We would rather be ruined than changed;
  We would rather die in our dread
Than climb the cross of the moment
      And let our illusions die.
                                                -W. H. Auden

 What You Need To Know

There are several questions that clients have when they come to me for evaluation and treatment. Some of the questions asked of me are: 1) who gets depressed, 2) what is depression, 3) how will I know if I am depressed, 4) what should I do if I have these symptoms, 5) how will treatment help me,  6) what type of treatment will I receive, and 7) who should see a psychologist.

 Who Gets Depressed?

Epidemiological data indicate quite clearly that despite the greater attention being given to mental health issues, despite the proliferation of countless approaches to psychotherapy, and despite advances in medical and psychological technologies for intervening, the rate of depression continues to increase. The facts as we know them about depression reveal that depression is not that uncommon of a phenomena. About 5% of the American population get depressed every year. This means that roughly 11 million Americans get depressed in any given year. It’s also known that woman are affected by depression more than men are. The statistics indicate that the ratio is roughly 2:1.

What Depression Is Not

Being depressed is NOT abnormal or crazy. In fact, it is one of the most common problems people experience. Depression is not just any bad feeling. For example, depression is not feeling anxious or nervous, although it is true that depressed individuals frequently feel anxious as well as depressed.
 

What is Depression?

Often times people ask me how to differentiate sadness, discouragement, or grief from depression. The feelings I’ve listed may be a reaction to a specific event that would elicit such a feeling. Such events may be a death in the family, a friend moving away, disappointment over not getting a job, or being constantly criticized by your boss. Such feelings associated with those events are natural reactions to events that occur in your life. These feelings tend to be experienced and then they go away. They don’t create any impairment in terms of your ability to function at home, at work, or at school.

Depression, in general, can be thought of as a syndrome. By syndrome, I mean a collection of events, behaviors, or feelings that often--but not always go together. The depressive syndrome is a collection of rather specific feelings and behaviors that have been found to be characteristic of depressed persons as a group. It is important to recognize there are large individual differences as to which of these feelings or behaviors are experienced and to what extent they are experienced. 

Depression is not a singular entity afflicting the individual sufferer. Rather, it is a complex disorder with numerous components on multiple dimensions. It is generally agreed that depression involves a multidimensional mix of problematic patterns. There is little doubt that emotional distress is the dominant feature for the sufferer of depression. However, it also seems true, that there are other dimensions implicated in the presence of depression. These include thought patterns, situational responses, physical condition, or relationship patterns.

The various dimensions of an individual’s experience each blend and interrelate in order to provide a sense of cohesiveness in the course of daily living. The dimensions of experience most relevant to the individual are physiological, cognitive, behavioral, emotional, and interpersonal. When depression evolves, there is an imbalance in the individual’s subjective experience of life.

More specifically, depression is a clinical disorder. There is a period of at least two weeks during which an individual has experienced a depressed mood or loss of interest or pleasure in nearly all activities. Other symptoms of major depression are:

significant weight loss when not dieting, or  
weight gain

sleeping more than usual or less than usual

fatigue or loss of energy nearly every day

feelings of worthlessness or excessive or inappropriate guilt nearly every day

diminished ability to think or concentrate,
or indecisiveness nearly every day

recurrent thoughts of death, recurrent suicidal ideation without a specific plan, suicide attempt or a specific plan for committing suicide
 

What Causes Depression?

There are many explanations for the cause of depression. Two popular explanations are a biological explanation and an interpersonal explanation. I prefer a “both/and” explanation to an “either/or.” Historically, when a client demonstrated physiological symptoms of depression, or manifested depression in the absence of any clearly identifiable external stressors, the depression was assumed to be “endogenous” or biological in nature. Now it seems that such a narrow and unprovable approach may not always be a useful one for either diagnosing or treating the most salient dimensions of depression. The treatment data support this contention. Treatments of an exclusively biological nature, most notably antidepressant medications, unquestionably have demonstrated an ability to reduce symptoms of depression rapidly, and even to provide full recovery from depressive episodes. However, when the therapeutic intervention is solely a course of antidepressant medication, the relapse rate is significantly higher than when the depressed individual receives effective psychotherapy, or psychotherapy in conjunction with drug treatment.

What we have learned in recent years is that depression is not exclusively a biological illness; neither can it be understood only as anger turned inward, a reaction to loss, or a condition that exists because the person is rewarded for it through secondary gain. Emerging in our understanding of depression has been a shift in focus from understanding the abstract issues of a person’s life, in favor of a focus on specific patterns the individual uses in organizing and responding to his or her perceptions of life and how that person interacts in his or her interpersonal world.
 

