Kehler Counseling Blog
I'm going to start this with the fact that as much as I am a professional counselor I have dealt with depression in my personal life for decades. You will not get 'sunshine' and platitudes in this blog. You are going to learn what has worked in my own experience, my practice and with my loved ones.
Depression is serious. It can be deadly. It is the #1 mental illness that can cause death if untreated. 30% of the population of USA has been through a significant depression at least once in their life.
If you have been depressed, know someone close to you who is depressed or have a child or spouse who is suffering through a depression it can be equally as challenging to be around it. Do not under-estimate what the experience does to those nearby!
As a professional counselor I was taught that I should 'never treat more than 2 depressed clients at a time' - that is the warning to professionals - who are educated, equipped and 'all knowing' of the experience! I'm lucky in my practice - for over 20 years if I get through a day without at least 2 clients managing depressions. Imagine what a week brings. Then having a spouse, relative and/or friend suffering through one when you return home for the day . . . they call it 'compassion fatigue'.
It is draining, unrelenting, and can be overwhelming. There were days when screaming, crying and running away weren't enough - so I decided to listen to my own advice and get medication. After sitting for more sessions than I can count - seeing clients shift from absolute hopelessness, obsessive ruminating, non-stop negativity to loving, enthusiastic, inspired 'real selves' - I had to take a try. I was amazed at the results. I became a believer that medication does work. It is a chemical imbalance -that needs proper attention.
This is how I present the challenge of trying medications to clients who are very resistant to choosing medication to help their depression:
- I give the client 3 weeks - 1x a week sessions to 'prove' to me that they can 'work' through their mood, sadness, problem, issue without medication. If at the end of the 3rd session they feel better, have started incorporating other helpful strategies or followed through with 'non-chemical' interventions I don't encourage medicine. Some depressions are situational, hormonal, or based on environmental resources - that once shifted, added, removed or changed - the sadness, irritability or anger lifts. The person feels and acts empowered - and all is moving forward.
- I question the specific 'chemical/ biological' symptoms of depression that include:
- Insomnia - especially very early morning awakening and not being able to return to sleep (most common) - or sleeping 'all the time' or whenever possible - more than is necessary or average. Feeling fatigued all day.
- Welling up - very obvious reactive anger - feeling emotionally sensitive to any slight, issue or confrontation - even the smallest. Women tend to tear up, cry very easily, feel like 'emotional train wrecks' while men may hide tears but more often than not will explode, strike out, hit and break objects, yell - and 'expel' 'ugly' instead of crying. It's the change or difference that makes it 'clinical' rather than situational. It doesn't go away - it may hide. Often clients can 'contain' themselves at work or school but all hell breaks loose at home - where it's 'safe'.
- Weight gain or loss - (10%) of body weight WITHOUT changing diet. Women tend to gain - and add 'emotional eating' of high carb 'comfort foods' - while men - 'fester' and lose weight. I have had male clients that lost 30 pounds in a month without trying. (don't worry it comes back when things improve).
If these events are happening - the person is suffering with a clinical depression -as these issues are all biological in nature - not about 'attitude' or fixing a problem. You cannot 'think yourself out of it' - you can eventually get a depression to lift without medications BUT it may take months - if not years and when suicidal thinking is present - even fleeting thoughts - you need to take the need for medication seriously.
Other symptoms of depression include:
- Preferring to isolate and avoid people and public situations. Wanting to stay in, preferring the comfort of home -bed -couch-recliner rather than the 'drain' of the public. Preferring the 'cocoon' of home than the intensity of 'out there'.
- Lack of interest and initiative to do activities previously enjoyed. It's different for each person but loved ones, friends and co-workers will see the person's 'candle go out' - losing enthusiasm for ideas, projects, accomplishments, hobbies, family activities that they previously enjoyed. It may be 'covered' with logical excuses that perpetuate the condition: no money, no time, too much trouble, outgrew it, no one around to do it with. .
- This can definitely mean sex, food, and family.
- Rumination and obsessing - when the brain chemistry is slowed down and barely functioning your brain gets caught in a rut - spinning tires. This translates to obnoxious repeated comments, never-ending arguments, paranoia of assumed 'wrongs' - and inflexible thinking. This symptom becomes extremely troublesome at work and in relationships - making it challenging to solve real problems, see opportunity, or be agreeable enough to complete team tasks or activities that require cooperation.
- Hopelessness and helplessness. It may be disguised with physical aliments that shift the 'pity' to chronic issues of pain management, fatigue or immobility - all further entrenching the person into a 'dark' place. When you're trying to talk and encourage a depressed person they will respond or react with defensiveness, projection (it's you not me), or blaming - further preventing them from understanding that the condition is their own - that needs professional help. Conversations become impossible as the person will respond with every negative, opposition, roadblock, or unavailable resource - to justify their 'state.' They may repeatedly resist any intention to help, guide or support professional help. Even they want to believe that it is temporary, they can change it or something tomorrow will shift it and make everything 'all better.'
