Cecilia Ford Ph.DDr. Cecilia Ford, who has been a psychologist in private practice in New York City since 1987, has addressed emotional issues for us in many articles over the years. Here she counsels a teacher, forced into retirement at 57, who is worried about her loss of engagement in life.

 

Dear Dr. Ford:

I am 57 years old and was forced to take an early retirement. I have a pension from my teaching job and have saved enough money for a comfortable retirement. My parents are dead and I have no siblings. I always thought I would have a second career, but I never got around to “doing my homework” for this assignment. I really loved teaching, and all of my friends were in the school system.  Some of us who were unmarried took trips together and went out once or twice a month. 

It has been seven months now since the school year started, and I rarely hear from my former coworkers. I have a dog and I take her for walks, read the newspaper, and email relatives in other parts of the country, but I am finding it harder and harder to fall asleep, so I watch television late, then get up in the morning only when the dog makes me take her for a walk.  I have gained 15 pounds this year and have no interest in going to a gym or going on a diet. I saw my GP and he told me to lose weight and to exercise, but other than that I am in good health and take no medicines.

The problem is that over this “school year” I have reached a place where nothing really interests me anymore, and the idea of a second career is unimaginable. A neighbor comes by occasionally for a cup of coffee, and she told me recently that she thought that I was depressed and suggested that I talk to a social friend of hers who is a therapist.  No one in my family was depressed. How do I find out if depression is causing me to put my life on hold?  And should I do something about it?

Maggie

Dr. Ford Responds:

Dear Maggie:

While the picture you paint of yourself does not include all the signs and symptoms of depression, there are certainly enough of them to indicate that you may indeed be clinically depressed. Two of the most telling symptoms, disturbances in sleep and appetite, are present in your list. While some people who are profoundly depressed lose their appetites, and many experience early-morning wakening—not being able to sleep past 4 or 5 in the morning—this illness can take root differently in each of us.

The main point is that you must see this as an illness. Even though the precipitant causes of your mood clearly have been the real-world changes in your life (what are known are exogenous factors—external, rather than endogenous, or internal, factors), chemical alterations may have taken place in your brain that may make it very hard for you to change your outlook on your own. People who are depressed, like you, are unable to think positively and unable to engage in activities—such as seeing friends or exercising—that might help improve their mood.

That is why it is imperative that you take your friend’s advice a see a therapist. Research has shown that talk therapy alone can reverse the chemical changes in the brain that cause depression. The most effective and fastest route for some is a combination of therapy and medication, but not all depression warrants medication, and many people would prefer to try therapy alone first. I do not recommend the practice—widely in use these days—of seeking a prescription for antidepressant medication alone. Not only does the use of medication require careful supervision, its course can take very varied and individualized patterns. A therapist’s input is needed not only to steer you and keep you safe along the path to recovery but to help keep you from getting discouraged during the inevitable peaks and valleys that are likely to occur. Having said that, though, for many people antidepressants are a crucial and necessary adjunct to psychotherapy.

Peter Kramer, M.D., is an expert in the field who says in his book Against Depression that it is “a disease, one we would do well to oppose wholeheartedly.” New research shows how depression damages nerve cells, heart and blood vessels. Upon autopsy the brains of depressed subjects are markedly smaller than those of non-depressed subjects, and the longer the person has been depressed, the more brain tissue is likely to have been destroyed.

In other words, not only is depression an illness, it is dangerous and destructive. There are good reasons why you are having trouble motivating yourself, and you should not try to go it alone. If you are clinically depressed, it is beyond your control. At the very least, a consultation with a professional can help you determine what is causing you to put your life on hold. That, in and off itself, will be a step toward ending your inertia.

Sincerely,

Cecilia M. Ford