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HOW TO OVERCOME DEPRESSION
A DEFINITION: It is not easy to define depression. In the literature, the word may be used to indicate many different emotional states. It can mean the condition of a person that is a little down in spirit, or a person who is so afflicted by depression that he or she would like to withdraw totally from life. Perhaps in its most common use, depression refers to a condition of disappointment, discouragement, pain, and pessimism, and it may be in relation to all kinds of problems, even those which to others may seem insignificant. Many think of depression as a state describing only the most debilitating conditions of life when they are so negative about themselves and the world that they lack motivation to do even the most simple tasks.
To give a general definition, depression may be described as a condition or a feeling of sadness, of being so overcome by the conditions of life that there is a growing pessimism concerning all aspects of life . the feeling of being blocked in and powerless. This condition is frequently accompanied by a loss of ability to concentrate, and a lessening of ability to reason rationally. Often, there are social symptoms including the tendency to get away from other persons, a loss of motivation, a diminished sexual drive (or a tendency to exaggerate), difficulty in being able to sleep (or wanting to sleep all of the time!), and a constant sense of sadness accompanied by the desire to cry.
As we have seen, the clinical definition of depression can include various conditions and levels of this emotional sickness, which in some form, afflicts a high percentage of persons of every age and every nation of the world. Someone has called depression the “common cold" of the emotional illnesses. In the US on any given day one would find five to ten percent of the population affected, and it is calculated that about twenty-five percent of the population will suffer a major episode of depression at some point in their life.
Depression is the most frequent cause of absence from work in the US. Unfortunately for them, women suffer depression more frequently then men do (perhaps it is because they have to deal with men!). For every man who is depressed, there will be three or four women experiencing this emotional problem. Actually, there are physical aspects unique to women which contribute to this difference. Typically, women feel depressed a few days before their monthly period, and some during their period. There is about five percent of women who suffer depression after giving birth in a condition called "postpartum depression." Also, almost all women suffer depression during menopause, although the intensity varies
from woman to woman. For a biblical description of depression see Lamentations 3:1-36.
1. Persons reared by parents, one or both of which typically responded to unwanted stimuli by becoming depressed and seeing themselves as victims. In this instance depression may become an acquired life style for their children.
2. Persons with a deep sense of unresolved guilt, either because of something they have done which they should not have done (so their moral failure becomes their badge of distinction), or someone who has failed to do something they should have done (so their failure to accomplish becomes their badge of distinction). In this instance, depression tends to be seIf-punitive.
3. Perfectionist personalities. In this imperfect world, there will always be reason to be less than satisfied, either with one’s own product, or with that of others.
4. Persons of moralistic personality. It is easy to acquire and carry about a spirit of seIf-condemnation. As stated above, anger toward seIf can cause depression which takes an auto-punitive form.
5. Some persons who live in the past will have the tendency to bring to each new day the negative memories of the past, causing depression.
6. Persons of dependent personality have a strong desire to please others. They like to live in the shadow of dominant individuals. Such persons are happy to serve others, particularly persons they admire. Because it is difficult for them to say "no" to the requests of others, such persons run the risk of feeling controlled by others, and eventually may become exhausted. With the passing of time, they may begin to be angry about being used, and become depressed since their dependent posture may not permit a more overt response.
7. Persons with obsessive/compulsive personalities have a strong sense of obligation, like order, accept change grudgingly, have the tendency to be inflexible, and may seem a little hard headed. If their world gets out of control, they may become depressed.
8. Persons with histrionic personalities tend to be quite dramatic, excitable, and subject to highs and lows. They tend to have a high need
of emotional affirmation, which if not forthcoming, may result in depression.
9. Persons who for one reason or the other attempt to hold others at a distance, and fear and flee from strong emotional involvement (sometimes called approach/avoidance) , and often suffer a sense of solitude and isolation which may bring about a state of depression.
10. Narcissistic personalities are so seIf-observed that they tend to live for themselves. This puts them at risk of finding themselves without friends, and eventually with no worthwhile purpose in life. Especially later in life, the feeling that one’s life has been useless may lead to depression.
11. Persons who have a history of abuse (either as children or as adults) whether it be physical, mental. or sexual often suffer from depression.
12. Trauma, of course, causes depression whether it be the loss of a loved one, thing, or position; or it be a grievous illness. Typically, depression resulting from trauma will subside after a period of adjustment.
