by James Hubbard, MD, MPH

What to do about depression was a question not easily answered back when I started practicing. There were really no good medical options. The few drugs available had major side effects. Psychotherapy helped, but good therapists were few and far between where I lived.

And then there was the stigma. Everyone thought any mental problem meant you were weak of mind and body. A strong person just toughed it out and suffered in silence.

The thing is, few people suffer alone. You have family, friends, colleagues who care about you. You affect them with your moods and, in cases of suicide, with your death.

I’ve had at least two dear friends who ended their own lives in times ago. I still mourn them regularly. And the families, well, they’ll never be the same. Until the day they die, they’ll have feelings of guilt mixed with anger and sadness over what they might have done and why it had to happen.

In this post I’m going to discuss what to do about depression using modern medicine and what to do about depression if we have a lengthy disaster or ever have to go back to the bad old days. But first:

Why do some people get depressed when they seem to have everything going for them?

Symptoms of Depression

Feeling blue or down are the obvious ones, but many times you may not feel that way with depression. It can be much more subtle.

You may be depressed if you:

  • Feel fatigued or tired most of the time. Of course, many things can do this, but it’s sometimes the only symptom you have.
  • Are irritable or have mood swings.
  • Have trouble concentrating at home or at work.
  • Eat a lot more or a lot less than you used to.
  • Sleep much more or much less than you used to (not being able to get to sleep or sleeping for a few hours, waking up in the early morning, and not being able to get back to sleep).
  • Don’t enjoy life’s simple pleasures anymore.
  • Have a reduction in sex drive.
  • Have unexplained aches and pains. Yes, I know these need to be thoroughly examined for other causes just like all of the other symptoms I’ve mentioned, but depression can cause physical pain.

Some people know why they’re depressed:

  • Hormone changes: it’s that time of the month, menopause, after a pregnancy, thyroid disease, or just plain old adolescence.
  • Loss of a loved one.
  • Family or financial problems or other extreme stresses.
  • Medications: prescription meds, especially sedatives.
  • Alcohol or marijuana, which are sedatives and can make you depressed.
  • Lack of sunlight. This usually happens in the winter months and is called seasonal affective disorder (SAD).
  • Childhood trauma: physical, mental, or emotional abuse.

But the truth is, your brain, not your external factors, ultimately controls your emotions. External factors can help you be happy or make you sad, but some people have a genetic tendency to be depressed. Then, just the littlest thing can put them over the edge.

One of probably multiple reasons for this seems to be a chemical imbalance. Just a tiny bit can cause a lot of damage. And they’re helpless. What most don’t realize about many depressed people is they don’t know why they’re depressed either. It’s like someone who has a stroke (but much more subtle). Stroke victims can’t just will themselves to start using their hand again.

Fortunately we do have treatments these days that help depression, and with much fewer side effects than in the past.

Conventional Treatments

1. Prescription medications such as the selective-serotonin reuptake inhibitors (SSRIs) and other even newer drugs help balance out the chemicals in your brain that have gone awry. Some people think these drugs (Prozac, etc.) make you a zombie or Stepford wife walking around with a big smile on your face, but I don’t find that at all. Instead, they help you get out of that depressed mode like sometimes nothing else can. They help you think clearer and not fixate on yourself. Then you can take action on some of the family or financial problems that might be part of the external reasons for your depressed state. And there are so many good drugs these days that your doctor can usually find you one with very few side effects. The biggest problem I see with these is that they can take several weeks to work. Be sure to talk to your doctor if you’re planning to or think you might be pregnant so you can get the risks and benefits of individual drugs.

2. Psychotherapy by a counselor or psychologist can help—talking with trained people, trying to work through some of the reasons other than brain chemicals that might be causing depression. Things, again, like family or financial stresses, or childhood physical, mental, or sexual abuse.

3. Regular exercise not only helps burn off stress, but it raises your endorphin level—one of those brain chemicals that makes you feel good.

Books ad4. Sunshine: Open the curtains. Get out more.

5. Meditation: A recent study showed 20 minutes a day of “compassion meditation” might help people who are depressed. Apparently this type of meditation is when you actively think good thoughts about helping people or wishing them well. It sounds a lot like what we Christians call prayer—but for 20 minutes a day. It wasn’t studied, but I’d bet a few minutes less than that would help also.

Alternative Treatments

I would always get expert medical help for depression if at all possible since it’s next to impossible to guess who might go from being mildly to moderately depressed, to suicidal. But during a disaster or anytime you can’t get expert medical help, here are some natural remedies you might consider.

1. St. John’s wort may be the most well-known. It works similar to the prescription SSRIs but may not be as reliable. It can have just as many or more side effects and can take up to eight weeks to work its best. So why take it? I’d say only do so in a long-term disaster when you’ve run out of your prescription meds and can’t get any. A typical dose is 300 mg three times a day. Just like prescription medicines, St. John’s wort can interact with many medicines, including other antidepressants, seizure medicine, and birth control pills. Don’t take if you might be pregnant. If you have episodes of manic moods when you get hyper, maybe feel a little too good, you’re probably bipolar (manic-depressive), and this medicine is not for you since it could make you worse.

2. SAMe (S-adenosy-L-methionine) may work a little faster than St. John’s wort but has the same warnings regarding interactions, side-effects, and pregnancy. The dosage is 400 mg to 1,600 mg on an empty stomach once a day.

3. Fish oil supplements: Just like for anxiety, they’ve been shown to help depression.

4. Vitamin B6 and folic acid may help.

There have been rare associations of increased depression, even suicide, with the very medicines that make most people better. If any treatment seems to be making the depression worse, stop it immediately, and talk to your health care provider if one is available.

Have you or a loved one ever been depressed? What has helped?

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Photo by Mary Lock–Goldilock Photography on Flickr.