Depression is a soul sucking vampire: it steals your life away and leaves you empty and alone. Sometimes it takes the Big Guns to fight back. Here is a depression lexicon with some suggestions for healing.
  1. Dysthymia--persistent depression
    Constant low level state of sadness and apathy. It feels like you're slogging through can function in the world but you're not having any fun. You feel like a downer and often you are--generally dysthymics have terrible self esteem,and feel hopeless much of the time therapy, exercise and either Welbutrin or an SSRI are your friends.
  2. Atypical Depression:
    you sleep too much, you eat too much, you're acutely sensitive and often feel slighted by others. It's not unusual to feel heaviness in your arms and legs. In the old days we prescribed MAOIs for this condition. Now we're trying some of the atypical antidepressants. Therapy too obvs
  3. Major depressive disorder
    This is a worrisome situation. With major depressive disorder people have what are called vegetative symptoms. That means they don't sleep, they have no appetite, they have "anhedonia"which means they take no pleasure in any experience. People feel terribly guilty and have negative attacking thoughts--often those thoughts are self-destructive and suicidal MDD requires a good team approach with pharmacologist, therapist, patient and support system working together
  4. There is what I call a double depression, really sucky stuff: when somebody has dysthymia and then gets hit with a major depression in the middle of it. Only a few things are worse than this.
  5. Psychotic Depression
    This is a terrible situation. People start off with depression but the guilty or negative thoughts they have become pervasive and irrational. Rarely do these people hallucinate or hear things, but more often with a psychotic depression one has truly crazy distorted negative beliefs, E.g. my husband's cancer is because I was angry with him. Hospitalization is required for this terrible terrible state. Some really big guns pharmacologically here
  6. Manic depression or bipolar disorder
    Manic, elevated hyperaggressive/hypersexual states alternating with deep depression. These folks are at risk for suicide, jail time-completely destroying their lives and the lives of their loved ones--see Silver Linings playbook for a good example. Hospitalization, meds, and ongoing therapy. Part of the problem with this disorder is that people enjoy the manic state until it totally gets out of control often they are not medication compliant which starts the cycle all over again
  7. There are some subtypes of these disorders, but these are the main categories people struggle with
  8. Research shows that the combination of medication and psychotherapy is far far more effective than either treatment on its own
  9. When therapy and medications fail, sometimes we need the big guns. Electroshock therapy, ECT, is not the brain destroying monster it was once upon a time
    Now it is considered the gold standard for treatment resistant depression. The shocks are administered to only one side of the brain at a time which preserves memory
  10. Another new treatment for depression is transcranial magnetic stimulation. The jury is still out on how effective this truly is and it's hard to tease out the benefits from the placebo effect
  11. Look folks, if you suffer from depression please don't try and go it on your own. Work with a wonderful therapist who gets what you're struggling with and find an excellent pharmacologist.
  12. Get exercise and engage with activities even when you absolutely hate the idea of getting out of bed and coping with life. Let your friends and family support you--please don't isolate and suffer alone.
  13. Love, DocP