October '23 - Depression Awareness

[Polegnyn Nemeara]

How does it differ from mood swings?

I seem to have picked up this ... saying? ... that goes "If you can tell you're depressed, then you're most likely not depressed". Any truth to this? Can a depressed person tell if they are depressed, or are they aware enough of their mental health state to be able to discern if they are depressed or not. And because this ability remains, they are not depressed.

I don't know where it came from, honestly, and I don't use it as a litmus test for anyone but myself during a rough patch. Probably why it's remained in my head so long... I'd love everyone's input whether to evict the thought, though. Has anyone else heard it before?

You all experience depression and are able to bravely talk about it openly so it seems like the thought is silly and needs to be quieted.

 

[Catt Heckathorne]

I think that a fair bit of that comes from certain ideas in the psychiatric field where people may not be able to tell when they're experiencing symptoms of their disorders when they first enter care, and a fair bit of it also comes from psychiatric practitioners who think they are the ones best suited to determine what someone is experiencing based on symptoms. However, with a LOT of work you absolutely can get to the point where it's easier to tell when symptoms are getting bad, and if you know your DSM and have a diagnosis it's even easier. Kinda like when you hear about people with cystic fibrosis being able to immediately tell when they might need antibiotics versus a normal person with a regular lung infection, it's hard to tell if you're not always constantly aware of your symptoms. A lot of that saying might also come from a specific perspective that mental disorders don't exist/cannot exist and therefore are taboo to talk about. Breaking down barriers by education about depression and other mental disorders is an excellent way to understand that mental disorders can happen to anyone and the best thing to do is to be willing to learn about them and understand them.

I can absolutely tell when I'm getting into a depression funk, and at this point I can often identify what kind of depression it is. This weekend it has been a combo of SAD, PMDD, and general depression disorder all at once. They all have very nuanced symptoms and triggers, but with the right kind of therapy or other self care work you can identify the symptoms pretty quickly, and that means it's easier to get out of the deep dark depression junk.

 

[Satara al'Caelahn]

I seem to have picked up this ... saying? ... that goes "If you can tell you're depressed, then you're most likely not depressed". Any truth to this? Can a depressed person tell if they are depressed, or are they aware enough of their mental health state to be able to discern if they are depressed or not. And because this ability remains, they are not depressed.

I don't know where it came from, honestly, and I don't use it as a litmus test for anyone but myself during a rough patch. Probably why it's remained in my head so long... I'd love everyone's input whether to evict the thought, though. Has anyone else heard it before?

You all experience depression and are able to bravely talk about it openly so it seems like the thought is silly and needs to be quieted.

I'm just going to speak from my own experience here, so take from it what you will. I'm not an expert.

For me, it boils down to self awareness and how many questions you're asking yourself about your mental health. On the one hand, I see myself as someone with more self awareness than most, and even then I had trouble admitting to myself that I was struggling with depression. It's not that I didn't recognize the symptoms and the struggles, but I'd always chalk it up to something else (which is easy when I also have ADHD which has certain sets of symptoms that can overlap with many depression symptoms.) But on the other hand, I am aware of where my struggles are. There are certain red flags that I keep searching for within myself. Activities that I no longer want to participate in, people that I've pushed away, many days in a row where I accomplish nothing besides existing.

But I'm a firm believer that knowing that something's wrong, recognizing it, and admitting it doesn't make it just go away. I know I have ADHD but that's not going to make my neuroreceptors function better. It's not going to increase my dopamine levels. The same is true for depression. You can know that you're struggling and even know why, but that doesn't make it simply disappear. It might give you some understanding and perspective, and hopefully a starting point to figure out what kind of treatment works for you, but knowledge doesn't make the problem just poof.

 

[Ruslan Rynar]

But I'm a firm believer that knowing that something's wrong, recognizing it, and admitting it doesn't make it just go away. I know I have ADHD but that's not going to make my neuroreceptors function better. It's not going to increase my dopamine levels. The same is true for depression. You can know that you're struggling and even know why, but that doesn't make it simply disappear. It might give you some understanding and perspective, and hopefully a starting point to figure out what kind of treatment works for you, but knowledge doesn't make the problem just poof.

