Depression at Various Life Stages
Section 38: PMS / PMT is helped by Antidepressants.
Section 39: Depression during pregnancy.
Section 40: Depression after Childbirth.
Section 41: Depression in Children.
Section 42: Depression in teenagers and young adults.
Section 43: Menopause and Depression.
Section 44: Depression and the older person: Maybe it is not Alzheimer’s Disease after all!
Section 45: Grief Reactions are often complicated by Depressive Illness.
Section 45A: Improving your relationship with your Partner
Section 45B: Stopping arguments
Premenstrual syndrome or premenstrual tension has long been recognised in human existence as a frequent and distressing phenomenon for many women, and for those close to them. We still do not know what causes this condition, which can occur from 1 to 14 days before the onset of a woman’s menstrual bleeding. However, the effects on the woman and on her family and friends can be very unpleasant and distressing.
The physical symptoms of being premenstrual are distressing enough, such as bloating, weight gain, breast tenderness and acne. However, it is the psychological changes of being premenstrual which typically cause most distress. Women affected premenstrually seem to develop a mini version of depressive illness. They may become very irritable, sad, tearful, and have sleep, appetite and sexual interest changes. They often have more trouble than usual in concentration and memory. Very often, even if they are aware of what is happening, women find themselves unable to control these symptoms, and friction erupts between themselves and those close to them, at home or at work.
Various and numerous treatments have been tried in this condition, but the very fact that there are innumerable treatments suggested for the condition confirms that no one treatment has high rates of success.
One of the most interesting pieces of research in this condition in recent years has been the finding, in research conducted on thousands of women, is that antidepressants of the SSRI group were by far the most effective treatment for this condition. For women severely affected by PMS / PMT, the nuisance of taking an antidepressant on a daily basis to prevent a few days, or weeks, of chaos may well be a worthwhile decision.
Many women affected by depressive illness notice that their symptoms, which appeared to have been progressively improving at a satisfactory rate, suddenly flare up quite badly when they are premenstrual. Similarly, many women who are normally quite anxious or perfectionistic find these facets of their makeup are much worse when they are premenstrual, often accompanied by them becoming very irritable.
These various bits of evidence all lend weight to the theory that premenstrual tension is a psychological illness of a mild degree, very prevalent in the community, induced by the hormonal and chemical changes of a woman’s normal monthly reproductive cycle, and with a high rate of response to modern antidepressants.
Other treatments reported to be effective in a minority of women include mild diuretics (medications which cause fluid loss), high dose Vitamin B6 (300mg per day premenstrually, which has to be stopped when the period starts), Evening Primrose Oil, and the oral contraceptive Pill.
Important Disclaimer: This site is medical information only, and is not to be taken as diagnosis, advice or treatment, which can only be decided by your own doctor.
SECTION 39
While society may paint pregnancy as an ideal and happy state, the reality for many women is very different. However, because of the expectation that she will be calm and happy, it is very difficult for many women to tell those around them how miserable they may feel at times.
Pregnancy brings with it increased oestrogen levels, which in most women make them generally calmer, more placid, and less vulnerable to depression. However, high oestrogen levels markedly interfere with the psychological health of a minority of women. Accordingly, some women taking oral contraceptives, taking oestrogen medication, or during pregnancy itself, are more anxious and more depressed than is normal.
Pregnancy also induces in every woman concerns about producing a healthy baby, and no-one can guarantee the health of your baby until it has been born, thus leaving you with the uncertainty and apprehension for many months. The pregnancy also causes changes in the practicalities of life, both now and for the period after the child is born, and changes in the relationship between the woman and her partner. Many women’s partners are unable to feel as emotionally involved with the baby in the womb as the mother herself, and this may cause relationship difficulties.
Symptoms
The symptoms of depression in pregnancy are the same as those of depressive illness at any other time in a woman’s life. Because of the high oestrogen levels of pregnancy, the Dexamethasone Suppression test for depression cannot be depended upon in this situation.
TREATMENT of depressive illness in pregnancy is complicated by the fact that we are all reluctant to expose babies in the womb to unnecessary medications.
