Posts Tagged ‘depression’

Different Types of Depression

Wednesday, March 21st, 2018

When a patient comes to my practice complaining of depression, it is important to distinguish the kind of depression that is presented. Depression can be situational, genetic or biological, or a combination of both.

Situational depression occurs when there is a triggering event which is distressing and creating a downward spiral. This can be a loss of a loved one, illness, rejection, abandonment, blow to one’s self esteem, a sense of failure in an important endeavor or trigger from past traumatic experience or event. All of us react to such events with deep sadness, but sometimes, it turns into feelings of depression which are associated with hopelessness, feelings of aloneness, lack of energy, sometimes guilt and shame.

Sometimes the depth of these feelings indicates a possible biological component as well. Situational depression can be treated and resolved with psychotherapy alone. Insight oriented therapy combined with a good therapeutic relationship can be enough. EMDR can also be very helpful as most causes of a situational depression have origins in past traumatic events. If the depression does not respond to therapeutic interventions, it may be a good idea to have a consultation from an experienced psychopharmacologist.

When a patient comes in with a depression that is more or less chronic with various degrees of severity and with no apparent trigger or precipitating event, there may be a biological cause. While psychotherapy is helpful, in these cases it is useful to consult a psychopharmacologist to explore options for antidepressant medication. A good psychiatrist is usually able to figure out the right medication which will alleviate the distressing feelings and lift the depression.

New Moms And Postpartum Depression

Monday, March 19th, 2018

Becoming a mother is the most profound experience any woman can have. However after 9 months of pregnancy and, sometimes, difficulties with conception, when that moment finally comes, some women find there are very often unexpected feelings of inconsolable sadness, darkness, feelings of unease, flights into unexplainable despair, rages, fear and panic which basically we now come to call Postpartum Depression.

There are many reasons for this phenomenon. The most common are hormonal shifts and for some the trauma of a difficult birth. Both wreak havoc on the brain and the nervous system. There is also a sense that this long anticipated event is done and there can be a possible sense of a letdown. Often times the moment of baby’s arrival and subsequent days and hours are challenging, especially to a new mother. Some women may experience a sense of inadequacy in not knowing exactly how to care for the infant. Another reason for many is the pain experienced after childbirth, whether it is due to severe trauma to the pelvic area and stitching or due to C-Section. For many mothers there is also a weight issue, which can take time to resolve, but can effect self-esteem and make a new mom feel unattractive.

Some of the new mothers I have seen in my practice developed obsessive thoughts about hurting the baby which were tormenting and quite severe. Other mothers were extremely afraid that somehow their actions will hurt or kill the baby.

I have also seen cases when a new mother is not willing to let anyone near the baby or hold the new baby. It still feels like the baby is part of them and not a separate person. They may also have fears that another person, including the father will somehow hurt the baby.

Another potential area of depression is when a mother has difficulties with breast feeding or has inability to get the baby to latch on to the breast. This is often associated with feelings of guilt and failure as a new mother.

Depression at times can also occur when bonding with the newborn does not occur immediately and takes time. This leads to feelings of being a bad mother and a terrible person. This almost always this resolves itself.

Finally there is lack of sleep which can cause depression due to exhaustion and irritability with those around, which may lead to conflict with spouse and family.

Some or most of these feelings and issues should resolve fairly quickly. If months and months go by, and the depression or obsessive thinking and behavior does not get better, it is a good idea to seek professional help. Talking this out with a therapist familiar with these issues can be immensely helpful. Normalizing the feelings and or uncovering possible underlying causes of these symptoms can speed up the recovery, and sometimes, an antidepressant is in order as well in particularly extreme cases.

Am I Sad or Depressed?

Wednesday, March 7th, 2018

Many clients come to my office wondering if what they are experiencing is depression or sadness.

Sadness is a normal and healthy human emotion, in response to variety of experiences. It often is connected to disappointment which is mild to moderate, feeling hurt by someone or something, feelings of occasional loneliness, work related stress or mishap of some kind or another. It is an opposite of feeling “happy” or joyful. This is usually a feeling that passes relatively soon, it can be days or hours and the person will return to a “normal” emotional state. Usually when one is sad there is no disturbance in sleep or appetite, no issues with functioning at the workplace or school or generally in any major area of life. Feelings of sadness usually resolve spontaneously.

Depression on the other hand is a more profound state. It is deeper than sadness, or is a sadness that does not lift over time. In fact, it usually gets worse. It is also, unless, biologically driven, connected to disappointment, failure, rejection, sense of aloneness, low self esteem and generally a profound sense of loss. Depression is characterized by low energy, lack of desire for anything, inability to experience any pleasure, social withdrawal, disruption in sleep and eating, a general sense of hopelessness and futility. It is a much deeper, darker and more profound state. Whereas a sad person can sometimes be cheered up, a depressed person, generally can not get out of their state and attention and intervention by loved ones do not help or if they do, it is not lasting. Depression can last a long time, and, over time can get worse and needs professional attention.

There is usually no treatment needed for sadness, it is part of natural ebb and flow of human emotions, and is as normal as joy. In case of depression, usually psychotherapy and often times medication as well, are in order. This combination is usually sufficient to resolve depression over time.

Depression After The Death of a Parent

Monday, March 5th, 2018

Death of a parent is a devastating event. Most of us have to at some point, face and cope with death of a parent and, eventually, both parents. This is always difficult and in some situations more difficult than for others. The pain of loss of a parent is unlike any. Additionally, the death of one parent is not the same as the death of both parents. There is a great book I recommend to many of my clients especially when the remaining parent dies. It is titled “The Orphaned Adult” by Alexander Levy. This is a beautiful, thoughtful, wise book which gives meaning to what it is being an orphan as an adult and many losses involved, including to one’s sense of identity.

Grieving a loss of a parent is normal. However, when it is extremely prolonged with not much significant ease, this can become what we call, complicated grief.  In a way what this means is that this is not only pain of a loss of a loved one, but, that there are complications in the relationship with a deceased parent that have not been worked through or resolved and it is difficult to move through the stages of grief and loss which leads to a “stuckness” of  unresolved feelings – most often guilt, anger and sometimes, shame. Sometimes, complicated grief reaction occurs when there is not sufficient separation that usually is a part of an adult relationship with a parent or if the death took place under sudden or tragic circumstances with no preparation for facing the loss.

In dealing with a loss of a parent, usually, emotional support from friends and family as well as time, can eventually provide some relief. As time passes and other things occur, there is a natural sense that “life goes on”, so to speak.

However if the loss, heartbreak and grief start turning into a feeling of depression, it may mean that the reaction to the death is “complicated” grief and it is time to seek professional help. With a help of an experienced therapist, it is important to identify the “unresolved” issues or any other elements of the relationship with a parent or other self  related feelings and issues that are in the way of integrating this major event into one’s life and continuing to experience life in its fullest capacity.