We do not know exactly why or how they work, but they do work! We know that our thoughts and feelings are influenced by many electrochemical reactions both in the body and in the brain. We know that when we are under stress, the adrenal glands secrete hormones which prepare us either to fight or to flee. The principal hormones are the epinephrine, the norepinephrine, and the serotonin and our glands continue to furnish these hormones until the supply is exhausted. At that point one’s system tends to lose its inner balance, and an individual may suffer depression, have a nervous stomach, become more subject to infection, have an increased rate of heart beat, and other symptoms. It appears that antidepressant medications restore equilibrium to our bodies. Some of those included in the literature are Elavil, Endep, Pamelor, Aventyl, Adopin, Asendin, Ludiomil, Desyrel, and the most popular at the moment appears to beProzac. When depression is accompanied by hysteria, phobias, or anxiety, medicines mentioned in the literature include Nardil, Naimid, and Pamate. CAUTION!!! I am not a medical doctor and I am not recommending any of these medications. None of these should be taken without the advice of and being under the direction of a medical doctor or a psychiatrist. There are, however, many varieties of these available and the task of competent persons is to find
one which will work to reduce the negative symptoms of depression for the specific individual, with minimum negative side effects. Because a medical approach to depression only reduces symptoms, it is almost always necessary to combine medicine with counseling.
Other treatments include acupuncture, hypnosis, electric shock, massage, physical exercise, natural remedies (St. John’s Wart, ccc.), diets rich in soy, fish rich in fats (salmon, mackerel), and foods rich in omega 3 fatty acids such as nuts, flaxseed oil, fish, etc. Recently there have been warnings in popular literature against certain natural remedies such as St. John’s Wart which have been found to cause harm to some people. Therefore, even these should be taken under the guidance of adequately prepared medical personnel.
I am convinced that, with the exception of depression brought on by trauma, the majority of those who suffer depression do so due to personal factors that relate to life style, or conduct. In this case, what is usually needed is not medication but rather a change in one’s way of seeing seIf, others, God, and the external world, and/or a change in conduct.
There are more serious forms of depression called either "unipolar" or "bipolar" depression whose cause appears to be mainly hereditary. In a study of seventy-five identical twins separated at birth and reared separately when one of them sufferes either the unipolar or the bipolar condition, it was found that sixty-nine percent of their "identical twins" also suffered this same condition. Other similar studies have given approximately the same results. In addition, it has been observed that the unipolar and bipolar conditions run in families. This would seem to indicate a very strong genetic causation.
The unipolar condition manifests itseIf in two possible ways. One is the euphoric or manic condition where the individual may have difficulty sleeping, have very rapid speech, have great energy, become easily irritated and impatient, experience a rapidly changing flow of thoughts, will often make unwise decisions and act impulsively (often in financial matters). A second condition is one of strong depression. The earlier given clinical definition of depression describes that state.
The bipolar condition is so named because it involves alternating states of euphoria and strong depression. The phases may come in short succession with each lasting a few days, or each phase may last for a month of longer. In rare cases the alternation may occur several times daily.
While medication is often not necessary in dealing with depression of other types, unipolar and bipolar depression usually necessitate medication for life. Lithium is the best treatment at the present,. Lithium is found in a compound state, usually lithium carbonate or lithium oxide. It has been approved for use in the US since 1969. Lithium is not a cure, but it does reduce symptoms so life can go ahead in a normal manner, and needs to be continued throughout life. It is good, however, to supplement Lithium with counseling.
1. With a low energy level, and a more or less continual sense of fatigue.
2. With the tendency to avoid almost all responsibility, and especially anything new.
3. With the tendency to approach one’s duty with negative personal feelings of one’s ability, and of the quality of one’s output. Especially in a condition of competition there may be a premonition of failure, and of doing poorly.
4. With a tendency to give a negative assessment of one’s own product even when it is excellent, and to discount praise or compliment.
5. With the desire to separate oneseIf from other people.
6. With a typically negative attitude, and a progressive sense of doom or disaster.
7. With the desire to flee, to just get away from everyone and everything.
8. With the feeling of being blocked, of being without power or the ability to defend oneseIf
9. With global body pain and discomfort in the more advanced stages of depression.
10. With either thoughts of or the intention to commit suicide.
SOME WAYS OF DEFENDING YOURSEIf AGAINST DEPRESSION:
l. Check to see if there is a physical cause, and if there is, deal with that.
3. If grief or loss is involved, express the grief openly. Crying helps (even for men!). Express your grief to a trusted person. Do not let your grief be stretched out too long! Life goes on!
4. In the event that depression is related to a failure to have access to something important to you, see if there may be another way to achieve what you desire. Get counsel and try to research the problem. There are instances where the depressed person has unreal seIf- expectancy, almost intentionally assuring his or her own defeat by setting perfectionist goals or standards; and sometimes one may find seIf trying to live up to goals that have been set for him or her by others.
5. If you are depressed because of guilt (either for something you have done, or because of something you should have done), then make whatever confession, adjustments, or changes you may need to make. Resolve in the future to do your duty and keep your word.
6. If you are depressed because you feel you are a failure, no good, that you have nothing to offer; then make a list of the things you can do, followed up with a list of people you can serve in ways consistent with your abilities, and begin doing something for someone else. You do have abilities, and you are needed! Someone has said, “God don’t make no junk!