In the first 13 weeks of pregnancy particularly (the first trimester), the baby’s organs are being formed, and this is the period in which everybody is most concerned to minimise the use of medication. However, if you have depressive illness of a severe enough degree that your doctor advises the use of antidepressants, you can be reassured that a number of older tricyclic antidepressants and perhaps also the newer antidepressants (although not yet fully confirmed), have been shown to not increase the rate of problems in babies. After the first 13 weeks, there is less concern about the use of antidepressants, as the baby is now fully formed, and is simply growing. Do keep in mind that tricyclic antidepressants have been available for fifty years, and there are no concerns about them causing damage to babies in the womb.
Increased risk of post-natal depression
If you have experienced depression during pregnancy itself, you are at increased risk of post-natal depression. It is necessary to be aware of this, so that post-natal depression can be diagnosed and treated at an early stage, if you do develop it. The issue of post-natal depression is covered in detail in this service.
Important Disclaimer: This site is medical information only, and is not to be taken as diagnosis, advice or treatment, which can only be decided by your own doctor.
SECTION 40
What is meant to be an immensely happy occasion has unfortunately a very high risk of developing certain depression related illnesses, and in fact is the period of highest risk statistically for women in terms of their risk of developing this illness.
“Baby Blues” : This is not an illness. It is a period of three to seven days usually, occurring within the first week after the birth of a baby. It happens in at least two thirds of women, and is thought to be due to the rapid drop in oestrogen levels, which occurs in women after childbirth. Typically, the woman becomes sad, tearful, anxious and irritable, and may even state that she no longer wants her baby. However, this is unfortunately a normal phase occurring after childbirth, and hopefully the woman will have been warned in advance that this is almost certainly going to occur. The partner, family and friends have an important part to play in this situation, assuring the woman of their ongoing care and support, and continuously reminding her that this is a short-lived chemical reaction, not her true self. Occasionally, taking a tranquilliser (not an antidepressant!) such as Valium, may lessen the emotional pain of this phase, although ideally the woman will be breast feeding her baby, and we would all prefer that neither the mother nor the baby be given medication at this time, if at all possible. I emphasise that the condition is a normal reaction, occurring in the vast majority of women after childbirth, which will heal itself spontaneously.
Post-natal depression : This is the term used for depressive illness occurring after childbirth, and it is estimated that at least ten per cent of women will develop this illness in the first 12 months of childbirth. If not diagnosed and treated, the period which is meant to be one of great happiness for the family, and intense bonding between mother and baby, can be turned into an emotionally extremely distressing time.
There are numerous changes associated with having a baby. At a purely physical level, the mother’s chemistry is suddenly changed, just like suddenly changing the transmission in a car from drive into reverse. For nine months, the mother’s physiology and chemistry have been relentlessly programmed to give priority to the baby in the womb. After childbirth, the reverse occurs, with physiology and chemistry now being programmed to look after the woman alone. It is not surprising that things go wrong during this abrupt shift.
Quite apart from the chemical and physiological changes, the role of many women is changed by childbirth, particularly when it is their first child. They may well have had to give up their jobs, losing the self-esteem and position they have developed for themselves over very many years. It is also very difficult for many women to find themselves in the position where they are no longer earning their own money. Also, for very many people, having a job in the paid work force gives them structure to their lives, social interactions and friendships, and a social label. To lose all of these components of one’s life simultaneously is very hard. Similarly, men who lose their jobs for whatever reason are faced with the same conflicts.
Life at home rearing a young baby is not easy. Babies do not come with instruction books, and it is very anxiety-provoking and exhausting to try and understand what is wrong with a baby who is crying and upset. Young babies need to be fed frequently, and this inevitably involves significant sleep deprivation. Furthermore, breast feeding, considered the ideal form of nutrition where possible, is physiologically exhausting. All of these problems are made significantly worse if the baby has problems, such as being premature, having some physical problem, or having pain after being fed (colic, reflux etc).
The mother’s tiredness and irritability due to the pressures of looking after a baby often cause problems in the relationship with the baby’s father, and matters may be made worse by the mother having lost her sex drive, due to stress or due to slowly developing post natal depressive illness.
