Medical Helping others with depression

[Borg]

I've heard the following logic from people who are depressed and I'm wondering how others would answer it.

I'm depressed so I try telling myself that I shouldn't feel so bad because there are others who are worse off than me. But, it doesn't help and I still feel depressed - which makes me feel even more depressed.

How do you deal with this logic?

 

[waht]

Depression is unique for every individual. I don't think there is anything you can say but encourage to stay positive. Also, have them pick up rigorous physical exercises to get the endorphins flowing.

 

[hypatia]

I don't believe one{a friend} can deal with that logic. Sometimes professional help is needed. When one of my friends is feeling depressed, I just hang out with them, maybe go for a walk or see a movie.

 

[f95toli]

I don't think there is anything you can say but encourage to stay positive

Actually, you have to be careful about telling someone that is depressed to "stay positive". There is a real risk that you make him/her feel guilty because they are depressed. One can of course still try to help them see things in a more positive light when possible (e.g. "No one cares about me", well tell him/her YOU care) but the risk is always that the person in question might put on a brave face but stay depressed.

Also, to answer the OP: Logic has nothing to do with it. People get depressed for many different reasons, but there is rarely any correlation between how bad a situation really is in "objective" and how deep the depression is. If possible try to make the person understand that.
In my experience all one can do is to make sure that the person in question knows that there is nothing wrong with being depressed and be as supportive as possible.

If the situation gets really bad one should encourage them to seek professional help. There are too many people walking around with depressions that never seek help because they are afraid of being labeled as "crazy".

 

[Borg]

Actually, you have to be careful about telling someone that is depressed to "stay positive". There is a real risk that you make him/her feel guilty because they are depressed. One can of course still try to help them see things in a more positive light when possible (e.g. "No one cares about me", well tell him/her YOU care) but the risk is always that the person in question might put on a brave face but stay depressed.

Also, to answer the OP: Logic has nothing to do with it. People get depressed for many different reasons, but there is rarely any correlation between how bad a situation really is in "objective" and how deep the depression is. If possible try to make the person understand that.
In my experience all one can do is to make sure that the person in question knows that there is nothing wrong with being depressed and be as supportive as possible.

If the situation gets really bad one should encourage them to seek professional help. There are too many people walking around with depressions that never seek help because they are afraid of being labeled as "crazy".

Thanks for the replies. I usually try to emphasize that most people go though some sort of depression at one point or another in their life and that things usually get better - with the usual advise to seek help if it doesn't.

My original post is more of a general question than anything else. I haven't had anyone tell me this phrase recently but, I have heard the same thing from different people over the years. None of them has been severely depressed from what I could tell - probably closer to melancholy. I've always found it odd that different people would explore the same 'logic' in an attempt to deal with it.

 

[Galteeth]

I've heard the following logic from people who are depressed and I'm wondering how others would answer it.

I'm depressed so I try telling myself that I shouldn't feel so bad because there are others who are worse off than me. But, it doesn't help and I still feel depressed - which makes me feel even more depressed.

How do you deal with this logic?

I would say that if they re experiencing depression in the chronic medical sense, help them realize they're thoughts relating to emotional states are not going to lead them to a productive place (you're not going to "outhink" depression), and encourage them to learn more about their condition and seek treatment.

 

[rainbow93]

Depression doesn't make sense. A lot of it is just in the mind. It can be really, really hard for your friend to believe that things can get better, but they can. Just being for them unconditionally can mean a lot.

 

[Evo]

Depression doesn't make sense. A lot of it is just in the mind. It can be really, really hard for your friend to believe that things can get better, but they can. Just being for them unconditionally can mean a lot.

Clinical depression is usually caused by a chemical imbalance in the brain. These people have wonderful lives, (in many cases) have no problems, but are severly depressed. It's when a person has no reason to be depressed that it's usually considered clinical depression (depression without an apparent external cause) Usually these people can be helped with anti-depressants to treat the chemical imbalance.

Sadness or despair about a situation is not clinical depression.

