Depression

Many people have an image of depression as the monster that keeps a person in bed all day, saps their energy, and colors their emotions blue.  This post is about another kind of depression that creeps up on a person, saps their energy, but does not put them in bed.  In this kind of depression a person is functional but has little motivation and little ability to accomplish things.  Neither of these depression types is more sever than the other, they are just different.  I choose to focus on this last type of depression, because it is the kind that I can speak about from personal experience.

Recognizing Depression

Here is a list of symptoms of depression as taken from the Major Depression category of the DSM IV-TR.

1. Depressed mood most of the day.
2. Diminished interest or pleasure in all or most activities.
3. Significant unintentional weight loss or gain.
4. Insomnia or sleeping too much.
5. Agitation or psychomotor retardation noticed by others.
6. Fatigue or loss of energy.
7. Feelings of worthlessness or excessive guilt.
8. Diminished ability to think or concentrate, or indecisiveness.
9. Recurrent thoughts of death (thoughts of suicide)

Symptom (4) sleep disturbances is stereotypically taken as the most indicative of depression.  It is understandable that changes in sleep patterns are easy to notice and certain to draw attention.  On the other hand, for people that do not experience disruptions in sleep, detecting the presence of depression can be more difficult due to the subjective nature of most of the other symptoms.  Particularly if one does not feel very 'blue' as in symptom (1) depressed mood, recognizing depression is challenging.

I am in the category of people who do not experience symptom (4) sleep disturbances.  In addition, I do not seem to experience (1) depressed mood or (3) weight gain/loss.  This leaves me with the following symptoms diminished interest, fatigue or loss of energy, feelings of guilt, diminished ability to think or concentrate.  Now, people that know the DSM and that are counting may have noticed that I did not list 5 symptoms of depression which is the threshold for a Depression diagnosis.  They would be correct.  Recall also that I have had diagnostic issues, perhaps partly for this reason.  Despite this issue, I feel that I have indeed experienced depression.

This leaves me with a problem, how do I detect the onset of depression?  All the easy indicators like thoughts of suicide and sleep disturbances are not appropriate.  While my strategy may evolve further, I am currently using an activity log to track my engagement in work.  This is similar to a time-sheet, but it involves extreme honesty about when I am actually working productively.  (This is for my eyes only, so I do not have to worry about a negative opinion from my supervisor.)  I track the time that I work productively each day and each week.  Then I can watch the trend over time.  If I start to become fatigued, uninterested in work, or lack the ability to concentrate, my weekly productive time drops.

You might ask if keeping an activity log is difficult.  I find that it is not (of course I sometimes lapse), but I have integrated the activity log with my lab notebook which records my research/work activities.  So, the log has a dual purpose.  Also, I use a computer to compute statistics like average productivity.

This tool is very important to me, because at the beginning of a depression it is easy to rationalize the symptoms.  I will end up thinking that I just need a break to recharge when in reality a break might only make the depression worse.  This tool allows an objective view of the time I spend being active and helps cut through the subjectivity of the situation.

Preventing and Treating Depression

For me, the primary prevention and treatment of depression is medications.  It has been critical to have the right combination of psychotropic medications and to treat physical illnesses that could cause depression.  Additionally, I use a motivational tool which turns out to be the activity log described above.

On the topic of medications, being a person with a bipolar family history of sensitivity to SSRIs, I avoid antidepressants.  I rely mostly on the antidepressant properties of Lithium.  I have experienced an instance where a failure to treat a thyroid problem appeared to result in depression.  So, I also keep on top of my general health.

The motivational tool that I use is the activity log mentioned above.  In a bad depression, I try to do at least one activity a day.  Once each activity is complete, I log it in the activity log making the log into a sort of achievement wall.  I get to feel good about each thing that I accomplish.  By continuing to track my active hours each day, I can also see whether the depression is improving which also makes me feel more positive.

The activity log could also be viewed negatively, if one were to focus on how little they accomplished each day.  To avoid this, I strongly subscribe to a view of life that everyone can improve from where they are at.  This view is typically accepting of whatever activity level I find myself at during a depression, and it helps to keep me focused on improvements, no matter how small.

Does anyone else have depression strategies to share?  If you do, please post them in the comments.