What makes depression so debilitating and often, deadly? Here are eight factors that make depression hard to overcome.
"My dear family, after four long years of battling this illness, I just can’t take it any more…" So begins the note I left for my family before attempting suicide on July 24, 2004. In my fight against depression, I had tried 23 different medications, electroconvulsive (shock) therapy on 20 occasions, transcranial magnetic stimulation, cognitive behavioral therapy, and many other conventional programs related to the treatment of clinical depressions. I also had tried alternative treatments, such as acupuncture, kinesiology, and self-improvement courses. But on that day in July 2004, I had completely lost hope that I could recover.
I’m very lucky and grateful to have survived. Through the unconditional support of my family and friends, the reassurance and support of my psychiatrist, Dr. Fisher, and a holistic recovery plan, I was able to find my way out of the black hole.
Unfortunately, there are many other stories similar to mine without positive endings. Depression is a debilitating, relentless disease, and it’s important for everyone to be educated about just how despairing it can be.
There is a lot of misinformation about depression; and there is a tendency to avoid discussing it, but it’s important we do. Doing so is the only way we can begin to break through the despair it causes so that sufferers can get the help they need.
Below, I outline a few of the factors that make depression so difficult to overcome:
1. People don’t understand what depression is… and what it isn’t. Many people simply don’t know the basic facts about depression: its causes, its symptoms, how it’s treated, etc. It’s important for everyone to understand that it really is an illness, just as cancer and heart disease are illnesses. People experiencing depression aren’t just in a funk by their own choosing. They can’t just "buck up" or pull themselves together. All of these misconceptions can prevent people from seeking help. They try to battle it alone—and sometimes they fail.
Many people don’t realize depression can strike anyone, at any station in life. Making a lot of money or finding a great partner or even having wonderful kids won’t protect against it. In fact, successful people may feel even more despair because they’ve reached the pinnacle, they’ve made it, and yet they’re still not happy. They lose hope and think, Is this all there is? Of course, happiness can’t be achieved through wealth, power, fame, or any other kind of material gain, nor will those things cure depression.
2. They feel they need to have a "reason" to be depressed. While an event like the death of a spouse, the end of a relationship, or the loss of a job can precede depression, that’s often not the case. Consider this quote from popular British actor and comedian Stephen Fry, "I have no reason to be depressed…I am overpaid, over-praised, over-pampered. I am fully cognitive of this, but at times I have felt like cutting my throat."
There are many types of depression, each with different symptoms and causes. Among those causes are genetics, biochemical factors, aging of the brain, gender, and personality. Some types of depression are believed to be present from birth. Others are mild but ever-present. Still others come about only during cooler, darker seasons of the year. The takeaway is this: If you are depressed, you are depressed. This is not something anyone should have to justify with a reason.
3. They don’t want to be viewed as "weak" or "defective." The undeserved stigma associated with depression prompts many people to choose to suffer in silence. This may be especially true of men, who feel societal pressure to "man up" when they feel anxious, depressed, sad, or stressed. In many cases people fear that getting treatment for a mental health issue could jeopardize their employment or relationships.
I have performed surveys whose results show this to be true. In a workplace survey, I discovered that only 14 percent of employees feel comfortable discussing their mental health with a co-worker. In another survey, I asked depressed individuals if they had personally experienced a stigma because of their mood disorder, and 41 percent responded that they had.
One reason I avoided getting treatment for my depression was a fear that I would be looked at as weak if I didn’t just grin and bear the mental health problems I was having. For anyone who feels that there’s a stigma accompanying depression, I can’t emphasize enough how important it is to understand the true nature of this disease. It is not your fault and it does not make you weak. In fact, getting help for depression and taking the steps to treat it shows great strength.
4. The exhausting, mind-numbing nature of depression can prevent people from asking for help. Often, people who are depressed feel unable to express themselves, worry that others won’t understand them, or don’t want to burden others with their problems. When we’re in the depths of despair, there seems to be no way out and no point in trying to find one. Our minds convince us that revealing to our loved ones that we’re struggling will cause more harm than good.
It’s important to note, too, that depression zaps you of your energy, mentally and physically. When you’re in the clutches of depression, getting out of bed is a challenge, so the thought of researching treatment options or trying to explain how you feel seems absolutely unmanageable. Of course, that’s precisely why it’s so important to share your thoughts and feelings with someone close to you. Whether it’s with a hug, a chat, or assistance with finding medical help, depressed people will need help from close ones to get out of the darkness.
