©1995 All Rights Reserved.
Commercial use of this material is prohibited .
By Dr. Steve Frisch, Psy.D.
would rather be ruined than changed;
We would rather die in our dread
Than climb the cross of the moment
And let our illusions
-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?
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. Its 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
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?
times people ask me how to differentiate sadness, discouragement, or grief from
depression. The feelings Ive 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 dont create
any impairment in terms of your ability to function at home, at work, or at school.
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.
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
various dimensions of an individuals 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
individuals subjective experience of life.
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
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
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?
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.
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 persons 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.
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. Ones 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 persons 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?
of the symptoms is the first step to take. So often people feel hopeless, and arent
able to mobilize themselves to recognize the symptoms and take action. Often, an
individual may blame themselves, have trouble asking for help, or dont know where to
go for help.
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:
stressors such as financial difficulties, loss of job, a death in the
family, children moving away
stressors such as being raised in an
alcoholic family, being sexually,
physically, or emotionally abused as a child
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
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?
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.
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
What Types of Treatment Are
The major treatments for
combined with psychotherapy
Why Should I See a Mental Health
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
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
Symptoms of Depression
someone is depressed, that person has several symptoms nearly every day and all day, that
last at least two weeks.
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
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;
Trouble sleeping or sleeping
Loss of energy or feeling tired
all of the time
Other aches and pains
Feeling pessimistic or hopeless
Being anxious or worried
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
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.
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.
high, euphoric, or irritable*
Needing less sleep
Talking a lot or feeling that
you cant stop talking
Being easily distracted
Having lots of ideas go through
your head very quickly
Having feelings of greatness
Making lots of plans for
Doing things that feel good but
have bad effects (spending too much money, inappropriate sexual activity, foolish business
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.
is treated in two steps. The first step is acute treatment, and the second step is
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.
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
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
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 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.
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 persons recovery and might prevent further episodes.
This approach views depression as having two component
1) Symptom formation, involving the development of epressive
affect and vegetative signs and symptoms which may derive from psychobiological and/or psychodynamic
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 clients immediate here-and-now
2) concern for the clients current important social and
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 clients 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 clients significant others.
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
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.
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. Frischs, Psy.D. Recovery book series.