The hidden pain of depression
Some years ago, a middle-aged patient of mine, Joe, walked into my office, and pleaded, “Paul, please talk me off the ledge”. He had struggled through a long period of work and relationship disappointments and problems with his youngest daughter. He grew up in a family with domestic violence and verbal abuse. He was at the very lowest I had seen him for a long time. He was experiencing the suffering of clinical depression.
Robin Williams’ recent suicide has brought the spotlight to this painful, but relatively common condition. Dr. Kay Jamison, a well-known psychiatrist, who has struggled with her own depression, contributed an essay titled “To Know Suicide” (New York Times, August 15, 2014). It is well worth a look.
Frequently depression stems from early childhood chaos and dysfunction triggered by challenging life events—death, divorce, or work issues. But sometimes it comes out of nowhere without any precipitant or apparent cause. This kind of depression, often with genetic roots, or part of a condition called Bi-polar disorder, is very confusing to the afflicted individual and their family because there are no triggering life events. Yet it’s pain and anguish is very real.
Dr. Jamison remarks: “Suicidal depression involves a kind of pain and hopelessness that is impossible to describe…It’s a state of cold, agitated horror and relentless despair. The things that you most love in life leach a way. Everything is an effort, all day, and throughout the night. There is no hope, no point, no nothing….When someone is in this state, suicide can seem a bad choice but the only one”.
Fortunately, with an accurate diagnosis, and treatment, patients can dramatically improve. There are a wide range of effective medications and psychotherapies that can make an enormous difference. Studies have shown that in moderate to severe depression, combining medication and therapy provides the most effective help. Despite these studies, many clinicians tend to focus either on medications or psychotherapy alone.
And many patients end up forgoing psychotherapy for medication, despite research that shows that patients who receive both do the best. Cost is a big factor. Most insurance plans pay more for medications and less for therapy. It can be expensive for adults to pay for both.
Depression is a challenge for family members too. It can be hard to be around a depressed person who experiences no pleasure in the little things of life. Adults with depression aren’t emotionally available to their partners or to their children. Their family doesn’t know what to do or how to respond to their depressed relative. They don’t understand depression and how it impacts an afflicted individual.
They may feel that their husband or wife should just “buck up”, “stop feeling sorry for themselves” or “pull themselves up by their bootstraps”. These comments, based on ignorance, can intensify the isolation that depressed individuals feel.
I hear many patients complain that their family hasn’t taken any opportunities to educate themselves about this illness. It is important for relatives to learn about depression, just as they might if they had a relative with diabetes, heart disease, or asthma.
The National Alliance for the Mentally Ill (NAMI) provides support and resources for family members that have a relative who suffers from a major psychiatric condition. Support groups and educational meetings are very helpful for family members. Dr. Jamison notes that when it comes to treating depression—“Empathy is important, but competence is essential”. If you or a loved one suffers from depression, talk to your primary care provider and get a referral to a specialist who treats depression.
Share your own personal stories. Let’s take depression out of the closet.