5. Depression can lead them to self-medicate—which, in turn, can lead to addiction. Because depression makes it difficult for individuals to reach out to others for help, they begin to self-medicate, often with very negative results. Self-medication through drugs and alcohol leads to addiction, which in itself is a life-threatening condition.
While the short-term "high" that comes from drugs and alcohol provides some momentary relief to a depressed individual, the withdrawal period that comes after can make them feel not only physically ill but even more depressed. Substances can also interfere with prescribed anti-depressants, making them less effective. Addiction is another disease that people struggle to get help with either because they think they don’t need it or they simply don’t know where to turn. If you or a loved one is struggling with addiction, I can’t stress enough how important it is to seek help. The Substance Abuse and Mental Health Services Administration is a great resource.
6. When people do seek treatment, it’s difficult to find the right one. There’s an assumption that anti-depressants are the most effective treatment for every person with depression. However, in a survey of 4,064 people who have lived with depression or bipolar disorder, most respondents didn’t rate medication among the most effective treatments that contributed to their recovery. In fact, the highest-rating medication came in at number 23, behind treatments like therapy, peer support groups, exercise, and fulfilling work! Medication can be essential for some people, but it is not a panacea. This highlights the importance of finding competent mental health professionals.
The "most effective" treatment regimen for depression is different for each patient, and it can take some time to find. After trying so many different things, my approach to recovery became extremely holistic. It involved dietary changes, meditation, exercise, intimacy with others, fulfilling work, and more—yes, including medication.
7. It’s also hard to find the right healthcare provider. When it comes to receiving appropriate treatment for mental health issues, all professionals are not created equal. While competent and well-meaning, many primary care physicians (PCP) simply don’t have the expertise to help patients deal with depression and bipolar disorder.
Often, the biggest regret of those who have lived through a depressive or bipolar disorder episode is that they suffered for years or even decades, and saw their conditions become even harder to manage, because they weren’t receiving the treatment they needed. Partnering with the right healthcare provider can make the difference between an endless, ineffective cycle of medications or treatments and obtaining a trusted ally with the training, reach, and support to truly help you.
If you determine that your current PCP isn’t best suited to help you deal with your depression, a good place to start for finding the right mental health professional is by asking for a referral from family, friends, associates, your insurer, or even, if you feel comfortable, your PCP. You can also consult a suitable directory, such as the Depression and Bipolar Support Alliance’s Find a Pro search engine.
8. Treatment is slow and prone to setbacks. On July 24, 2004, I had beaten four previous episodes of depression. However, I had also made three previous suicide attempts. After the attempt in 2004, I continued to suffer. Nine months later I was back in the hospital for treatment of my depression. I stayed in the hospital for nine weeks.
I emerged from the hospital a little better, but not much. Beating my depression was a long and difficult path. I didn’t feel confident that the usual treatments for depression could save me. I’d tried so many approaches that hadn’t worked for me. As previously mentioned, it took a combination of many things for me to begin to recover. And such is the case for most people battling depression. There is simply no silver bullet.
If you were surprised by any of this information… good! The more you learn about depression, the better equipped you’ll be to overcome it or to help a loved one do the same. In the course of making hundreds of presentations on depression, I’ve found that an incredibly important way to conquer it is to learn more about it, and through that quest for knowledge to seek assistance and support of others.
Also, don’t ever, ever give up. There is always a solution.
Graeme Cowan is the author of "Back from the Brink: True Stories and Practical Help for Overcoming Depression and Bipolar Disorder". He is also a speaker who helps people build their resilience, well-being, and performance. Despite spending most of his career as a senior executive in Sydney, Australia, with organizations like Johnson & Johnson, Pfizer, and A.T. Kearney, Graeme had struggled with depression for more than 20 years. Graeme reemerged with not just a best-selling Australian book series to his name, but a new attitude toward the way individuals approach recovery. Cowan is also the author of the report "The Elephant in the Boardroom: Getting Mentally Fit for Work." Cowan is one of Australia’s leading speakers and authors in the area of building resilience and mental health. He is also a director of the R U OK? Foundation (www.ruokday.com).
