Depression Diagnosis & Treatment

The Prevalence of Addiction in Individuals Suffering from Depression

Depression is an intense feeling of sadness and loss that persists, regardless of what’s happening on the outside. Someone who is trapped in depression seems physically incapable of experiencing joy, even when something wonderful is happening right now. It can be hard for people like this to discuss their concerns openly, simply because they’ve lost the ability to believe that life can get better. They have no hope, so they’re not certain that even bringing up the issue will do any good at all.

Not surprisingly, many people who are depressed choose to self-medicate with drugs and alcohol. In fact, the Anxiety and Depression Association of America suggests that about 20 percent of people who have a mood disorder like depression also have a substance abuse disorder. People like this may not understand that addiction can make depression so much worse, but understanding family members may be able to provide the guidance and support that can help the truth to come to light.

Types of Depression

When most people think about depression and they attempt to describe its symptoms, they focus on major depression. This is the type of depression that’s associated with an extremely low mood that persists for weeks and weeks with no end in sight, and it’s the type that can cause an intense amount of suffering. But it’s certainly not the only type of depression available.

In fact, there are a number of different forms of depression, including:

• Psychotic depression, in which a low mood comes with delusions or hallucinations
• Post-partum depression, which is a form of depression brought about by the birth of a child
• Seasonal affective disorder, in which changes in the season trigger a low mood
• Premenstrual dysphoric disorder, in which depression strikes in tandem with a woman’s cycle

A persistent depressive disorder like this can be intensely debilitating, as it can seem to become a way of life for the impacted person.

Similarly, depression can sometimes be a symptom of a deeper mental health disorder. For example, people who have bipolar disorder often have depressive symptoms. Some experience depression that alternates with feelings of power or mania, while others experience depression of varying intensity while feeling no joy at all. These people might not get a diagnosis of depression, but their feelings are definitely depressive in nature.

The Link to Substance Abuse

Few studies have pinpointed the exact statistics regarding substance abuse among people who have different types of depression. As a result, it’s difficult to state with precision what type of depression is most closely associated with the need to use and abuse drugs. That need is certainly there, but it’s not clear what type of depression causes people to feel that need most acutely.

However, research does suggest that some types of depression are borne out of a previous episode of substance abuse or addiction. For example, an article in the journal Violence Against Women suggests that postpartum depression is more common in women with a prior history of substance abuse, when compared to women who don’t use drugs.

It’s not clear why this is the case, but it’s possible that women do damage to their brain cells due to drug use, and that damage makes them more vulnerable to depression when their hormones go wild after a pregnancy.

These sensations are brought about by the intense release of dopamine that hits the inside of the brain when drugs are available. People who have depression often have a low level of dopamine available, so the hit of drugs seems to correct a chemical imbalance and provide them with relief. The first time people like this take drugs, they might feel better. That kind of reward is often associated with persistent addiction.

Help for Depression

While people who have depression often feel as though they’ll simply never get better, there are a number of therapies that can help them to leave both addiction and depression behind. For example, the Substance Abuse and Mental Health Services Administration suggests that depression is remarkably amenable to psychotherapies, including Cognitive Behavioral Therapy. In CBT, people work with a therapist and identify the triggers that tend to bring about depressive thinking. For some, it’s a change of the seasons or a time of the month. For others, it might be a critical person or a place in which they feel unsafe. Then, the team works together to come up with a list of alternate reactions to that trigger that don’t involve depression or drugs. It might sound easy or even simplistic, but therapy like this can often transform the way that people think, and they can get better as a result.

In addition to therapy, some people with depression do need to take medications to balance their brain cells and reduce the risk that they’ll relapse to drugs. There are a number of different therapies to try, including some made for bipolar disorder and others made for major depression. People who take these drugs often need to do so for months before they begin to work, but they can be quite helpful for people dealing with a low mood that won’t lift.

