Category Archives: Depression

Treatments for Depression and Dysthymia

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Depression.
Photo courtesy of Pixabay.com

What are the available treatments for Depression?

So you have symptoms of depression. Is it Major Depressive Disorder, Dysthymia, or an adjustment disorder? First, I recommend you see a professional and make sure you have the problem you think you have. Remember this is a general description of the treatments available; I can’t diagnose or treat you over the internet. If you need treatment this is not a do it yourself project, see a professional.

The first stop should probably be a medical doctor – Primary Care Physicians.

Some mental illnesses look like psychical problems and vice versa. Most people who commit suicide have been to see a primary care doctor in the 30 days before they attempt. When you feel bad it is natural to think there is something medically wrong with you. Most people are surprised to find out they are depressed or have Dysthymia.

Many doctors will spot Major Depression; sometimes they identify other mental illnesses. They can be especially helpful in ruling out things like brain tumors or heart problems. If you do have a medical illness, treating that issue will often reduce or eliminate the problem, but not always. You could have a physical issue and a mental illness.

More than half of all the psychiatric medication prescribed is prescribed by primary care doctors. If you get a prescription for antidepressants and you didn’t really need them, most of the articles I have read say taking them won’t hurt you. It just may not help. But if you do have serious depression the meds alone are rarely enough. If you don’t change your circumstances or your thinking, eventually the meds may stop working. The medication will help you work on your problems; the meds won’t solve problems for you.

We hope doctors take seriously the presentations and if after checking the person out they decide this is more likely a psychiatric problem than a physical one, they may try you on an anti-depressant. If that does not help, most likely they will make a referral for you to see another professional.

In my experience medication is absolutely essential for someone with psychosis. It is highly recommended for anyone with Bipolar Disorder. People with Major Depression respond well to medication but need therapy or the meds stop being helpful after a while. The research seems to tell us that meds are not all that helpful for Dysthymia.

The primary care doctor may refer you to see a psychiatrist.

Psychiatrists specialize in treating mental illnesses. They have lots of knowledge about psychiatric medication; they know which meds could make a physical problem you have, like high blood pressure, worse. They also know about new medications and can prescribe medication a primary doctor would not want to prescribe. For psychosis or Bipolar Disorder, a psychiatrist is highly recommended.

A psychiatrist will probably not be enough. They are trained to prescribe medication. Few if any will have the time or the inclination to spend more than a few minutes with you. Ten or fifteen-minute med check appointments are the rule. If you need someone to help you deal with your problems day-to-day, the psychiatrist will probably refer you to a counselor or therapist.

What treatments will a counselor use that the doctor didn’t?

In a previous post, I wrote about the differences between Therapists, Counselors, and Social workers. What is important to you, if you have depression, is finding someone, preferably knowledgeable and licensed, who knows how to help you with your problem.  The therapist will probably use one of the theoretical approaches below.

Cognitive Behavioral Therapy (CBT.)

This is my preferred method for treating Depression and a lot of other things. Not all therapists use this but there is a whole lot of research data to recommend this approach.

CBT is based on the idea that a change in thinking can change your feelings; a change in feelings will change your behavior. This works in reverse also, so if you begin to make small changes in your behavior, your feelings will start to change, and eventually, your thinking will change. A change in thinking will result in a change in the neurochemicals in your brain.

In CBT the therapist helps you see your problems from different viewpoints, helps you perform experiments or do homework and in effect, they coach you through becoming able to change yourself. This is sometimes called getting a “new pair of glasses” or simply cleaning the glasses you have.

If you are looking out at the world through dirty glasses, then, of course, the world will look dirty and gray.

Dialectic Behavioral Therapy (DBT) is a close cousin to CBT.

DBT adds skills training to the CBT. It can include mindfulness techniques, meditation, relaxation, or any other calming skill. Other skills can be included as needed. My understanding of this approach is sometimes we get so caught up in the problem or the crisis of the day that we forget to work on learning the skills to have a better life. DBT combines the change-your-thinking part with the learn-a-new-skill part.

DBT is especially helpful if you have multiple problems, several mental illnesses, or a personality disorder on top of your depression.