- Low self-esteem - this is less obvious -because there's usually so much confusion with emotions that are visible especially anger and tears. Over the years I find that low self-esteem is generated the longer a person is entrenched in a depression because they begin to eliminate all the activities in life that bring a positive self esteem. Too often they have contained their lives to recliners, couches and desks that they are getting little or no positive feedback from anything or anyone. They are so limited in activity and being 'seen' that they are also not getting the compliments, the conversations and the 'good job' that we all desperately NEED to feel good about ourselves. Sure a person can have a ton of positive affirmations on their bathroom mirror but hearing it from a stranger, acquaintance, or supervisor can be a real -unforgotten and needed boost.
- Fleeting thoughts of suicide - or beginning to see suicide as an 'answer' - this is usually what scares people into the physician's office - even they begin to realize that things are not changing or improving and the distress is now overwhelming. I will also share that more often women, especially those with children, may want to 'drive away' - 'escape' or take a 'road trip' - rather than thinking about the fatal decision of death. They just want a break. Over the years I have had female clients who 'just drove' and ended up in North Carolina . . . I also have to add that for the price/ cost of hospitalization in a very scary psychiatric facility - spending the money for a 3 day stay at a very good hotel - with service, spa, pool, scenic outdoors, nearby outdoor activities might be exactly what will help boost a person out of a depression - but I would do it after getting the prescription for meds first - take the first weekend getting 'away' to let the medication WORK. A truly -clinically depressed person will NOT improve or feel better with a simple vacation - everyone may be surprised by this fact - but it actually proves how clinical they can be! I would recommend a 'get away' once meds are introduced.
So the first thing to do for someone who is depressed is get educated. Arm yourself with information. Use search engines, hospital and mental health websites to gain control over what to do to really HELP and support your loved one. Instead of staying on the sidelines - empower yourself to be truly helpful.
Here's a quick list of where to start.
- Educate yourself - for both the symptoms,and also treatments, strategies and specific actions.
- Listen and be prepared. The person may share some scary thoughts and details that are plaguing them -listen quietly - acknowledge - and ask them how they would like you to help/support them.
- Offer to make an appointment to familiar MD, attend with them - give MD added information so they can formulate best treatment. Too often the person is not even aware of how serious their symptoms are - they may need you to give the physician the real truth. Follow up with a counselor to help with the distorted thinking, anger issues, pain and sadness as well as unresolved grieving. MD's are great at meds but don't have the time to counsel - after the initial assessment. Call a counselor who is experienced in managing clients with depression. I usually work with clients 1x a week for a month or two then spread sessions out gradually to bi-weekly then 1x a month. The good thing about having a counselor in place is that they offer the depressed person a new, fresh audience who has not heard the 'story' before and therefore not resistant to hearing it again and again . . . this is why being around a depressed person can be so exhausting. Loved ones do stop listening - they assume you will say the same thing again and again. The body language attached to this is perceived by the depressed as dismissive and further encourages depressive thoughts.
- Look after the little things that they have neglected - due to immobility, fatigue and lack of interest: Clean main room, bathroom, do dishes, laundry, offer to perform chores, mow lawn, walk animals, car care, take children to park or school.
- Take suicide 'talk' seriously. Call their regular MD first - they will/can assess for appropriate level of care. If MD is not available -call your local mental health hotline - they will send someone to your home to assess the situation. Some cases do not require hospitalization - others do - allow professionals to guide this - often both the depressed person and their loved ones are not in the right state of mind to offer constructive help - let the professionals guide you. It's better to be safe than sorry. This may require police intervention for hospitalization - but usually it is limited to 3 days - enough time for professionals to assess and begin appropriate treatment.
- Use emails - texts- cards and calls to contact the person at least one time daily - and encourage others to do the same. Share the 'project' adding variety to who they are talking to and getting positive feedback from. Send funny ecards, jokes and cartoons when you don't know what to say. In my worst days - it was the emails and facebook funnies that made me laugh out loud and move on.
- Create a FUN - uplifting playlist on their phone, tablet, MP3 player - with earbuds that put them in a 'happy' mood - get a list of favorites - and remove any music that triggers sadness, pain or broken hearts. I find the easiest thing to do is play the newest music - that you don't have memories attached to yet. This is helpful in 'energizing the brain' the stimulation of music keeps the brain active - something that depression hates - but is needed!
- Turn off the TV! Nonstop 'crisis' announcements, school shootings, local murders, innocent deaths are NOT helpful. Encourage them to switch to the radio or playlists. Movies can be a better substitute.
- Invite them OUT. Keep it really SIMPLE. No big parties, fundraisers, or fairs - just a simple 'tea' at 4pm, coffee and snack, a quiet meal with just 2. Remember that they perceive people as 'draining' so don't overwhelm them! It is more important to get them out of their house and comfort zone and out into fresh air and sunshine with the stimulation of conversation and nature. Take a walk in a local park, walk dogs, go fishing.
- Encourage them to journal or write letters and not send them - the writing process is healing and also activates the brain functions.
- Praise, compliment, notice, encourage actions they are taking to move forward. Encourage them to do things that are visible to further encourage positive remarks. Start small and simple - even adding a piece of jewelry can make a difference - wear bright colors - bring flowers.
- Take care of yourself! Depression is draining. I used to say it was like having an 'acid bath' after having dinner with 2 depressed relatives at the same time. Make sure you take and get your own 'time outs'. Get outside. Take a walk or take your own 'escape ride' - blast that stereo . . . that's what worked for me!