By Sunda Friedman Tebockhorst, PhD, LPC
“The opposite of depression is not happiness, but vitality.”
This quote from writer Andrew Solomon contains some important wisdom about the nature of the beast we call depression. It is normal to experience sadness, to have days of feeling grumpy or down. We all have days like this, sometimes a few in row. It is normal to feel sad in response to distressing life events – these are the bumps in the road of life, and for most of us, we navigate over the bumps and get on with the life we recognize as ours. However, when the obstacle is not the normal vicissitudes of daily life, but rather a run-in with depression, this can be altogether a different story. Life becomes a foreign and exhausting experience, where it feels like there is no respite and no hope for a more engaged tomorrow. Here are some things to look for if you aren’t sure whether or not you might benefit from help for depression. If you have found that, for more than two weeks or so:
1. Everything is exhausting: the tasks of daily living – getting the mail, taking out the trash, doing the dishes, talking to friends or family – are overwhelming and extraordinarily demanding. If it feels like doing the little things of everyday life is just too much to face, you may be dealing with depression.
2. Everything is annoying: for many people, and this can be especially true for men, who in our culture our discouraged from acknowledging that they feel down or sad, depression shows up as extreme irritability. If you find that you are responding to the other people and events of your life with intractable bouts of extreme irritability not in proportion to the events in question, you may be dealing with depression.
3. Everything is overwhelming: you used to find that life was a pretty comfortable place for you, but now find that even minimal levels of stimulation are overwhelming for you. People in your life talk too much or talk too loud, bright colors are intrusive, any change in plans or routine is unbearable, even music, books or movies you used to enjoy demand too much energy – if this sounds familiar, you may be dealing with depression.
4. Everything is un-interesting: you used to enjoy your hobbies, had activities or events in your life that predictably brought you pleasure, but now, nothing is pleasurable or enjoyable. If food tastes bland, jokes are never funny, you don’t look forward to things you used to, you can’t seem to care what’s going on around you, you may be dealing with depression.
5. Anything could provoke tears: if you find that you cry frequently, sometimes for reasons you don’t understand, or for no reason at all, you may be dealing with depression.
6. Nothing provides relief: if you have come to a place where you feel no hope that things will change or improve, and/or you feel helpless to gain traction and return to a place where life held some pleasures, if a sense of defeat and purposelessness has invaded your daily routine, you may be dealing with depression.
It’s important to note that, if several or all of these things ring true for you, you do not have to just suffer through it. There are effective tools for managing and resolving depression, most notably, therapy and medications. Statistically speaking, the best outcomes in terms of recovery happen when we use both of these approaches together; you will have to find the specific remedy that best suits your particular needs. What’s most important is that you know that you don’t have to keep struggling and you certainly don’t have to accept that this is just the way things are. Depression is an awful monster that can take over people’s lives, whisper horrible things in their ears, and prove a relentless and formidable burden. While you may not know what to do to get rid of this monster if it has invaded your life, you don’t have to do it alone. A skilled therapist can help you move back to a place of vitality and engagement in life. Please – if this describes you or a loved one – know that we as a community of experienced therapists would like to help you begin the work of taking back your life from this monster. There is hope, and there is help. Finding the right therapist can be a great first step.
Q: Some parents I know seem in a rush to have their children go on medication for things like depression and hyperactivity. What should parents do before making the jump to medication?
A: For psychological disorders, a thoughtful and accurate diagnosis is key to developing an effective treatment plan. What elementary child does not have occasional concentration problems in class? Does this mean that he/she has Attention Deficit Hyperactivity Disorder (ADHD)? Similarly what adolescent isn’t moody from time to time? Do we diagnosis him/her with Bipolar Disorder? Many mental health professionals would agree that these two disorders are highly over diagnosed in children and adolescents. This is a significant concern because both ADHD and Bipolar Disorder are typically treated with strong psychoactive drugs. Once diagnosed, patients may be on these drugs for the rest of their lives.
The accuracy of a diagnosis is a function of gathering information from multiple sources and thoughtfully ruling out other variables that may better explain the symptoms. For example poor concentration is also a symptom of depression. Some would argue that mood swings are a normal function of hormonal changes in adolescence. While it can be costly, considering formal testing by a trained psychologist can dramatically increase our objective data and thus increase the accuracy of our diagnosis. There are specific psychometric tests that can assess attention impairment (e.g. the TOVA), mood disorders (the MMPI), and other psychological conditions. A comprehensive psychological evaluation would include a battery of tests; an analysis of the child’s medical, family, educational, and social history; as well as surveying parents, teachers and children, in order to get a convergence of multiple data points as to the source(s) of the presenting problem. In the end the cost of a thorough psychological evaluation may be far less than the impact of an incorrect diagnosis.
When accurately diagnosed and treated, medications can prove to be a great blessing in treating conditions like ADHD and Bipolar Disorder. We just want to do everything we can to be sure of the root cause, which allows us a much better chance of developing a treatment plan to address it.
By Jan Hittelman
Last month’s column focused on teen depression. A reader whose son has suffered from depression most of his life took exception to the following statement: “The good news is that depression is highly treatable. Talk therapy, medication or a combination of the two has been shown to be highly effective.” Her story poignantly depicts the challenge that many families experience in trying to obtain effective treatment.
