Major Depression Makes You Feel Like The Walking Dead

Major Depression Disorder is extremely debilitating and can even be deadly. For most the onset is insidious and then grows into full bloom symptoms that plunge you into the deepest of valleys with no way out.    

You can literally start to feel like the walking dead, where you lose interest in living.  This is an updated post with some of the newest treatment options. 

It is like having a large dark cloud that engulfs you.  Your life becomes slow motion or even paralysed.

Through your eyes, you see only gloom, and the deepest of sorrow envelopes your total being.

There is no escape from the agony and eventually, you break down wishing you were not alive to face another tortuous day.

I call depression the great rapist because it literally rapes and robs you of life.  Emotionally and physically.  Spiritually and philosophically.

You become dead inside emotionally.  Your body limps through the day, and every movement or task seems overwhelming and even impossible to complete.

This dark tunnel of despair erodes your very being.  You no can longer participate in life as before.  You are now a robot, only capable of doing what is forced and contrived out of you.  You dance with dreams of dying and go through various schemes of checking out.

Major depression disorder is different from  Bipolar disorder in that there is no history of any manic or high states that manic-depressive people have in a cyclic fashion.

Although it can happen just once, most of the time it is recurrent and it is also called unipolar depression.  Response to loss and death will produce similar symptoms, but that is not diagnosable as major depression unless the bereavement continues for a long time.

Other mood disorders, such as Dysthymia, Seasonal Affective disorder, and Post Partum Depression also have different criteria.  Double dip depression is when dysthymia slides into major depression, which is fairly common.

There can be psychotic symptoms, but that is extremely rare except in cases of Post Partum Depression.  I should mention that patients who suffer from thought disorders such as Schizophrenia and Schizoaffective Disorder can also have severe depressive states too.

Physical causes should be ruled out, especially low thyroid function, which can cause some depressive symptoms.

Symptoms are:

• deep feelings of sadness
• loss of energy, chronic fatigue
• inability to concentrate
• insomnia or hypersomnia
• decreased appetite with weight loss
•  increased appetite in a few patients
• crying spells or inability to cry
• loss of motivation
• hopelessness
• decreased libido
• chronic negativity
• irritability or angry outburst
• unable to feel pleasure in hobbies or interests previously enjoyed
• social withdrawal
• suicidal thoughts
• agitation in some patients
• neuro vegetative symptoms: not wanting to get out of bed, or move about, not wanting to bath or brush teeth, and hair.
• can have anxiety
• poverty of speech(talks little with few words)

There are gender differences that I have noted throughout the years, in that men might not describe themselves as sad, but flat or empty. They are more prone to agitation and irritability too.  Women may have a tendency to gain weight, rather than loss, and seem to have more lethargy and fatigue.

Treatment should begin as soon as possible with antidepressant medications if symptoms are full blown and debilitating.  These medications are first-line treatment options because they generally are well tolerated and quite effective for most.

I am always amazed by patients who are resistive to antidepressants, yet think nothing of taking antibiotics for a cold or upper respiratory infection which is usually viral, making antibiotics useless.

The safest antidepressants to take are the SSRI’s such a Prozac, Zoloft, Paxil, Lexapro and Celexa.  Wellbutrin is in a different class and is wonderful for patients who gain weight or have sexual dysfunction of SSRI’s.  Wellbutrin is sometimes added to SSRI’s to increase effectiveness.

Other medications such as Effexor and Cymbalta are called SNRI’s because they work on increasing not only serotonin but norepinephrine, another neurotransmitter.

Treatment protocols always start with less than the therapeutic dose, and slowly increased, unless the patient has taken the medication often in the past.

It takes about two weeks to start to see any relief of symptoms and a full month or two to see complete relief.  I always tell my patients that relief is not like a jet plane taking off, but comes in increments and initially can have setbacks.

If symptoms are abating then one should stay on the medication for about a year to ensure neuronal healing.  Stopping the medication too soon will usually bring a relapse.

I always remind patients not to stop abruptly antidepressants!   Some, like Effexor and Paxil in particualar, have to be very slowly weaned off, or they can cause very unpleasant symptoms. 

Some patients with treatment resistive depression will usually have their dosage increased before being changed to another antidepressant.  If that does not work, some innovative physicians can add thyroid medication to help precipitate a better response, which I have personally observed as being effective.

Some psychiatrists will also choose to add one of the newer antipsychotics like Abilify or mood stabilizers such as Lamotrigine.  In worse case scenarios, there is always ECT, or electroshock therapy, which is only a last resort reserved for patients who have tried everything else.

Neurostimulation is also becoming fairly popular for treatment resistive depression.  Transcranial Magnetic Stimulation was approved in 2008 in the US and can be helpful for some after several weeks of intensive therapy, but is expensive.

Vagus nerve stimulation is also an option for treatment resistive depression but requires a surgical intervention to place the pacemaker-like case that emits the nerve impulses to the vagus nerve.

Esketamine nasal spray has just been approved for use in the United States, not surprising for a whopping price per month!  It is stated to be a fast-acting agent but must be administered in a doctor’s office with approximately a two-hour observance afterwards for any side effects, which will certainly add to the cost of this treatment method.

Another very promising treatment is the neurohormone called pregnenolone, which is a steroid and precursor to progesterone, androgens, estrogens, glucocorticoids and mineralocorticoids.  It can be obtained as a over the counter medication and has been used widely with anti-age physicians, especially in Europe.

It has shown promise in a 2014 study in Duke University Medical Center for the treatment of severe depressive episodes in Bipolar patients.

A new clinical trial is to start in July 2019 at the University of Texas Medical Center using fairly high does of pregnenolone for the treatment of MDD.

Most depressive patients also need and will benefit from conjunctive psychotherapy to deal with the ever-present cognitive distortion and underlying issues that could have been contributory.  With therapy and medication, most patients can be helped.

I should add that any outdoor exercise, especially walking is marvellous in mood-lifting for everybody!  Hanging around plants and flowers and doing gardening helps too and is highly recommended as well!

If you have ever suffered from depression, you know the agony and miserable existence it entails.  The more we bring this disease out into the open, and share, the more people can be treated and saved from this silent hell.