7. If you have gradually cut yourseIf off from people (even your own family), then start making a conscious effort to be with people. Either plan or join family activities. Join a club, become active at church, volunteer to work in a worthy group cause, invite people into your home, take them out to dinner, give sympathy and comfort to help those who are grieving .
8. One good way to rebuild sagging seIf—esteem is to add something to yourseIf. Take a course, read a helpful book, learn to play a sport, achieve a new skill, or do anything to get off dead-center.
9. Check to see if you are enjoying your depression, if it has become a kind of crutch for you, your excuse for not achieving (the loser’s limp). If you find this is true, then refuse to let yourseIf get away with it any longer. You do not have to be depressed in this instance, it is a matter of choice.
l0. Start heading off depression before it gets its hold on you. When you see it coming, get your hair cut, go to a movie, call a friend, go shopping . Activity and company are the enemies of depression. Depression wants to stop you and all of your positive activities and get you alone. Like a vicious predator, it wants to get you away from the pack!
11. At its worst, depression wants to eliminate you.it wants to kill you. If you have suicidal feelings you must tell others near you, and get the help that you need immediately. Jumping out of the frying pan into the fire is not a solution you can live or die with.
12. Above all, when your feelings are negative, you so not have to cooperate with them. While feelings do not obey commands, they can be changed by actions. That is why Christ could command us to love our enemies (Matthew 5:44). You do not start this process with strong positive feelings toward an enemy! Instead, you start with the will to love your enemy, and then you begin doing the acts of love that your will demands. In time, feelings change to coincide with your actions. Thank the Lord that we can decide the way we want to feel by doing what it will take to make our feelings become what we want them to be! We have the choice! We can let our feelings dictate our actions, or we can by our actions control our feelings.
1. We are made in God’s image. We are His children. Innate to us is
the nature of God and of greatness. We are persons of inestimable value. We are nobility. "See how great a love the Father has bestowed upon us, that we should be called children of God; and such we are!" (1 John 3:1).
2. God is in control, and has promised that those who love Him, and
are following Him, will experience that EVERYTHING will work to their good (either physically or spiritually or both), in even the most negative of things. "And we know that God causes all things to work together for good to those who love God, to those who are called according to His purpose." (Romans 8:28).
3. Because we are surrounded by the love of God, nothing can defeat
us! "Who shall separate us from the love of Christ? Shall tribulation, or distress, or persecution, or famine, or nakedness, or peril or sword? . But in all these things we overwhelmingly conquer through Him who loved us." (Romans 8:36,37).
4. God exercises a control whereby problems are held in
properdimension so that they will not exceed our ability (with God’s help!) to cope. “No temptation (trial) has overtaken you but such as is common to man; and God is faithful, who will not allow you to be tempted beyond what you are able, but with the temptation will
provide the way of escape also, that you may be able to endure it.” (1 Corinthians 10:13).
5. Therefore, we can be thankful even for our trails and problems
because we know they will not be allowed to destroy us, and also that they will become a means of greater spiritual (and usually material) progress. "Consider it all joy, my brethren, when you encounter various trials, know that the testing of your faith produces endurance. And let endurance have it perfect result, that you may be perfect and complete lacking in nothing." (James 1:2-4). . `
6. We all have gifts from God which if used will lead to more, which
means no one of us is good for nothing! "However, each man (and woman) has his (her) own gift from God, one in this manner, and another in that."(l Corinthians 7:7). "For to everyone who has (who uses his gifts) shall more be given, and he shall have an abundance; but from the one who does not have (who does not use his gifts), even what he does have shall be taken away." (Matthew 25:29).
7. God will empower us to do all that is in His will for us to do. "I
can do all things through Him who strengthens me." (Philippians 4:13). "Now to Him who is able to do exceeding abundantly beyond all that we ask or think, according to the power that works within us, to Him be the glory in the church and in Christ Jesus to all generations forever and ever. Amen." (Ephesians 3:20-21).
8. When we do wrong, we have forgiveness when we repent. When
we have been forgiven, God will not bring it up again. "And their sins and their lawless deeds I will remember no more. Now, where there is forgiveness of these things, there is no longer any offering for sin." (Hebrews 10:17-18).
9. Under God’s care, we are challenged to live happily and fully a day
at a time without trying to "bite off" the future. “Therefore do not be anxious for tomorrow; for tomorrow will care for itseIf. Each day has enough trouble of its own." (Matthew 6:34).
In those moments of depression, seek the comfort that
comes from God! Paul did! "But God, who comforts the depressed, comforted us by the coming of Titus." (2 Corinthians 7:6).
Psychiatric CLASS OUTLINE -- WEEK ONE Discussion/Lecture: Review of Important Concepts from Chapters 5, 9, 10, 11. Please follow your Lecture Outlines in the “Lecture Notes” in the Syllabus. Ch. 4: Psych MH Care in Acute Care Settings Ch. 8: Nursing Process and Standards of Care Ch. 9: Therapeutic Relationships Ch. 10: Communication and the Clinical Interview Note: Read each c
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