Initially she “noticed he was having more and more of a problem with depression that would not “lift”, and it had gotten so bad I really feared that my beautiful, kind, shy, and intelligent son would kill himself”.
At first she tried to utilize her health insurance. Her son was initially diagnosed with Attention Deficit Disorder and placed on stimulant medication. His depression worsened. Subsequently he was switched to a different medication, but indicated that her son “felt like a zombie.” She added, “Their “talk therapy” sessions were 20 minutes long and consisted just of drug monitoring, no cognitive behavior therapy, which is the most effective therapy for depression”.
She subsequently brought him to a licensed psychotherapist and noted some improvement, but “after another six months, my son no longer wanted to go because he felt “nothing was getting any better… During this time, my son had flunked out of college.” He subsequently attended Front Range Community College and his mom notes that “Being held accountable by an entity who NOTICED him (at FRCC) and also having a very good advisor there, who also noticed him and leveled with him, has helped. Time has helped. Getting a job and moving away from home has helped him more than anything… He is now doing better and has learned a lot of skills and lessons along the way.”
She sums up her son’s experience as follows: “Drugs have never helped my son except to briefly make him feel slightly disoriented. And “talk therapy” is something apparently only those with money receive”.
I applaud this challenged mom for her ongoing efforts to assist her son. While their journey has been challenging, I wonder how much more challenging it would have been if his depression went unnoticed. This is often the case, as children and adolescents who are depressed can present with irritability instead of a sad mood. One must also wonder how her son would have responded to a more effective treatment strategy. Finally, there is a powerful message as to the importance of caring individuals noticing him and putting effort into assisting him at his school.
We can learn a lot from this parent’s story. While dealing with depression can certainly be a great struggle, we must do everything that we can to try and address it. It is also clear that as a community we must make sure that resources exist to provide effective treatment for our family, friends and neighbors regardless of their ability to pay. Finally and perhaps most importantly, we each need to care enough to notice and let those in pain know that we care.
By Dr. Jan Hittelman
There is tremendous debate underway concerning the impact of medical marijuana laws on the perceptions and behaviors of youth. One concern is that by youth seeing that marijuana use is more socially acceptable with the passing of state medical marijuana laws, it will increase their use and lower their perceptions of danger and risk. Surprisingly, there are a number of studies that indicate that youth marijuana use has actually gone down in states that have legalized medical use. Not surprisingly, these often appear on web sites that support medical marijuana use and frequently the legalization of the drug. According to the Journal of the American Academy of Pediatrics: “Several recent studies concerning American adolescents, the Dutch experience with decriminalization (from 1984 to 1992), and the relationship between cheaper marijuana and use by adolescents suggest that decriminalization increases marijuana use by adolescents.” We have begun to see this trend locally, with surveys of high school students indicating a reduced perception of harm regarding marijuana usage.
At the same time considerable anecdotal evidence suggests that marijuana may be effective in treating a number of medical conditions. These include: reducing chemotherapy-induced nausea, wasting and anorexia associated with AIDS, intraocular pressure in glaucoma, and muscle spasticity arising from such conditions as multiple sclerosis. At the same time there is little objective scientific evidence that demonstrates the benefit of medical marijuana on these health concerns, let alone that other available drugs don’t work better than marijuana. This is in part due to the federal government restricting availability of marijuana needed to actually conduct the research.
By Dr. Jan Hittelman
Recently, voters in Colorado approved the legalization of Marijuana. While the potential impacts of this decision continue to be debated, one likely result will be the perception on the part of many adolescents that because it’s legal that means it’s also safe. Ironically, two of the most lethal drugs on the planet have been legal for years; cigarettes and alcohol. No two drugs can claim a higher death toll, let alone the other physical and emotional consequences of chronic tobacco and alcohol use. Another quickly emerging substance abuse concern centers around prescription medications. It is increasingly common for adolescents to experiment with highly addictive and dangerous prescription drugs, often found in the family medicine cabinet. Here too, many adolescents have the potentially deadly misperception that because it’s legal, it’s not dangerous. As parents, it is critical that we initiate conversations with our adolescents about these legal but lethal drugs. Research is clear that the likelihood of teens engaging in any at-risk behavior is dramatically reduced when parents have these discussions on a regular basis.
By Dr. Jan Hittelman
Attention Deficit Hyperactivity Disorder (ADHD) is estimated to affect 3-7% of school-age children. Over the years there have been increasing concerns that many children are inaccurately diagnosed as having ADHD. In fact, children with anxiety, depression, learning disabilities, and many other conditions, can present with very similar symptoms. In these cases, an accurate diagnosis is critical in determining the correct treatment.
In order to accurately diagnose ADHD, there needs to be several indicators that together confirm the diagnosis. These would include: feedback from parents, teachers and children themselves; objective evidence based on standardized psychometric tests; and meeting the specific criteria developed by the American Psychiatric Association. Too often these critical steps are skipped and psychotropic medication is prescribed.
While psychological testing can be time-consuming and expensive, it is an effective approach in arriving at an accurate diagnosis. In addition, tests that specifically measure ADHD can be used to monitor and adjust dosage levels to ensure maximum effectiveness.
When a child is accurately diagnosed with ADHD and put on the proper medication regimen, the results can be dramatic in terms of their newfound ability to focus in school and reduce their impulsive behaviors. In addition, behavioral strategies to help strengthen the child’s social, coping, and problem solving skills are often an important component of an overall treatment plan.