The most important issue in this situation is the diagnosis of postnatal depression at an early stage. You may wish to complete the questionnaire on this site, as a guideline to show to your own doctor. There are support organizations for postnatal depressive illness in many countries. Emotional support from partner, family and friends, together with practical support and help in looking after the baby and the household tasks are all very useful.
Antidepressants of the tricyclic group have been widely used very safely in breast- feeding women over the past 50 years, with no harmful effects on their children. (In fact, tricyclic antidepressants have been used for at least 30 years in young children with certain medical conditions, without any harmful effects being detected.) Recent research also suggests that the many of the modern antidepressants are almost non-existent in breast milk. Studies of children whose mothers took certain modern antidepressants while breast- feeding have indicated no problem in the children over the first 5 years of their lives.
It is very important to be alert for this very common illness, which can affect any woman, knowing that the emotional health and happiness of the whole family, including the baby, can turn out for better or worse, if appropriate diagnosis and treatment are instituted at an early stage.
Psychotically severe depression : This is a condition which affects 1 to 2 mothers per thousand, and is considered to be a variant of bipolar illness (manic depressive illness). Typically, this condition develops in the first three months after the birth of a child, and the depression in this condition is often extremely severe. The condition may or may not be preceded by a hypomanic phase, in which the mother is unusually positive and extrovert, with lots of energy and much less need for sleep than usual. When this very severe depression strikes, it may become so severe that the mother regrets having had the baby, believing this is not a good world in which to have babies. In this situation, it is very important to physically protect the baby until the mother’s illness has been treated. Typically, mother and baby are usually admitted together to a specialised unit, where the mother’s illness can be rapidly treated, while the bonding between the mother and baby continues in the normal way.
Thoughts of harming the baby : Women who have just given birth to a baby may be horrified to find that they have thoughts of harming the baby, and be ashamed to discuss this with anyone. These thoughts normally come into two categories.
In post-natal depressive illness, a percentage of women will develop what are called obsessional thoughts. These are thoughts which the sufferer regards as horrible and alien, but which continue to intrude. For example, a woman may develop a fear that she will pick up a knife and stab the baby, and be horrified and distressed by these ideas. It is generally considered extremely unlikely that these ideas, when they are due to obsessional symptoms developing in depressive illness, will be acted upon.
In contrast, in the very severe depressive illness described above, as the psychotic category of depression after childbirth, women may contemplate killing the baby to save the baby the inevitable suffering of living in this terrible world. This is a very serious situation, and the baby must be continuously protected until these thoughts have been wiped out by treatment.
If you or someone close to you has any of these thoughts, please understand they are manifestations of illness, and are not real aspects of the mother or the baby. Please do discuss them with your doctor, who will be able to wipe out these thoughts very rapidly and effectively.
Emotional effects on baby : In recent years, considerable research indicates that the babies, and indeed the children, of mothers with depression, are negatively affected by the situation. It does seem that babies and young children intuitively respond to the emotional wellbeing, or lack of wellbeing, of their mother. Babies and children of depressed mothers therefore manifest a whole range of behaviours indicating they are not happy, ranging from difficulties with eating, sleeping and behaviour, to signs suggesting the children themselves are becoming irritable and depressed. For the sake of all involved, it is important that depressed mothers be given the best available treatment of their condition.
Important Disclaimer: This site is medical information only, and is not to be taken as diagnosis, advice or treatment, which can only be decided by your own doctor.
A number of adult sufferers of depressive illness, once they have been cured, describe how they have had similar phases of depression and blackness extending as far back in their lives as they can remember, or extending back to their early or later years at school. They are insistent that the unmistakable quality of the depressive illness they had as an adult is identical in every way to the phases they also had as young children. There is increasing evidence that young children can indeed experience depressive illness.
It is very important not to over-diagnose illnesses of any sort among young children, and therefore great care has to be taken in considering a diagnosis of depressive illness. This is a situation in which a specialist opinion is essential.
