IS IT DEPRESSION OR MOURNING? by Carol W. Berman, M.D.

02/01/2017 02:14 pm ET

Joanne*, a 52-year-old, was resigned to all of her many relationships ending after a year at the most. She always blamed herself. So she was not surprised when her boyfriend dumped her after ten months. However, this time she’d fantasized that the relationship would last and she was deeply disturbed by the ending.

She’d escaped a dysfunctional family at an early age. Her father had been a “rage-aholic” and her mother a submissive target. In college she’d experimented with every drug around. In psychiatry, we call such behavior “self-medication.” When people feel depressed or anxious and fail to recognize that they are emotionally distressed, since they’ve been living with the same symptoms for years, they often turn to whatever drug is available on the street. Joanne* turned to alcohol, marijuana, uppers, and downers. Fortunately, after she hit 35, Joanne* got sober by attending 90 AA meetings in 90 days. The meetings had been a suggestion from a psychiatrist she briefly visited.

As often happens with people who are sober, with no substances to cloud their minds, Joanne* realized she was depressed.

Her symptoms (and the symptoms most people feel when depressed) included:

(1) Oversleeping (hypersomnia): The only thing she wanted to do was stay in her soft bed and sleep – sometimes 10 to 15 hours/day. She didn’t feel like getting up. Other people may have insomnia instead.

(2) Not eating (anorexia): She couldn’t bring herself to eat a decent meal. She only ate haphazardly. Many people have the opposite behavior, in which they overeat or binge eat when depressed.

(3) No energy: It makes sense given the fact that she wasn’t eating, but even if she had eaten, depressed people feel like a ton of iron is weighing them down.

(4) Suicidal ideation: She had passive ideation, wishing she wouldn’t get up the next day, or that she’d have cancer and just die, or that a car would hit her. Active suicidal ideation is when a person makes plans and attempts, either with pills, jumping, hanging, cutting, etc.

(5) Crying spells: Whenever we touched on the subject of her boyfriend leaving her (which was what triggered this episode), she would cry non-stop. It was hard to reach her then.

(6) Feeling blue: She spent most of her waking hours feeling blue and not taking pleasure in anything.

(7) Feeling guilty and worthless: She kept blaming herself for the break-up. She said, “if only I had been prettier or younger.”

Her mother had had untreated depression. Her mother’s depression had been masked by her alcoholism. We know that major depressive disorder is 1.5-3 times more common in first degree biological relatives than in the general population. So Joanne* had a huge chance to be depressed like her mother.

When we diagnose major depression, we have to be careful not to confuse it with mourning, which Joanne* was doing about the loss of her boyfriend, but if we look at the time period that mourning lasts we can usually distinguish the two. Mourning the loss of a person usually lasts about 3 months to one year. When people lose spouses or parents, the time period could run into years. Joanne* had lost many boyfriends (and other friends) in the past. She usually took 6 months or so to recuperate. When she first came to me, she’d been depressed for two years.

Also in the mourning process, a person doesn’t usually feel guilty or worthless. He or she may obsess about the lost person or just think of him or her often. Joanne* was convinced she was guilty of every infraction in the relationship. She felt worthless as well, since her boyfriend had just treated her like a sexual object towards the end. He said, “I might as well just use one of these sex dolls. You’re so unresponsive.” She believed every degrading thing he told her.

Joanne* and I agreed that she had major depression and she wasn’t just mourning the loss of the relationship. She was reluctant to go on any anti-depressant after her seventeen years of sobriety. In AA, she’d learned not to take any “substances.” Many people in the program believe that anti-depressants are substances that could lead drug addicts and alcoholics back to their addictions. I was giving her psychotherapy once per week, but until she decided she would take an anti-depressant, we were stalled in our efforts to get her better. She cried non-stop during sessions and berated herself relentlessly. Finally, she decided to take the 20 mg of fluoxetine/day that I’d prescribed. She had the usual side effects of headaches and some diarrhea at the beginning. Then after four weeks, she began to feel a little better each morning. Instead, of wishing herself dead and dragging herself around all day, she started to enjoy her life again. After six weeks and an increase to 40 mg/day, Joanne* felt well and happy. She ate normally and slept 8 hours/night instead of 12. Also she felt that her ex-boyfriend was responsible for the break-up. He had watched porn excessively and then expected her to perform many of the acts he saw on the videos. Joanne* couldn’t please him, no matter how hard she tried. She finally became angry about the way he’d treated her, which was an indication that she was feeling better.

Fortunately, we had diagnosed depression and treated her appropriately, rather than mistaking her condition for mourning and simply waiting for it to pass, which is what Joanne* had wanted to do before she started treatment.

If you find yourself obsessing about a lost relationship or death of a loved one for longer than one year, don’t hesitate to get professional help. You may be suffering from major depression, which is treatable.

*not her real name

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