Narrative Therapy can help you think about things differently.

Most of us have a “story” we tell ourselves about who we are. If you keep telling yourself you are a failure, you will become one. Some of us bought into negative “stories” about ourselves as children and we keep retelling these. A narrative therapist helps you write a new story and tell it. If you tell your new story enough, parts of it start coming true.

Psychodynamic or “Client-Centered” therapy.

I hear the most complaints about these approaches. This is the therapist who lets you talk and says nothing much in return. I recognize some people have a lot of stuff they need to tell about childhood and that sometimes just talking it out is helpful, but it frustrates me and a lot of clients to have to be in pain that long.

This is most likely to be helpful if you have lots of unfinished business from childhood. Victims of abuse or molestation may need to move more slowly and take more time to get things out.

Groups can be very helpful.

Groups are like “way powerful” when it comes to recovering from depression. Groups run by a profession are at the top of the list, but self-help groups can be very helpful also. In person, groups are the best, but online groups are useful also. Groups are hard to find sometimes but worth the search.

“Alternative recovery methods”

Hobbies, religious groups, gyms exercise programs all have their place. Having a good support group or finding a support group is also important. Some people say nutrition was helpful.

Fad treatments worry me. The nutritional supplement or spiritual retreat of the week helps some people, but mostly they end up back at the doctor or the counselor’s office in a few weeks when the weekend collides with the real work week.

Electro Convulsive or Shock Therapy (ECT)

I am not a fan of Electroshock therapy as it has large risks. It is called Convulsive for a reason.

It has helped some people who had found no other help, but the risks are high enough that I suggest you try all the other options first. This is used ONLY with extremely severe Major Depressive Disorder. It is not recommended for Dysthymia, Adjustment Disorder, or milder depressions.

Some clinicians, me included, wonder if ECT should ever be used.

There are some thoughts on possible treatments for depression and Dysthymia, questions as always, are welcome.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Dysthymic Disorder –chronic sadness untreated

Posted on by
24

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Depressed person

Depression.
Photo courtesy of Pixabay.com

Dysthymic Disorder, a forgotten Mood Disorder.

Mood disorders are separated into two groups, Depressive Disorders, and Bipolar Disorders.

Major Depressive Disorder gets all the press while it’s craftier and more insidious cousin Dysthymia gets almost none.

In Dysthymia the person feels pessimistic and “down in the dumps” but the condition is not yet severe enough to be recognized as full-fledged Major Depressive Disorder. In children, this disorder is likely to be missed or to be misdiagnosed as a learning disability, attention problem, or poor behavior.

In adults, we call these people pessimists or grumpy old men. People often have been suffering from dysthymia for so long they come to believe this is simply the way they are. They think the sadness is a part of their personality, and don’t know that dysthymia is a treatable condition. They can’t imagine feeling happy as others do.

Diagnosable Dysthymia is a long-term overall sadness that interferes with having a happy life. As a Cognitive Behavioral Therapist, I am sure a faulty belief system either creates or perpetuates this disorder.

Dysthymia is not an occasional “BAD HAIR DAY.’ It involves someone who, while not always depressed, is sad and down more of the days each week than not. It is also not just a rough patch in the road. We may all have weeks or even months of tough times that make us sad. People with Dysthymia have at least two straight years of mostly sad, depressed days but somehow they keep trudging on. If they would just give in and stop trying they might get the diagnosis of Major Depressive Disorder.

For kids, we reduce the two-year requirement to one year, if the child can avoid the “ADHD, heavy meds, hits someone and become a bad kid” trap.  In kids, the mood is more likely to be irritable all the time than obviously sad or depressed. Kids show pain by being irritable. They may also become pessimistic and stop trying to complete their work. Their grades drop and their sad mood leads to missed school days and few friends.

This is a chronic condition and without treatment, it rarely goes away. About half the time Dysthymia deepens and becomes Major Depressive Disorder. The combination of both is sometimes referred to as Double Depression and even when the Major depression lifts the person may still have the overall sad mood of dysthymia. This makes it important that they get treated not just for the Major Depression but for the Dysthymia also.