Young children’s ways of indicating emotional distress are limited, and usually they will not have the vocabulary to be able to describe what is happening to them. However, significant and prolonged changes in a child’s behaviour pattern, desire to mix with other children, academic abilities and sleep or appetite all raise the possibility of childhood depressive illness. It is important to establish whether or not the child is reacting to emotional difficulties at home or at school, and to establish whether or not some unpleasant event has happened to the child. However, even if an unpleasant event is discovered and rectified if possible, it is still possible that the stress of the event has triggered off an episode of childhood depressive illness.
Understandably, we are all reluctant to expose children to long- term medications, such as taking antidepressants for a number of months. However, if your doctor decides this is necessary, do keep in mind that tricyclic antidepressants have been used in children for over fifty years, with no evidence of long- term complications. For example, the antidepressant agent Imipramine seems to immediately stop bed-wetting, for the nights that it is taken at least, for reasons which are still unclear. After 50 years of use, we have no concerns about the safety of Imipramine.
The safety of the new antidepressants in children has not yet been established, but equally there is no evidence to suggest they are in any way unsafe.
Unfortunately, in rare occurrences, young children have been found to have committed suicide, and it is very likely that they did so while suffering depressive illness, as is the case with the vast majority of adults who commit suicide. Accordingly, a young child expressing suicidal thoughts needs very careful intervention.
Important Disclaimer: This site is medical information only, and is not to be taken as diagnosis, advice or treatment, which can only be decided by your own doctor.
SECTION 42
In many countries in the western world, suicide rates in older teenage and young adult males have tripled in the past ten years! International research has repeatedly shown that the vast majority of people who die from suicide have had depressive illness at the time, and it is very likely that adequate treatment of the illness would have prevented death in the vast majority of these cases. It is therefore very important not to miss the diagnosis of depressive illness in this group, especially if they indicate in any way that they wish they were not alive, or regard their own lives as meaningless.
We all know the mood swings of normal teenage development are frequent and intense, and this makes diagnosing an emotional illness affecting a teenager particularly difficult. However, typically these mood swings are relatively brief, lasting hours or days. If a teenager is continuously miserable or withdrawn for two weeks or more at a time, there needs to be increasing concern about the possible development of depressive illness. You may find it useful to complete the questionnaire on depressive illness on this site, and more than five ‘yes’ answers over a consistent period of time indicate the need for further specialised assessment, or at least a discussion with your family doctor if possible.
It is also worth reading the Section on this site which discusses the differences between depressive illnesses and unhappiness. Certainly, if a teenager or young adult has continuous low mood, or has trouble concentrating or remembering, the chances are much higher that that person is suffering from depressive illness, not just teenage mood swings or temporary unhappiness.
Some doctors are very reluctant to diagnose depressive illness unless the biological drives of sleep, appetite or sexual interest are affected. In my opinion, teenagers and young adults have such powerfully driven biological drives that they can often have depressive illness despite having ongoing normal sleep, appetite and sexual interest.
Many people express disbelief that teenagers and young adults, in the prime of their lives, and with a lifetime of possibilities ahead of them, could possibly develop depressive illness. However, the reality is that the pressures and expectations on teenagers and young adults have escalated hugely compared with a generation previously. Young people are now expected to be socially skilled and confident, be verbally well equipped, and be able in many cases to initiate and maintain a demanding psychosexual relationship, and at the same time be able to be academically or occupationally successful. In contrast, it is not that long ago that such expectations were only placed on those in their mid- twenties and older. Furthermore, there is far more intake of alcohol, marijuana and other substances among young people compared with some years ago, and these substances significantly increase the risk of depressive illness and suicide when consumed in excessive amounts. Research shows that depressive illness is starting earlier with each generation.
As indicated above, suicide rates have escalated dramatically in young males, and to a lesser extent in young women, in many countries in the western world over the past ten to twenty years. Increasing pressures, and higher intake of alcohol, marijuana and other substances, and the increasing prevalence of depressive illness in all age groups in society are likely to be the major explanations.
Furthermore, the risk of suicide is increased when an individual feels that he or she is NOT NEEDED. Against the background of normal parent - teenager friction and power struggles, young adults may be lead to believe they are nothing but a burden on their families and society, as they are obliged to spend many years dependent on their parents while gaining qualifications for the increasingly sophisticated occupational roles required in today’s society.