This is so true, at least for me. In my experience, it is very hard to get people without depression to understand that simply knowing the problem and even how to fix the problem does not necessarily lead to fixing the problem. People can get stuck in their depression/depressive episode, and it can take quite a bit to claw one's way back out.

 

[Catt Heckathorne]

I saw this the other day. It's a really good example of how exhausting a simple, basic task can be with depression or other disorder on a bad brain day.

 

[Polegnyn Nemeara]

How is Depression depicted in popular culture?​

From television to YouTube, depiction of depression is depicted in a myriad of negative ways. While there are some positives, namely celebrities speaking out about their own struggles with mental health and deeper awareness and understanding by society as a whole, these conditions are not as stigmatized as they once were. Source: Centres For Health and Learning, https://cfhh.ca/blog/how-pop-culture-has-helped-reduce-the-stigma-of-mental-illness/

One may have also heard Eeyore mentioned during their educational journey or conversations about depression. Why? All the core Winnie the Pooh characters are used to represent facets of mental health. Eeyore, in particular, is representative of having a major depressive disorder. Despite this, he is still supported and included in his friends' adventures when he feels the desire to participate. Read more: https://www.abmhealthservices.com/winnie-the-pooh-mental-health/

How does everyone feel about how Depression is portrayed in the WoT books/show/either?

 

[Catt Heckathorne]

I think Perrin's portrayal is probably the closest, especially in the show. Trying to do this as spoiler free as possible--the catalyst is the death of someone close to him in the Two Rivers during the Winternight raid, and I really appreciate how the show portrays his reaction to that event and interaction with almost a PTSD situation beyond that night. But even in Min's case in the show, there is the PTSD/trauma catalyst, which helps show that they weren't just like that and that something major triggered it. It's helpful in that it's saying to viewers that it's not because of a lack of religious awareness or some other notion that a lack of spiritual or social strength causes it.

 

[Satara al'Caelahn]

Honestly, I've been looking more at the over-arching themes in the show. For me, seeing it on TV really highlights some of the underlying currents from the books in regards to the Dark vs. Light battle, especially when it comes to Ishamael and his motivations for serving the Dark One.

I don't think it's too much of a spoiler to say that multiple people in the show talk about the Dark One's desire to stop the Wheel from turning and to stop people from being reborn and I think that really closely mirrors (TW) suicidal ideation and other depressive symptoms. It's like the Dark One, Forsaken, and all these Darkfriends (maybe not shadowspawn because they lack that humanity aspect) are all just so ovewhelmed by sadness, apathy, pain, fatigue, frustration, and hopelessness that they want it all to just stop and they're willing to cause pain to see that happen.

I think it's really meant to play on real feelings that people watching or reading might be experiencing and to make it relatable. When it's put into that context, it's easier to see how people might be tempted to swear to the Dark.

 

[Calen Velervron]

This should be interesting. I have fought off depression for most of my adult life. Usually, I am really pretty good at it. I just get used to being sad at a simmer level. Its kinda like you are always sad, but it doesn't hurt so much. In college, I tried to overdose and end my life, after that happened, I got into therapy and on some meds that helped. I started to feel better and was able to deal.

A few Saturday's ago, I was driving to work. I notice now looking back that it was my 56th day in a row of working without any time off. I have always been someone who worked a lot, but I think even I lost track this time. I think especially before my current life situation, so much of my self worth came from my job or my education- that work was how I got through things. So I am driving to one of the satellite offices. I start to sweat profusly in my car and my legs start shaking. I start to get dizzy and then I have to pull over to the side of the road. When I got parked, my jaw started crushing together, involuntarily- it was hard to breathe.

So, instead of work, I headed to the ER. After many tests, and much concern about my 200+ blood pressure in that moment. I was told I had an acute panic attack. I am now being treated for it, and trying different medication. This was the single scariest reaction my body ever had. I knew as I got older that I would not be able to shrug stuff off so easy, but boy did it teach me.