Just being down, depressed, or irritable for two years is not enough to get you this diagnosis. This disorder will also probably not get you disability, as people with Dysthymia keep trying and are able to go to school or work even when they hate life and are chronically unhappy.

People with Dysthymia will also have features similar to Major Depressive Disorder in being rather Melancholy or having atypical symptoms. They either eat-and-sleep like bears hibernating for the winter or they can’t eat and can’t sleep.

One common characteristic of people who have dysthymia is low self-esteem. They don’t have much self-confidence and they don’t think they can accomplish much; as a result, they give up trying. This can be the result of a difficult childhood, bullying, or simply a lack of having had the experience of succeeding at little things in life.

People with dysthymia are often hypercritical of themselves, others, and the world in general. They may complain a lot and have difficulty having fun. This leads to low productivity and a lack of positive relationships with others.

People who failed a lot or who were never told that what they did was good enough are prone to Dysthymia. Lack of praise was supposed to make for more accomplishment. Some parents ask me why they should praise a child just for doing what they should be doing anyway? The answer is that without praise kids begin to think that no matter what they do, or how hard they try, it will never be good enough. Eventually, they stop trying.

People with Dysthymia don’t get much pleasure out of life. As a result, they avoid doing anything that might be stressful or involve a risk of failure. They become increasingly sad and withdrawn. They find it difficult to make decisions and to start or finish projects. No use in trying if “nothing is going to turn out all right anyway.”

This may be hard to spot, as people with dysthymia avoid social situations and lack of social support is a factor in perpetuating dysthymia. It is hard to make new friends when you are sad, feel bad about yourself, and don’t have a belief in your ability to succeed.

Families tend to share their mental illnesses. If one member of the family has depression, major or minor, then other members of that same family may have dysthymia. This suggests that there is either a hereditary risk factor for Dysthymia or an environmental risk factor. Families provide both.

Dysthymia is extremely common among alcoholics and substance abusers. People who are sad a lot are more likely to abuse substances and people who abuse substances have plenty of reasons to be sad. What brings these people to treatment is an out of control addiction or when the dysthymia becomes Major Depressive Disorder. Many people with Dysthymia have psychical illnesses and conditions also.

Dysthymia frequently starts in childhood and affects both functioning and development. It is important for a child’s healthy development that they know it is possible to succeed and achieve. Having good, positive, and close friends is also an antidote.

The elderly are at increased risk to develop Dysthymia as they lose family and friends, become more isolated, and may have difficulty providing self-care. Changes in appetite, fatigue, sleeping problems, and isolation can all be mistaken for the usual results of aging instead of being recognized as symptoms of Dysthymia or depression in the elderly.

Treatment for Dysthymia is possible and has been shown to be highly effective. Group counseling and support groups are helpful. Individual therapy and medication are useful, though medication appears to be less effective with Dysthymia than with Major Depressive Disorder.

Because of the chronic nature of Dysthymia and the high risk, this will turn into Major Depressive Disorder early treatment is important.

Related articles: Mood Disorders, Depressive Disorders,

Major Depressive Disorder, Bipolar Disorder or Depression?, Bipolar or moody?, Am I Bipolar?, Hyperthymia, Are you hyperthymic? 

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

What is the difference between depression and Major Depressive Disorder?

Posted on by
20

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Depressed person

Depression.
Photo courtesy of Pixabay.com

Depression, Mood Disorder, or Major Depressive disorder?

Major Depressive Disorder is a specific diagnosable disorder listed in the DSM (Diagnostic and Statistical Manual of Mental Disorders.)  Sometimes we use the term imprecisely to refer to both the common-sense feeling of sadness and a series of specific mental disorders that we professionals call mood disorders.

The dictionary definition of depression is essentially sadness. In the mental health field, it means so much more.

The differences in mood or depressive disorders are largely a matter of certain specific features that the person has rather than saying anything about the cause. There are also some related conditions that are not currently official “depressive disorders” but for which depression is a feature.

Confused yet? It takes 4 years of college and two more of grad school to make it all this complicated.