Features considered particularly indicative of an increased risk of suicide among teenagers and young adults are
1. the presence of depressive illness; having problems with memory or concentration is a strong indicator of depressive illness, not just being unhappy.
2. heavy intake of alcohol, marijuana or other substances;
3. confiding in friends about thoughts of suicide;
4. a sense of hopelessness about the future;
5. a sense of not being needed or of use to anyone;
6. parting with important personal possessions;
7. episodes of SELF-INFLICTED harm, such as burns or cuts, or attempts at suicide, no matter how insignificant they may appear. (Psychologically, they are indicators or a sense of desperation; the single factor most often found in those who commit suicide is a previous failed attempt).
Ideally, an unhappy teenager or young adult can be brought along to see a doctor or counsellor. However, the reality is that very many teenagers and young adults would refuse to do this, or would not confide in the person they were brought to see. If any self- destructive behaviour has occurred, or has been threatened, it is advisable to involve professionals, regardless of the temptation to cover over the event, and/or to accept the young person’s explanations and promises that the behaviour will not be repeated.
Hopefully, the young person will read the information on this site, or in other reference sources, and understand that it is not surprising that the most sophisticated part of our body, being our brain, is at risk of developing the most subtle and sophisticated illnesses. It is not surprising that this complex of chemical and electrical energy goes off the tracks at times, and this illness is very common and usually very easy to treat with modern antidepressants.
In dealing with teenagers under stress, some of the following general reminders may be useful.
Firstly, a useful rule of thumb is to remember that your teenage children are 2 to 3 years older than their chronological age! The trick therefore is to make the transition as smoothly as possible from telling a child what to do, into a situation where you discuss the options in a situation and your own beliefs and advice. Reserve the laying down of the law to as infrequent a role as possible.
Secondly, it is useful to try to understand the viewpoints of the younger generation as much as possible, to the stage where you can accurately summarise his or her views, and the reasons for them. This does not mean you have to agree with each other, but it does mean you are able to understand each other’s viewpoint, and accept the theory that all viewpoints have some greater or lesser degree of validity. Indeed, it is often a useful way of avoiding arguing with another human being to suggest that each party understands the others viewpoint, and will think about it, without necessarily having been converted on the spot.
Thirdly, it is important to let the teenage and young adults about whom you are concerned know that they are emotionally needed, and are important to you, even despite their inability to be financially independent at this point in time, and despite the inevitable arguments and power struggles inherent in teenagers growing to be independent adults.
Fourthly, seek advice from friends and relatives, and be prepared to consider their opinions. Also, do seek advice from counsellors and doctors, even if the young person involved refuses to go with you. You may find it useful to complete the questionnaire on depressive illness on this site, and, either on your own behalf if you are reading this site, or in the way you think it would be answered by the young person about whom you are concerned, and bring it with you when seeing the doctor or counsellor.
Important Disclaimer: This site is medical information only, and is not to be taken as diagnosis, advice or treatment, which can only be decided by your own doctor.
SECTION 43
It seems increasingly clear that there is an increased rate of depressive illness affecting women at the time of their menopause. Debate and research continues in an attempt to decide how much of this increased susceptibility to depression is related to life style and relationship changes taking place at this time, and how much is due to the hormonal changes that take place. However, regardless of the various factors contributing to the depression that does occur at this time in many women, what matters most is the awareness of diagnosing depressive illness, and intervening at an early stage, to minimise the suffering involved.
The symptoms of depressive illness at this time are the same as depressive illness at any other time in a woman’s life. However, normal hormonal changes of menopause, such as sleep disturbance, may complicate the diagnosis. Also, the hot flushes which affect many women at this time are similar in some ways to the hot and cold feelings people experience when very anxious as part of being depressed. However, apart from these symptoms, a careful listing of the symptoms you experience will usually fairly easily clarify the issue.
You may also find it useful to complete the questionnaire on depressive illness, and bring this with you to your doctor if you believe you suffer from depressive illness.
The Dexamethasone Suppression test for depression, described in detail in this service may also be a useful piece of evidence in deciding whether or not you do have depressive illness. However, if you are already taking oestrogen replacement therapy, you cannot depend on the results of the DST, as the high oestrogen levels in your body will give abnormal results in many cases.
