What People with Depression Need to Hear

Depression is one tough condition. Contrary to those cheery ads on tv and friends who want you to get over it, it is not easy to recover. Doctors also, in their eagerness to get you to do something that will help, sometimes oversell their solutions.

Chris Aiken's recent article in Psychiatric Times presents a more helpful picture.

Five Things to Say to People with Depression

You can expect, and do deserve, a full recovery. Aiken's point is that people with depression have a hard time believing we will ever feel any differently. (This is true. Boy, is this true.) Nevertheless, chances are, we will feel better. There is a rub here however. Most people get to full recovery, not all. As a patient, I'd like to hear up front that even if it comes back, chances are that things will get better again. So many of us feel like failures when depression recurs, when actually both remission and recurrence are part of the natural course of the illness.

You don't have to do a lot to make your medication work better, but you do have to do a little. Here's a line I want to shout from the rooftops. 70% of patients will not recover fully on antidepressants. Antidepressants are not magic happy pills. When doctors fail both to acknowledge the odds up front and to alert the patient of the process ahead (of which antidepressants are only one piece), patients feel betrayed and more hopeless than ever.

Simple changes help. But there is so much more that we can do to improve our health. When we are depressed, we don't have much motivation to do all that self-help stuff. But one change, just one, helps a little, and helps us tackle the next change. Aiken's Mood Treatment Center website has a whole menu of things to try that are evidence-based. Pick one that seems doable, that fits your life and your goals. Start there. Bonus: many of these strategies help our medication work better too.

Depression is not an emotional illness. Damn whoever came up with the DSM chapter heading Mood Disorders. The feeling of depression is not the illness of depression. The feeling of depression is not the illness of depression. Learn that line. Chances are, you'll need it a lot for friends and family who tell you that everybody gets depressed. The illness of depression attacks parts of the brain that address motivation, energy, sleep, appetite, memory, and a variety of neurological functions. In fact, some people with depression don't feel depressed at all -- we feel nothing. The feeling is not the illness.

Recovery means you can function: Prioritize, figure out what's important and act on it (not all the time, but enough to get by.) How we feel is not a good measure of how we are doing. That may seem odd, especially if we went into treatment because we wanted to stop feeling so bad. But action is where the action is. I'll never forget the day when I played with the water caught in the rocks on the shore of Lake Superior. I stuck my hands in the water and compared the temperatures in different sized puddles. The light shone on the water, the sky was blue, the breeze was gentle. And then I realized, I was not thinking about how I was feeling! I was playing! I was living! The way out of the morass is to do something that so captivates you, you are lifted out of the morass.

Now one day playing in puddles did not cure my depression. But it turned a corner. And it gave me a day of joy. Wouldn't that be nice again, even one day of joy?

See, the truth really works better than hype in the long run. Let's hear it for the truth, which sometimes is good news, sometimes not so good, but always more helpful than promises that cannot be kept.

I will add a sixth thing to Aiken's list. Recovery is a process. Pills are a part of it, one part of it. But it's a whole change in your life, step by daily step. It's a trip worth taking.

photo of Chris Aiken from Psychiatric Times
book cover from Amanzon.com
photo of rocky shoreline, Apostle Islands by Yinan Chen and in the public domain

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