When I think about what I have learned from people with depression my brain floods with memories of people that struggled for a long time on their own before telling anyone about how their body was reacting.

My lessons from my clients are many but I will focus on only two for this blog.

Lessons

1. Long term depression begins to have a lot of power and control on the person. It steals away, fun, energy and the ability to find joy. The video that I have embedded in this blog talks about the robbing of one’s vitality.

2.  The second lesson I learned from one client in particular, came at a much later stage in our work together.  After both of us worked diligently to break down the structure and power of depression I thought to myself.

   “All righty now we are ready to move forward to help the client have a great quality of life. “

   I was quite pleased with my client’s progress and ready to continue to work with my client.  In our very next session the client thanked me for my work and said the following words

   “I have never felt better or more hopeful in my whole life and think I am ready to move forward on my own”.  My lesson that final day was this: I don’t get to define when the client is better, that is up to them.  

So... what exactly is depression?

It is much more than feeling down or having the blues for a day or two.  Depression can be an all encompassing sense of despair and hopelessness.  It robs your energy, both physically and emotionally and it feels like it will never end.  As more than one client has told me “don’t forget to tell people that it robs your intelligence too, because you feel like you are in a fog all the time .  A simple problem seems overwhelming, simple daily routines like showering or getting dressed seem impossible. The over arching lesson that I have learned is that EVERY SINGLE THING is harder than it should be when you have depression.

However we also know this. That depression is treatable.

How does depression present itself.

One of the things that I have learned from my clients is that depression also presents in many ways , some of them surprising.  I think of depression as a bit of a chameleon in that it can take so many forms and wear many faces. It can also be many degrees of darkness. Depression can steal our deep connection with other humans.

• You know that cranky person at work, who is always annoyed with everyone ,they could be struggling with depression,

•  The person who cries at the drop of a hat, that could be depression,

•  The quiet person in the corner at a gathering could be living with depression. 

• The person who is painfully shy and hates any sort of spotlight could also have depression

• The person who seems to be an extrovert or the life of the party but then goes home and beats themselves up for being too loud. 

• Someone who has explosive rages

All of these can be the face of depression.

Types of Depression

There is some discussion about how to categorize depression but in general the types of depression we see most often fall into the following categories:

1.     Major Depressive Disorder

2.     Dysthymic Disorder

3.     Treatment Resistant Depression

4. Depression mixed with Anxiety

5.    Post partum Illness

6.   SAD =Seasonal Affective Disorder

There are also some subcategories to the main types of depression. Situational depression is a kind of depression which I see often.  Depression can also be part of other mental health conditions.

Depression presents differently in children than it does in adults.  This blog can’t look at all of the different kinds or reasons for depression but I will include some great links at the end of the blog if you want to know more. Please note that most of the time I will try to use Canadian sources of information but occasionally if I find something awesome and user friendly from other countries I will use them as a resource.  

Something I noticed in my research for this blog is that many of the articles about depression are very long, detailed and has far too many rules to follow for people who experience depression.  One of the things about depression that I have learned is depression causes your brain to work more slowly than it used to and people are easily overwhelmed with long lists. I had a wonderful supervisor many years ago who told me to:

“Always go where your client is. What works in the books does not necessarily work in real life, so go simply and slowly.”

Treatment : Medication, Counselling and Healthy Living

All the experts say that depression is treatable and it is but…it is darn hard work and can be a whole lot of trial and error on your part and whoever your helper is. Medication helps with some kinds of depression and not so much with others. There are many different kinds of medication and some of them can have some pretty serious side effects including: lethargy, unusual sleeping patterns, odd and very realistic dreaming and weight changes. In my experience I have learned that it takes a lot of hard and consistent work, self talk, healthy living and exercise as well as socialization in order to begin the journey back to good health. But again we take small steps at first.

What I do is called Cognitive Behavioral Therapy (CBT) and that means we look both at how you think and how you act. I also use mindfulness and dialectical behaviour therapy (DBT)in combination with the CBT. At the end of our time together you will have some new skills in your toolbox that will help you retrain your brain away from some of the kinds of thinking that goes along with depression. The next blog I do will talk a lot more about what we actually do in a counselling session.

The Healthy Living part of treatment includes, drinking more water, exercise, paying attention to what you eat as well as building up your community and faith networks. But again everything is done in small steps with acknowledgement of the effort and energy it takes. When I work with you I give you very simple homework at the start and that is a good thing, then you build on those life changes every day just a bit.

The Portable Therapist:(Its a book series)

I am going to go on and on a bit about this series of books so if you want you can skip this part. Many years ago I found the Portable Therapist series of books by Susanna McMahon PhD. What I especially like about these books and Dr. McMahon’s writing style is that she knows that people who are struggling with focus have a difficult time focusing  for a whole chapter of a book.  How she has addressed this dilemma for her clients is to write books with short one page  to questions that most of us have. The first Portable Therapist book that I read is divided into five (5 ) sections. 