HORMONE REPLACEMENT THERAPY is a double-edged sword in the treatment of the menopause. In some women, the use of hormone therapy is a great benefit in treating the multiple symptoms of the menopause, both physical and psychological. In some women also, low dose hormone therapy can very effectively be combined with antidepressant medication to relieve depressive illness at this point in time.
However, hormones can precipitate very severe depression in some women, and this typically happens within one to two weeks of starting the hormones. Women with a previous history of depression especially have to be very careful at this point in time, if they are going to experiment with hormone replacement therapy.
In a small number of women, daily normal doses of Vitamin B6 (Pyridoxine), such as 100 mg per day, can offset the depression they get due to oestrogen.
Given the role changes and health changes that occur in women around the years of their menopause, it is important at this time to retain and cultivate as positive a mental attitude as possible, and to remain as physically and socially active as ever.
Important Disclaimer: This site is medical information only, and is not to be taken as diagnosis, advice or treatment, which can only be decided by your own doctor.
SECTION 44
Depression and the older person: maybe it is not Alzheimer’s Disease after all!
Increasing age increases our vulnerability to a large number of illnesses, including depressive illness.
The lifestyle and health changes of older people in many cases increase the risk of depressive illness. Factors such as social isolation, loneliness, failing physical health, financial insecurity and worries about the future all increase the risk of developing depressive illness.
A vital concept in the older person and depression is that depression in the elderly mimics the onset of Alzheimer’s Disease or other forms of dementia, known in lay terms as senility.
IT IS VERY IMPORTANT TO REMEMBER THAT AN ELDERLY DEPRESSED PERSON APPEARS TO HAVE ALZHEIMER’S DISEASE, AND THERE IS NOTHING TO BE LOST, AND EVERYTHING TO BE GAINED by treaTING AN ELDERLY PERSON WITH A TRIAL OF ANTIDEPRESSANT MEDICATION, TO ENSURE THEY REALLY DO NOT HAVE DEPRESSIVE ILLNESS. Indeed, many apparently irreversibly demented elderly people have made dramatic recoveries following treatment of their depression. As any antidepressant has only a seventy per cent chance of helping an individual patient, a trial or more than one antidepressant agent from different categories may be appropriate.
Even in cases of established Alzheimer’s Disease or other forms of dementia, it is quite common for depression to develop also, especially where the person involved has some awareness and insight into their illness. In such cases, an antidepressant may significantly improve the older person’s remaining quality of life, although of course it will not help the underlying Alzheimer’s Disease.
Elderly people who develop depressive illness often lose the ability to care for themselves, become very forgetful and easily confused, and develop various behavioural problems totally out of keeping with their normal personality. Similar symptoms do of course develop in Alzheimer’s Disease, but usually at a much more gradual rate. Establishing the correct diagnosis, or deciding that both Alzheimer’s Disease are simultaneously present, usually requires a specialist opinion, and/or a trial of one or two antidepressant agents.
Hopefully, before any elderly person is classified as having irreversible Alzheimer’s Disease, or indeed depressive illness, their physician will have ensured that all underlying common medical illnesses have been out-ruled, such as gradual heart failure, or an under-active thyroid gland.
Suicide
The harsh reality is that the elderly have the highest rate of suicide in any population, although most publicity in recent times has resulted from the increasing suicide rates in young adults. In theory, vigorous treatment with antidepressant medications would prevent very many of these suicides, and would markedly improve the quality of life of very many elderly people suffering from undiagnosed depressive illness.
Important Disclaimer: This site is medical information only, and is not to be taken as diagnosis, advice or treatment, which can only be decided by your own doctor.
SECTION 45
The fundamental message here is that research indicates at least forty per cent of people undergoing a normal grief reaction will also simultaneously develop depressive illness. Because we understand why someone is distressed, we should not be blinded to the possibility that some of their distress actually arises from an illness brought about by the same event.
After the death of someone close to us, the normal human reaction is to be very distressed, cry, be difficult to console, perhaps be very irritable and perhaps be looking for somebody to blame. Some people are surprisingly calm, and it may be that they are too emotionally numb as a result of their loss to display much emotion at this point in time.
