That’s well-known as shock therapy. Over the years, it seems to be a lot better, essentially. I’m definitely not an expert on it. The people I talk to who do it, they say it’s really kind of a last resort. That said, they say it is much safer than the public believes. The main thing that people tend to worry about with ECT once you’re taken through the whole process is the side effects of memory loss which does occur, but it tends to be minimal and it tends to return over time.
If I remember correctly, I think a lot of the issues with memory loss is that people sometimes have trouble after ECT making new memories. It doesn’t necessarily affect the ones you already have. It’s more about creating new ones and that, essentially, it tends to go away. I don’t think that it’s universal, that everybody experiences memory loss or anything like that, but ECT is not sort of the barbaric thing that people envision when they see films and things like that. It’s not like that at all.
17. What about the stigma surrounding depression?
About Dr. Rob Dobrenski
I received my B.A. from Rutgers University and my M.A./Ph.D. from the University of Toledo. I completed my postdoctoral studies at Cornell Medical Center/New York Hospital in 2002 and have since been in private practice in New York City. In 2007, I launched the website, ShrinkTalk.Net. This proved to be a popular blog due not only to its mission to debunk myths and stigmas related to mental health, but also in part to the sometimes humorous tone and light-hearted, deprecatory nature toward mental health providers (especially me). My work has been published in The Best of Creative Nonfiction, Volume 2 and a peer described my writing as "nice words that are in a pleasant order."
In 2011, my first book, Crazy: Notes on and off the Couch was published by Lyons Press. Met with critical acclaim, I have vowed to never write another one unless millions of people buy it.
When not practicing psychology, I actually have very few interests. Sports and red wine would be two of those and, should I think of another, it will ultimately be posted here. If you have nothing better to do, follow me on Facebook and Twitter.
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