Work let me go on some mental health leave so I have a flex schedule through Christmas. They are trying to avoid me burning out. But Depression hurts... I wish people who didnt suffer it could understand that there is a price you pay. You aren't just sad.

 

[Catt Heckathorne]

Oh, Calen. I'm so glad you got help, panic attacks are scary and no fun.

I think that overall, the big issue I continually see with depression in at least Western society is that it's treated as the person has some kind of mental failing. The most common misconception seems to be they're doing something sinful or there is some other religious or moral failing in their life. It's classed as a mental disorder but it should really be classed as a physical illness, because it affects so many physical body systems and so often things don't improve unless you take meds to make the symptoms improve.

 

[Satara al'Caelahn]

Calen. Panic attacks literally feel like you're dying and I hate that for you.

You aren't just sad.

This.

 

[Alora Sionn]

It's classed as a mental disorder but it should really be classed as a physical illness, because it affects so many physical body systems

This is so true, mind and body are linked and can affect each other. Stress and emotional states cause flare ups in auto immune disorders as one example, damage isn’t just limited to mental and emotional but pretty much affects multiple aspects of life, body, relationships etc. just like any illness there’s no shame in getting help

 

[Catt Heckathorne]

I also wish that there was a more appropriate way to describe depression other than just being "sad". In my experience that's not even close to describing it. "Sad" symptoms are from the overwhelming nature, but they are not the entirety of the symptom set. I wish there was a way to convey how heavy everything feels and how exhausting it is to just breathe some days, or trying to make appointments at the right time of day so you don't burn yourself out trying to get to an 8 AM appointment but also so you're not in paralysis mode because the appointment is after noon, or the annoyance of someone shouting across the car park you'd look prettier if you smiled but depression gave you a resting b*tch face and no energy to deal with such nonsense anyway.

 

[Ruslan Rynar]

Depression doesn't even need to have a sadness component.

I also wish that there was a more appropriate way to describe depression other than just being "sad". In my experience that's not even close to describing it. "Sad" symptoms are from the overwhelming nature, but they are not the entirety of the symptom set. I wish there was a way to convey how heavy everything feels and how exhausting it is to just breathe some days, or trying to make appointments at the right time of day so you don't burn yourself out trying to get to an 8 AM appointment but also so you're not in paralysis mode because the appointment is after noon, or the annoyance of someone shouting across the car park you'd look prettier if you smiled but depression gave you a resting b*tch face and no energy to deal with such nonsense anyway.

+1 on every level. Wonderful post.

 

[Polegnyn Nemeara]

Thank you all for sharing your experience with depression and insight regarding what you have learned about it. So glad you chose not to go into work, @Calen Velervron (Side note: for text-only readers, this emoticon reference code does not match the way this emoticon is used. Should be a distressed reaction. Not "oh well"...)

I saw this the other day. It's a really good example of how exhausting a simple, basic task can be with depression or other disorder on a bad brain day.

This is a great illustration and makes it easy to see how easy it is to be overwhelmed when every task is like this. Thank you for sharing

I think that overall, the big issue I continually see with depression in at least Western society is that it's treated as the person has some kind of mental failing. The most common misconception seems to be they're doing something sinful or there is some other religious or moral failing in their life. It's classed as a mental disorder but it should really be classed as a physical illness, because it affects so many physical body systems and so often things don't improve unless you take meds to make the symptoms improve.

Thank you for mentioning the physical aspect of depression as well, Catt&. It truly is not limited to emotional and mental aspects. I hope you don't mind your post being used as a segue into the next discussion topic. Do feel free to continue the discussion out of order, everyone.
__

What happens to the brain during a depressive episode?​

(Thank you, @Nebka Galyn!)

When you suffer from depression, your brain is physically changed. Research by the National Institutes of Health shows that you lose gray matter volume (GMV) when you suffer from depression. This loss is caused by parts of your brain shrinking due to the hormone cortisol impeding the growth of your brain cells.