The next phase in a grief reaction is a period of weeks or months in which many people feel a sense of despair, hopelessness and intense sadness. This is a normal reaction, and over a number of months, the sadness becomes less persistent, and we are able to accept what has happened. We may never forget the person who has died, but we are able to continue with our normal lives.
However, depression is a stress-induced illness, and the death of someone close to us is one of the most serious stresses we will ever face. It is not surprising that research indicates that about forty per cent of people, when faced with this stress, will undergo a breakdown in their internal chemistry, resulting in them developing depressive illness. It is in fact very difficult to decide when a person has developed depressive illness in this situation.
The core issue in deciding whether or not you or someone close to you has developed depressive illness as a result of a grief reaction is whether or not your emotional pain is subsiding within a reasonable period of time. If, two or three months after the death, you are continuing to be very distressed, have a lot of trouble eating, have severe trouble sleeping, and if you still cannot focus your mind on things you have to do, it is increasingly likely that you have been pushed into depressive illness, not just grief, as a result of the death.
Treatment of depressive illness at this stage will considerably reduce your suffering, and will allow the normal grief process to continue, to the stage where you will be able to accept the death. In contrast, not having treatment for your depressive illness at this time increases the risks that your depressive illness will continue for a long period of time, and increases the risk that your emotional life and relationships with others will be permanently damaged by the death that has taken place.
Important Disclaimer: This site is medical information only, and is not to be taken as diagnosis, advice or treatment, which can only be decided by your own doctor.
Section 45A:
Improving Your Relationship with Your Partner
A good relationship, in which you can talk to your partner about anything and everything is the MOST IMPORTANT protection against developing depression at times of stress. On the other hand, difficulties in the relationship between two people is one of the most common causes of depression. The following outline is a simple but very effective way of improving relationships between two people.
When two people first meet, they rapidly start spending a lot of time alone together, talking when they are alone and throwing in some friendly physical contact! In contrast, when they have been living together for some time, and without any conscious awareness of the damage that is taking place, a couple often find themselves doing much less of these activities, which are vital in the bonding of human relationships. It often happens the two partners find themselves very busy, and when they are sitting in a room together, they often find themselves watching TV. When they socialise, they often make a point of catching up on friends at the same time, so that they almost never socialise just the two of them alone. Although both parties see themselves as working hard for the joint benefit of the relationship and perhaps of the family, they are often unaware of the fact that they are not maintaining the bonding of their relationship, leading them to become more irritable and negative towards each other.
TRICKS TO IMPROVE YOUR RELATIONSHIP
1. TALK TO EACH OTHER FOR 20 MINUTES A DAY! The one thing we are all short of in life is time. Deliberately spending regular time to talk with one other person only is objective proof of care for that person.
It is therefore very useful to make sure that each evening the two of you sit down together, with the TV turned off, no newspapers available, and the children not around. Younger children may be in bed and older children can be told not to interrupt private adult time, a good example for them for future years as to how to run a relationship. It does not matter what is discussed, as long as arguments are avoided.
2. THE RIGHT OF VETO. To prevent these 20 to 30 minute sessions, perhaps with a cup of coffee or a drink, turning into arguments, each party has the right of veto, so that potentially explosive subjects can be dropped before they escalate into an argument. To prevent deadly silence after the veto has been used, the person who vetoes one subject has to raise the next topic of conversation. It needs to be emphasized that the use of a veto is a constructive approach, designed to ensure that the time together is a positive rather than negative experience.
3. GO OUT ALONE TOGETHER ONCE PER WEEK. Having a nice time outside the house socially is very important. However, if this only happens in the company of other people, it takes away from the reminder that you and your partner can have a nice time together, just in each other’s company. This is an essential component of enjoying the relationship with your partner. When you were dating each other, you did not bring half a dozen friends with you every time you saw each other!.
4. MAKE DEALS. As time passes, we are all tempted to become less patient with the habits of our partners, and indeed they may well develop new habits as the years go by. Sometimes, it is very useful to make a list in private of particular types of behaviour that you would like your partner to change, and ask your partner to make the same list. Once a week, or less often, you can then perhaps make a deal about doing something differently, in return for your partner also doing something differently. Both people really trying to change bits of behaviour that annoy the other, or are frequent flashpoints for arguments, again confirm that you care about each other, and want a good relationship.