Mood problems often occur in “episodes” so they can come and go with or without treatment. The episodes don’t get specific diagnoses, but they do get used to seeing if you have all the features of a specific diagnosis.

Now if you are depressed and suicidal, which specific mood disorder you have may not matter to you, but it matters a whole lot to the insurance person approving your treatment. Since not everyone agrees which things are severe enough to require treatment, the list fades in and out with time.

What makes depression into a Major Depressive Disorder rather than a garden-variety depression is a few key factors.

How long you been feeling that way?

To be major depression it should have lasted for more than 2 weeks AND there should be at least 4 other symptoms of impairment. The effort here is to separate normal life problems from an illness that needs treatment.

How has this affected you?

There needs to be some problem in your life over and above just being sad. Being over sad all the time but not quite getting bad enough to be diagnosed with Major Depressive Disorder is called Dysthymic Disorder.

So we look to see can you work? Do you have friends and family? Do you still do some things for fun? These things separate out the sad moods and the sad-for-a-reason from the sad-way-to-much-and-too-long that characterizes Major Depressive Disorder.

Major Depressive Disorder is also separated into “single episodes” and “recurrent.” The first time someone has Major Depression we look more for causes. If they have repeat performances of depression we look at this as likely to be something produced by the person, either biologically or thinking wise.

Depressive Episodes, hence Major Depressive Disorder can also be “graded” into mild, moderate, and severe. For the treating professional this helps plan treatment. For the insurance company, it helps them known how big a bill they are getting for this treatment.

Sometimes the depression gets so bad that the brain starts making up stories. This looks a lot like the psychosis in Schizophrenia but it only happens to some people and then only when they are severely depressed.  This is called with (or without) psychosis depending on whether you have or do not have psychosis.

People who have Major Depressive Disorder do not all look or act the same. Some people become so depressed they have trouble moving. This is called Catatonia which is also associated with sleep paralysis.

The old fashion name for depression was melancholy. This is typically very severe in the morning but gets better as the day moves forward. People with this variety also wake up early. They don’t feel like eating and they either sit unable to summon up the energy to do anything, or they pace aimlessly about.  Often they also feel guilty about everything and hate to bother people.

People with atypical features are more like bears hibernating for the winter. They are hungry when awake and they sleep day and night but are still tired.  They are likely to feel that people are rejecting them and don’t what them around. People with atypical features can brighten a little for a while if you dangle something they like in front of them, but this improved mood doesn’t last long.

Postpartum Depression is also a recognized type. This is easy to understand in women soon after the birth of a child, due to the changes in the hormones in the woman’s body. It can also be seen in men especially after the birth of the first child as there is a change in the primary relationship. The fairy tale is over. Some men become excited about fatherhood, others feel like they have lost a lover.

There is also a seasonal pattern associated with depression. Sometimes this is referred to as Seasonal Affective disorder or “winter blues.”  This pattern can occur in the summer or at the spring and fall changes of weather, but those changes are more likely to be associated with Bipolar Disorder than Major Depressive Disorder.

For more on related conditions check the categories list to the right of the posts or watch for words to turn blue indicating they have been linked to other posts about this topic. My plan is to add links as quickly as I can finish the posts on these other topics.

Feel free to leave comments or email me about your questions. While I can’t provide therapy or counseling over the internet, you need to come to see me in the office for that, I will be glad to try to answer questions of general interest.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

What is Reactive Depression?

Posted on by
3

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Depressed person

Depression.
Photo courtesy of Pixabay.com

Do you have Reactive Depression?

Reactive depression is one of those terms, like Manic-Depressive Disorder, that still gets used even though we have come up with new, presumably more precise names. The underlying assumption, which is often hiding here, is that if we could find ways to categorize the various mental, emotional and behavioral problems, we should be able to find precise treatments, medication, or therapy for your specific ailment. If only it was that simple.

