Identifying Depression

In order to do something about depression, you first have to recognize its existence. In fact, some people are depressed and don't even know it. Although depression can take different forms, following are some common symptoms and characteristics:

• feelings of sadness
• guilt feelings
• discouragement regarding the future
• feelings of failure and self-blame
• decreased satisfaction and enjoyment of activities you used to do
• increased tearfulness
• increased irritability and low tolerance for frustration
• decreased interest in being around other people
• decreased energy and motivation
• difficulties sleeping at night
• feeling tired all the time
• decreased appetite or excessive eating
• decreased interest in sex
• thoughts of suicide
• feelings of helplessness and hopelessness

No one chooses to become depressed. Rather, it just seems to happen. Sometimes feelings of depression are triggered by something specific like a particular loss or disappointment, or even an unhappy memory. At other times, it may seem to come out of nowhere. You may even wake up feeling sad or blue.

For those with chronic pain, depression can arise from several sources. Following are some sources of depression:

Losses.

It is natural to feel sad when you lose something or someone of value to you. We refer to this type of sadness as mourning or grief. Losses and disappointments are a part of nearly everyone's life. Certainly it is true that some people seem to have a lot more misfortune than others. People with chronic pain and disability can experience a number of significant losses and disappointments. While grief in response to loss is normal, depression can result when one fails to cope with the losses. It is important to keep in mind that depression is not a necessary direct consequence of misfortune. Rather, one of the key factors is how one perceives (thinks about) misfortunes when they do occur.

Learned helplessness.

This is the type of depression which develops when pain and disability persist and you feel that there is absolutely nothing you can do about it. No matter how many doctors you see or medical treatments you try, nothing seems to work. After awhile you feel no sense of control over the pain and feel totally at its mercy. This feeling of helplessness can then generalize to other areas of your life as well.

Irrational beliefs and distorted thinking.

It is important to remember that true depression is always associated with distorted thinking. Irrational beliefs and distorted thinking can create depression and distorted thinking results from depression. Depressed feelings and depressive thoughts go hand in hand.

Irrational beliefs which lead to depression typically involve rigid, absolutist musts and demands. These musts and demands can be applied to oneself, e.g., "I absolutely must perform well at important tasks (including gaining the approval of other people), or else I am an inadequate, worthless person." Unrealistic beliefs may also refer to one's situation in life, e.g., "The conditions under which I live must almost always be comfortable, enjoyable, and certainly free of pain, otherwise my whole life is miserable and rotten." When these rigid expectations are not met, as is pretty much inevitable whether or not you have chronic pain, you may then respond by "awfulizing," e.g., "this is absolutely terrible and awful, I just can't stand the way things are." Adding to the misery, you may make the irrational assumption, "because I feel terrible and awful right now, I will always (forever and ever) feel miserable and rotten." Then if you want to compound the misery even more, you can mentally beat yourself up for feel this way, e.g., "Because I am so irrational in my thinking and am making myself so miserable, I am basically a stupid, worthless, and no good person."

Pain medication.

Unfortunately, it is also possible that pain medication can contribute to depression. In particular, the opioid pain relievers when taken in sufficient quantity over an extended period of time can not only depress pain awareness and other mental activities, but can also depress your mood.

Chemical imbalances in the brain.

Many doctors believe that chemical imbalances in the brain cause depression. It is also possible that depression itself can cause chemical imbalances in the brain. Although in some cases it may be a chicken and egg question as to which comes first, current psychiatric thinking is that some people are biologically prone (i.e., genetically predisposed) to develop problems with depression.

It is also important to understand that depression is like a trap. Once you are in it, it is difficult to break free. Some describe it as feeling like you are sinking into a dark hole. Unfortunately, all the feelings, thoughts, and actions which go along with depression serve to reinforce and magnify each other. For example, the more you withdraw into your depressed shell, the more you tend to dwell on your pain and other negative thoughts. Depression frequently involves interacting vicious cycles.

Because depression is such a trap, breaking free of it is not easy. Unfortunately, if you wait until you feel better before you start doing something about it, you may be waiting a long time. Following are some constructive steps that you can take to break free from the trap of depression:

• Identify and forcefully dispute the irrational and distorted thinking that underlies your depression. Remember, depression always distorts your thinking and fools you into thinking that things are much worse than they really are.
• Talk to a trusted friend or a professional counselor. Allow them to give you feedback regarding your distorted thinking.
• Do your best to continue meeting your normal daily responsibilities, even if you don't feel like doing them.
• If you feel like having a good cry, go ahead and let the tears flow. After you are done crying, get up and do something constructive.
• Do some form of physical exercise. It is hard to be depressed and physically active at the same time.
• When you are really stuck, remember the phrase, "Move your muscles, change your thoughts." Do something to distract yourself from depressive thoughts. If it means just going through the motions, do it anyway!
• Write down your depressed thoughts and feelings on a piece of paper. Later, you may want to crumble the paper and throw it in the garbage, because that is probably where it belongs.
• Stay away from alcohol and other non-prescribed drugs (including stimulants such as cocaine). Although you may feel better in the short run, they will only make you feel worse in the long run.
• Remind yourself that feelings of depression won't last. Although you may not be able to simply snap your fingers and make the depression go away, you can do everything in your power to keep it from getting worse or persisting longer than necessary.
• Make a list of all the things in your life that you have to feel grateful for.
• Learn and recite to yourself the "Serenity Prayer"
• See your doctor about getting on antidepressant medication. A number of effective antidepressant medications are now available.
• Develop a depression self-management action plan. This can follow the same format as your Chronic Pain Flare-up Survival Guide. Using the worksheet on the next page, you can develop a list of specific things to do or think about when you are experiencing depression. This list should be kept handy so you can readily pull it out and review it whenever you are feeling depressed.

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