Situational versus chemical depression, and what it (doesn’t) mean for treatment
Some therapists do not “get” the difference between having life problems, and having mental illness (plus, often, life problems). My suggestions for dealing with this, if you are mentally ill and seeking therapy, are:
1) Look for therapists affiliated with hospitals, they tend to have more experience with psych patients.
2) Be leery of anyone who makes a big deal out of “situational” versus “chemical” depression. It’s all chemical; it all happens in your brain and body. Peter Kramer, a psychiatrist who is pro-therapy and writes books about therapy and books about medication, argues that research shows that depression triggered by repeated situational events comes to look no different from depression with a heavier genetic component. It’s just that some people start higher or lower down the slope.
Those who start further down the slope - who some people would say have “chemical” depression - can still be helped by therapy. For example, people who are more prone to depression following negative life events can learn to better anticipate and/or avert those events, and cognitive therapy can help people interpret those events in ways that are less damaging. It’s not always enough, but it can be very helpful.
Those who start further up the slope can still be helped by medication. It looks the same as more genetically triggered depression, particularly once you’ve had it enough…and it can be helped by the same things. Medication can also help people be in good enough shape to better deal with situations.
It’s also true that situations are not feasible to change. If you are depressed because you are dealing with a live-in parent with Alzheimer’s that you can’t afford to put into a nursing home, a daughter who has become addicted to drugs, a neighborhood full of violence, and a difficult job you can’t afford to lose but are going to lose unless you start performing at your normal levels, it’s considerably more humane to offer you medication than to tell you that you that you get to be depressed until you’re able to fix all those things. Likewise, if you’re so depressed by losing a long-term relationship that was everything to you that you can’t get out of bed to go to therapy, medication might be very helpful.
The important thing is not that we divide up depression into “situational” and “chemical” so that we can make sure that people with “situational” depression don’t get drugs (or that people with “chemical” depression don’t get effective therapy), but that we treat depression with whatever approach(es) will help a person most effectively deal with their minds and their lives both short-term and long-term.
January 05 2008 09:04 am | |
Suzan on 10 Aug 2010 at 11:40 am #
Thank you for your “balanced” comments on this subject. For those of us who are extremely depressed long-term and have ongoing unresolved or perhaps unresolvable situational issues, it is difficult, if not impossible, to figure out whether the situation came first or the depression did. Of course, one would aggravate the other regardless of which came first. Your article suggests to me that it makes sense to consider taking an antidepressant to lift my mood enough to begin to address the situation more clearly and effectively. Otherwise, it seems like I am going down the drain with nothing to stop me. The question is, then, after unsuccessfully trying nine different anti-depressants, which one might actually help?