At Black Bear Lodge, we’re committed to helping our patients overcome depression, so they can go on to live a happier, healthier, drug-free life. We utilize psychotherapies, medications and more to break the spell of negative thinking, and our follow-up care ensures that our lessons stick for the long term. Please call 706-909-9811. Our admissions coordinators are available now, and we’d love to tell you more.

Atypical Depression

Depression presents itself in many forms, and some of those forms may be more difficult to recognize. “Atypical depression” is a diagnosable type of depression that affects a surprisingly large number of people who, because of the unique symptoms, may not otherwise think that they have a form of depression.

But make no mistake about it, atypical depression is a subtype of depression.¹ Despite the name, it is not uncommon: Atypical depression is responsible for between 23 to 36 percent of all cases of depression, but because of the non-standard symptoms, it often goes unrecognized and undiagnosed.²

Symptoms of Atypical Depression May Include

• Sleeping a lot, sometimes up to ten hours a day or more (hypersomnia),or difficulty sleeping (insomnia)
• Overeating (hyperphagia) instead of losing appetite
• Changes in weight
• Irritability
• Anxiety
• Temporary relief from depression during positive events¹

“Talking about my depression gives it light and helps me to share the load of it, not an easy task; it can be heavy for the support person and oftentimes downright exhausting…

The face of depression can be deceiving. That person who seems to have it all together may be having a really bad day, maybe they are, right at that moment, anxious about three things at once and seem aloof or distant, maybe they were up all night worried about a sick child, maybe it took an act of God to get dressed and get their kids’ lunches made, or maybe they just want to understand how it feels to be carefree and spontaneous.

One of my favorite quotes is: ‘Be kind, for everyone you meet is fighting a battle you know nothing about.’ It’s true…and you are not alone.”

-Erin of Heroes in Recovery

Other Symptoms of Atypical Depression

One recognizable symptom of atypical depression is what is known as mood reactivity and rejection sensitivity. These problems can be misleading and make diagnosing a little more difficult.

Often, people with atypical depression feel much worse after they experience things like rejection or loss. While nobody enjoys the feeling of rejection or denial, people who struggle with atypical depression may struggle to maintain daily activities after experiencing social rejection. This “rejection sensitivity” does not exactly balance with the positive mood reactivity. A person with atypical depression may experience just a little happiness when something good happens, but struggle to overcome negative stimuli.

The same person may be able to feel better when life is going well. These temporary pick-me-ups often hide the effects of long-lasting depression. However, as with similar conditions such as postpartum depression, the feelings of happiness do not last, and the common feelings of depression return soon after.³

Another symptom of atypical depression is what is known as “leaden paralysis.” This condition may cause you to feel physically unable to move, as though their body is being weighed down by lead. This sensation may last as little as an hour, or take up many hours of the day.⁴

How to Overcome Atypical Depression

Treatment for atypical depression follows the same pattern as treatment for other forms of depression. There are two main courses of treatment for atypical depression: supportive counseling, and medical or medication assistance.

Psychotherapy can help strengthen you. A supportive counselor can help you learn new coping skills for everyday life events, and coach you through your positive changes. Group therapy can offer a space for you to overcome challenges among people who understand your goals and what you have been through.

Medical management through medication has made a great deal of progress in the last ten years. Medications like selective serotonin reuptake inhibitors, the newer generation of serotonin and norepinephrine reuptake inhibitors, and tricyclic antidepressants can all make a big difference. These medications are constantly being tested and refined, and, like humans, each antidepressant is unique.⁵

Although the symptoms of atypical depression can be frustrating, there is a world of help and assistance for you, or for a loved one who you feel may be atypically depressed. We can answer your questions about the signs of atypical depression, as well as give you the information you need regarding treatment here at Black Bear Lodge. Call 706-909-9811 for more details.

