Depression Treatment

Why can’t I shake this low feeling? What’s wrong with me?

You may have depression and not realize it.

Depression is a very serious condition. It can cause chaos in your life. It can make getting through each day a major challenge. It can cause problems with work, relationships and substance abuse. Most seriously, it can make you wonder if life is worth it.

Depression is an insidious disease. That means it can sneak up on you and take hold before you realize it. Maybe you’ve lived with low-grade depression for years. Or you may have recurring severe episodes. It may also be based on events, such as part of grief and loss.

If you know or think you have depression, please take it very seriously. Educate yourself and get help. The sooner treatment is received, the better the result.

Depression is common and many people don’t get treatment.

According to the 2020 U. S. National Survey on Drug Use and Health:

About 21 million adults age 18 or older had at least one major depressive episode. This number represented 8.4% of all adults.
A major depressive episode is defined as having at least one period of two weeks or longer in the past year when for most of the day, nearly every day, they felt depressed, or lost interest or pleasure in daily activities; and they also had problems with sleeping, eating, energy, concentration, self-worth, or having recurrent thoughts of suicide.
It affects young adults the most. The prevalence of adults with a major depressive episode was highest among individuals aged 18-25 (5.6 million people or 17%.)
In 2020, an estimated 14.8 million adults aged 18 or older had at least one major depressive episode with severe impairment. This number represented 6% of all U.S. adults. Severe impairment is defined as the inability to manage at home or work, have relationships with others, or have a social life.
An estimated 66% or 13.8 million people received care by either talking to a healthcare professional or taking medication.
Approximately 34% of adults having a major depressive episode did not receive any treatment.

There are many possible symptoms.

Regardless of how it arrived, depression will bring suffering into your life. Symptoms include:

Low energy or fatigue
Low motivation
Reduced sex drive and performance
Weight gain or loss
Disrupted sleep
Frequent sadness
Crying spells
Isolation from family and friends
Discouragement and failure
Guilt and disappointment
Self-harm
Persistent sad, anxious or empty mood
Hopelessness and pessimism
Irritability and annoyance
Worthlessness and helplessness
Loss of interest or pleasure in hobbies and activities
Difficulty concentrating, remembering, or making decisions
Thoughts of death or suicide

There are also gender differences in how adult depression looks. For example, according to the National Institute of Mental Health (NIMH), women tend to have symptoms of sadness, worthlessness, and guilt; whereas men are more likely to report experiencing tiredness, irritability, sleep problems, and loss of interest in previously pleasurable activities.

Depression is both simple and complicated.

It’s simple in that the symptoms can usually be readily identified. An experienced professional will most often be able to determine what your symptoms are. However, it’s complicated in that no two depressions are alike. Everyone is affected differently by depression. This can make diagnosis and treatment challenging.

We don’t know exactly what causes depression. Current research suggests that depression is caused by a combination of genetic, biological, environmental, and psychological factors.

It can be one or a combination of things such as:

Family genetics – if it’s in your family, you may be at higher risk.
Stressful life events – such as death, divorce and relationship problems.
Adverse childhood experiences – unresolved childhood trauma can trigger depression in adulthood.
Medical problems – chronic illness and major surgery can lead to depression.
Side effects of medications for other conditions.
Changes in brain function – such as from concussion or traumatic brain injury.

What’s the difference between normal mood changes and depression?

Everyone has a range of emotions over time, typically changing based on what’s happening in your life. When disappointed, we usually feel sad. When we suffer a loss, we grieve. Normally these feelings come and go.

Depression tends to feel heavy and constant. It doesn’t lift and nothing seems to help. People who are depressed are less likely to be comforted, motivated or relieved.

When you’re grieving, painful feelings come in waves and are often mixed in with happy memories of the person who died. When you’re depressed, your mood and thoughts tend to be negative most of the time. Feelings of worthlessness and low self-respect are also common in depression. People who are grieving can usually maintain their self-esteem.

What happens in therapy?

We judge the severity of depression by assessing the number of symptoms and the degree to which they impair your life.

Mild: You have some symptoms and find it takes more effort than usual to accomplish what you need to do.
Moderate: You have many symptoms and find they often keep you from accomplishing what you need to do.
Severe: You have nearly all the symptoms and find they almost always keep you from accomplishing daily tasks.

The three stages of treatment.

Often, treatment is divided into three phases. Keep in mind, though, that there are no sharp lines dividing the phases, and very few people take a straight path through them.

In the acute phase, the aim is to relieve your symptoms. Generally, this occurs within several weeks, but it may take longer depending on your response to the first treatments we try.
In the continuation phase, we work together to maximize your improvements. Further treatment adjustments, such as changing your sleep pattern or modifying the dosage of a medication, can help. This period may take several months.
In the maintenance phase, the aim is to prevent relapse. Continuing treatment is often necessary, especially if you have already had several depressive episodes, have chronic low mood, or have risk factors that make a recurrence more likely.

In my practice I primarily use experiential methods of therapy. That means we will trace all of the experiences in your life that had a major impact you. A thorough family history is very important. We will look for things like unresolved childhood trauma, patterns of disappointment and loss, relationship problems, alcohol and drug abuse, chronic illness and injuries.

Depression can also relate to themes such as meaning and purpose. We may also use a screening tool such as the Beck Depression Inventory to help determine a diagnosis.

We will explore these experiences in depth looking for suppressed thoughts and emotions. Once revealed, we will process and assimilate them so that you become an integrated whole person.

One goal is to understand the factors that may be causing your depression so that we can figure out a solution.

The following may help you cope with depression:

Try to be active and exercise, even if it’s just a walk around the block.
Set small, daily, realistic goals for yourself. I will shower today is a goal.
Use your support system. Ask for help. Talk to a trusted friend or relative.
Expect your mood to improve gradually, not immediately.
Postpone important decisions until you feel better.
Continue to educate yourself about depression.
Practice mindfulness and meditation.
Express your creative side through art, journaling or music.
Eat healthy.
Get enough proper sleep. That means enough deep, non-REM sleep.

Do you need medication?

Maybe. Most sources say doing psychotherapy and taking medication at the same time gives the best results. For me, the question is how depression affects your daily life. If you can go to work each day with no workplace problems, maintain healthy relationships, get enough proper sleep and be otherwise functional, you may not need medication.

However, if you are missing work, sleeping too little or too much, having relationship problems or abusing drugs or alcohol, medication may very well be needed.

Antidepressants are medicines that treat depression. They may help improve the way your brain uses certain chemicals that control mood or stress. You may need to try several different antidepressant medicines before finding the one that improves your symptoms and has tolerable side effects.

Medication prescription and management must be done by a doctor who has experience in treating depression. Often, a psychiatrist is the best choice.

It will eventually go away.

No, it probably won’t. And why take the risk? Get professional help for a consultation to know what you’re dealing with.

All I need is a pill. It’s a lot easier and cheaper than therapy.

That may be true in the short term. But is it better for you long term? Research shows that the best long-term results occur when both medication and therapy are used at the same time.

I can handle it on my own.

You probably can for a while. But eventually it will wear you down. Without treatment, it’s stronger than you are. The sooner you get help, the better the outcome will be.