Depression following any trauma is pretty common although not a necessary consequence. Please keep in mind there is a difference between feeling depressed and being depressed. Any trauma produces feelings of shock, rage, despair, confusion and sadness and back again. And once the dust settles and the shock diminishes, grief begins. So one can actually feel worse after the initial shock. But grief is not only a normal part of healing, it's a necessary part of the process. Any trauma involves great loss and all loss must be mourned or else it stays entombed somewhere in our psyche forever. But please keep in mind neither sadness nor the anguish of grief constitutes clinical depression. Of course that is not to minimize the pain, and although psychotherapy can be helpful, medication is rarely indicated. When people experience this kind of depression/grief, it's important to know that tincture of time helps a great deal and that most people go through this and almost all of them heal. Talking about one's life helps, support systems help and so does doing something that brings happiness daily. So feeling depressed is pretty typical.
But clinical depression is an entirely different animal. Symptoms include sleep disturbance, change in appetite, difficulty functioning and feelings of hopelessness. But these symptoms don't begin to capture the real experience of depression. I had a clinical depression about five years after my accident. And despite being a psychologist, I didn't know what was happening to me. All of a sudden I was feeling more socially tentative and less secure about my thoughts and ideas. My mind was racing because of all the anxiety and insecurity and I felt I was different from everyone else in the room. Frankly, I felt crazy inside and was too ashamed and too confused to talk about it. I thought that this was my life period. And then one day I was driving with my nurse and she glanced over at me and said: "Dan, you look like you have the weight of the world on your shoulders." I brushed her comments off, but that helped me realize I was depressed and I started psychotherapy and got on medication.
Like most, the combination of the two helped a great deal and I was able to begin the process of rebuilding my life. So the gold standards for depression are medication and psychotherapy. Cognitive behavioral therapy has the best track record.
Please keep in mind that a clinical depression is a brain disorder and people at highest risk for depression after trauma or people who had a history of depression. But because it is a brain disorder, the longer one waits before they get treatment for worse the prognosis. When in doubt, see a shrink!
And by the way, the same things that helped normal sadness and grief also help depression -- support systems, activities that bring joy, social activity healthy diet, when possible, exercise.
Daniel Gottlieb Ph.D.
www.DrDanGottlieb.com