The Reactive Depression terms meaning has changed over time. Most recently it was in use to describe times when a person became depressed as a result of a specific stressor. Say you lose your job, that loss might make you sad. A small amount of sadness for a while is normal. Staying a lot sad for a long time is excessive and so you are sort of depressed. In this view reactive depression is depression caused by your specific reaction to an identifiable event. That event might be a one-time thing or it might be repeated exposure to the same sorts of events. Some people have called this Situational Depression.

This is not the same thing as Posttraumatic Stress Disorder (PTSD.) A person with PTSD may or may not have depression but Depression is not part of the definition of PTSD. People with PTSD can’t get the thoughts of the event out of their heads. It is as if they are continually re-experiencing the trauma. Anything that reminds them of the trauma is upsetting and they will try to avoid things that trigger those reminders. PTSD usually disturbs sleep. Other symptoms include disturbing dreams, nightmares, trouble falling asleep and more trouble staying asleep. PTSD is an ANXIETY disorder as opposed to an Anxiety disorder. It also includes a lot of stress and trauma-related features.

There is another idea, similar to reactive depression, currently called Minor Depressive Disorder which is currently listed as a disorder listed for further study. While Reactive Depression is in response to something that happened to you, Minor Depressive Disorder is a sad or depressed period with some symptoms but it is just not as deep or severe a depression as a Major Depressive Disorder. So far neither of these ideas is an accepted diagnosis under the current text, the DSM-4-TR. Some of these ideas will change when the DSM-5 comes out but that is very controversial at this time.

There is another name and criteria set that we are currently using to cover both of these issues. We call this disorder or group of six disorders – Adjustment Disorders. There are good reasons why people might suffer from adjustment disorders and need treatment but still not have all the symptoms of Major Depressive Disorder or Bipolar Disorder.

In my experience, Adjustment Disorders result in more people in crisis than most of the other disorders. By definition, Adjustment Disorders should be time-limited. If it goes on too long after the event or if the symptoms continue to be severe or worsen, then the diagnosis will get increased to Major Depressive Disorder.

That does not mean that a Reactive Depression or Adjustment Disorder is not dangerous. People, who find out their partner is leaving them or has cheated or those who lose a job or house they love, can and sometimes do get violent towards themselves and others.

So let’s return to the person who just lost their job, or spouse or has a sick family member. Might that make them sad? Might they be scared and anxious? Hey, what if they got both depressed and anxious?

This is why we have diagnoses of Adjustment Disorder with Depressed Mood, with Anxiety, and with Anxiety and Depressed Mood. What else might happen?

Could a person who lost their spouse start drinking and get arrested?  Maybe a teen that fails a class or gets in trouble might run away from home or get mad and break windows? So one reaction to a problem, one adjustment difficulty, could be to behave in ways that make society disapprove of you. We would call that Adjustment Disorder with Disturbance of Conduct.

Think about this for a moment. That teen, might he be depressed, anxious, and act badly? What about his unemployed father who gets scared he won’t find another job, starts drinking, and gets into a fight. We call these sets of behavior Adjustment Disorder with Disturbance of Emotions and Conduct. Lots of names for the ways in which adjusting to a problem could affect someone.

If you have been counting that is only five diagnoses and I promised you six.

We always need a loophole. We call that Adjustment Disorder Unspecified when we can’t figure out which other one it is.

Regardless of the name the preferred treatment for these issues in counseling. Cognitive Behavioral Therapy or solution-focused counseling is recommended. The main direction of this kind of therapy is on problem-solving and changing the ways in which you think about your problems.

So whether you call it Reactive Depression, Minor Depression, or an Adjustment Disorder, the way we react to life’s stresses can result in crises that require and often bring people to counseling.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

More depression these days?

Posted on by
2

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Depressed person

Depression.
Photo courtesy of Pixabay.com

Is there more depression now than they used to be?

More anxiety? More ADHD or PTSD? In fact, could we say there are more diseases like cancer now than in the past? Is the increase in disorders the result of chemicals or toxins or something else?

Let me be radical and suggest something here. Now remember I am coming at this from a therapist’s, this therapist’s to be more precise, viewpoint. I am not a medical researcher and I do not have data to back up this viewpoint, though I can cite some authorities in those fields who seem to explain this issue.

