The Invisibility Of Depression

Depressed man standing in front of large window

Sadness In The Shadows

Depression is like an invisible dark cloud that hovers in the stratosphere, looming all around us and ready to attack when in our weakest states of mind. The invisibility of depression can be observed through the actions of those affected: avolition, abulia, apathy, anhedonia and more. Sadness in the shadows is much more common than you would think.

Just because someone may not act like it or talk about it, does not mean that they are not experiencing depression. Many suicides that occur are never seen coming, “He was the last person I imagined would ever do that”, “She always seemed so happy! I never saw any signs of depression in her.”

You can never assume that every person who you meet is showing their true feelings. Many people mask their depression out of fear of embarrassment and ridicule. It’s not easy nor comfortable to experience depression: it lowers your self-esteem, makes you feel worthless and crashes your self-confidence.

With the symptoms mentioned above, it’s no surprise why many people find it difficult to share their depressive feelings with others. The fear of people not understanding or the thought of others viewing them differently is sometimes too much to handle. They prefer not to take the chance and just deal with the symptoms in the shadows.

Hiding your depressive feelings is what makes up the invisibility of depression; no one can see it if you don’t reveal it to others. It’s as if you’re wearing an invisibility cloak, but deep inside there is something tortuous and potentially deadly brewing. That’s why it’s so important to keep fighting for the end of mental health stigma.

As long as the stigma prevails, the invisibility of depression will continue striving in the shadows, attacking potential victims at its first opportunity. The importance of eliminating stigma cannot be stressed enough, and this can only be done with openness, support, comfort and honesty.

The DSM Ready community calls on everyone from all walks of life to come together and help eliminate mental health stigma. Together we can and we will!

Are you Ready? (This is Defeating Stigma Mindfully)

Being Open About Depression

Depressed man with arm against wall staring out the window

Share Your Stories With The World

You’d be surprised how many people suffer from depression. People who you would never expect to experience depressive symptoms, may have been suffering for years. Depression is not always how we envision: someone who appears sad, disheveled, does not talk much and appears tearful all the time. Being open about depression is something that we should all be doing.

Many depressed people do not always appear depressed: they continue to remain functional, go to work, play tennis, maintain friendships, pay the bills, etc. It’s not until they tell you face to face about their depression that it surprises you. But should it really surprise you? Mental health problems are so common that almost everyone has some experience; it’s just whether we admit it or not.

Can you imagine going through life feeling depressed, all while remaining functional in society? Nobody has a clue of how you truly feel; the worst part is that everyone probably thinks that you are happy. People thinking that you are happy is not a bad thing, but it can be when you are feeling depressed and hiding your symptoms from others.

Sharing your stories with the world can help you overcome depression; of course, you have to find the right people. But believe it or not, by sharing your stories, you can accomplish two things: you might feel better about yourself and you might discover that someone else has been going through a similar experience as you have.

When you find people to connect with about your mental health problems, it makes an entire world of a difference: you no longer feel alone and you finally feel understood. Sometimes just connecting with someone who also feels depressed or is battling another mental illness, is more effective than an antidepressant or psychotherapy!

So stop doing yourself more harm than good by hiding your depressive feelings. It’s time to be open about your depression and find a few trustworthy people who you can share your experiences with. By sharing your stories with the world rather than hiding them in the closet, you will start to feel much better about yourself.

Are you Ready? (This is Defeating Stigma Mindfully)

Winter Sun

Sun shining behind rocky mountains filled with snow

When New Hope Rises Behind The Horizon

Winter for many people can feel like a never-ending passageway deep underground; lost in a cave that you innocently went exploring and can no longer find your way back into humanity. That’s how the winter can feel for many people. These short days which quickly turn into darkness leave you wondering, “Will I ever seem tomorrow again?” The answer is yes, because the winter sun is always shining!

New hope always rises behind the horizon: you just have to notice it and grasp onto it. Winter months may seem very long, especially when it’s cold outside and darkness creeps in early in the evening. But darkness does not consume hope, because hope is always available for anyone who seeks it.

And this hope lies in the winter sun. As its rays rise up every day to give light to this world, we become healed by its warmth and beauty. But those who get lost in depression no longer know how to harness the positive energy provided by the winter sun. And that’s where we can come in as fellow human beings: to help guide those who are lost and show them the way back home.

