Depression and Depression Therapy
Depression is a complex set of responses to normal, accumulated, and/or extraordinary personal and environmental stress in combination with an individual’s unique biological, temperamental, and emotional makeup and social/environmental context. Depression is one of the most common mental health disorders in the United States.
Depression is medically defined as “…a mood disorder that causes a persistent feeling of sadness and loss of interest. Also called major depressive disorder or clinical depression, it affects how you feel, think and behave and can lead to a variety of emotional and physical problems.” (Mayo Clinic)
Clinical depression is differentiated from depressed mood caused by a loss, such as the death of a loved one, or a medical condition, such as thyroid disorder. An individual struggling with clinical depression may have difficulty doing normal day-to-day activities, and may feel unrelentingly sad, hopeless, lethargic, fatigued, of low spirits, and at times, as if life isn't worth living. Depression can be more basically described as a deficiency of psychological, emotional, physical, spiritual energy and motivation.
Who can experience a clinical depression? Frankly, anyone…any age, any culture, any economic status. Depression has been observed and described in infants, it is found in the wealthiest, most successful, loved, admired among us.
We are more vulnerable to some form and degree of depression at certain developmental stages of life – adolescence, middle age, elderly and in conjunction with serious or chronic illness and experiencing major life changes, trauma, or stress.
We are more vulnerable if there is a personal or family history of depression and/or anxiety disorders. Anxiety is frequently found to be a strong co-factor with depression and are best treated together.
Extreme depressive episodes are sometimes experienced by individuals suffering from Bipolar disorder cyclically with periods of euphoric or irritable moods called mania or hypomania, a less severe manic experience.
Some widely recognized and experienced categories of depression are:
Persistent depressive disorder (also called dysthymia) is a depressed mood that lasts for at least two years.
Perinatal depression - a more serious situation than the “baby blues” (relatively mild depressive and anxiety symptoms that are hormonal in nature and usually clear within two weeks after delivery) that many women experience after giving birth.
Seasonal affective disorder – thought to be a response to the lessening of hours of natural sunlight at the onset of late Fall and Winter months. Symptoms are some degree of social withdrawal, sleep disruption or the need for increased sleep, and weight gain (fueled by an apparent increased desire for carbs). S.A.D. predictably returns every year and for most is resolved by the return of Spring and Summer although not always.
Psychotic depression occurs when a person has severe depression plus some form of psychosis, such as having disturbing false fixed beliefs (delusions) or hearing or seeing upsetting things that others cannot hear or see (hallucinations).
The DSM-IV includes disruptive mood dysregulation disorder (diagnosed in children and adolescents) and premenstrual dysphoric disorder (PMDD)as new classifications of depressive disorder.
- Persistent sad, anxious, or “empty” mood
- Feelings of hopelessness, or pessimism
- Feelings of guilt, worthlessness, or helplessness
- Loss of interest or pleasure in hobbies and activities
- Decreased energy or fatigue
- Moving or talking more slowly
- Feeling restless or having trouble sitting still
- Difficulty concentrating, remembering, or making decisions
- Difficulty sleeping, early-morning awakening, or oversleeping
- Appetite and/or weight changes
- Thoughts of death or suicide, or suicide attempts
- Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment (nih.gov)
Depression is a highly treatable disorder although in its more serious and persistent forms, multiple modalities and intensive interventions may be required. Generally, a regimen of medication or psychotherapy or a combination of the two is implemented. If severe symptoms continue, electroconvulsive therapy (ECT) and other brain stimulation therapies may be options to explore.
Because no two person’s depression is the same, I will first of all encourage you to tell me the story of “your” experience of depression – past, present, and possible future factors. I will ask you about your childhood experiences, what you know of the medical, familial, and other environmental factors that may have impacted your physical, cognitive, emotional, spiritual and relational development through childhood and what is going on currently in these realms.
I will ask you about past psychiatric treatment and medications you have or are prescribed.
I will ask you about drug and alcohol use, past, present and any treatment you may be involved in.
I will ask you about suicide - thoughts, plans, means, and any prior attempts or completions by you and your family or friends. If warranted, we will work on a plan and safety contract.
I will ask you about homicidal thoughts, plans, means. If necessary we will contract around this as well.
Physical factors may include poor diet, childhood illness, accident, abuse, neglect or physical abandonment, and traumatic physical stress of any kind including sexual.