There are probably less of most diseases than ever before! Does that surprise you?  What has changed is the salience of diseases. Salience is a new word, relatively. It first started being used in 1836. FYI the word allergy did not make the dictionaries till much later. Before 1900 presumably, no one had allergies because there was no word in the dictionary for this. Lots of people had hay fever though. So does changing the word for something change the number of people diagnosed with a condition, yes. Does changing a name alter the amount of human suffering, I think not. What about mental illnesses and depression in particular?

The ancient Greek writers talked about bile and humors. One-color made you sad and depressed another made you overactive and impulsive. The descriptions remind me of depression and mania. I suspect there was a lot of depression during the great ice age but they didn’t blog about it.

Sapolsky tells us that one reason for the increase of certain disorders is that we are living longer.  When the average lifespan of Americans was 40, most people did not live long enough for us to worry about cancer or Alzheimer’s. Many of our current physical health issues are the result of people living long enough to be diagnosed with diseases of old age. For the record, they may not have had Alzheimer’s way back when but my great-grandmother died of senile dementia. Not sure what the difference is but I want to live long enough to find out.

When half the people in town die one summer from the black plague no one worries about the person who killed themselves as a result of depression.

Depression is a new name. In older books, they wrote about Melancholy (literally black bile.) But that disorder was usually reserved for the upper or aristocratic class. Poor people were too busy dying of dysentery and milk sickness to live long enough to be depressed.

If you read journals of the early American settlers you would find plenty of stories about suffering, just back then we all accepted suffering as inevitable, just part of God’s will. People began to distrust that bad things might be part of some higher powers plan and started thinking that we just might be able to reduce human suffering without challenging the power of the Almighty. Then we started looking for cures to conditions that might have been considered normal in the past.

Until this last century, we thought mental illness was incurable. There were only two choices, pray over them and hope or chain them to the wall. Then we discovered that there were medications that could turn previously “crazy” people into functioning members of society.  This discovery took mental illness out of the demon possession category and moved it over into the treatable illness category.

There are still some people, politicians mostly, that think that people with mental illnesses are faking it to get out of work and just need to snap out of their disorder.  Other times they will tell you that these people are really just criminals and need to be locked up. There are lazy people and there are criminals for sure, but that is a different group than the mentally ill, though sometimes a person can have two or three conditions.

For sure there are toxins and environmental hazards. Some of these things have increased the rates of specific illnesses. But I can’t blame them for depression or anxiety.

The last century was a turning point in the fight to control diseases. We began to use antibiotics, vaccines and now we have advanced diagnoses and treatment. The next century holds promise for the integration of mental and emotional disorders into the mainstream of care. Let’s hope that the increased awareness and detection of mental health and substance abuse disorders increases society’s willingness to tackle these sources of human suffering.

So for the record, I don’t think there is significantly more depression or more of most other diseases. The numbers of people diagnosed with a particular illness do go up and down. But as we are able to see them, the diseases become more important. But isn’t ending suffering, both physical and mental a part of having a happy life?

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

How do antidepressants work?

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Here is the best way I have found to explain the way in which antidepressants help. Remember this is an analogy, not a scientific explanation. In a previous post, I talked about the way in which thoughts are moved around in the brain by neurotransmitters and the way in which they might regulate thoughts and emotions.

The most commonly prescribed antidepressants these days are SSRI’s. That stands for Selective Serotonin Reuptake Inhibitor. Complicated name but let’s try to make the idea behind it simpler.

One thing that happens after a message is moved from one neuron to another by a neurotransmitter is that the neurotransmitter needs to be released from its receptacle. The key needs to be removed from the lock otherwise that neuron could never receive that message again. The released neurotransmitter starts floating around and eventually it gets eliminated from the body. If you only got one use out of a neurotransmitter then you might start running out of them really fast. So your brain has a recycling department. The used neurotransmitter is recycled by enzymes and other “stuff” that breaks it down and lets the brain reuse it.

Think of this analogy.

