The Bare Facts

According to Psychology Information Online:

Depressive disorders come in different forms. There are several different diagnoses for depression, mostly determined by the intensity of the symptoms, the duration of the symptoms, and the specific cause of the symptoms, if that is known.

Major Depression - This is the most serious type of depression, in terms of number of symptoms and severity of symptoms, but there are significant individual differences in the symptoms and severity. You do not need to feel suicidal to have a major depression, and you do not need to have a history of hospitalizations either, although both of these factors are present in some people with major depression. There is no official diagnosis of "moderate depression."

Dysthymic Disorder - This refers to a low to moderate level of depression that persists for at least two years, and often longer. While the symptoms are not as severe as a major depression, they are more enduring and resistant to treatment. Some people with dysthymia develop a major depression at some time during the course of their depression.

Unspecified Depression - This category is used to help researchers who are studying other specific types of depression, and do not want their data confounded with marginal diagnoses. It includes people with a serious depression, but not quite severe enough to have a diagnosis of a major depression. It also includes people with chronic, moderate depression, which has not been present long enough for a diagnosis of a Dysthymic disorder. (You get the idea!)

Adjustment Disorder, with Depression - This category describes depression that occurs in response to a major life stressor or crisis.

Bipolar Depression - This type includes both high and low mood swings, as well as a variety of other significant symptoms not present in other depressions.

Psychotherapy
Psychological treatment of depression (psychotherapy) assists the depressed individual in several ways.

First, supportive counseling helps ease the pain of depression, and addresses the feelings of hopelessness that accompany depression.

Second, cognitive therapy changes the pessimistic ideas, unrealistic expectations, and overly critical self-evaluations that create depression and sustain it. Cognitive therapy helps the depressed person recognize which life problems are critical, and which are minor. It also helps him/her to develop positive life goals, and a more positive self-assessment.

Third, problem solving therapy changes the areas of the person's life that are creating significant stress, and contributing to the depression. This may require behavioral therapy to develop better coping skills, or interpersonal therapy, to assist in solving relationship problems.

Unfortunately, many poorly trained counselors never move beyond providing supportive counseling. This alone will not eliminate the depression. As a result, the depression, and the therapy, continues indefinitely, with little improvement. Supportive counseling "feels" helpful, and as part of the overall treatment plan does help.

But, unless the depressed person makes critical life changes, the depression will continue. These changes are both internal and external. Internal changes are usually needed in problem assessment, self-evaluation, the evaluation of others, and the expectations the depressed person has for himself/herself, others and about life. External changes may be needed in problem solving skills, stress management, communication skills, life management skills, and the skills needed to develop and sustain relationships.

The length of treatment will vary, according to the severity of the depression, and the number and kind of life problems that need to be addressed. Most people will begin to experience some relief with 6 to 10 sessions, and approximately 70-80% of those treated notice significant improvement within 20-30 sessions.

Mild depression may be treated in less sessions, and more significant depression may require extended treatment. Treatment sessions are usually scheduled once per week, although they may be scheduled more frequently initially, or if the person is experiencing significant life crises.

Medication
Except in the more severe depressions, and bipolar depression, medication is usually an option, rather than a necessity. Antidepressant medication does not cure depression, it only helps you to feel better by controlling certain symptoms. If you are depressed because of life problems, such as relationship conflicts, divorce, loss of a loved one, job pressures, financial crises, serious medical problems in yourself or a family member, legal problems, or problems with your children, taking a pill will not make those problems go away.

However, some symptoms of depression, such as sleep and appetite disturbances, significant concentration problems, and chronic fatigue, interfere with your ability to make the life changes necessary to eliminate the depression. In more serious depression, suicidal thoughts and urges, and preoccupation with death, may require medication in addition to psychotherapy.

Antidepressant medication can help relieve those symptoms, and allow you to make needed life changes. The decision to take medication, in addition to participating in psychological treatment, should be discussed with your treating psychologist and your primary care physician.

Your thoughts and feelings regarding medication, after considering information about both the benefits and risks involved, are an important part of a collaborative treatment approach between psychologist and client. If medication is part of your treatment, either your primary care physician or a psychiatrist will supervise the medical part of your treatment, while you continue psychotherapy with a psychologist.

If you have a chronic medical condition or a serious illness, and you are taking medication for that condition, then the medical specialist treating that problem should be involved in your treatment. The medical specialist may supervise all of your medications, or coordinate the medical treatment with the physician providing the antidepressant medications.