Dysthymia

There are many different types of depression, and dysthymia can be a particularly insidious type. Its symptoms are not as intense as those of regular depression, so it can be harder to diagnose, leading patients and people in the patients’ lives to simply write off the symptoms as stemming from a negative disposition. Despite the lack of clarity it presents, dysthymia can be treated and managed.

Dysthymia Symptoms and Scope

Dysthymia is also known as chronic depression because a depressive period of dysthymia can last for two years, if not longer.

Like other forms of depression, this can mean:

• Lack of interest in hobbies and activities
• Constant fatigue
• Sleeping too much or sleeping too little
• Decline in job or school performance
• Unintended weight loss or weight gain

Unlike standard depression, however, the symptoms of dysthymia are not as severe or prevalent, but the tradeoff is that they persist for much longer than they do with standard depression. They will still disrupt daily life and cause tangible problems in interpersonal relationships and behavior. However, since dysthymia is not as potent and recognizable as standard depression, patients can go for decades without seeking treatment, completely unaware that they have a form for depression.

Around 1.5 percent of the adult population of the United States has dysthymia, according to the National Institute of Mental Health (although Psychology Today puts that figure much higher, at six percent). Women are two to three times more likely to develop dysthymia than men, probably due to combinations of genetics and hormonal factors.

Dysthymia and Double Depression

Since dysthymia is difficult to diagnose, a patient can experience periods of major depression, even while their dysthymia is in effect. This is known as double depression – which can again go untreated, because a patient has become so acclimatized to their depression that the onset of major depression is not considered out of the ordinary. Double depression can occur in more than half the people who have dysthymia.

Notwithstanding that dysthymia does not present itself as immediately damaging like standard depression, it can still cause significant and debilitating difficulty in managing everyday life, which PsychCentral calls a key diagnostic criterion.

Treating Dysthymia

Treating dysthymia follows the same pattern as treating standard depression. If a doctor determines that medication should be administered, SSRIs, or selective serotonin reuptake inhibitors, are a popular choice. They work by stopping the brain from reabsorbing the serotonin neurotransmitter, and the continued presence of serotonin in the system can help boost mood and positive feelings. Common SSRIs include drugs like Prozac and Zoloft.

A second line of treatment involves psychotherapy, where a doctor teaches the patient new ways of thinking and behaving in relation to their dysthymia. This can be in the form of Cognitive Behavioral Therapy, which helps a patient understand the negative patterns of thought typical of dysthymia, and then change them into more positive and functional skills and management tactics. Other forms of therapy can include interpersonal therapy, where a patient learns how to cope with how dysthymia affects their relationships, and vice versa.

Dysthymia can be insidious, but there’s no reason it should be untreated or ignored. At Black Bear Lodge, we know the damaging effects of depression, and we want to help you make your life better. We can answer your questions on dysthymia and how treatment can help you manage and control your depression. Call us today at 706-909-9811.

Major Depression

We all have moments when we feel down in the dumps, but when that depression encroaches on how we live, on our daily activities, and on our feelings of self-worth, that’s a sign of major depression, which is also known as clinical depression, or major depressive disorder. There are many types of depression, and major depression is the most severe form of the disorder.

What Is Major Depression?

Major depression can be identified by the patient feeling a persistent, enduring sense of hopelessness.

When this is the case, it becomes too difficult and burdensome to put in the effort to maintain normal behavior, such as:

• Meeting the standards of professional and academic behavior
• Spending time with friends and family
• Enjoying hobbies and activities
• Eating and sleeping

A patient may also feel the following effects as a result of major depression:

• A constant state of fatigue
• Feelings of unfounded guilt or worthlessness
• Inability to concentrate and focus
• Thoughts of death or suicide
• Weight loss or weight gain

While these effects are true of any form of depression, they have to be in place for two weeks for a diagnosis of major depression, consuming most of each day of that period. For weight fluctuations to be a diagnostic criterion, they have to account for five percent of the patient’s original weight over the period of a month.

In 2012, the National Institute of Mental Health estimated that around seven percent of the adult population of the United States – about 16 million people – experienced a period of major depression in a single year.