 

[Jasongreat]

I have a brother that has been diagnosed with depression, he actually tried to take a bunch of pills and end it all a few years ago. From what I've noticed, it isn't so much if he has a positive or negative outlook on life, its more about worrying about things he has no control over which gives him his negative outlook. That is a very dangerous thing to do imo since if he has no way to change the circumstances into his favor, no way to solve the problem, he gets the feeling that why should I go on if it isn't possible to be happy. He used to allow peoples actions to take control of his life, he would sit around and just let himself get worked up over things that imo should just be forgotten about or atleast ignored. It's also very hard to talk him into just letting things go but once he does you can see his attitude change 180 degrees instantly.
The thing that scares me is when he is on his anti-depressants, since I have yet to see one advertised that suicidal thoughts isn't one of the side effects. It seems strange to me to prescribe a drug, to a segment of society, that has a side effect that is the thing they are trying to prevent but I am in no way trying to say that people should stop taking their medication, do what the doctor says.
I do agree with rainbow93, the thing that seems to help him the most is to be there when he needs to vent. For example he called today worked up about work, he was feeling under appreciated. He was just given a lot more responsibilty but not much more pay, he said that he was pissed they didnt offer him more money but he also stated that he wouldn't have taken it any way(he works for an uncles dealership) but it would of made him feel like they appreciated him more. I pointed out that if he wasnt going to take the bigger raise anyway it didnt seem logical to me to be pissed that they didnt offer it. So far he seems to be feeling better but I'm sure we are going to be revisiting this topic a few more times this weekend before he heads back home and I am glad to do so.

Disclaimer: All my observations are just that, observations I have no medical training and nothing I have said should be taken as me recommending any action. I only have experience with one or two people with depression so I am in no way a credible diagnostic technician. Please follow your doctors advice.

 

[Galteeth]

I have a brother that has been diagnosed with depression, he actually tried to take a bunch of pills and end it all a few years ago. From what I've noticed, it isn't so much if he has a positive or negative outlook on life, its more about worrying about things he has no control over which gives him his negative outlook. That is a very dangerous thing to do imo since if he has no way to change the circumstances into his favor, no way to solve the problem, he gets the feeling that why should I go on if it isn't possible to be happy. He used to allow peoples actions to take control of his life, he would sit around and just let himself get worked up over things that imo should just be forgotten about or atleast ignored. It's also very hard to talk him into just letting things go but once he does you can see his attitude change 180 degrees instantly.
The thing that scares me is when he is on his anti-depressants, since I have yet to see one advertised that suicidal thoughts isn't one of the side effects. It seems strange to me to prescribe a drug, to a segment of society, that has a side effect that is the thing they are trying to prevent but I am in no way trying to say that people should stop taking their medication, do what the doctor says.
I do agree with rainbow93, the thing that seems to help him the most is to be there when he needs to vent. For example he called today worked up about work, he was feeling under appreciated. He was just given a lot more responsibilty but not much more pay, he said that he was pissed they didnt offer him more money but he also stated that he wouldn't have taken it any way(he works for an uncles dealership) but it would of made him feel like they appreciated him more. I pointed out that if he wasnt going to take the bigger raise anyway it didnt seem logical to me to be pissed that they didnt offer it. So far he seems to be feeling better but I'm sure we are going to be revisiting this topic a few more times this weekend before he heads back home and I am glad to do so.

Disclaimer: All my observations are just that, observations I have no medical training and nothing I have said should be taken as me recommending any action. I only have experience with one or two people with depression so I am in no way a credible diagnostic technician. Please follow your doctors advice.

There is a subset of depression referred to as "atypical" depression which is characterized by mood reactivity, hypersomnolence, and increased appetite. This has somewhat different treatment indication then "conventional" depression.

 

[denverdoc]

I have a brother that has been diagnosed with depression, he actually tried to take a bunch of pills and end it all a few years ago. From what I've noticed, it isn't so much if he has a positive or negative outlook on life, its more about worrying about things he has no control over which gives him his negative outlook. That is a very dangerous thing to do imo since if he has no way to change the circumstances into his favor, no way to solve the problem, he gets the feeling that why should I go on if it isn't possible to be happy. He used to allow peoples actions to take control of his life, he would sit around and just let himself get worked up over things that imo should just be forgotten about or atleast ignored. It's also very hard to talk him into just letting things go but once he does you can see his attitude change 180 degrees instantly.
The thing that scares me is when he is on his anti-depressants, since I have yet to see one advertised that suicidal thoughts isn't one of the side effects. It seems strange to me to prescribe a drug, to a segment of society, that has a side effect that is the thing they are trying to prevent but I am in no way trying to say that people should stop taking their medication, do what the doctor says...