Once in my younger days, maybe more than once, I had this car that kept overheating. I would fill the radiator up and drive as far as I could until it started getting hot. Water leaked out of that old rusty radiator in several places. To go all the way to work or school I might need to carry water or stop a few times to refill the radiator. It was a hassle. A friend of mine suggested I try this product he called “slow leak.” Something like that. You put it in the radiator and it found the places that were leaking and plugged them up. It did not eliminate the leaks completely but I got a lot more miles from my car before I had to stop and put water in it.

An SSRI kind of works like that. It keeps those “packman like” enzymes from finding my brain’s serotonin and recycling it before I am done with it. It does not put more serotonin in your brain but it helps you get more mileage out of what you have there.

A cognitive-behavioral therapist, (wait a minute, that’s me!) might argue that diet, exercise, and good thinking could help you make and release more serotonin. Brains like cars differ. Some brains can get more mileage out of their serotonin. Some brains might “leak” the stuff out or overheat and boil it off. You with me so far?

See how keeping the serotonin in my brain longer might improve its performance. That “leak stopper stuff” did a great job on the radiator so some SSRI just might work on my brain.

Now back to that old wreck of a car. You can trade in a car and get a newer one. So far we don’t have brain transplants so we need to take the best care we can of the brains we have.

My car was so much better. I could make it all the way to school without stopping to put water in the radiator. My friends were impressed.

One day some of my buddies were over to the house and I was bragging about that “fixum leaks up” stuff I had discovered. They said they were impressed. From the looks on their faces, I could see they were skeptical. So let’s say I go into the house and get my dad’s old shotgun. Play along with me here. The shotgun is not to scare my buddies; it is to demonstrate the effectiveness of my “Leak fixer-upper stuff.”

I fire that old shotgun right at the front of the radiator. Just as expected the water pours out.  I now get out the “leaker solver” can and put some in the radiator. Only this time it no work so good. The thing continues to leak.

Some of you are now asking – who would do a thing like that?  Stay with our analogy here. Lots of people do just this thing. After taking all that medication to reduce their depression, they go and drink some alcohol. Alcohol is a depressant drug. So drinking alcohol undoes all the effects of the antidepressant.

Now some of you are arguing about alcohol being a depressant drug. You will tell me that it makes you more energetic. With alcohol in you, you want to party, at least until you pass out. The truth is that you only think that alcohol perks you up. It shuts down the functions of the frontal lobe of the brain and some other parts also. So under the influence of alcohol the part of the brain that tells you “hey stupid – don’t do that!” is not working.

I hope this little tale has offered you a way to understand how an antidepressant might help with depression while not instantly erasing it. Hopefully, you also see how mixing psychiatric meds with alcohol and street drugs might be a bad idea.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Bipolar or Major Depression?

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Depressed person

Depression.
Photo courtesy of Pixabay.com

Since episodes of depression are a feature of Bipolar Disorder, how would we know if this is indeed Bipolar Disorder? And does it really matter?

Yes, it does matter. People who have Bipolar Disorder are more likely to have major problems in many areas of their life. Certainly, depression is debilitating, it causes more disability than lots of physical disabilities but Bipolar cases more noticeable and life-threatening problems. Treating someone who has Bipolar Disorder for depression may result in creating manic episodes and make the condition worse. No professional ever intends to make the patient worse, at least I hope not, but not seeing the signs of Bipolar can result in incorrect treatment. Now in fairness to doctors and other professionals often the client, not knowing the differences, fails to report symptoms that might have helped in getting the correct diagnosis. Here are some things that might indicate that the condition under treatment was, in fact, Bipolar Disorder and not Major Depression.

1. Sudden onset of episodes.

Clients with Bipolar are more likely to have sudden episodes of depression and sudden remission of depressive symptoms. Major Depression is more likely to creep up on you. And Major Depression rarely just goes away suddenly without treatment or some other reason. Bipolar Disorder may strike suddenly and it may switch to an elated mood or mania all of a sudden.

2. Early age of first onset.

There was a time when we thought little kids did not get depression, not anymore. Very small children do indeed experience episodes of depression. One way we have found this out is that more and more people who struggled with depression or Bipolar Disorder as children have become professionals.

