The latest news about the need to discuss problems is this: talking actually makes it worse, at least for women.

The study, which will appear in the July issue of the American Psychological Association journal Development Psychology, involved observing boys and girls in the 3rd, 5th, 7th and 9th grades over a six month period to see how sharing problems with friends correlated with anxious and depressed feelings. They found that for girls, sharing problems with friends strengthened their friendships, but it also increased their feelings of depression and anxiety. Boys, however, did not react the same way. While feelings of friendship also increased with boys, there was no apparent impact on their depression or anxiety levels.

Back to the old “stiff upper lip”? Actually yes for girls, but no for boys: not talking at all is bad too.

The study summary:

In contrast, boys who discussed problems with their friends reported more positive friendships and had no increased risk of developing emotional difficulties…

Well, a lot of this makes sense.

A lot of teenaged therapy is hormones, but a lot of it is learning to cope with being an adult. In structured societies, where you knew exactly how you were supposed to act, it was less stressful than today’s society, where you have choices.

But of course learning to choose the good over the less good is part of becoming a full human being. It’s painful. And sometimes one makes mistakes.

But harping over and over again on your mistakes only makes you feel like a loser, because you are reinforcing the idea of failure.

In contrast, one of the “non drug” way to treat depression is congnitive therapy.

Too often girl talk is:

I’m no good I’m too fat No one likes me I’m dumb.
And the reply: I’m no good too. I’m too fat. Ain’t it awful.
Repeat daily.

Once is fine, but some girls get stuck in the rut, and the idea sticks.

In Cognitive therapy, we teach that when the idea comes saying “I’m no good” to remind oneself immediately of why we are good. (I’m no good…ah, but you did the dishes without mom having to nag you. that is a good deed ) (I’m too fat…ah, but isn’t the fact that you made an A in Algebra more important than a few extra pounds?) (No one likes me…but your dog loves you. So does your mom, and your best friend).

You get the idea. Let it out, but don’t make a habit of it. Something is bad? Well, a lot of things are bad, but a lot of things are good too. After awhile, the person learns to put things into perpective.

Most mild depressions that go along with life go away with no treatment. So many of those we docs see and prescribe medicine never take the pills, and get better simply because we listened to them.

But I used to remind my patients that they couldn’t separate the head from the body, nor the mind from the body and the body from the soul. And that is where a good doctor comes in handy if a simple depression doesn’t go away.

Medical problems can cause depression, and so can chemical imbalances in the brain.

There is no talk therapy that cures a major depression, or the depressive phase of a bipolar illness. Some things need psychiatrists and strong medicine. If you don’t treat a person with severe depression, some of them commit suicide. You don’t tell a person with pneumonia to “put up with it so your body will get stronger” because people die of pneumonia. Similarly we don’t tell a deeply depressed person: put up with it and you’ll get over it, because some of them don’t get over it, they get dead.

But a lot of mild biochemical depression seen in private practice is due to medical problems: menopause, diabetes, cancer, chronic pain. And often the anti depression medicine helps.

But doc, a patient asks, why do I need an antidepressant? I’m sick and tired and hurt all the time, but I’m  not depressed.
Well, it’s like my old dog with arthritis who sleeps all day because he hurts. The pain is causing you to feel tired: it’s the body’s way of letting you heal. But in your case, it is making things worse. If we use the antidepression medicine, it gives you more energy, and increases your pain threshhold. So you don’t need as much medicine for the pain, and you can function better.

Part of the exam is to check for medical causes of depression. Several times I have diagnosed “depression” only to have the lab tests come back later and show thyroid problems or anemia or diabetes or mild hepatitis. Which is, of course, why I did the lab tests in the first place: to check out problems that didn’t show on exam.

But sometimes more subtle reasons for the depression are revealed:unresolved grief, unforgiveness, or guilt over doing something wrong.

I remember one lady who was in counselling and on prozac who came to me for her refill. She was not feeling better, and since the appointment with our psychiatrist was not for another six weeks, I started probing various issues. I knew she was active in a certain church, and I asked if she had asked for them to lay hands on her to ask God to heal her…and she began to cry…  for behind her depression was a terrible and unresolved anger against God after watching her mother die of lung cancer. She was ashamed to admit this anger, and indeed she saw it as the unforgivable sin. This ended up in a long discussion and suggestions to make an appointment with a different pastor who was good in grief counselling. Alas, not all pastors have ever gone through the crisis of faith that leads to a more mature concept of God, but there are some, and every good doctor and psychologist have a list of which pastor is good for this type of counseling.

For guilt, unforgiveness/anger and grief, a mature religion is better at these things than psychology. And many traditional religions and belief systems have Sacraments, prayer services, laying on of hands, cermonies and sings that have a communal aspect and a connection to the deity that  helps a troubled soul by assuring them of love of their fellow man, love of the deity, and that there may be no easy answer, but there will be an ultimate answer.

In summary, depression has physical, biochemical, mental, and spiritual roots, but we docs are better at treating the biochemical and physical aspect. But often this is enough, since by decreasing the lethargy of depression, a person then is able to work on the psychological roots (i.e. cognitive therapy) or the spiritual ones.

USNews has a test here to take, and in our practice often we would hand people a Beck depression inventory test, or a similar quickie test to screen for depression.

But ironically, the best screening tool for busy doctors to diagnose depression is simply to ask: Are you depressed?

And then, if the answer is “yes”, we send the nurse out to warn the other patients they might have to wait, because that simple ten minute consulation for “bronchitis” turns out to be a 45 minute discussion.

Nancy Reyes is a retired physician living in the rural Philippines. Her website is Finest Kind Clinic and Fishmarket, and she writes medical essays on HeyDoc Xanga Blog.

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