I often see patients who suffer with depession for many years before coming to see a psychiatrist.  They feel like they “should” be able to handle their moods on their own, or that they “have nothing to feel depressed about.” This is a myth about clinical depression.  Certainly there are events in life which cause all of us to feel sad, to grieve, or to feel low and irritable.  However, when those moods persist and begin to interfere with usual daily functioning, a clinical depression may be setting in.

When thinking about a clinical depression, I ask my patients to consider the following analogy.  Many of us in America have the experience of making spaghetti for dinner.  On a typical evening, one might boil a pot of water, and add a handful of pasta.  We all have different levels of water in our pot.  Generally, 4 quarts is recommended, but many of us just eyeball it. When guests show up for dinner, we adjust the volume of water and the amount of spaghetti in order to feed everyone.  When guest show up unexpectedly, we may feel a bit stressed, and depending on how many guests arrive, we may easily meet their dinner needs, or become overwhelmed.

Depression works in a similar way. Serotonin is the water, and the spaghetti is stress.  We all have different levels of serotonin in our brains that get utilized to meet the stress of daily life.  When stress increases, some brains are able to make more serotonin and meet those demands.  However, at some point, when the stress outweighs the brain’s ability to make more serotonin, the brain’s emotional system gets overwhelmed and a clinical depression sets in.

During the spaghetti dinner, the host may use different strategies to make sure her guests are satisfied. She may make other dishes, serve smaller portions, pull out cheese and crackers from her cupboard, or serve more grape juice. Likewise, people who feel stressed can also use coping mechanisms to help address the additional stress.  But even when using coping mechanisms, every individual has a limit to the amount of serotonin that the brain can make available.

We have the ability to choose what we think about.  We do not have the ability to choose to be depressed or not.  Depression is a biochemical condition in the brain, it is hereditary, and it can be triggered by life situations.  We can learn to think in hopeful, healthful ways despite feeling depressed. However, to link thinking to changes in behavior requires that depression be treated.

There is too much stigma and ignorance about mental illness. Patients rarely hesitate to take an antibiotic for a respiratory illness, despite knowing that most of these ailments are caused by viruses and not suspectible to antibiotics. Or that most colds can be prevented by proper handwashing. There is no stigma or guilt around getting or spreading a cold. But depression, which is not contagious, is something to be ashamed of?

Antidepressants are among the safest medications available. The fear of becoming dependent is understandable but not accurate.  That fear is more likely to be rooted in a fear of success than a true fear of a medication.  I say this because many people who fear getting dependent on an antidepressant, will readily accept other medications which can and are likely to cause physical and psychological dependence (like pain medications, and anti-anxiety medications).

When my patients worry that taking an antidepressant will cause them to feel “flat” or take away their creative “edge,” I agree with that worry and encourage my patients to partner closely with me. My goal is for us to find the right balance of medication and other treatments to resolve the depression, so that my patient feels free to be themselves and live to their potential.

Everybody is vulnerable to mental illness.  The stigma perpetuated about mental illness is an outward denial of inner vulnerability, and ultimately leads to denying our most important needs. In other words, by acknowledging and learning about mental illness, and practicing compassion for those who have mental illness, we will pay more attention to our needs and be more tolerant and compassionate about our vulnerabilities in general.