Remember that you are not alone during the winter: many people experience the “winter blues” or seasonal affective disorder. But the last thing that you want to do is to lose your hope. Your hope is what should be keeping you alive to see another day. Your hope is what is going to prevent you from hurting yourself and others around you.

Through hope, we can come together and defeat depression on a global level. The winter sun is available for all of mankind: God gave his only son Jesus Christ to humanity in order for us to be saved from mental illness, physical disorders, sin and suffering. Through the winter sun, we wake up and rise like Jesus Christ once did.

If you notice somebody who is feeling down or acting outside of their character, say something! Sometimes just a “hello” can make someone’s day: it makes them feel recognized and alive. Don’t seclude yourself into your own selfish world. Reach out to people and show them that you care, even if you don’t know who they are!

Together we can and together we will! This is DSM.

Are you Ready? (This is Defeating Stigma Mindfully)

Why Is Depression More Common In Females?

Depressed blonde woman leaning against brown wooden wall

The Gender That Is More Depressed

While depression is more common in females, it’s important to note that depression happens quite commonly in males as well. There are many factors that predispose women to developing depression: hormonal changes during puberty, premenstrual syndrome, pregnancy, giving birth, perimenopause, life circumstances and culture and other psychiatric conditions such as anxiety, schizophrenia, eating disorders and drug abuse.

Hormonal changes during puberty as well as emerging sexuality are reasons for why females experience depression during this time period. It is thought that estrogen and progesterone are the hormones that disrupt the function of serotonin in the brain, resulting in depressive feelings. In addition, their emerging sexuality, interest in partying, identification with peers, mood swings and conflicts with parents are reasons behind their depressive experiences.

Females who experience premenstrual syndrome struggle with abdominal bloating, breast tenderness, headaches, irritability and anxiety. These symptoms are obviously distracting from everyday life, increasing their chances of feeling depressed. In addition, some women progress to develop premenstrual dysphoric disorder, a disabling depressive experience that may interfere with their studies, work and relationships.

Depression during pregnancy can occur due to many reasons: a lack of social support, lifestyle changes, unplanned pregnancies, stopping use of antidepressants, previous episodes of depression, etc. Pregnancy can be a very big stressor for many women, easily leading to depressive symptoms when inadequate support is an issue.

While about 60% of women experience the postpartum blues, about 15% also develop postpartum depression. The responsibility of taking care of a child, hormonal changes, previous episodes of postpartum depression, infant complications and poor social support are some of the reasons behind developing postpartum depression.

Perimenopause or the transition to menopause may cause depression in some women. This may be due to interrupted sleep, history of anxiety or depression and hormonal changes. For some women, just the idea of entering “menopause” may be shocking to them: the realization of “aging” can be quite hard on some women.

Lastly, life circumstances and culture can also lead to higher rates of depression in females. Many women tend to work and maintain responsibility at home, such as taking care of the children and the house. And while the divorce rate remains elevated, many women may be experiencing single parenthood, having to work a job and take care of a child at the same time.

Because women are more likely than men to experience sexual abuse, they’re also more likely to experience depression as a result. In addition, unequal power and status is still a major concern around the world for many women, resulting in a lower self-esteem, feelings of negativity and a sense of lack of control, all increasing the chance for the development of depression.

As men, we need to become more supportive of women overall. They are the ones who tend to be more nurturing than us, take care of our children, cook and clean the house and maintain a job to make ends meet. They also have to experience fluctuating hormones, resulting in mood changes, stress and irritability.

Let’s come together and help all the women in the world. Together we can.

Are you Ready? (This is Defeating Stigma Mindfully)

Antidepressants: Should I Take Them?

White antidepressant pills in round plastic compartments

My Depression Is Not Getting Better

Deciding to take antidepressants is a big decision. It means that you have reached the point in your life where you’re considering the help of a psychotropic medication to alleviate your symptoms. For some, this may be an embarrassing decision to make: the stigma of taking an antidepressant remains locked in their minds.

The stigma of taking antidepressants is not what it once used to be. About 10% of Americans take an antidepressant. But your decision to take one should not be influenced by how many people you know that take them. Even if you do decide to be prescribed to an antidepressant, it does not mean that you have to tell people about it.

It’s no one’s business whether you take psychiatric medications or not. And you should not be ashamed of it if you are! Many people are slowly coming out and revealing their mental struggles with their friends and family. Celebrities are also opening up about their life struggles, mental illnesses and addictions which they have battled throughout their careers.