While major depression can strike anyone, regardless of race, demographics or lifestyle, there are certain factors that put more people at risk than others. Poverty, childhood abuse and a family history of depression can make a person more likely to develop major depression as they get older. Extreme amounts of grief, whether from the death of a loved one or due to divorce, can also be a trigger.

Treating Major Depression

Major depression is a serious condition, but there are a number of ways it can be treated. Antidepressants like Zoloft (belonging to the family of selective serotonin reuptake inhibitors) are a popular method of pharmacological treatment, with Zoloft being prescribed more than 29.5 million times for major depression in adult patients in the US in 2007 alone. SSRIs help restore balance in the brain’s neurotransmitters by preventing the reabsorption of serotonin, which is considered to help in feeling good and positive.

Given the severity of major depression, a comprehensive treatment plan will include both a course of antidepressants and psychotherapy, the latter of which helps address the emotional and psychological causes behind the depression. A common form of psychotherapy is Cognitive Behavioral Therapy, whereby a psychologist helps their patient understand the dynamics behind the onset of a depressive period. That understanding is used to develop healthy ways of dealing with the effects of the depression.

Major depression is very difficult to live with, but there is always hope in treatment. At Black Bear Lodge, we know that living with depression is not simply a case of waiting until it passes, which is why we want to help you as much as we can. If you have questions about what you’re feeling, if you’d like to start a treatment program, or if you’re concerned about a friend or family member, we’re standing by to answer your questions and begin the process of healing and recovery. Give us a call at 706-909-9811 today.

Seasonal Affective Disorder

Every season brings about some measure of difficulty – it’s too hot, too cold, too wet – but for some people, going into a particular season brings about an acute form of depression. Perhaps the reduced amount of sunlight depletes them of their energy, diminishes their desire to do things they once enjoyed, or deprives them of a good night’s sleep. This condition is known as seasonal affective disorder.

The Mechanics of Seasonal Affective Disorder

While seasonal affective disorder (or SAD) can develop as a response to any seasonal transition, it most commonly occurs in late fall and winter.

This is the time of year that the days get shorter, which in turn disrupts sleep patterns, and presents symptoms typical of seasonal affective disorder:

• Fatigue
• Inability to concentrate
• Depression
• Irritability and agitation

Without sufficient sunlight – especially if a patient has to work indoors during the few precious hours of sunlight, or if they move to an area of the world that doesn’t see the sun at all during the winter months – the human body cannot produce the required amount of vitamin D, which Psychology Today calls “the sunshine vitamin” in an article entitled “Vitamin D Deficiency and Depression.”

In true seasonal affective disorder, the symptoms dissipate once the seasons change again, and the factors that triggered the SAD – reduced sunlight, cold weather, etc. – have been replaced.

Seasonal affective disorder may also be due to a biochemical imbalance in the brain that is triggered by a lack of consistent sunlight. The American Psychiatric Association warns that this may upset circadian rhythms, making the person unable to fall asleep during the night, and being constantly exhausted and fatigued during the day.

Particular to seasonal affective disorder is that the patient experiences cravings for food rich in carbohydrates. This may be due to an unconscious desire for comfort food to boost their mood when their SAD is in full effect. As with other forms of depression, this can lead to unwanted weight gain, which is not only a sign of possible SAD, but can be a cause for depression in and of itself (if there are concurrent body image issues at play).

With over 500,000 Americans being affected by seasonal affective disorder, anywhere between 60 and 90 percent are women. SAD is about four times more common in women than men; however, the Mayo Clinic warns that men may have more severe SAD symptoms.

How Can Seasonal Affective Disorder Be Treated?

