Reader’s Question

My friends all tell me I have the perfect life. I have a doting husband (we’ve been married for four years and truly have never had a fight), and I always get compliments on how well behaved my daughter and son are. Neither my husband nor I have been affected in our jobs by the recent economic downturn, even though I work for a mortgage company. We live within our means, and we raise our kids right. I am well-liked at work, and have excelled there greatly over the past year.

But a series of events in the last year — a death in the family, major back surgery that failed with no pain relief, and a rift in my relationship with my sister — have caused me to slump into what seems to be the worst depression since I was in high school and was diagnosed with major depression.

I can’t get the motivation to do anything. I have started avoiding social situations with people who were once very important to me. I have almost no sex drive anymore. My temper is becoming shorter every day, and I’m afraid that my children will start to suffer if it doesn’t stop soon.

I’ve talked to my husband a couple times about seeking therapy. He thinks it’s just “a case of the blues” and I’ll snap out of it, but I don’t see any end in sight. I feel guilty for even thinking about taking time for myself to go to therapy. I should be on top of the world with all the blessings in my life, but I can’t get excited or happy about anything. I feel like I’m a spectator in my own life, and that I’m watching my kids grow up right in front of me, but I’m not truly “there” with them. Being able to take care of my home used to be easy for me, but now my husband is lucky if he has clean clothes for work.

I’ve lost over 25 pounds in the last 9 months (I only weigh 98 pounds now), and I can’t sleep at night. I have crying spells for no reason, and I’m exhausted by mid-afternoon. I don’t feel like there is enough time in the day to do everything I need to do for my family, and that’s with me working only 25 hours a week.

Could it be chronic pain that is causing the depression? And if that’s the case, can traditional therapy help me with the depression if the pain will still be present? The doctor is looking at another surgery, but I have no idea how quickly that will happen (or if it will work).

Any advice would be truly appreciated.

Our Clinical Psychologist’s Reply

Besides the fact that your history suggest that you might have some constitutional vulnerability, you also outline several significant stressors that could easily play a role in precipitating a depression. And, given your apparent level of conscientiousness, you’re seeking explanations and feeling guilty not only for succumbing to this mood disturbance but also for even thinking about doing something to take care of yourself.

Whether “traditional” therapy will be effective depends a good deal on what you mean by the term. Depression is a multi-faceted illness with biological as well as psychological components. Research indicates that comprehensive care involving both medical and cognitive-behavioral therapies is the most effective. Just as there is likely to be more than one “cause” for your difficulties, effective treatment is likely to involve a combination of therapies geared toward helping you restore normal biochemical balances in your system, confronting thinking and behavior patterns that typically accompany and perpetuate depression, and addressing personality and other variables that might heighten your vulnerability to the illness.

Before taking off in an airplane, you’re always given the caution that in the case of a loss of cabin pressure (i.e., oxygen), you must put your own mask on first in order to have the clarity of mind to help others. My best suggestion: stop internally questioning yourself about the source of your distress or whether you should even seek help for it. Once you’re being treated effectively, you’ll have the clarity of mind to appreciate your life once again and to deal with family and friends in the manner you desire.