5. THE PACKAGE DEAL CONCEPT. Apart from you and I, nobody is perfect! We all have positives and negatives, and it is easy to take the positives of your partner for granted, and become preoccupied with the negatives. If you know you would miss your partner if he or she died suddenly, then you obviously are glad you have the package. Of course it would be wonderful if various other extras could be added, but if they are not perfect, then you do not have to aim to be perfect either!
All normal relationships have good and bad phases.
BE TOLERANT OF EACH OTHER !
Section 45B
STOPPING ARGUMENTS
Whether associated with depression or not, arguments between people are a huge source of distress in our lives. At the same time, arguing is a normal part of human existence, but I hope the following tips will minimise the distress to those involved.
1. KEEP YOUR VOICE DOWN, EVERYBODY!
Our instinctive response in arguments is to raise our voice to emphasise how strongly we feel about what we are saying. However, such raising of the voice brings with it automatic responses within us, ranging from changes in our facial expression and body language to the production of “vibes” indicating aggression. These vibes may well be accompanied by the production of phermones, hormones which we produce without being aware of them, and which are picked up through the sense of smell in those around us, without them being consciously aware that they are being affected by these hormones.
The automatic instinctive human response to someone else raising their voice and giving off the above signals is to do the same ourselves, leading to escalating friction and intensification of the fight.
Therefore, the simple message is that everybody can say what they have to say, but in a quiet voice. This policy allows people to express their point of view, and even to say negative things to each other, but without the exchange becoming unconsciously magnified by unintentional invitations to fight being issued to the person with whom we are talking.
2. EVERY VIEWPOINT HAS SOME VALIDITY
The fear that the other person does not understand our viewpoint, or is dismissing it as irrelevant or wrong often leads to arguments arising from attempts to discuss various issues between people. If voices get raised, the problem is even worse. A very useful tactic is to say to the other person something along the lines of “I understand your point of view and I will think about it”. This is particularly useful if the person with whom you are talking is saying the same thing over and over again. Such a phrase does not mean that you agree with them, but that their message has been received by you. It then is quite appropriate to add “I hope you understand and will think about my point of view which is…”. Mutual acknowledgement of both parties points of view having been understand will hopefully allow the subject to be dropped without further hostility.
3. THE 0 – 10 SCALE
When two people have different opinions as to how to handle a particular situation, where to go for a social arrangement etc, the following technique can be quite useful in avoiding angry exchanges or raised voices in trying to emphasise how strongly we each feel about the situation. Whether it be which restaurant or movie to go to, or which school a child should attend, what is needed is a way of easily establishing of how each party feels about his or her viewpoint. Therefore asking each other to rate how strongly you hold your viewpoint on a 0-10 scale is very useful. This of course requires that both parties be honest! You cannot have a 9 out of 10 strength of opinion about everything. If one person feels much more strongly about a particular choice than the other, it would seem appropriate to go along with the more strongly held viewpoint, unless one person is continuously coming up with the highest rating, so that there is no equal power in the relationship. If both people involved have equal ratings, then maybe it can be taken in turns to make decisions in such a scenario, or even something as simple as tossing a coin may prevent an argument and hurt feelings. Why not try it and see? Using numbers to transmit your feelings is presumably better than raising your voice!
4. DROPPING THE SUBJECT
Once both parties have expressed their opinions, and have received some indication that their point of view is understood, it is often very useful to then suggest that the subject will not be discussed any further, until both people have really had time to let their emotions settle and even think about what has been said. Phrases such as “Let’s drop the subject so that we don’t argue”, or “Let’s agree to have different opinions for the time being”, are a useful way of dropping unpleasant subjects without leading to more friction. It is a good idea to then raise another topic, to avoid subsequent deadly/hostile silence!
These techniques of conflict resolution can be applied in a whole range of situations whether it be with a partner, a colleague at work or a disagreement between teenagers and parents.
This is medical information only, and is not to be taken as medical advice or treatment