The more serious depression a person suffers, the more GMV they lose. Since GMV contains most of your neurons or nerve cells, slowed growth means that your cognitive capabilities are at risk of impairment.

A depressed person’s brain goes through many changes due to the influx of brain chemicals and loss of matter. In this section, we break down the three major things that happen to a depressed person’s brain.

• Shrinkage Of Several Brain Regions​

  One of the most common changes seen in a depressed patient’s brain is shrinkage, especially in the hippocampus, thalamus, frontal cortex, and prefrontal cortex. How much these brain areas shrink depends on the length and severity of your depression.
  
  A chemical imbalance caused by the hormone cortisol is what triggers this shrinkage. Depression causes the hippocampus to raise its cortisol levels, impeding the development of neurons in your brain. The shrinkage of brain circuits is closely connected to the reduction of the affected part’s function.
  
  While other cerebral areas shrink due to high levels of cortisol, the amygdala enlarges. The amygdala controls emotion, so this may cause issues like sleep disturbances, mood swings, and other hormone-related problems. An enlarged amygdala is also linked to the development of bipolar disorder.

• Brain Inflammation​

  Major depression is linked to cerebral inflammation. While there’s no solid evidence from experts on whether depression causes cerebral inflammation or vice versa, researchers have posited that these two are closely linked. Studies found that people who have suffered depression for over ten years experience 30% more cerebral inflammation compared to those who suffer from a shorter period of depression.
  
  Since cerebral inflammation kills neurons, it can lead to many complications. The death of neurons and neurotransmitters may lead to shrinkage as well as reduce a person’s neuroplasticity – the ability of brains to change as the person ages. Since new neurons and neurotransmitters will have a tougher time growing, this leads to cognitive problems in the affected person.

• Restricted Oxygen Intake​

  Although researchers have yet to prove a conclusive link, major depression may reduce your oxygen intake. The leading theory is that depression induces a change in your breathing patterns, which can lead to oxygen restriction or hypoxia.
  
  Even minor hypoxia can impede your cerebral function. People who suffer from minor hypoxia exhibit poor judgment, a decrease in motor skills, and memory loss. If sustained for long periods, reduced oxygen intake can lead to inflammation and brain cell damage.

Source: https://www.transformationstreatment.center/treatment/what-happens-to-the-brain-during-depression/

 

[Catt Heckathorne]

I saw this the other day. It's a really good example of how exhausting a simple, basic task can be with depression or other disorder on a bad brain day.

Just realized that the author of this comic forgot to include the whole after bit about washing dishes....

 

[Polegnyn Nemeara]

When to call a professional?​

If you or someone you love is showing signs of depression, please at least reach out to them. Show you care and support them. It is recommended they contact a professional after two weeks of experiencing depressive symptoms. According to the Mayo Clinic, indication of depression can vary from person to person but may or may not include:

• Feelings of sadness, tearfulness, emptiness or hopelessness.
• Angry outbursts, irritability or frustration, even over small matters.
• Loss of interest or pleasure in most or all normal activities, such as sex, hobbies or sports.
• Sleeping too little or too much.
• Tiredness and lack of energy, so even small tasks take extra effort.
• Reduced appetite and weight loss or increased appetite and weight gain.
• Physical problems that can't be explained, such as back pain or headaches.
• Anxiety, restlessness or nervousness.
• Slowed thinking, speaking or body movements.
• Feelings of worthlessness or guilt, focusing on past failures, or blaming yourself for things that aren't your responsibility.
• Trouble thinking, concentrating, making decisions and remembering things.
• Spoiler: In case this is triggering

  Frequent or repeated mention of not wanting to live, suicidal thoughts, suicide attempts or suicide.