1. The first section is called Philosophical Issues and it addresses questions such as Who am I, Why Can’t life be fair and so on.

2. Her second section is Conceptual Issues : In this section she addresses issues such as self esteem. How can I learn to let go etc. 

3. The Third section is called Individual Issues .  This section gets to the meat and potatoes of emotion: anger, confusion, resentment etc.  

4. Her fourth section is about Relationships  and here she writes about co-dependency and family

5. Her final section is much simpler and answers only one question and it is What is a natural High. 

I often recommend her books because people who live with depression often have the same questions about their lives. Sometimes for homework I will ask a client to choose a page or two from the book and reflect on only those pages until the next time we talk. If depression is keeping people from going outside I might ask them to stand on the front step or balcony of their home. Eventually I will ask them to get out and experience the physical world outside, the wind, the cold, the smells the noise. Just being present in the physicality of the outside often helps people feel connected to something. I usually tell them to do this between the hours of 10 am-2:00 pm because that is when we get the light that will help with Seasonal Affective Disorder (SAD) .

The whole goal of all this is to become present with self when every ounce of your being is asking you to dissociate from your sense of self and the world around you.. If clients are distressed with the messiness of their home I ask them to practice by making their bed or cleaning off only one small part of a table or cupboard. Then you must congratulate yourself on every single thing you do. The depression will be telling you that you are not enough but you are enough. I think often of this little story of my grandson

Before COVID when I could see clients in my home office I would often give them tea. After my day at work sometimes I would leave the tea things on the little table. When my grandson would come to see me he would take the cups and tea pot into the kitchen for me. one at a time. Ever time he came back into my office he would give himself a little pat just above his heart. When I asked his mom what he was doing she said this “he is congratulating himself for doing a good thing”

When I think about the wonderfulness of small children, I wish that as adults that we had not lost the ability to say good job to ourselves when we take a small action, especially when it takes so much effort and energy when we are depressed. Depression tries to take away that mindfulness of noticing when we are enough. Control can back in small steps.

How to start and keep a conversation going with someone who is experiencing depression:

1. Don't say "it'll be okay."  To a person with depression. What they hear is that you are minimizing their illness. It also minimizes their pain. Tell them that you will do everything you can to help them get through this. Remember your friend of family member is an adult.

2. Don't say "I understand." Even if you've been diagnosed with depression yourself, your friend might think that you again are minimizing their pain or how deep their depression is. Ask them what it is like for them. Ask them what they need but don’t expect an answer right away or at all.

3. Don't lecture. Don't hesitate to ask if a depressed loved one has been taking their medication. Do not tell them that all they have to do is garden, go for a walk or be sociable. They can’t do that right now.

4. Don't tell the person to snap out of it: If strong wills could make depression go away that would be awesome but this is not a matter of just getting over it.

5 If the person invites you to the doctor’s appointment take the time to go and let them set the rules.

6. Don't forget the things you SHOULD do.

• Give hugs, gentle touch with permission

• Eat with the person, you can bring the food, or cook with them or take them out.

• If you can’t think of anything to say just tell them that you know depression is hard or that it just generally sucks.

• Talk about normal things, tv, sports or whatever or just sit in silence.

• Be present and sometimes silent. those of us without depression have no idea how hard it can be to make the effort to talk.

• Do not forget about the person…invite them out even when they say no time and time again. Keep on remembering your friend.

• Learn everything you can about their kind of depression but don’t lecture of become a depression expert.

• Listen when the person with depression talks and do not offer solutions. (This can be hard to do).

• Be an advocate with the health care system if you are invited by your friend or relative.

• Continue to know that your person wants to be well again just as much as you want them to be well.

Suicidal thinking:

Take suicidal ideation seriously every time.

I will talk more about this next time. Ask questions that might seem scary to you such as: Have you got a plan, place, time. Has their behaviour changed in any way, do they suddenly seem unusually chipper after being very depressed for a long time, are they giving their possessions away and so on. Have the conversation and take action. If there are guns or knives or extra medication in their home plan with the person about storing them in a safer place for awhile. If they need to go to hospital for an assessment take them there and wait with them. Yes this might be inconvenient but do it anyway.

I often think of Carl Sandburg’s poem as a metaphor for how depression can creep into our lives. But like fog it can also dissipate when we persist and persevere on our path even when we are too tired .

Fog: BY CARL SANDBURG

The fog comes

on little cat feet.

It sits looking

over harbor and city

on silent haunches

and then moves on.

What I will do next week is look more closely at types of depression and specific treatments. Depression is one of the most common conditions that keeps people away from work . I think it is time we started to identify it for what it is. I have included a video that is part of a TED talk series about depression.

Thanks for reading again.

Deborah

Resources and References

Mood Disorder Society of Canada: This website has a lot of useful and accurate information. https://mdsc.ca/

Canadian Mental Health Association: https://sk.cmha.ca/

HELP GUIDE: https://www.helpguide.org

 https://www.helpguide.org/articles/depression/depression-treatment.htm