A Thorn By Any Other Name Would Cut As Deep: Considerations in Depression Prevention.

A rainy day with many gray clouds above a long road. A rainbow in the distance, touching down at the end of the road.

Last week in this space, I related a cross-section of stories collected from hundreds of health care leaders of a large Midwestern Catholic provider. Over the course of 32 retreats I was able to peer through the eyes of executives, directors, managers, and supervisors who are approaching three years of shouldering a “Once-In-a-Century Pandemic.” Conversations never failed to circle back to themes of “not enough staff,” “not enough resources,” or “work-life balance out-of-whack.” In the midst of these dialogues, the semi-diagnostic term, “burnout” would surface. I wasn’t at all surprised by the head nods signaling personal recognition and experience with it. I was taken aback by the not-infrequent eye-roll that also accompanied use of this word. One leader explained, “That term is used so frequently, I’m not even sure what it means?!”

Come to find out, these leaders were not alone in their confusion about the term. This week in the New England Journal of Medicine, Srijan Sen, MD, Ph.D. reported a kind of imprecision that exists in healthcare settings regarding the use of the term: “burnout” (“Is It Burnout or Depression?” N Eng J Med. Nov 3, 2022. 387: 1629-1630.). In an effort to conduct a meta-analysis of it, he discovered 140 different definitions across a wide variety of studies. Most all of them were unsupported by rigorous analysis. When precise methods were applied, “burnout” ended up sounding an awful lot like “depression.” They appear to travel in tandem.

So what’s the problem with the overuse of this word? According to Sen, the short answer is that docs and nurses are less likely to get appropriate treatment for depression when they need it. And it would appear that many more of them need help than are willing to ask for it. It may seem counter-intuitive, but anyone who is married to a physician or a nurse will tell you that they are incredibly slow to admit the need for help. Despite their training, and diagnostic knowledge, these smart, giving people tend to still regard depression as a diagnosis for their patients and relatives, but not for them! “Burnout,” they reason, is due to broken healthcare systems. “Depression,” they assume, is a personal failure. That assumption is wrong when their patients think it! It is wrong when they think it!

In my profession of counseling, it would not be unusual at a conference to hear research findings about MD’s and RN’s resisting diagnosis and treatment of mood disorders. Such a finding would be accompanied by knowing head-nods and self-righteous comments equivalent to: “Doctors!… Oiy!… Am I right?!” The unspoken message: “We far wiser, and more experienced counselors would know better!” It was with great humility that I read Dr. Sen’s findings about the ongoing clinicians’ stigma associated with depression. I realized, that despite my training, and thirty years of assisting others, it took me more than ten years to admit to colleagues and clients that depression has been a companion of mine as well. Despite what I have been telling clients for years, I was worried that if word got out, my practice would suffer! In real life (as opposed to what I had made up in my head), the opposite appears to be true. My insider’s status tends to lend more credibility rather than less, when working with my fellow way-farers who also carry a mood issue in their backpacks.

What if You Think You Are Suffering from “Burnout?”

My reflections of this past week have me wanting to go back in time, and re-introduce my resilience retreats with a preamble that would include several points. I would explain Dr. Sen’s findings and add, “If you think you are burned-out, there is a significant possibility that you are actually depressed.” I would recommend seeking out a counselor to discuss this possibility, stressing that medication, while often necessary to treat a mood disorder, is never sufficient for long-term relief. Finally, I would suggest to those who suspect that they may be suffering depression that my resilience research and practices be viewed as prophylaxis for future episodes. Once in an episode of depression, counseling, gentle aerobic exercise (if at all possible), and if appropriate, medication are necessary. In short, for someone in an episode of depression, proper treatment is the best resilience practice!

Something to Consider as the Days Grow Shorter and Grayer

Do you know the telltale signs that may indicate a potential episode of depression? An unmistakable signal is when previously enjoyable activities bring little to no pleasure (“anhedonia”). I become particularly concerned when a client is suffering sleeplessness or significant sleep disruption. Some researchers believe that insomnia is both a product of depression, and the engine that drives it. A sense of meaningless or hopelessness about the future is a clear signal of the onset of depression. Isolation from relationships is common in the depressed, and should be taken seriously by concerned friends and family members. Emotional reactions that don’t seem to fit the circumstances at hand can be important indicators. Look for an exaggerated temper, or frequent tearfulness. A genetic predisposition for depression should also be considered relevant. Substance abuse may be an attempt at self-medicating an underlying depression. It must be treated prior to working with its antecedent.

What Can I Do To Prevent Depression: Follow Dr. Tom’s Resilience Research (Of Course!)

A habit of aerobic exercise at least four times a week should be considered a must! Speaking of “a must,” sleep hygiene is the hottest topic in wellness literature. Don’t forget the three most important rules of depression mitigation: Relationships, Relationships, Relationships. As the weather turns, connect with significant friendships early and often! Regular daily, or twice-a-day meditation has been shown to increase happiness, and decrease the incidence of anxiety and depression. When a Christian practices meditation according to their spiritual theology, it is called “contemplation,” and aims at intimacy with God. Religious practices rooted in a community can feed two birds with one crumb. A hobby, that while not therapy, but “therapeutic” can work wonders as a preventative measure (e.g. sewing, wood working, gardening, fishing, hunting, etc…). The benefits of nature are well documented in building up the human spirit. Do you have cold weather gear for hiking? Finally, for those with Seasonal Affective Disorder, light boards have been shown to reduce the incidence of depression.

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