*Sarah came to therapy for the first time on the cusp of age 40.  Until she lost her the job she’d held since college graduation 11 months previously, Sarah had always been easily able to handle whatever psychological curveballs came her way. Although she’d found another job just three months after the lay-off, employment hadn’t eased her downward spiral.

Eyes rimmed with tears, in a monotone Sarah explained at our first session, “Some days I can barely get out of bed. It’s a wonder I haven’t lost the new job. My boss is very kind – she’s the one who said I really needed to go to therapy.” She added, “The instigator to my depression is solved. I have a fabulous new job. Why do I still feel so awful?”

Not All Depressions Are the Same

Depression, of course, is not a rarity. The National Institute of Mental Health (NIMH) estimates that in 2016, 6.7% of adults in the United States —16.2 million!—endured at least one major depressive episode in a given year.

Obviously, it feels miserable to feel miserable whether it’s a temporary or chronic condition. But it  is essential to know what you are dealing with so you can get the proper treatment as quickly as possible.

Major Depressive Disorder is diagnosed when you experience five or more of the following symptoms over a two-week period that impact your ability to function day to day:

  • Feelings of sadness, hopelessness, emptiness
  • Loss of interest or pleasure in activities you normally enjoy
  • Lack of energy and fatigue
  • Feelings of worthlessness
  • Sleep disturbances
  • Difficulty focusing
  • Anxiety, restlessness 
  • Unexplained physical pains such as headaches or backaches
  • Thoughts of suicide or suicide attempts

There need not be a trigger or obvious cause for these symptoms to develop.

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Adjustment Disorder with Depressed Mood, also called Situational Depression, may sometimes feel nearly as bleak as MDD, but a major difference is that it does not arise out of the blue.  Rather, situational depression occurs after there is a specific trauma–divorce, accident, death of loved one, a major life change…

The good news is, situational depression is not permanent. Typically it has an onset within three months of the upset and the symptoms usually begin to recede within six months.

Take *Pamela. Four years ago she experienced a sudden depression that “stopped me in my tracks.” The 33-year-old recalled, “My emotional breakdown was caused by two cousins who were like my sisters…until they betrayed me by sharing secrets I’d told in strictest confidence to the entire family. Their betrayal was so unexpected and so wounding and caused relatives to take sides…Thankfully, most importantly, my parents and sister were unwaveringly there for me.”

The ray of light is that within a month of the onset of her depression Pamela sought therapy: “I’d never been to a shrink before, but my sister insisted that it was the best way to sort out my complicated feelings and understand what this all meant. I had to really look back on my childhood and life and evaluate my relationships right down to their core.”

For a while Pamela was on psych meds to control her symptoms so that she could use the tools she was learning to handle rather than be swept away by her chaotic emotions and thoughts. She decided to cut off communication with the relatives who had betrayed her, and to figure out healthier boundaries with people in her life. A few months before ending treatment, Pamela weaned off the meds under the guidance of the psychiatrist who had prescribed them. “I felt acceptance if not total closure of what I’d gone through. I’d learned more about myself and that I was stronger than I thought.”

Throughout her husband’s year-long battle with stage 4 cancer treatment and eventual decline *Annie experienced “a selfish, even shameful sense that I was going to make sure I lived even if he wasn’t going to.” She was a staunch advocate for her partner of 12 years, researching his illness and being his caretaker.  Almost immediately after *Ben died, for the first time in her life Annie “was hit with the soul-crushing, lingering depression that tells you life is meaningless and perhaps there is no point in going on.” She began wishing she were dead.

“Ben’s hospice nurse had warned me I’d be more exhausted and absent-minded than I could ever imagine after he died, but I hadn’t realized losing your own will to live was a side effect of grief.”

Two things kept her going: having a dog who needed to be walked and fed and loved every day… and 13 months of free grief counseling provided by the hospice center.

The counseling helped her  “learn to adjust to life without my  partner after his cruel, miserable death and incorporate grief into my life and re-commit to living.”

She’d learned through counseling that what she was enduring was part of grief, a path she could walk through with guidance and helping hands (and paws).

Two years after being widowed she says, “I’m still grieving, some days really f-ing hard but I’m doing my best to live, too.”

Pamela and Annie were able to come through their crises because they realized they were going through crises and shouldn’t just proceed as if nothing in their lives had changed. Imagine breaking an arm or leg and never getting it treated—you wouldn’t because the physical pain tells you something must be done: I cannot proceed with anything else until I deal with this.

Contrast that with my patient Sarah who was hit so hard by losing her longtime job that although she quickly found new employment, solving the problem did not arrest her emotional tailspin. This was because Sarah buried her despair, buried her sense of failure and hopelessness. “I hadn’t realized my sense of self was defined by what I did. After being cast out of my safety net, I didn’t know who I was.”  Rather than taking the time to mourn what was no longer there and learn to redefine herself in a way that encompassed much more than a job title, she “just kept it moving.”

Thus her plunge deepened, continuing to severely impact her daily functioning, and developed into MDD.

Once she finally came for help, and opened the wound, it finally stopped festering and began to cleanse.

If You Undergo a Life-Changing Trauma, Do This

Acknowledge the loss and that things will never be the same – cry, scream, most importantly don’t instantly return to life as normal. Take time to heal.

Go to individual and/or group therapy.

Get a check-up—the physical and emotional are very connected and you want to ensure you take care of all parts of yourself.

Be physical—exercise is vital.

 Eat healthy and do your best to maintain good sleep patterns.

 Don’t depend on alcohol and/or drugs as a crutch.

 Stay connected to people who care about you versus isolating.

Sarah says, “Now that I don’t rely on my job to totally satisfy my needs, I have a much fuller life – close friends, hobbies, the ability to enjoy just being by myself. Before I always needed to be busy because I was afraid of my thoughts. Now I know I’m enough.

*Names and identifying details are changed

Last Updated: Sep 25, 2020