This latter view of the cause of depression postulates depression as caused by biopsychosocial variables. Cultural influences such as the breakdown of family relationships, and confusion over who a person is in our culture today are cited as contributing to a larger sense of malaise throughout our culture. Familial influences modeling behaviors that perpetuate learning experiences that cause depression account for a psychosocial transmission factor for depression. Influences of individual history contribute to depression as well. One’s idiosyncratic socialization history contributes to the development of specific ideas, values, and ways of thinking and relating that can all contribute to the development of depression. In this respect, it seems that depression is the consequence of powerful experiences that the individual is not equipped to manage competently. It is not so much what happens in a person’s life that is the basis for depression; but how the person responds to circumstances that determines whether depression will result, and if so, how severe and chronic it is likely to be.
 

What Action Should I Take?

Recognition of the symptoms is the first step to take. So often people feel hopeless, and aren’t able to mobilize themselves to recognize the symptoms and take action. Often, an individual may blame themselves, have trouble asking for help, or don’t know where to go for help.

Psychologists or family practitioners are resources that you can consider. A psychologist can help you determine whether depression is present and to what degree, what different factors are contributing to the depression, and what the appropriate treatment options are for you. There are several factors to consider, and they include:

psychosocial stressors such as financial difficulties, loss of  job, a death in the family,  children moving away

trauma-induced stressors such as being raised in an alcoholic family, being sexually, physically, or emotionally abused as a child

interpersonal stressors such as isolation caused by shyness, social awkwardness, or being a stranger in a new city; self-defeating patterns in relationships that perpetuate cycles of abuse, chaos, and/or despair; procrastination that prevents you from achieving your personal and professional goals

physical causes such as substance abuse, emotional reactions to other physical circumstances such as diabetes or other illness, physical injury, or weight gain
 

How Will Treatment Help Me?

Treatment can reduce the pain associated with the symptoms of depression. Being able to break the vicious cycle of apathy, emotional turmoil, procrastination, sleeplessness, and fatigue will allow you to become more functional in your day-to-day life. This ability to function more fully in your life will contribute to further alleviation of feelings of hopelessness, worthlessness, and guilt.

Most people are able to benefit from treatment. However, there is some time lapse between starting treatment and returning to your previous level of functioning. This point underscores the need to be patient with yourself and to seek treatment as quickly as possible.
 

What Types of Treatment Are Available?

The major treatments for depression are:

psychotherapy

antidepressant medicine

antidepressant medicine combined with psychotherapy

Why Should I See a Mental Health Specialist?

Many people with depression can be treated successfully by a general health care provider. However a mental health specialist, such as a psychologist, is trained to assess, develop a treatment plan, and implement therapy for the majority of people suffering from depression.

A psychologist can:

provide consultation with your physician or offer a second opinion

develop a treatment plan that may include an antidepressant prescribed by a physician

provide treatment on an out-patient basis  
with psychotherapy

Symptoms of Depression

When someone is depressed, that person has several symptoms nearly every day and all day, that last at least two weeks.

You can use this list to check off any symptoms you have had for two weeks or more.

Loss of interest in things you used to enjoy, including sex*

Feeling sad, blue, or down in the dumps*

Feeling slowed down or restless and unable to sit still

Feeling worthless or guilty

Changes in appetite or weight loss or gain

Thoughts of death or suicide; suicide attempts

Problems concentrating, thinking, remembering

Trouble sleeping or sleeping too much

Loss of energy or feeling tired all of the time

Other symptoms include:

Headaches

Other aches and pains

Digestive problems

Sexual problems

Feeling pessimistic or hopeless

Being anxious or worried

If you have had five or more of these symptoms including at least one of the first two symptoms marked with an asterisk (*) for at least two weeks, you may have a depressive disorder. It would benefit you greatly to see a psychologist or health care provider for an evaluation.

If you have some depressive symptoms, you should also consider seeking an evaluation by a psychologist or your health care provider. Sometimes a few symptoms can go on to become a major depressive disorder. Some forms of depression are mild, but persistent or chronic. Chronic symptoms of depression also need treatment.

 Bipolar Depression

Some people experience another kind of depression: Bipolar or manic depression may be experienced as having very high moods and very low moods. The duration of these moods may last from a few days to a few months.

     You can use this list to learn the symptoms of mania and to check off any you might have.

Feeling unusually “high,” euphoric, or irritable*

Needing less sleep

Talking a lot or feeling that you can’t stop talking

Being easily distracted

Having lots of ideas go through your head very quickly

Having feelings of greatness

Making lots of plans for activities

Doing things that feel good but have bad effects (spending too much money, inappropriate sexual activity, foolish business investments).

If you have had four of these symptoms at one time for at least one week, including the first symptom marked with an asterisk(*), you may have had a manic episode. You should see a psychologist or your health care provider for an evaluation. There are effective treatments for this form of depression.