Stigmata

I have to force myself to write this blog. It's hard to write about it, even though I have suffered from depression for years. I know the stigma and shame of being female, black, and blue. I admit I’m afraid of being judged, vilified, or laughed at. We as black people often look askance at each other if one brings up the subject. But, most often we don’t talk about it. Like many of the issues we don’t talk about in our community; homosexuality, AIDS, incest or sexual abuse – we choose to ignore it or vilify the victim instead.
I didn’t talk to my mother about my depression. I didn’t talk to her about a lot of things that a mother and daughter should talk about. We didn’t have that kind of relationship. I didn’t talk about it with either of my grandmother’s – both of whom I was closer to than my own mother. From my mother’s mother – I learned how cook – mouth watering greens - picking fresh dandelions from the yard to add to the pot; fried fish seasoned like they do down in New Orleans, and succulent, tender baked chicken, and cornbread. I also learned a lot about men from her. “Don’t let a man know too soon that you’re interested in him. Let him tell you first,” she would tell me, while we worked in her small hot kitchen that smelled of hot cross buns, sweet potato, strawberry rhubarb, and lemon meringue pies and pound cakes. But, I never discussed with her the overwhelming sadness and depression that had begin to plague me in my teen years.
Nor did I discuss my sadness with my father’s mother who was a Pentecostal minister. I grew up saying morning and evening prayers with her on our knees side by side. I knew she would start quoting scriptures and tell me to pray about it instead. But, I needed someone to talk to me about the feelings I was having. I wasn’t ready to take it to the Lord yet.
And I never talked about it with my Aunt Nadine to whom I was also close. Even when we sat and watched tv together. Or the times I would come in from work and go straight to bed and she would check on me to see if I was alright -I never said anything. I guess because no one in my family ever talked about being depressed or blue, not to me anyway. I felt like I was the only one who had this monkey on my back. If there was someone with depression – I never heard about it. I was considered the black sheep of the family, so maybe that’s why I didn’t talk about it.
According to mentalhealthamerican.net the myths and stigma that surround depression create needless pain and confusion, and can keep people from getting proper treatment. The following statements reflect some common misconceptions about African Americans and depression:
“Why are you depressed?
If our people could make it through slavery, we can make it through anything.”
“When a black woman suffers from a mental disorder, the opinion is that she is weak. And weakness in black women is intolerable.”
“You should take your troubles to Jesus, not some stranger/psychiatrist.”
Shauna Curphey, a WeNews correspondent wrote in an article about depression and black women - In California, African American women have the shortest life expectancy among women of all racial and ethnic groups in the state. They also have the highest mortality rate for heart disease and stroke and the highest prevalence of high blood pressure and obesity. Recent research indicates that mental health plays a role in these health disparities in California--and across the nation. But while many black women know and discuss the threats to their physical health, when it comes to mental health, there's silence and inaction.
Latonya Slack, executive director of the California Black Women's Health Project, an Inglewood, Calif., community-health organization, says "There's a fear of putting our business in the street . . . of somehow revealing too much.”
Lorraine Cole, president of the Black Women's Health Imperative, the Washington, D.C.-based parent organization of the California Black Women's Health Project, agrees. "There's a deep-seated feeling that seeking professional help is a sign of weakness," she said.
Slack and Cole, both African American women, have lead efforts to address the physical, mental and spiritual health needs of black women. Both have commissioned studies that revealed many black women are struggling with mental health issues but are not seeking professional help. They and others see improving black women's access to mental health treatment as a crucial element to addressing the serious, but often manageable, illnesses plaguing their physical health.
One study found that the proportion of African Americans who feared mental-health treatment was more than twice that of whites, according to the surgeon general's report. Part of the fear stems from wariness of the medical establishment that arises from past abuses, said Slack, such as the Tuskegee experiment. (In 1932, the federal government sponsored a study to examine the impact of untreated syphilis involving black men. The experiment went on until 1972 without the test subjects' knowledge and most of the subjects died without receiving treatment.)
As a result of the distrust engendered by the now-infamous experiment and the stigma associated with seeking help, many black women rely on spiritual leaders and community members to handle personal problems. There's also an added pressure from the ethic of the strong black woman, a cultural value that promotes toughness and self-sacrifice. "There are so many women who are not diagnosed or are under-diagnosed who are just existing on a thread," Slack concluded. " . . . They think 'My mother suffered. My grandmother suffered. It's just the lot of black women in America. It doesn't have to be that way."

Resolutions

Resolutions for the New Year 2008
1. Probably the number one resolution in the country - Lose weight. For me - lose some more weight. I have lost some, but not enough.
2. Practice my yoga and meditation on a more consistent basis - like everyday.
3. Write everyday! I'm not just talking about my blog. I'm talking about the memoir I need to finish or the novel I started or the lyrics I want to write. I just need to get into the habit of writing something everyday.
4. Spend more time with nature. Whether it's taking long weekend walks through Central Park or getting away for a weekend retreat at a yoga center in the country.
5. Save money.
6. Volunteer my time somewhere.
7. Just be good to myself.