Often the call starts with a tentative voice on the line saying “ I don’t know if this is really something that I need to see someone for…” The pauses and hesitations do little to hide the pain in the woman’s voice. I know how much courage it takes to pick up the phone and call me……… I am a therapist. Calling any therapist means a step to acknowledging that there is something wrong – either with her or in her life – and that is scary. There is also the uncertainty about the investment of time and money and would it help.
Sadness is an emotion that is part of the human condition. It is a natural reaction to life’s circumstances. Sometimes we can recognize what triggered the feeling and sometimes we can’t. It’s normal to have days where you may have less patience with your children or find yourself moody. There may be days where you don’t feel like getting out of bed to start your day. These days pass.
Someone who is experiencing an episode of depression experiences the world differently from before they were depressed. During a depressive episode the world seems like a dark place. The person feels like the weight of the world is on their shoulders. Relationships that were meaningful and loving now seem empty. The depressed person begins to question everything in their life as well as their decisions. Is this the right job for me? Am I a good mother? She loses interest in meeting with or talking to her family and friends. She loses interest in the things she enjoyed before. Sometimes the changes are slow and subtle so that the people around her don’t notice.
Most people seem to have a basic understanding of depression as a deep and unremitting sadness. They imagine that people who are depressed can’t get out of bed, can’t take care of their family or work obligations and may even become suicidal and require hospitalization. This represents only the more extreme experiences of depression. And thank G-d, most people don’t experience depression to this degree. Most people who are experiencing a depression are working, taking care of their children and family and for all outside appearances are doing just fine. The toll depression takes is on the inside.
The women describe how hard it is to keep up the impression that all is well. They struggle with being irritable at and yelling at their children. They find themselves annoyed with their husbands about things that never bothered them before. They have trouble shutting down to go to sleep at night. Maybe they lost their appetite. They begin to doubt themselves. Stop accepting invitations. They can’t seem to remember ever feeling good. Their life history seems rewritten as they remember only the bad things and not the good.
When they get to this point – its difficult to remember ever feeling well. What they are experiencing during this episode feels totally real and any evidence to the contrary is dismissed. If during the episode, the woman begins to feel unloved, if someone reminds her of the closeness she had with her husband, she believes that that wasn’t real. Her brain – at that moment in time – is telling her that those emotions don’t exist. She can’t remember feeling different.
Often well-meaning friends offer advice and suggestions which may make her feel worse. They encourage her to get out more, to exercise, to do chesed, daven more. Often, the advice only makes her feel more misunderstood and isolated. She may feel ashamed that she is having these feelings – when she cant explain why.
While depression will often occur following a time of stress – such as a new birth, a move from one town to another, death of a loved one – often there is no event to point to as a trigger. While the depressive episode will usually pass in time, there is a possibility that the symptoms will worsen and then become more difficult to treat. In addition, a person who experiences an untreated depressive episode is more likely to have a recurrence in the future.
The first recommendation that people make is to improve self care- try to get more sleep, don’t skip meals, exercise, get out more. While this is good advice, someone with mild to moderate depression may not be able to mobilize themselves to act. The essence of depression is the feeling of pessimism that “ I will always feel like this”, “nothing will change” – a sense of hopelessness.
A form of psychotherapy called Cognitive Behavior Therapy, has been found to be effective in over 1000 outcome studies. Studies have evaluated its effectiveness as comparable to medication for mild to moderate depression. In cases of severe depression it has shown to have an added benefit to medication – raising the improvement rate. The basic idea in CBT is that our thoughts determine how we feel. So if our thoughts are negative and pessimistic – our emotions will be as well. If we feel negatively – it will influence our behaviors. The CBT therapist and client work as a team to identify what thoughts come to mind in situations that lead to the negative emotions and through examining and questioning these thoughts – learn to challenge and change them. The focus of CBT is on the here and now issues that the person is facing.
1 out of 5 people in the US experience depression in their lifetime. It’s hard to know when to keep trying on your own and when to seek help. My suggestion is to ask yourself, “how much is this effecting my life?” If the answer is “too much” - then its time to pick up a phone.
Sarah Schleifer, LCSW
