Dear Dick
articles about wide ranging psychological issues
from "The Local Bulletin" (Brisbane Australia)
by Dick Rigby
©all articles are copyright 2006

April 2000
My husband suffers from depression.  He takes Zoloft (an antidepressant) prescribed by our local GP.  The drugs seem to help a bit, but he still has his periods of quite bad depression.  We both don’t like him being on this medication long term.  I have heard that there are alternatives.  Do you know about this?
Mrs K
Dear Mrs K
Yes I do know about alternatives to medication for treating depression.  But first a bit about antidepressants.  Zoloft is one of a new group of antidepressant drugs called the SSRI’s.  They act on the nerve junctions (synapses) in the brain to increase the level of the chemical transmitter serotonin.  In general, the more serotonin available, the less depressed a person feels.  (This is a very simplified version of a complex process.)
These antidepressants have their place and can be very useful for a person who is suffering from severe depression.  But they don’t fix any underlying psychological issues that may be causing the depression.  They just treat the symptoms.  That is why it is generally recommended that antidepressants are used in association with psychotherapy.
Psychological guidance can help cope with depression whether the causes are mainly psychological or physical in nature.  Depression is a shutting down mechanism.  I describe it as “a strong feeling with nowhere to go”.
Most psychologists help depressed people by helping them to find alternative coping strategies.  Since depression is often an old “tried and true” coping mechanism, some depressed people are reluctant to experiment with new ways of coping.  New ways may be seen to be more risky than staying depressed.  But if a sufferer is determined enough to get undepressed, then they can and they will.
I have found that clients who make progress in finding alternative ways of coping, will wean themselves off the antidepressants with no side effects.  A case comes to mind.  Jack was a 41 year old man working in a job that he hated.  He felt that he couldn’t change jobs, because he might get into something worse.  His depression increased until he began to feel suicidal.  The problem with his depression was that it resulted in his thinking becoming more and more distorted.  He also lost the energy to do anything about his situation.
In therapy, he was able to stand back from his problems and see that there were ways through the swamp.  He slowly came out of his depression enough to make the move to find a better job.  Jack is now in a job that he likes and is free of depression.  Yes there are better ways than just relying on antidepressants.
 

Emotionally distraught mother

April 1998
I was reading the Bulletin last month and in it I saw your column answering questions from readers.  I think it's a great idea for local readers to be able to access a helpful service.  I have a query that you may be able to help me with.
My mother is an elderly woman who lives alone.  My father passed on several years ago, and for the first two years after his death she was fine enough.  Now she has sunk into a deep depression that we cannot seem to lift her from.  We all love her very much, but nothing seems to help, and now she won't leave her house.  She is quite good physically, and has all her faculties, but emotionally she is distraught, and has become obsessed with things in her life. She has had "shock treatment" but even that does not work anymore.  Is there anything we can do to help her?
J M
Dear J M.
This is a very distressing situation that you describe.  You mentioned that your mother has received shock treatment.  I presume that she is also on antidepressant medication. 
Depression like this can have many causes.  In an elderly person, there could be the beginnings of brain deterioration, but from how you describe her in your letter, this may not be the case.
My guess is that her depression is a delayed reaction to her husband’s death.  Sometimes people (particularly the elderly) have a long period where they are unable to really accept that their loved one has gone, and when it sinks in, the person becomes quite depressed.
From a psychological point of view, depression is an emotional “shut down” reaction.  In other words, your mother may be stuck in one of the stages of grieving and unable to move on.  Often developing obsessions and fears (such as agoraphobia) can be symptoms accompanying depression
She would almost certainly benefit from talking to a suitably qualified psychotherapist (such as a clinical psychologist) to assist her to move through the normal grieving processes.  The therapist would need to find out what is going on for her at a sub-conscious level and help her start to look at things differently.  This is called “reframing”.
A rehabilitation program would need to encourage her become actively involved in a hobby or some community activity.  Singing and other forms of music therapy can be very useful here.
I believe that shock therapy should only be used as and absolutely last resort after psychotherapy such as I have described has been given a really good chance.
The love and support that your family offers your mother will be very beneficial to her recovery.
 