In addition to the usual approaches of psychotherapy and medication, seasonal affective disorder has a unique treatment method. It’s called light therapy, where a patient sits next to a special “light box” for 30 minutes every day after they wake up. The light box stimulates high-intensity sunlight, so a regular house lamp or other source of illumination will not be sufficient. Light therapy like this would start whenever the patient’s symptoms begin, which is usually around the onset of fall, and the person would do this every day throughout fall and winter until the spring and/or summer.

Comprehensive treatment of seasonal affective disorder will also involve a course of antidepressants, such as fluoxetine (Prozac) and bupropion (Wellbutrin), which studies, like this one published in the American Family Physician journal, have shown to be effective in helping patients deal with SAD.

Lastly, there is also psychotherapy like Cognitive Behavioral Therapy, which helps patients identify the thoughts and feelings that predict the onset of seasonal affective disorder. With a doctor’s help and insight, the patient can learn from that identification process and develop coping skills to better manage their SAD.

It can be difficult trying to adjust to the change, and Black Bear Lodge understands that. Our professionals can help diagnose if you are experiencing a mental health condition; and if you are, treatment can help you find a healthy new life in recovery. Call us at 706-909-9811 for more information.

Psychotic Depression

For some people who have depression, their attacks are so powerful that it damages their perception of reality.They may hear voices that do not really exist or believe harmful things about themselves that are completely untrue. These are signs of a severe form of depression known as psychotic depression, where the usual symptoms of depression are combined with psychosis – a loss of contact with reality.

Psychosis and Depression

Psychosis – whether or not as part of depression – manifests in distinct ways:

• Hallucinations: hearing voices or seeing things in the absence of any real stimuli
• Delusions: false beliefs without sufficient evidence with which to believe in them
• Catatonia: loss of control of motor skills
• Cognitive impairment that affects logical speech

Symptoms like these will be felt in combination with the symptoms of depression. For example, while a patient with depression will have periods of feeling worthless or guilty about something, a patient with psychotic depression will experience hearing voices that reinforce those feelings (hallucinations). They may believe that they have committed a crime or wrongdoing to justify their misery, even if they are completely blameless (delusions).

Psychosis is found in other mental health conditions, such as schizophrenia and severe instances of bipolar I disorder. However, PsychCentral explains that patients with psychotic depression are fully aware of their psychoses; they realize that the voices they hear and the delusions they believe are not based in reality, but they are helpless to prevent the hallucinations and false beliefs from coming to them. For this reason, patients may be too ashamed or scared to disclose this information to a loved one or doctor, making psychotic depression difficult to diagnose.

Delusions can also take the form of paranoia; not only does the patient believe that he or she has done something wrong, but they further believe that they are being persecuted (usually by law enforcement) for whatever crime they think they have committed.

The National Alliance on Mental Health reports that symptoms of psychotic depression develop in approximately 20 percent of people who have major depression. In such cases, the risk of suicidal thoughts or behavior is quite high. The American Journal of Psychiatry notes that patients with psychotic depression have double the risk of death than patients who have depression that does not present with psychosis.

For this reason, patients with psychotic depression will need to be hospitalized for residential psychiatric evaluation, both for their own safety and the safety of those around them.

Treating Psychotic Depression

Due to the severity of psychotic depression, treatment involves the prescription of antipsychotic drugs (in combination with antidepressant medication), and close observation and follow-up by doctors. The National Institute of Mental Health reports that electroconvulsive therapy (ECT) is an effective, if occasionally controversial, method of treating psychotic depression. ECT involves electrically inducing seizures to jumpstart the brain, in an attempt to reset the central nervous system, which is regulated by a small electrical current. ECT should never be thought of as a first measure and should always be employed in conjunction with more conventional treatment methods (such as antipsychotic and antidepressant medication, and psychotherapy).

Psychotic depression can be difficult for the patient and his or her loved ones, but help and treatment are available. Black Bear Lodge knows that simply making that first phone call can be the toughest part of any journey to wellness, and that’s why we’re here to answer your questions about the symptoms of psychotic depression and how to find a new life in recovery. Call 706-909-9811 now.