It’s Not “Just” Depression

Something that I hear a lot, and often from people that should know better, is “well, it’s just depression.” I hear this in many different contexts, for example, a woman who has been having GI issues goes to see her doctor, who tells her that there really isn’t anything wrong with her digestive track, “it’s just depression.”

According to http://www.dictionary.com, the word “just” has several meanings, but in the above context it means, “only or merely.” That doctor could have easily substituted the word “merely” for “just,” as in “there isn’t anything wrong with your digestive track, it’s merely depression.” Then, said doctor refers the woman to see a therapist, and thinks that the problem is resolved.

Only, it’s probably not resolved. In these cases, people often continue to have health problems. If they do seek help from a therapist, they get suggestions about handling stressors, but therapists can’t treat physical symptoms directly. It’s possible that with time and work the symptoms will resolve, but it’s also quite likely that the patient will continue to struggle with health problems.

Unfortunately, after having their symptoms dismissed as “just” depression, people are unlikely to seek medical attention again because it’s too embarrassing to be dismissed like that. If they do seek medical treatment, they’ll likely see a different doctor, and the first one never learns that the referral to a therapist was unhelpful in resolving the symptoms.

It’s true that emotional symptoms can manifest as physical health symptoms, but the unfortunate fact is that doctors jump to this conclusion much too rapidly, without testing, and make a diagnosis based on opinion instead of on evidence.

If the physical symptoms are truly caused by mental health issues, there are often things that doctors can do to alleviate symptoms while the patient works on underlying mental health issues. However, due to their own inherent bias that it’s “just” mental health problems, they choose not to treat. In my own case, it truly was a physical problem, but since the doctors couldn’t easily fit my symptoms into a tidy box, they told me that the symptoms weren’t medical, and were “just” anxiety, and told me to see a therapist. It took me months and multiple doctor’s appointments with different doctors to get the anti-emetics that I needed so that I could keep food down. That’s months of illness that could have been avoided if doctors had simply taken me seriously enough to even treat my symptoms.

While all of this is bad enough, the medical system’s dismissal of mental health symptoms as not being worth treating bleeds out into the public attitude that mental health symptoms are made up and imaginary, leading to advice from well-meaning loved ones such as, “Well, you just need to get over it,” or “just focus on the positive more. You’ll be fine.”

That’s not how it works. People with mental health symptoms aren’t stupid. They’ve tried taking walks, thinking positive, remembering that the weather is nice, and all of the other too-easy fixes that people suggest to them.

Depression is complex. It takes work and time to overcome, and acting like it’s not serious or is easily conquered makes people with mental health problems feel even more alone than the depression tells them that they are already.

The truth is that depression is a serious disease with a death count. People die of depression in alarming numbers. According to the World Health Organization, more that 264 million people worldwide suffer from depression, and “close to 800,000 people die due to suicide every year. Suicide is the second leading cause of death in 15 to 29-year-olds.”

This idea that it’s “just depression” is a serious barrier to sick people getting the care that they need. An alarming number of patients with depression refuse medication saying that they “don’t want to be dependent on a drug to feel happy.” They wouldn’t refuse other life-saving medications for physical health problems, but they refuse medication for depression because of the idea that depression is something that they “should be able to overcome on their own,” and isn’t really serious.

It is extremely serious.

When people suicide, the big question that as themselves is, “but why would they do that?” People point to the fact that they had everything to live for, and seemed happy.

The answer to this question is that people suicide because they are depressed. It really is that simple. Depressed people can fake happiness quite well in order to get by in the world, but that doesn’t mean that they aren’t depressed.

Conventional wisdom says that depression means that the person is “just sad.” People think, “well, I’ve had the blues before too, and it went away.” Depression doesn’t work that way. Often people that are depressed don’t feel sad at all. Depression often presents with anxiety or irritability, but there is one underlying truth with depression–it tells you that you’re terrible and people don’t care about you. In severe cases, depression says that the people in your life would be better off without you, and might even be relieved that you’re gone.

It doesn’t matter how much external proof there is that these thoughts aren’t true. When someone is depressed, these thoughts feel like truth, and anything that contradicts them feels like lies. This is why people die of suicide. It’s not that they’re selfish or weak. It’s that they truly believe that the people in their lives will be better off when they’re gone because depression says they are terrible people, and it feels like truth.

Another ironic truth about depression is that one of the main symptoms is a lack of motivation. A person suffering from depression might not feel sad, but will likely have a difficult time getting motivated to do things. If they are able to accomplish things, depressed people get very little enjoyment out of what they do.

This makes treating depression complicated. It may be that the sick person has seen a therapist and gained knowledge of skills and behaviors that would help, but can’t seem to get enough motivation to perform those behaviors. They are not being lazy. Lack of motivation is one of the most common symptoms of depression.

When motivation is an issue, the best approach is often to start the patient taking antidepressants in order to get the small amount of motivation needed to start applying the skills they are learning in therapy. Antidepressants are important in the treatment of depression in order to increase motivation to do the work to get well, which is why it’s so important to remove the stigma associated with taking them. Antidepressants truly do save lives, and a combination of medication and therapy is often the most effective approach.

If there is a depressed person in your life, the best thing that you can do is reserve judgment and refrain from advice giving. Simply sit with the person if that is all that they are able to muster the motivation for. If the depressed person speaks, just listen. Don’t tell them that they aren’t thinking correctly, and please don’t tell them to get over it or just get outside or be more social. A little-known truth about depression is that hearing unhelpful advice makes the depressed person more depressed. It confirms their depressed thoughts that they are alone, nobody understands them, and people would be better off without them.

So what can you say? Express your willingness to be with them even thought they aren’t happy right now. Tell them that they are loved and important. Encourage them to seek professional help, but stop there with advice giving.

Here is a list of great things to say to depressed people:

  • What you’re going through right now is really hard.
  • I’m here for you.
  • I love you.
  • What can I do to help?
  • What do you need right now?

If they don’t know what they need, that’s OK. The fact that you asked is what’s important. It shows them that you care about them and that you’re willing to listen. Being present with a depressed person is probably the best help that you can give.

Remember, it’s impossible to talk someone out of being depressed, and trying to do so makes the depressed person feel alone and misunderstood, so don’t try.

If you are a depressed person, I urge you to seek professional help. I know that it feels like you shouldn’t have to, but that’s the depression speaking. When your therapist gives you skills to learn and homework to work on, give it your best shot. It may feel silly or like a lot of work, but there is a good reason for it. Your therapist is helping you to create new pathways in your brain that are healthy and move you away from the pathways of depression that are so well worn and easy to walk down. Remember that small movements forward are progress, and give yourself credit for every baby step.

If you are feeling suicidal, know that what depression is telling you about yourself and the people around you is a lie. The people in your life do love you and care about you and will be devastated if you are gone. You are worthy of love and belonging simply because you’re human. You don’t have to do anything to deserve it. Immediately take yourself to your nearest emergency room, or call a suicide helpline. If you can’t muster the motivation, call 911 and professionals will come to you.

The National Suicide Prevention Lifeline phone number is 1-800-273-8255, and it is available 24 hours a day. Call.

Let’s all start treating depression as the serious and life-threatening illness that it is. It’s not “just” feeling sad. It’s not fake, selfish or weak, and changing the public attitude towards mental health problems will save lives.

Here are some resources for more information:

Doing Harm Website

Compassionomics TED Talk

TED Talks on Depression

World Health Organization’s Depression Page

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