Source: Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/depression/in-depth/depression/art-20045943

What, if anything, can be done to alleviate/mitigate depression?​

Once a decision to be treated for depression has been made, your doctor may determine a diagnosis of depression based on:

• Physical exam. Your doctor may do a physical exam and ask questions about your health. In some cases, depression may be linked to an underlying physical health problem.
• Lab tests. For example, your doctor may do a blood test called a complete blood count or test your thyroid to make sure it's functioning properly.
• Psychiatric evaluation. Your mental health professional asks about your symptoms, thoughts, feelings and behavior patterns. You may be asked to fill out a questionnaire to help answer these questions.
• DSM-5. Your mental health professional may use the criteria for depression listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.

Source: Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/depression/diagnosis-treatment/drc-20356013

Oftentimes, psychotherapy may also be suggested. There are a variety of psychotherapies available so a psychiatric evaluation will be conducted to help figure out which would be a good starting point. These, along with a brief description of each, are linked for convenience.

In addition to prescription medication and psychotherapy, the United Kingdom's National Health Services suggests the following self-help ways to ease depression symptoms:

Stay in touch with a peer group as socializing can help raise one’s mood.
Be active. Exercise helps circulate fluids throughout the body and can release serotonin. Even a short walk is better than nothing at all.
Try not to avoid difficult things. Depression affects one’s desire to do things we once loved to do. This can snowball into a loss of confidence and difficult things may seem even harder.
Avoid drinking too much alcohol, especially as a coping mechanism or a way to fill time.
Having and sticking to a routine will also keep one’s body in sync with usual times to eat, exercise, and sleep.

These things will not cure depression, but hopefully ease it and help propel one through a depressive episode in addition to medication and/or psychotherapy.

Having shared that, we have already learned that one's miles may vary when it comes to the NHS' (and other institution's) suggestions. Linked to from earlier conversation, the following experiences have been shared when it comes to similar suggestions:

Lillian's insight
Cattrin's insight and here
Satara's insight

How can I help someone with depression?​

The Mayo Clinic and the U.S. Department of Health and Human Services offer pages full of helpful ways to support someone with depression so links have simply been provided: https://www.mayoclinic.org/diseases-conditions/depression/in-depth/depression/art-20045943
https://health.gov/myhealthfinder/healthy-living/mental-health-and-relationships/depression-conversation-starters

Bottom line: be involved and be proactive.

General Resources -​

• Depression & Bipolar Support Alliance - DBSA
• Families for Depression Awareness
• My Depression Team
• Anxiety and Depression Association of America - ADAA
• Psycom
• National Alliance on Mental Health - NAMI
• U-M Depression Toolkit

What did we fail to mention during this month's focus?

 

[Catt Heckathorne]

One thing I forgot about until this week is kind of important and one that people don't think about very much.

If you take medication for depression there are some contraindications to keep in mind. Virtually all psych medications can raise serotonin levels to induce something called serotonin syndrome, which can be dangerous. This can happen most commonly with cold & flu and allergy medications. I've been lucky enough to be able to find a decongestant medicine that tends to not enter the blood stream in the same way as regular decongestants do--flonase--so that has been an absolute godsend this year to be able to actually use decongestant medicine when I need it.

Additionally, if you take MAOI (monoamine inhibitor) antidepressants, you need to be mindful of tyramine levels in food. Tyramine is an amino acid that forms in aged and cured food, and there are indications that this can become dangerous even if you eat day old leftovers. Symptoms can range from blood pressure problems to raging migraines. While there are a variety of antidepressants available, unfortunately there are times when MAOIs are the only option that can work to keep someone out of the danger zone of depression and anxiety.

For more about tyramine:

Avoid the combination of high-tyramine foods and MAOIs

A low-tyramine diet is important for anyone taking MAOIs.

www.mayoclinic.org

For more about serotonin syndrome: https://www.mayoclinic.org/diseases-conditions/serotonin-syndrome/symptoms-causes/syc-2035475

Finally, one of the most frustrating problems of antidepressants--even the herbal ones that affect neurotransmitters in similar ways as traditional pharmaceutical medicine--I wasn't aware of is that heartburn that doesn't clear up with medication or diet change is a very real side effect.

If you are contemplating taking medication for depression symptoms it is always a good idea to be informed, but do not let side effects take away from the quality of life that psychiatric medicine can give you!