Suicide attempt

May 1998
Recently our family went through a very distressing time.  Our youngest daughter is 16 and she attempted suicide (by taking pills) after her boyfriend broke off the relationship.  They had been going steady for nearly a year.  My daughter was admitted to a psychiatric hospital ward and kept there few a few days.  She saw a psychiatrist several times and she said that this was of some help.
We want to know what is the best thing to do now.  My daughter had always been such a happy child and our family has been a loving one.  After the suicide attempt, we read her diary and got quite a shock about what was written in there.  She wrote about her unhappiness over a couple of months.  We didn’t know about it.  In hindsight, the only clue was that she spent a lot of time in her room.  She always had a smiling face.
We want the best for her.  I hope that you can help
Mrs P
Dear Mrs P.
I am really pleased to read that your daughter’s attempt at suicide was unsuccessful.  In the aftermath of this near disaster, there is much that can be done to help your daughter.
 You said that she always had a smiling face and was a happy child.  This smiling face may be a mask worn by your daughter so that people cannot see the pain behind the mask.  She may be the sort of person who helps others, but never asks for help for herself.  She may feel guilty about “burdening” others with her problems.  She might say that other people’s problems are much more serious than her own.
When a crisis like her boyfriend leaving her comes up, she may have felt that she had no one that she feels able to talk to.
I believe that it is important she is able to discuss what happened at some length with a qualified therapist.  She should receive ongoing counselling until such time that she has developed the coping skills to deal with a similar situation in the future.  It can take from a few sessions to several months to sort matters out.
As well, it is usually a good idea that both parents and sometimes other members of the family be involved with your daughter’s therapy.  A family therapist can help facilitate this.  One aim would be to improve communications within the family, so that there are more opportunities for family members to discuss issues in the future. 
Often after the tragedy of a youth suicide, parents and family members feel traumatised with guilt about not seeing the warning signs.  Nearly always there are warning signs, but they are often subtle.  A suicide attempt is nearly always preceded by a period of depression.  The signs of depression include changes in eating patterns, sleeping patterns, lack of energy and motivation, signs of distress such as crying, withdrawal and mood instability.
You said that your daughter was spending more time alone in the bedroom.  When you see an change like this, then it is time to ask her what is going on.  If you get an angry reaction and she tells you to “stop bugging” her, it is probably an indication that something is going on.
For all parents, it is better to risk being a “nagging parent” than much worse consequences.  If you have any doubts, seek the guidance of a psychologist or other suitably qualified therapist.  It is better to be safe than sorry.
 

Antidepressants; blessing or curse

June 2005
I’m going to go out on a limb here.  I think that antidepressants are over used in our society.  I am talking about the SSRI’s (Selective Seretonin Re-uptake Inhibiters) group of drugs.  There has been a lot of concern in the press lately about how these drugs are being prescribed.  There is particular concern for children being put on these drugs.
My worry is about their long term use.  I do not have a problem with a person who has acute depression taking a short course in the SSRI’s, provided that they also receive counselling from a professional fully qualified in psychotherapy.  In some circumstances the SSRI’s can be a life saver.  I don’t want to see these drugs restricted.  I just want to see them used more carefully and always in conjunction with psychotherapy.
Some clients have come to me having been on these drugs for years without receiving any psychotherapy.  I am most concerned abut this situation.  The problem with these drugs is that they work.  They work too well. They boost the serotonin in the brain which makes a person feel better.
But the underlying causes of the depression are never dealt with by these drugs alone.  These causes need to be dealt with in psychotherapy. I have treated many clients who have been taking these drugs for long periods of time.  They have not had good outcomes.  These clients have become dependent on the antidepressant chemicals and seem to have lost some of their ability to solve the underlying problems. 
In my experience, I have observed that these drugs lead to a “dulling down” of the thinking process.  People seem to loose their focus in relation to problem solving.  I have heard the same story many times from clients on long term SSRI’s.  When they report to their doctor that their medication is not working and they are feeling more depressed and/or anxious, more often than not they will be prescribed a higher dose of SSRI or have their medication changed to a different type of SSRI.  I would like to see people ask the question “Is the long term use of antidepressants creating more problems than it is solving”?
I can understand the doctor’s dilemma.  If they recommend a person comes off the SSRI’s and that person suicides or becomes severely depressed, then the doctor could be held liable.  That tends to make drug withdrawal protocols very conservative. 
I believe that we need to shift the emphasis away from a quick fix chemical solution towards the hard work of problem solving.
 

