QUESTION:
Dear Dr. Heller,
My former wife was diagnosed by a CA licensed MFCC to have Major Depression, Recurrent, With No Psychotic Features. She also recommended drug therapy. To a lay person - What does that mean? How long does it take to diagnose a person with Depression? What steps does a mental health professional use to determine that a person is suffering from depression? I do feel that she was mildly depressed. She was able to function in her very stressful job. She also had some medical problems. She had lost her mother (not very close, the year before, and then she almost lost her father, very close - too close in fact) six months later.
The company she worked for was doing a Ponzi scheme. She was in a very high pay job doing the taxes and family planning for the number one stock holder of a R & D company. We lost a lot of money when the Ponzi scheme folded (I didn't know that this was happening). She had a serious medical problem right after she lost the money. She divorced me, quit her job, and rode off in the sunset with her father. She concealed from me the fact about the financial loss. I found out about it a year later.
I understand a few things, so let me tell you what I think is true. 1. Unipolar Depression is common. 2. Depression is genetic. 3. Depression can be caused by medical problems. 4. Unipolar Depression can be treated by psychotherapy or drugs, or both. Please correct me if I am wrong. I was blamed for every medical and psychological disorder she ever had. I think that this was very unfair. I did place myself in therapy because I needed to know what I did to cause a thirty year marriage to fail. I found out during this process that my former wife is a full blown narcissist.
Now for the next question - Are narcissistic people likely to suffer from depression? Thank you for your attention in this matter. I tried to give you a very short summary about what may have caused the depression. I have many unanswered questions in mind about depression. I look forward to some of your answers.
ANSWER:
1) Major depression means a person has a significant depression that
has lasted two weeks, and that she has never had a manic or hypomanic episode. There are
official DSM criteria, but many physicians use other means of diagnosing it. There are
tests like the Zung depression index, the Hamilton depression test and others. Only 40% of
individuals with depression go through one episode, the other 60% have it recur. Her
diagnosis means she's been depressed at least twice, and has shown no evidence of
psychosis (misinterpreting reality, hallucinations, etc.). Depression is a medical problem
- and studies such as PET scanning show a significant difference in blood flow to the
brains of depressed individuals.
2) Some patients can be diagnosed when you walk into the room. Some
clinicians take a long time to make the determination. Some use a test to determine
depression. Since depressed people are functioning at the same level as an individual with
end stage heart disease, it's an extremely important diagnosis to make - and it is
inappropriate to wait until "all the tests are normal" to treat.
3) Depression can be genetic, but not always. It can indeed be caused by
medical problems, medications, and situational problems. Psychotherapy can work as well as
medications - but it takes much longer, and the depression injures the body. The
combination of therapy and meds is usually best.
4) The Narcissistic disorder is very difficult to treat - they tend to
view the world as superior people and inferior people - and the definition of superior is
anyone who agrees that they are superior. It's an extremely difficult diagnoses to
deal with. These people are usually in a great deal of pain, and depression is common.
They have a strong tendency to blame others for their problems.
