CLINICAL DEPRESSION

1. An Overview & Symptoms
2. Causes
3. Treatment

1. An Overview

‘A significantly lessened ability to enjoy previously pleasurable activities, to function at a normal level, and to handle relationships and responsibilities.’

• Depression can occur to anyone, at any age, and to people of any race or ethnic group.
• Depression is never a "normal" part of life, no matter what your age, gender or health situation.
• Between 80% and 90% of people with depression respond well to treatment, and almost all patients gain some relief from their symptoms.
• Early treatment is more effective and helps prevent the likelihood of serious recurrences. The longer a depression lasts the slower the recovery.

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Symptoms:

• Persistent sad, anxious or "empty" mood
• Sleeping too much or too little, early morning waking
• Changes in appetite resulting in weight losses or gains
• Loss of pleasure and interest in activities once enjoyed
• Restlessness, irritability
• Persistent physical symptoms that do not respond to treatment (such as chronic pain or digestive disorders)
• Difficulty concentrating, remembering or making decisions
• Fatigue or loss of energy
• Crying frequently and/or involuntarily
• Feeling guilty, hopeless or worthless
• Recurrent thoughts of death or suicide

If you have five or more of these symptoms for two weeks or more, you could have clinical depression and should see a professional therapist, a psychiatrist or other qualified mental health professional for evaluation.

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Causes:

Depression is an intricate interweaving of psychological, biological and external factors.

• Psychological
  For some, depression is experienced as they make major transitions in their lives, as losses are experienced and as they wrestle with difficult decisions. Or there may be chronic feelings of sadness, guilt or low self esteem that become more intense and unmanageable over time. ‘Cognitions’ such as negative thinking patterns and self-talk, also leave one more vulnerable to depression.
• Biological
  Genetics is known to be a major pre-disposing factor in clinical depression. Neurotransmitters in the brain are affected such that they no longer transmit the needed amounts of serotonin, dopamine and norepinephrine to provide a sense of well being. Hormonal fluctuations over the lifespan can contribute toward a depressive episode, as can the side- effects of some medications.
• External / Situational
  Difficult life events, including divorce, financial problems or the death of a loved one, can all contribute their share to clinical depression. Life circumstances can become so oppressive that one’s biochemistry is affected by the external stress.

Since a person’s biology, life history and psychological makeup is unique, the way in which problems affect one will also vary. People who appear to be experiencing similar life events will react differently. And it is important to note that depression can occur under seemingly ideal living circumstances.

Contrary to popular belief, clinical depression is not a "normal part of aging" nor is it a "female weakness." Depression is a treatable medical illness that can occur in anyone, at any time, and for a variety of reasons.

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3. Treatment

Psychotherapy has proven to be highly effective, and may be used either alone or in combination with antidepressant medications. Depending on the severity of the depression, significant improvement can be made in 8 -16 sessions. Clients report that changes they receive peak around 12 sessions.

Below are listed some of the models of therapy I draw on – as appropriate - for the treatment of depression.

• Interpersonal Therapy, which focuses on correcting "here-and-now" factors that directly interfere with social relationships.
• I combine it with Communications work, which sustains and nurtures our relationships with important friends, family, and co-workers.
• Family of Origin healing, which includes the working through of unresolved grief, anger or other emotions.
• Cognitive Therapy is designed to alter automatic self-defeating thoughts, or excessive self-criticism. We work together to identify these and replace them with more affirming attitudes.
• Behavioral Therapy: a practical, skills-oriented form of therapy that coaches the new, desired responses that the client wishes to learn. Homework shortens the therapy time needed.
• Solution-Oriented Therapy: the focus is on what is working or going well in people's lives, and on the times they are not depressed. The therapeutic conversation builds on the factors which contribute to these problem-free moments, to help the depressed person create more of these times and expand them into other parts of her life.
• Narrative Therapy: here there is an inquiry into larger environmental factors that may have led a person into a depressed "lifestyle", such as the cult of perfectionism, community isolation, and lack of connection. This type of therapy helps people "re-author" their lives based on how they prefer to be in the world.

Together we work toward a greater understanding of the contributing factors, an empowered approach toward negative circumstance, and the choice of appropriate tools to enhance feelings of coping, meaning, relating, and well-being.

A few words about Medication

Whatever the triggers of depression might be, the biochemistry is or becomes involved. This is the reason why severe depression is often treated with a combination of psychotherapy and anti-depressant medication.

When appropriate, therefore, I may recommend, and coordinate with, a prescribing physician for medication evaluation and management as a part of the healing process.

Antidepressants correct imbalances in the level of chemicals in the brain. They are not sedatives, "uppers," or tranquilizers; they are not habit-forming, and they generally have no stimulating effect unless bi-polar (manic) depression is present. They usually take full effect within 3-6 weeks after therapy has begun. If little or no improvement is noted after 6-8 weeks, the psychiatrist will alter the dose of the medication or will add or substitute another antidepressant. It is usually recommended that patients continue to take medication for 5 or more months after symptoms have improved.

For those people who cannot tolerate antidepressants, there are other "natural medications". These include St. John's Wort and the amino acids 5-Hydroxy-Tryptophan (5-HTP), L-tyrosine and S-Adenosyl-Methionine (SAM). 5HTP, for example, is thought to be a precursor of neurotransmitters needed for stable mood and feelings of well-being. (Important: even "natural" substances can produce strong reactions in sensitive individuals. Anyone taking these remedies should do so under the supervision of a nutritionally-oriented physician).

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