Disclaimer: All my observations are just that, observations I have no medical training and nothing I have said should be taken as me recommending any action. I only have experience with one or two people with depression so I am in no way a credible diagnostic technician. Please follow your doctors advice.

To what extent the possible anti-depressant side effect of suicidality is real or even the exact prevalence remains in my experience a conundrum. I have treated many patients with depression and believe it may have occurred in one or two cases. In the more unfortunate case, the young man had been seen in the ER and was started on the AD Zoloft. 9 days later he suicided. Does this mean that the AD caused the suicide? The answer depends on who you ask? The older literature postulates that there is an increased risk of suicide as people begin to respond, owing to the observation that many report increased motivational and energy levels before any subjective improvement in mood occurs. The notion is that they may have been suicidal before but were only able to act on the thought after they started to "improve."

More recent thinking is that many of these patients may be in fact undiagnosed patients with bipolar illness instead of unipolar depression. This population is at greater risk for adverse AD related events, and some psychiatrists feel strongly that under no circumstances should they ever be given an antidepressant, as it may lead to more rapid and severe mood swings, which carries with it a much amplified risk of suicide.

The other issue to keep squarely in sight is that suicide is a risk associated with depression of whatever type--unipolar or bipolar. So it is not unreasonable to expect suicides in this population whether they have been given AD's or not. Its somewhat like the H1N1/vaccine thread--it is relatively easy to demonstrate that AD's generally save lives, and that the few cases of suicide which may or may not be the result of AD therapy, is dwarfed by the positive effects seen in the majority. Certainly great care and vigilance needs to be exercised during the first few weeks of therapy, starting with a careful discussion with the patient.

( BTW, the FDA has taken a somewhat simplistic approach IMHO that may do more harm than good in pointing out these risks in the form of black box label warnings. I hope that someone is keeping score re the number of adolescents who suicide as a result of not being treated wuth AD's because of concern over this possibility, versus those who are caused to suicide by the meds. Unfortunately, this decision seems to be based as much on politics as medicine. The Yale study which purported to show an association in children/adolescents was considered flawed by many, and other studies which didn't show such as association were ignored).

 

[Galteeth]

To what extent the possible anti-depressant side effect of suicidality is real or even the exact prevalence remains in my experience a conundrum. I have treated many patients with depression and believe it may have occurred in one or two cases. In the more unfortunate case, the young man had been seen in the ER and was started on the AD Zoloft. 9 days later he suicided. Does this mean that the AD caused the suicide? The answer depends on who you ask? The older literature postulates that there is an increased risk of suicide as people begin to respond, owing to the observation that many report increased motivational and energy levels before any subjective improvement in mood occurs. The notion is that they may have been suicidal before but were only able to act on the thought after they started to "improve."

More recent thinking is that many of these patients may be in fact undiagnosed patients with bipolar illness instead of unipolar depression. This population is at greater risk for adverse AD related events, and some psychiatrists feel strongly that under no circumstances should they ever be given an antidepressant, as it may lead to more rapid and severe mood swings, which carries with it a much amplified risk of suicide.

edit: It would be interesting to note how many of the ssri suicides occur in this window.


EDIT: It would be interesting to see how many of the SSRI suicides occur in this window.
The other issue to keep squarely in sight is that suicide is a risk associated with depression of whatever type--unipolar or bipolar. So it is not unreasonable to expect suicides in this population whether they have been given AD's or not. Its somewhat like the H1N1/vaccine thread--it is relatively easy to demonstrate that AD's generally save lives, and that the few cases of suicide which may or may not be the result of AD therapy, is dwarfed by the positive effects seen in the majority. Certainly great care and vigilance needs to be exercised during the first few weeks of therapy, starting with a careful discussion with the patient.

