Over the past four months I've been getting counseling and read a book that has caused me to face some depressing realities. My counselor does not think that I am depressed and confuses me.

I went to my psychiatrist and he gave me Wellbutrin - who is right? I think that sometimes my pain is too much and I'd save the world a lot of grief. I've been struggling for all my adult life and what for a dead end job and loser boyfriends.

I found that when I was responding to your question, I was wishing that you were here with me so that I could ask you some questions about how you are coping now. I want to know how you are feeling since taking the Wellbutrin, if in fact, you are feeling better, worse or the same. I thought that I would provide you with some information about what depression is and based on this you can assess (coupled with the information from the psychiatrist and counselor) whether you are suffering from a major depression or not.

A key element of depression (according to the DSM-IV) is whether you have been experiencing a depressed mood or an absence of pleasure and interest in most aspects of your life for more than two weeks. There must also be the presence of at least four of the following symptoms as well, some of which you may not notice yourself, but others having been providing you feedback about these:

1. Notable weight loss or weight gain, or an increase or decrease in appetite every day.
2. Inability to sleep well (insomnia) or sleeping too much (hypersomnia).
3. Experiences of psychomotor agitation (difficulty sitting still, hand wringing, pacing) and retardation (slowed speech, thinking and body motion and decreased volume and amount of speech).
4. Fatigue or loss of energy every day.
5. Feelings of worthlessness and excessive guilt almost everyday.
6. Impairment in your capacity to remember, to think or concentrate or being indecisive, nearly everyday.
7. Recurrent thoughts of death, thoughts of suicide with or without a specific plan of committing suicide or a suicide attempt.

In addition, to be considered a major depressive episode or even in milder cases, a presence of some impairment in the functioning of your relationships, parenting ability, workplace or other aspects of your life must exist. Treating depression requires a combination of medication and counseling and a desire to go into the pain that is contributing to the depression.

You sound like you are in a form of collapse and that your fear is that your pain is too much for you to bear. The body and mind have a tremendous capacity to heal and they will not take on more that you can bear even though it feels like you might die from feeling so much pain. It is important to be working with a counselor or psychiatrist that can support you and guide you through the pain because it has been my personal experience that there is no way around grief, sadness, anger and all of the other feelings that we associate with ‘pain'. Life, in the form of relationships (loser boyfriends) and jobs (dead end) and other experiences come along to give us what we need so that we can grow. So if we need to experience our sadness and grief and anger (because we forgot to feel them when we were young)), but we have been avoiding feeling these (because most people prefer to feel happy), then life comes along and provides an experience which forces us to feel our hurt, anger or sadness. So rather than avoiding these feelings, feel your fear about how you will not survive your pain and try sitting and feeling and expressing these feelings, but do not allow yourself to be brought down by these feelings. I find a lot of counselors provide excellent head or cognitively oriented therapy and this approach is useful, only, in my experience, if it is balanced with some body focused, emotional focused therapy which allows you to experience the feelings you did not feel at the time a painful experience happened.