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August 29, 2015 / 14 Elul, 5775
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Coping With Depression

(Names are changed)

Many people in my generation were brought up with an aversion to any medication that did not deal with a physical problem. We were doctor oriented and went to the doctor for anything from a bad cold to a serious bone break. The doctor knew best … the doctor said … There was no Internet to give us access to information about symptoms, holistic alternatives, other medical healing and side effects, and so we relied heavily on whatever the doctor told us to do for everything.

Anxiety and depression were something you coped with silently. You rarely discussed it, even with your doctor. After all, nothing could be done about it medically (so we thought) and seeing a psychiatrist well… it just wasn’t done. That was for crazy people, we mistakenly believed, not ordinary people with problems. If life was hard, you needed to learn to deal with it.

Today, things have changed somewhat. A bit of the old attitudes remain, but many people will seek help for family problems, even if it means seeking this help in a different community in order to remain anonymous. But the attitude about taking medication in order to help you cope better with your problems or your depression often remains the same.

Many older well spouses are hesitant to talk to their doctors about their chronic sadness. They remain embarrassed by the depression that stalks their waking hours and denies them the relief of sleep at night. The lack of sleep only further adds to their depression.

I asked for clarification recently from a doctor friend on how medication can help with a problem that is caused by a situation and is not due to a physical cause like a chemical imbalance. I was quite surprised at her answer. She told me that according to the old theories, there are two unrelated, distinct types of depression: those caused by a chemical imbalance, and those caused by difficult life situations.

This belief has been replaced by a new theory. Today, many doctors feel that situations that cause us to feel depressed over long periods of time affect the balance of chemicals, such as serotonin, in the brain. The problems caused by a difficult and depressing situation cause barrages of intensely negative thoughts. These thoughts and stresses affect the balance of chemicals in the brain that control our moods. This problem can be helped with medication, in conjunction with psychotherapy.

Both medication and psychotherapy work to address a chemical imbalance in the brain. The medication does so chemically. Cognitive psychotherapy helps achieve the same result by helping change intensely negative thought patterns. This, in turn, affects the chemical imbalance in the brain and relieves the depression.

Medication will not help with your spouse’s illness and all its offshoots, but it may help you get out of bed in the morning and deal with what you need to do to get through the day. It may even give you enough mental energy to do something nice for yourself. It is definitely an avenue that a well spouse, or anyone else having difficulties, should consider exploring with his or her physician.

Heather was a veteran well spouse. Her husband’s chronic illness had been ongoing for over 20 years. Until now, Heather had coped fairly well. Though life had been difficult, she had raised her children, married off one, became a grandmother, all the while working at a stressful job. Now, 20 years later, Heather found herself having difficulty getting through the day. She had difficulty getting out of bed in the morning. The desire to just stay under the covers was almost overpowering.

Simple household tasks became insurmountable chores, and even doing the laundry or making dinner seemed to take more energy then Heather could muster. Heather could not understand this change in herself. Her doctor suggested she go on an anti-depressant medication to see if it would help. At first Heather was reluctant, but as getting through the day became harder, she agreed. Slowly Heather began to feel better. As she felt better, she functioned better. She was shocked one day to hear herself singing as she did the dishes. Singing was something she couldn’t remember doing for years.

Sarah was also a veteran well spouse. Over the years, Sarah looked forward to any “simchas” they had. Happy occasions were just too rare to not milk them for every bit of joy. She loved the preparations for her sons’ bar mitzvas and her children’s weddings. The work never bothered her as she embraced each task with joy. That is why it was a shock to Sarah when she couldn’t summon the energy for her youngest son’s wedding. She even went so far as to suggest that there be no wedding at all. She suggested that the couple just take the money both families had budgeted for the wedding and have the immediate family only witness a ceremony in a rabbi’s study. The couple and the bride’s family rejected that idea, leaving Sarah to deal as best she could with her part in making the simcha. Everything that she had once done with such joy was now a tortuous task. She put off dealing with everything until the last minute, unable to summon the energy for the most simple of tasks.

Sarah summoned the courage to speak with her doctor. Reluctantly, and under her physician’s care, Sarah started on medication. Within six weeks, Sara began feeling like her old self. Her only regret was that she hadn’t talked to her doctor earlier.

Tzvi’s thoughts had lately turned to suicide. He knew he would never take his own life but found himself thinking of driving off the bridge, opening a plane door when flying, and jumping off a balcony. Each time these suicidal thoughts came, he always thought, “Then the pain will just be finished.” Tzvi had taken care of his wife for most of their forty years of marriage. These thoughts that popped into his head scared him. He had become anxious all the time. It was difficult for him to admit these thoughts to anyone, including his doctor. Tzvi could not believe the relief he felt once he began the medication his doctor suggested.

I am neither a doctor, nor a social worker. I am just a well spouse relaying stories of other well spouses for mutual support and to heighten awareness. I am not advocating medication, nor telling you to avoid it. What I am suggesting is that if you are having difficulty coping with life’s major ups and downs, an alternative that may help is to speak to your doctor. Help to get through the day is available. It is an avenue worth exploring for anyone walking around with a cloud on his head or the weight of the world on his shoulders.

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When one is blind one learns to use Braille to read. When one cannot walk, a wheelchair gives mobility. Sign language allows a mute person to speak and ocular implants assist in hearing when one is deaf. These are all compensatory strategies that help a person function despite his disability. But compensatory strategies are not just for physical problems. Understanding our psychological weaknesses and setting up our lives to ensure that we are not tempted to repeat our past mistakes, is as necessary as any aid to the disabled.

Well spouses have often discovered that their friends and relatives, despite their closeness to the situation, often don’t realize the tremendous emotional impact living with chronic illness has on the family. With the best intentions, suggestions, ideas and criticism are offered, based on the non-experience of those with healthy families. Even when the good intentioned get a taste of the difficulties, it is sometimes not enough for them to then identify and understand what the family of the chronically ill must face on a constant basis.

Over the past two weeks I have shared letters from a therapist and a well spouse. Both of the letters gave personal insights into the process of losing hope, how we react when that happens and some ways of coping when test scores, diagnosis and just simple repetitive behavior indicate that change for the better is impossible.

Dear Ann,

I’ve read your last few articles on psycho-neurological testing (Oct.8-22) with interest. As a therapist who has counseled couples dealing with chronic illness, I’d like to give you another perspective.

Dear Ann,

Your articles on the Neuro-Psychological Testing were right on (October 8-22). My husband underwent testing twice and your articles explained it things exactly the way they were. Besides the test, we also tried therapy.

Very often when we can’t face our big hurts or big loses we focus on the little ones. We can discuss those. We can cry over the small loses, be angry at the smaller hurts even though it may look trite and sound ridiculous to others.

Over the last two weeks we have been discussing one way in which well spouses can determine whether behavior displayed by their ill partners is caused by their illness or is a way they have chosen to act. We have focused on Psycho-Neurological testing, what it can tell us, as well as its pros and cons.

Last week I discussed a question that haunts many well spouses: not knowing if the difficult and often inappropriate behavior frequently displayed by their partners are caused by the disease and therefore not-controllable, or if the behavior is a choice the spouse makes and can therefore be changed. This doubt can be the source of much frustration and many marital disagreements. One way of alleviating this doubt is by having a psycho- neurological work up done. But that path is not so simple.

Printed from: http://www.jewishpress.com/sections/magazine/coping-with-depression/2004/11/03/

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