( BTW, the FDA has taken a somewhat simplistic approach IMHO that may do more harm than good in pointing out these risks in the form of black box label warnings. I hope that someone is keeping score re the number of adolescents who suicide as a result of not being treated wuth AD's because of concern over this possibility, versus those who are caused to suicide by the meds. Unfortunately, this decision seems to be based as much on politics as medicine. The Yale study which purported to show an association in children/adolescents was considered flawed by many, and other studies which didn't show such as association were ignored).

Something else to consider is that ssris, due to increased stimulation of the 5ht autoreceptor, may lower serotonergic activity before the autoreceptors downregulate.

 

[Galteeth]

Something else to consider is that ssris, due to increased stimulation of the 5ht autoreceptor, may lower serotonergic activity before the autoreceptors downregulate.

My point was about the suicides. It would be interesting to look at how many fall into this window.

 

[denverdoc]

My point was about the suicides. It would be interesting to look at how many fall into this window.

That is an interesting postulate--i wonder what the stats for Bupropion (lousy tho it may be) and MAOI's are. I have seen a fair amount of ECT and never seen a suicide during treatment (tho they are probably out there) which has led me to doubt the conventional wisdom re sick enuf to be suicidal, well enuf now to do it theory. Since the theory emerged prior to SSRI's--probably a risk of TCA's at least. IIRC, only one TCA, clomimpramine has much impact on 5-HT. But that is not to say a similar action might not occur at the NE receptors.

BTW, I no longer even believe bipolar and unipolar depression are different illnesses, only opposite ends of a spectrum with multifactorial causes and sensitivities. S

 

[Proton Soup]

BTW, I no longer even believe bipolar and unipolar depression are different illnesses, only opposite ends of a spectrum with multifactorial causes and sensitivities. S

any tips on achieving a state of hypomania ?

 

[denverdoc]

any tips on achieving a state of hypomania ?

LOL.

Short of illegal pharma, one can take antidepressants in a haphazard fashion, become sleep deprived (unfortunately short lived), or win a lotto/Nobel/election. Illegal substances remain the most reliable measure, hence their popularity.

 

[Galteeth]

That is an interesting postulate--i wonder what the stats for Bupropion (lousy tho it may be) and MAOI's are. I have seen a fair amount of ECT and never seen a suicide during treatment (tho they are probably out there) which has led me to doubt the conventional wisdom re sick enuf to be suicidal, well enuf now to do it theory. Since the theory emerged prior to SSRI's--probably a risk of TCA's at least. IIRC, only one TCA, clomimpramine has much impact on 5-HT. But that is not to say a similar action might not occur at the NE receptors.

BTW, I no longer even believe bipolar and unipolar depression are different illnesses, only opposite ends of a spectrum with multifactorial causes and sensitivities. S

In regards to clomimpramine, you mean on 5-ht1a right?

 

[Proton Soup]

LOL.

Short of illegal pharma, one can take antidepressants in a haphazard fashion, become sleep deprived (unfortunately short lived), or win a lotto/Nobel/election. Illegal substances remain the most reliable measure, hence their popularity.

thanks. that lotto option sounds best.

 

[denverdoc]

In regards to clomimpramine, you mean on 5-ht1a right?

Actually, I am not sure. I do know that of all the TCA's, it alone has anti-OCD effects (and may be better in this regard than SSRI's) and the fact that it has SSRI in addition to NSRI at least in part led to the belief that 5-HT pathways are crucial in the development of OCD. I trained during the introduction of SSRI's and remember just how good many of the older agents are, safety issues aside.

 

[Galteeth]

Actually, I am not sure. I do know that of all the TCA's, it alone has anti-OCD effects (and may be better in this regard than SSRI's) and the fact that it has SSRI in addition to NSRI at least in part led to the belief that 5-HT pathways are crucial in the development of OCD. I trained during the introduction of SSRI's and remember just how good many of the older agents are, safety issues aside.

OK. They all have some serotonergic antagonist action, clomimpramine ithe most, and it has great affinity for HT1A (the auto-receptor that inhibits serotonin release prior to its downregulation by treatment)