First things first: have you given yourself a fair shot at getting over your depression naturally? This involves:

  • Talking it out with someone who you trust
  • Exercising and eating healthy on a consistent basis
  • Adopting a good sleep hygiene
  • Getting involved in extracurricular activities
  • Seeing a psychologist or psychiatrist for psychotherapy

If you have tried all of the above and still find yourself trapped in a depressive state of mind, then it’s probably time for you to be prescribed to an antidepressant. There are several classes available:

  • Selective serotonin reuptake inhibitors (SSRIs – currently the most widely used and recommended for major depression)
  • Selective norepinephrine reuptake inhibitors (SNRIs – almost as widely used as the SSRIs)
  • Norepinephrine dopamine reuptake inhibitor (Bupropion: effective for increasing energy in major depression and smoking cessation)
  • Tricyclic antidepressants (TCAs – very effective antidepressants but not as widely used anymore due to potential cardiac side effects)
  • Tetracyclic antidepressants (Mirtazapine: effective for depression with weight loss and insomnia)
  • Monoamine oxidase inhibitors (MAOIs – very effective antidepressants but not as widely used anymore due to interactions with tyramine-rich foods)

As with any medication, antidepressants do have side effects which have to be taken into consideration prior to being prescribed to one. However, not everyone is prone to experiencing the side effects. But on a positive note, they do work very well for depression and anxiety! However, it also takes about 4-6 weeks to see a difference in your mood.

And if you’re considering going on an antidepressant, don’t think that you can now stop the healthy lifestyle and psychotherapy which you were previously doing. Most people experience remission when they combine psychotherapy + antidepressants. And living a healthy lifestyle should always be a given!

If you have given yourself an honest effort at trying to defeat your depression, but still haven’t been able to do so, then it’s probably time to start considering an antidepressant.

Are you Ready? (This is Defeating Stigma Mindfully)

A New Beginning

Hopeful man standing on stone in front of body of water looking at sunset

A Reason For Living

Life brings us so many unexpected, unfortunate and unpredictable moments at such random times, that it can sometimes cause some serious damage if unprepared for. You see, there’s no pattern to mental health prior to a mental illness developing in someone. Each individual has his or her own unique experience.

Someone’s depressive course may be completely different than another’s. They may have grown up in similar neighborhoods, have gone to similar schools, have smoked the same amount of Godfather OG and still present with a completely different type of depressive experience.

But just because you might have been genetically predisposed or environmentally affected to developing a mental illness, does not mean that you should give up all hope and future expectations. Life goes on, whether you have a mental illness or not. Look at it as a new beginning, a reason for living!

Life will present you with many moments where you will feel like giving up and even taking your life. These moments require a lot of strength to get you through the rubble; if you give into these depressive states of mind, they can take you away like a powerful tide. Therefore, don’t take the risk of wading through depressive thoughts.

Once you’re hit by them, seek help as soon as possible. This may be through talking to a good friend or family member, seeing a psychiatrist or even sharing your feelings and thoughts on The DSM Ready platform. The important point is to act! Never go through depression by yourself; you are only asking for trouble.

What have your experiences with depression and suicidal thoughts been like?

Are you Ready? (This is Defeating Stigma Mindfully)

Is It Possible To Die Of Boredom?

Young asian lady bored and staring out the window

How To Deal With Boredom

The quick answer is no! The complex answer is maybe. Boredom is a state of being weary and restless through lack of interest. When you are feeling bored, your mind is not being stimulated. Your current activities just don’t do it anymore and you find yourself losing drive to perform them.

The problem with boredom is that it can gain more and more energy over time and become a bigger problem. It’s a mentality that is very easy to get stuck into if you do not eliminate it in its infancy. Today, you may be bored for half an hour, while tomorrow you may be bored for two hours.

It’s not so much the activities that make you bored, but rather you mindset and will. It’s as if the mind is stuck in limbo and you are just waiting for a resolution. The way to deal with boredom is to jump back into your activities or new ones as soon as you start feeling boredom coming on.

Do not give boredom a breeding ground. As soon as you sense it, detach from the feeling by distracting your mind with an activity. The more you do this, the less you will experience boredom. From time to time, it’s normal to experience it but only for brief periods, like 5-10 minutes. But chronic boredom increases your risk of developing a substance use disorder or mental illness.