Treating Depression

Depression is treated in two steps. The first step is acute treatment, and the second step is continuation treatment.

The aim of acute treatment is to alleviate the presenting symptoms of depression until you feel well. Continuation treatment (continuing the treatment for some time even after you are well) is important because it keeps episodes of depression from returning. Depending on the type of treatment you have, your chances of staying well for 6 months on continuation treatment are extremely good.

When depression is recurrent, a third step to treatment is implemented. Recurrent depression is defined as three or more episodes of depression. Maintenance treatment involves staying involved with treatment for longer periods of time. This treatment allows the individual to stabilize, consolidate the changes made in his/her life, and maintain gains made in treatment. This type of intervention is utilized to help prevent the likelihood of relapse.

 What Are The Benefits of Treatment?

Early treatment may help the depression and the psychosocial consequences of the depression from becoming more severe

Suicidal ideation and suicidal attempts may be part of the syndrome that you are experiencing

It is critical that you put yourself in the care of a mental health specialist so as to reduce the chance of harm to yourself

Successful treatment of your depression will involve a cessation of the suicidal ideation

Although the majority of symptoms may subside between episodes of major depression, 25% of people suffering from major depression will still experience some symptoms that may impair participating in their daily activities as much as they would like.

Psychotherapy

Psychotherapy can be done in many different treatment modalities. Individual, family, couples, or group therapy are the different modalities utilized to treat depression. Individual therapy is done with you and a mental health specialist such as a psychologist. Couples therapy is done with you, your significant other, and a therapist. Family therapy is done with you, relevant family members, and a therapist. Group therapy is done with you, other individuals that are experiencing similar symptoms as you are and a therapist(s). Different modalities all share the common purpose of alleviating symptoms of depression by providing and developing a support system,  problem solving skills, educational information, a new belief and value system, and  interpersonal skills. Interpersonal psychotherapy is an effective approach to treating depression. It must be emphasized that psychotherapy alone is not recommended for severe forms of depression or for bipolar depression.

 Interpersonal Psychotherapy

Short-term interpersonal psychotherapy is a brief  (12-26 weeks) psychological treatment which focuses on current social and interpersonal difficulties in ambulatory, nonbipolar, nonpsychotic, depressed individuals. The main premise of interpersonal psychotherapy is that depression, regardless of symptom patterns, severity, biological vulnerability, or personality traits, occurs in an interpersonal context and that clarifying and renegotiating the context associated with the onset of symptoms is important to the person’s recovery and might prevent further episodes.

This approach views depression as having two component processes:

1) Symptom formation, involving the development of epressive affect and vegetative signs and symptoms which may derive from psychobiological and/or psychodynamic mechanisms.

2)   Social adjustment and interpersonal relations, involving interactions in social roles with other persons which derive from learning based upon childhood experiences, concurrent social reinforcement, and /or personal mastery and competence.

The focus of Interpersonal Psychotherapy is on:

1) the client’s immediate “here-and-now” problems
2) concern for the client’s current important social and interpersonal relationships
3) engaging the client in mastering the current situation by clarification and modification of current interpersonal relationships and by changing maladaptive perceptions or unrealistic expectations

The overall goals of Interpersonal Psychotherapy are reduction of depressive symptoms resulting in restoration of morale and improved self-esteem, and improvement in the quality of the client’s social adjustment and interpersonal relationships. The latter may entail assistance in dealing with the personal and social consequences of the depression, or changes in attitudes, expectations, and behaviors in relation to the client’s significant others.

Choosing Psychotherapy

If you choose psychotherapy, it is imperative that you:

Keep your appointments

Provide as much information as you can to the treating psychologist

Be an active participant in your treatment

Keep your psychologist informed about how treatment is going for you

Taking Care of Yourself

Be patient with yourself. Do not expect too much too fast. This will only set yourself up at a time when you need to feel as encouraged and as hopeful as you possibly can.

Do not allow yourself to get discouraged through your negative thinking. Negative thinking is a symptom of depression and will discontinue once the depression starts to lift.

Do not make major life decisions when you are depressed. If decisions need to be made, be sure to confide in someone you can trust.

Avoid drugs and alcohol. Research shows that drinking too much alcohol and the use of drugs can cause or worsen a depression. It can also lower the effectiveness of antidepressant medicines or cause dangerous side effects.   

G.B.U.

Steve

Dr. Steve Frisch, Psy.D. is a clinical psychologist in private practice in Chicago, Illinois and Northfield, Illinois. You can contact Dr. Frisch, Psy.D. at drfrisch@aliveandwellnews.com  or at (847) 498-5622. Recover from chemical dependency and its toxic impact on family members. Raise your children to choose to be alcohol and other drugs free. Learn how to in Dr. Frisch’s, Psy.D. Recovery book series.