The younger the child is when they first experience a mood disorder episode the more likely they are to go on and develop Bipolar Disorder. Now we are not saying that the child is to blame for being moody. If they are able to control the mood swings then it is not Bipolar or Depression. We are also not talking about that day-to-day moodiness or event-triggered moods that all children experience. Each type of mood disorder, depression, Dysthymia, Cyclothymia, Bipolar one, and two each have a minimum length of time that is needed. This separates the events of living from a true episode of a mental illness.

3. Presence of Psychosis

With Bipolar Disorder there is almost always some disturbance of reality. This does not mean that the client is hallucinating. Psychosis also includes delusions, irrational thinking, and lots of grandiosity. During manic episodes, people with Bipolar simply try to do way too much. And they believe they can and should be able to do these things.

There is also a diagnosis of Major Depression with Psychotic Features, so the boundary between Depression and Bipolar gets blurry the closer you look. The good news is it doesn’t matter which label you get, the treatment is about the same. The bad news is that by sticking with the treatment for depression sometimes the diagnosis and treatment of Bipolar Disorder gets delayed. If you or those around you say you have thinking problems, grandiosity or delusions make sure to tell the professional who is treating you. If you don’t have someone treating you and experience delusions, seek help quickly. The sooner you get help the better the prognosis.

4. Presence of “Psychomotor retardation”

During episodes of depression some people get so tired they have trouble moving. Sometimes they literally can’t get out of bed. These extreme levels of impairment may signal that this is Bipolar and not Depression.

5. Having “Atypical features”

Many people with depression become very agitated. They can’t sleep and they can’t eat. People with atypical features are just the opposite. A shorthand way of explaining Atypical features is like a bear hibernating for the winter. These clients eat all they can. They may be over hungry at certain times of the day. Then once they get to bed they want to, need to, sleep far beyond what other people do. During extreme episodes of depression with atypical features, a client will be unable to do anything but sleep and eat.

These “Atypical” features can be seasonal as in Seasonal Affective Disorder or they can come and go with the rhythms of the year.  Having an episode of depression with atypical features increases the chances that an episode of mania or hypomania is just around the corner and with that episode comes a diagnosis of Bipolar Disorder.

6. Having a sudden overwhelming improvement in depression mood when given an antidepressant.

Antidepressant medications need time to work. Usually, the effects of antidepressants build up slowly over time. Antidepressants are not “happy pills” they do not suddenly make someone happy. They should usually be coupled with some form of therapy or addressing life’s problems.

When people with Bipolar Disorder take antidepressants they are sometimes propelled from depression to mania. A sudden huge response to antidepressants needs to be monitored for possible mania or delusional thinking. Too much response to an antidepressant suggests that this is, in fact, Bipolar disorder.

If you are unsure about this or think you may have Bipolar instead of depression talk with your doctor, psychiatrist, or therapist before making any changes in your meds. Your doctor needs to know what is happening in order to monitor your condition and there can be adverse results to suddenly stopping or changing a medication.

7. Family history of Bipolar Disorder, Psychosis, Schizophrenia, or excessive irrational behavior.

The more people on your family tree with an issue, especially close relatives, the more likely you are to have problems. Being Bipolar has had some advantages in some situations. Many people with Bipolar disorder are highly creative and productive as long as they can keep things on track.

Some families have avoided getting professional help and so there may be no formal diagnoses but most families have their stories about family members with mental health issues. Family trees with lots of depression in them seem to produce more people with a genetic risk factor for depression. Families with lots of people who had hallucinations, delusions or mania increase the risk for Bipolar Disorder. Lots of substance abuse in your family tree increases risks for substance abuse and mental illness, for a variety of reasons. Remember however that risk factor does not equal an illness. Lots of people grow up in high-risk families and have no problems, other people are the first in their family to get a diagnosis or have a problem. We are still trying to figure out why this happens.

Hope this was food for thought for you and that it encouraged some people to go for the professional help they need.

Till next time this is David Joel Miller, LMFT, LPCC saying so long.

If you have any thoughts on depression or Bipolar Disorder and the differences between them, please leave a comment on this blog.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel