Dear C and Dr. B,
I hear the term depression all the time and people are on medication for depression because it’s considered a serious psychiatric condition. Okay, I have a question – who really needs to be on medication, and what does it do to solve the problem long term? I’m depressed almost all the time, but I continue with my life anyway. I don’t want to do anything and I feel completely blank when it comes time to decide something to do because I don’t feel motivated. I can’t see the point, but I keep forcing myself to move anyway and I refuse to give in to the urge to end it all. So, am I suffering from a clinical condition, or am I just depressed like a normal person? What is the difference between a medical condition that really needs a doctor’s attention and just an outlook on life that has gotten worn down by too many disappointments? I heard that a mood like this that lasts more than 2 weeks is serious. I’ve been going on like this for decades; it never gets any better, no matter how much yoga, meditation, exercise and everything else I do. Am I certifiable or what?
Dr. B says: There are two factors that decide if something needs to be treated. First factor: Is this the way anyone would feel in the same situation? If so, then is not a psychiatric condition but a normal human response. For example, let’s look at a person experiencing loss. Grief is a normal human response to loss and isn’t amenable to medications. In fact covering up grief with medications or substances is detrimental, although it is possible for grief to become or coincide with major depression. This leads to the second: functionality. Does your depression impede your life and keep you from productivity over a significant period of time? If so, it may be a psychiatric problem.
Humans have many emotions, but if you only have one and it never fluctuates and precludes all other emotions, that is considered dysfunctional, no matter what the emotion is. We are supposed to be in an environmental feedback loop with the environment. A person who only feels joy no matter what occurs in the environment would also be highly dysfunctional.
What you are describing is called dysthymic disorder. You have had a low lying depression over a very long period of time that isn’t impeding your ability to function or work, yet the whole gamut of human emotion is precluded. You have no feedback loop with the environment, just an internal sadness. This impedes your quality of life. Medications can make a huge difference for you. There is no legal medication that can make you happy but what the medications do is decrease all emotion such that you can be able to change the internal feedback loop back into an external one reconnecting you with the environment. The idea behind this is to take you out of your own head. You still have to cultivate the behaviors that can make for a balanced, fruitful, fulfilling life; medication can’t do that work for you. But medication can help to remove the excessive weight holding you down. At that point, therapy is important in order for you to work on skills, expectations and intent. You might have learned many things growing up that just don’t work or aren’t true to begin with. Make an appointment to see a psychiatrist and a therapist and begin your journey to a better place.
C says: Okay, this is where Dr. B and I part ways in our views. I am sure that he has seen patients who make recoveries if put on medication and given a program of therapy. The problem with that idealized scenario is that we are talking about Americans here. We have been trained from an early age to expect doctors and pills to do the work for us, and the majority of us, if given medication that removes our emotions and makes us more comfortably functional, will just stay on the meds forever and blow off the therapy. Insurance companies tend to blow off the therapy, too. I have seen far too many people become dependent on antidepressants, try to get off them, and then find themselves unable to cope with the returning feelings. At this point, they go back to the pills. If their doctor won’t prescribe them, they find somebody who will. Half the antidepressants in this country are prescribed by doctors with no psychiatric training at all, and none of these supply the accompanying therapy that might make the pills beneficial.
My recommendation to you is that you forget about the antidepressants, but get yourself some therapy. You aren’t certifiable, but you have a very negative world view. If you go into yoga, meditation and exercise with a negative attitude, I don’t know how you expect to get positive results. Before anything is going to work for you, you have to take a more positive attitude, whether it comes naturally or not. I think you are going to have to trust someone to teach you something new. Life is hard. Coping mechanisms are essential. Right now you are barely treading water. If you learn how to swim, your whole world will change.
You can visit Dr. B’s blog at drbrilliantcliche.wordpress.com