Allowing boredom to take over your mind like a malignant neoplasm can turn out to be very dangerous. People who aren’t stimulated for longer periods of time can start to experience depression. Long periods of boredom stir up feelings of insecurity, uncertainty and low self-esteem. And this can promote substance abuse as a way to cope with the negativity.

Over time, this can quickly progress to major depressive disorder, the leading cause of disability worldwide. When one enters depression, it is very difficult to experience remission without treatment and/or strong family support. Depression is like a virus that slowly shuts down the system; in this case, the mind, body and soul.

When depression advances far enough, suicidal ideation, intent and plan become evident in many people. As you can see, uncontrolled boredom can lead down a path of mental destruction. Therefore, always stay preoccupied and keep your mind active and stimulated!

Are you Ready? (This is Defeating Stigma Mindfully)

Ketamine For Depression

Depressed man sitting on street with hand on face

How Does Ketamine Work For Depression?

Ketamine is a street drug, anesthetic and an antidepressant for treatment-resistant depression; cases were conventional treatments such as antidepressants and psychotherapy are not effective. Ketamine can be given by nasal spray or infusion. It is not meant to be a long-term treatment due to its addictive properties; patients receive a few doses of ketamine and go on to continue with an antidepressant and/or psychotherapy.

Ketamine is an NMDA receptor antagonist but it is not exactly clear how it helps treat depression. It is believed that it increases the neurotransmitter glutamate in the synaptic clefts between neurons. Glutamate then activates AMPA receptors on other neurons, leading to the release of other molecules which help neurons communicate with each other, resulting in improved mood and cognition. It is very fast-acting and effective for depressed and suicidal patients (i.e., those walking into an emergency department after attempting to kill themselves).

Ketamine is effective for depression because it can rapidly reduce suicidality as well as depression combined with anxiety. While other conventional treatments such as antidepressants and psychotherapy take weeks or even months to work, ketamine is very fast-acting and works within hours to days.

There is racemic ketamine (IV ketamine) which is given as an infusion into the bloodstream. It was approved many years ago by the FDA as an anesthetic. Currently, it is used off-label to treat depression; some patients respond after 1-3 infusions. Esketamine or Spravato was FDA approved in March, 2019 and is given as a nasal spray.

IV ketamine may cause nausea and vomiting, high blood pressure, perceptual disturbances and out-of-body experiences. Esketamine nasal spray may cause the same side effects.

Overall, depression can be a very daunting mental illness that may take years to resolve. Besides SSRIs, ECT and ketamine, one of the best treatments is to find a close friend, family member or therapist and open up about your thoughts, feelings and emotions. Depression is often triggered by life events that can be worked through via consistent talking over time.

No matter how deep your depression takes you, never give up! There is always hope!

Are you Ready? (This is Defeating Stigma Mindfully)

What Is Depression?

A brunette female appearing depressed with a double next to her

Low Serotonin Levels

Appetite, sleep, interest, suicidal thoughts, guilt, agitation/retardation – these are the components that make or break a diagnosis of depression. There are many forms of depression: Major Depressive Disorder, Situational Depression, Major Depressive Episodes, Substance-induced Depression, Bipolar Depression, Pseudodementia, etc.

It is hypothesized that serotonin is in low quantities in the synaptic cleft of neurons, which results in depressive symptoms. Depression is not just an emotional event; actual brain chemistry is changed at the neuronal and receptor levels in the brain.

People experience depression in many ways. Some quit their jobs and lay in bed all day while others are still functional; some unfortunately commit suicide. It is not clear what the exact source of depression is.

Environmental triggers definitely contribute to it: loss of a loved one, substances of abuse, accidents, loss of a job, etc. But others may be genetically predisposed; especially if their family members have depression.

Is depression curable? Curable is a strong word. I’m not sure if anything is curable. But it is treatable and manageable. Psychotherapy and antidepressants together is a stronger therapy than either alone. Prozac, Lexapro and Wellbutrin are some of the antidepressants you may have heard of; they work great, but for some people, even that is not enough.

Some people may require ECT: electroconvulsive therapy. ECT involves 12-20 sessions of shocks delivered to the brain. Believe it or not, it works! I had a patient in Baltimore, Maryland who was doing better on it. It is time that we come together and eliminate the stigma of ECT and antidepressants; we must utilize all approaches and help each other along the way.

Are you Ready? (This is Defeating Stigma Mindfully)