As a primary care physician, I see and treat a lot of people with depression and anxiety disorders. Despite the fact that we know more about these illnesses than ever, I’ve noticed that a lot of misconceptions remain, so I would like to dispel a few myths:
1. Depression symptoms are not something a person can control and not a failure of character. I can’t believe we still have to make this point! You cannot just “get over it,” or “pull yourself up by your bootstraps.” These are things said by people who have never experienced depression! People that think this way may have gone through some rough times in their lives that caused them to get very down. . But unlike people who experience depression, they only needed some time, soul-searching, and an attitude adjustment, and they got back on track. So, of course, this is what they think the depressed loved one needs to do!
Depressed people typically try every positive affirmation, attitude adjustment, lifestyle change, and self-analysis they can conjure up, and still feel miserable! Are there lifestyle and thought pattern changes that can help control symptoms? Yes! This is what counseling is all about, but for many people, this is not enough to make them feel normal.
This goes for anxiety symptoms as well. People with an anxiety disorder cannot, “just relax,” or “stop worrying,” even in the face of objective evidence that there is no need to worry. They are fully aware that the anxiety is irrational, but cannot stop it. They very much try to relax, but are invaded by intrusive thoughts of “what if,” and “the worst case scenario,” as well as uncontrollable physical symptoms like palpitations, chest pain, nausea, jitteriness, and trouble breathing.
2. Pointing out all the positives in their lives does not help a depressed person. In fact, thinking about all the good things is often a tactic depressed people try that can backfire. Not only does this not help a depressed person, it can often make them feel worse because they feel guilty about not appreciating all of their blessings. They are fully aware of others struggling with much larger issues, and yet, they cannot elevate their own mood.
3. Depression and anxiety symptoms walk hand in hand. Many people erroneously believe these two illnesses are opposites. In fact, it is unusual for people to have depression without anxiety symptoms and vice versa. Classic depression is characterized by depressed mood, lack of motivation, fatigue, and not enjoying life, but also by irritability, mood swings, racing thoughts, lack of sleep, internal “jitteriness” and excessive worry. The latter symptoms are often more prominent and bothersome to people, so it is very common for me to hear people say, “I’m not depressed, I’m just really stressed,” or it’s “just my nerves.” Also, this terminology is more palatable and socially acceptable for many people. Many times they are surprised to hear me say I think they are depressed, and occasionally they are angry with me. I believe this relates back to the idea of depression as a character flaw, and they are insulted by the label of depression. This is really unfortunate, because obviously, my intent is to help, not offend, and getting an accurate diagnosis is the first step to getting better.
4. Seeking treatment for depression is not a sign of weakness. On the contrary, it takes a very strong person to recognize that things are not going well and take action. I recognize that coming to see me or another doctor to discuss these symptoms is frightening and humbling. Many people I treat for depression and anxiety disorders never imagined they would experience this problem. One patient summed up her difficulty in seeking treatment by saying, “I don’t even believe in this stuff! I never thought depression was real!” Needles s to say, she has changed her tune.
5. Depression and anxiety are diseases with a tremendous genetic component. This means that they tend to run in families and your tendency to develop these illnesses strongly correlates with your genetic makeup. This underscores the difficulty people with mood symptoms have in controlling symptoms without treatment. I always say, “It’s hard to change your genes!” This doesn’t mean that if depression and/or anxiety disorders are in your family, you are doomed to an unhappy life. It does mean that you need to be cognizant of this tendency and address issues when they occur. Don’t be afraid to discuss this with family members. Maybe there are others who are struggling and bringing this family tendency to light will help them.
6. There are even more misconceptions about medication for depression. I’ll discuss these in the next blog.
Shari S. Phillips, M.D.