We’ve all been depressed. We use the term often and loosely, describing sadness or unrelenting lethargy or any point in between. Many take prescription medications to alleviate its symptoms while others self medicate with alcohol, drugs, or bad behaviour. We grudgingly exercise to lift depression’s cloud, or we pull up the covers and watch TV reruns. Some sit before mammoth lamps during the SAD (seasonally affected disorder/depression) months while others seek therapy. Depression is a stern master and regaining our composure after a long ‘down’ period may involve experimenting with all these (and more) techniques.

Why is it so difficult to treat depression?

Part of the problem is in our definition of the term. In fact, there are two distinct depressions: situational and clinical. Situational depression is temporary, appropriate, and predictable. In situational depression, we are reacting appropriately to a life event; when we experience loss, we feel sad. To recover, we navigate the stages of grief and wait for time to heal our wound. There are no pills or potions to heal a broken heart.

Clinical depression, on the other hand, has quite different features. Its onset may not correspond with life events, its affect varies from person to person, and it is often unrelieved by time. Clinical depression finds its roots in our complex soup of brain chemistry. Serotinin, our ‘feel good’ hormone, becomes disrupted, causing us to feel depressed. This depression is alleviated with pharmaceutical enhancers (SSRIs and the older tricyclic medications) to address the physiological symptoms and with talk therapy to tackle the emotional lows associated with the condition. It’s a working combination, and we now know that antidepressants and talk therapy in combination is the treatment of choice for clinical depression, the two together working better than either does alone.

Neither depression grants immunity.

When assessing depression, we must remember that both situational and clinical varieties can occur in tandem. Folks suffering clinical depression face losses of course, and grieve in response. By the same token, those in the throes of grief can develop the clinical form (in fact we may be more vulnerable during those periods). The combination of situational and clinical depression is a real double whammy and requires sensitive attention from both the therapist and the health care professionals to tease out effective solutions and support systems.

It would be so much easier if we called the two depressions by different names, for then we could explain better how we feel and know better what might help. We can distinguish between sunburn and birthmarks, for instance, even though we understand they are both skin conditions, treated differently. Sadness is evident in both situational and clinical depression, but its roots, treatments, and outcomes vary. Unrelenting discouragement and paralyzing grief benefit from professional help, regardless the cause. If you are stuck in a grief pattern, or if you just can’t shake that ol’ blue feeling, invest in an assessment. Suffering may not be optional, but it can certainly be minimized. Ask for help.

© 2005. Pega Ren, Ed.D. All Rights Reserved.