Emotional difficulties can emanate from any of the above but include poorly developed emotional regulation, chronic frustration and stress, anger, hostility, chronic fear and anxiety, unresolved grief and loss, emotional neglect and abandonment by caretakers for any reason, being exposed to constant conflict or domestic violence, dealing with mental or physical illness or addiction of adults or siblings, school difficulties, bullying, and more.
Cognitive challenges include chronic negativity and distorted thinking, unproductive ruminations, poor self-esteem, inability to take another’s perspective or gain useful insight and knowledge from life experiences, poor problem solving and interpersonal skills, being stuck in the past, paranoia, anxiety (negative ways of thinking fuel the negative emotions of anxiety) and the presence of a personality disorder or living with someone with a personality disorder.
Relational/Social issues stemming from inadequate childhood learning and modeling by adult caregivers, chronic and ongoing family of origin problems that remain unaddressed and unresolved, conflict avoidance, withdrawal, intractable negative emotional states such as jealousy, shame, or guilt, and character weaknesses such as inflexibility and stubbornness, impatience, lack of empathy, and selfishness or narcissism, difficulty with intimacy both emotional and sexual. Relationship and marital issues have a major impact on general psychological, emotional, physical and spiritual health. (See couples counseling)
Spiritual disconnect is what I view as a fundamental cause of much depression and anxiety. When I speak of spirituality, I am not talking about religion per se although a religious practice can be a meaningful mode of expression, education, and connection for a healthy spiritual practice. Spirituality is an antidote to many of the problems and symptoms listed above particularly the self-centeredness, ruminative, dispassionate, unyielding sense of emptiness and lack of purpose that underlies much depressive thinking and feeling. To search for and find a satisfying understanding and connection with the broadest meaning of life in general and humanity specifically elevates the mind and emotions in a way that nothing else can.
Career and work issues also deeply impact all the above factors and vice versa and are an important area of exploration as an underlying cause and maintenance of depressive symptoms.
After assessment what?
We will together consider the best course of treatment. I will undoubtedly refer you for a medical examination if you haven’t had one lately and if I feel that your symptoms are severe enough, we will discuss the possible need for medication and referral for a psychiatric medical evaluation.
There are now many different antidepressants that your doctor can choose from. They include: Selective serotonin reuptake inhibitors (SSRIs). These common medicines include Celexa ( citalopram), Lexapro ( escitalopram), Paxil (paroxetine), Prozac ( fluoxetine), and Zoloft ( sertraline
Talk therapy is a standard modality of treatment that allows you to explore and possibly resolve or relieve any of the afore-mentioned factors underlying your depression and to problem-solve and change what can be addressed and perhaps surrender what can’t, hopefully moving through the stuck places and eliminating or containing current stressors. I include elements from each of the modalities that follow, as determined to be appropriate, helpful and effective.
Cognitive Behavioral Therapy is a short-term, goal-oriented psychotherapy treatment that uncovers and encourages practice of certain problem-solving techniques and skill aimed at changing untenable patterns of thinking and behavior that create or contribute to negative feelings and moods.
Dialectical behavior therapy (DBT), a form of CBT, was developed by Marsha Linehan, Ph.D. It was initially developed to treat people with suicidal thoughts and actions. It is now also used to treat people with borderline personality disorder (BPD) and other disorders based in difficulty regulating emotional responses and behaviors. It’s a skill-based model that is highly effective.
Solution Focused Therapy is another short-term therapy incorporating a strength-based perspective and particular therapeutic techniques designed to explore a person's present circumstances and future goals.
Interpersonal therapy, or IPT, is a short-term, limited-focus treatment for depression. Studies have shown that IPT, which addresses interpersonal issues, may be at least as effective as short-term treatment with antidepressants for mild to moderate forms of clinical depression
Spiritual counseling for the non-religious or non-Christian individual involves the exploration and hopeful discovery of a sense of life purpose, overcoming obstacles to emotional and interpersonal growth and putting pain and grief into a perspective that one can live with and find peace and harmony with one’s environment and culture. Mindfulness and meditation techniques may be incorporated.
Biblically based Christian counseling is based in the teachings of the Bible as the Word of God and assists the individual to explore problems of living and health on all levels – mental, physical, emotional, and spiritual – through understanding and practicing the tenets and doctrines found within its pages including prayer, meditation of the Word, confession and forsaking of sin, receiving redemption and salvation as a free gift of grace, fellowship and community within a church body, and ordering one’s relationships and lifestyle accordingly to the teachings of Jesus Christ. Counseling operates from this foundation and incorporates evidence based treatment modalities as appropriate and useful.