More about depression

August 2000
More and more the topic of depression seems to be in the news.  I wrote about depression in last April's edition of the Local Bulletin.  I want to say some more about this very important topic.  As I mentioned in the other article, depression is a shutting down mechanism.  It is “a strong feeling with nowhere to go”.  It is often a “tried and true” coping mechanism that may be out of date.
Depression can come to anyone where they see a situation to be hopeless. Depression is a natural adaptive response to shut down when there does not appear to anything productive or useful to do.  Depression is usually organized at a subconscious level, and sometimes a person can be quite depressed and not know that they are.
Common symptoms of depression include a general lack of motivation and energy, reduced interest in daily activities, a change in sleep pattern (either sleeping too much or too little), significant weight loss or gain, feelings of worthlessness and inability to concentrate.  It makes a pretty depressing reading, does it not?  There can be other symptoms that indicate a person is depressed.
It can be a very debilitating disorder and can be costly in terms of suffering, loss of working hours, medical intervention and even loss of life.  It is worth treating depression in the early stages.
When I am treating a person with depression, I try and find out what are the underlying causes.  Sometimes these causes are well hidden.  You cannot do much to fix the depression if you don't know what is causing it.
Some people will self medicate their depression with alcohol or other drugs.  Alcohol works well on the short term, but doesn't do anything to address the underlying causes, and it usually makes the problem worse.
Depression can result from being too afraid to make a move.  Take the example of John.  He was a 23 year old man living at home.  He was not happy living there.  But he had overwhelming anxiety about moving out to live on his own.  When he saw a psychologist, he learnt to overcome his fear of moving out.  As soon as he made the move to share a flat with a friend, his depression lifted. 
Sometimes, depression is a message telling us about the change we have to make.
 

Gratitude

September 2005
There is one antidepressant I can strongly recommend.  It’s good.  It’s really good.
The problem is that it hasn’t had a lot of publicity.  The reason is that the pharmaceutical companies are not making any money out of it.  Therefore these is no expensive advertising budget or subsidized conferences for doctors and phamacists.
That’s the bad news.  The good news is that “Gratitude” is widely available.  You can get it almost anywhere. First some background.  When you get depressed, everything seems bleak and hope disappears from the horizon.  It seems like the world is against you.  “Why me” you ask?  “Why have I been singled out for such rough treatment?”
When you feel depressed, your feelings are real.  No doubt about that.  You are not bunging them on.  Why would you?  (Well some people might, but not you.) 
Here’s the catch.  Even though the feelings are real, they are usually based on a distorted view of reality.  When people are depressed, they tend to see the negative things in life and ignore the positive.  Everything goes through a “black filter”.  Reality gets distorted.  As a result of this process you end up telling yourself lies.
Depressed people wake up in the morning often dreading the coming day.  They know it’s going to be miserable and sure enough, that’s the way it turns out.
If you suffer from depression, I am recommending a three step recovery program.  The first step is to admit that you are lying to yourself in certain areas.  This is usually very difficult to do, particularly when you really are going through a rough time. 
But depression is more than just a reaction to hard times.  It is a dysfunctional reaction to hard times.  Depression is being stuck and you filter out the positive things that are happening in your life.  This nearly always involves dishonesty.  When you admit to the dishonesty in the way you filter information, you can move on to the next step.
The next step is to take a mega dose of “Gratitude”.  Look around and see all that you do have and be grateful for it.  Be careful not to block the use of gratitude with the black filter.
The third step is to look and what changes need to be made in your life.  If these changes seem overwhelming, get some professional help to work out strategies.
In summary, remove the “black filter”, be grateful for what you have, and do something about making changes.  It’s not easy, so ask for help if you need to.