All of us occasionally feel dejected, sad, or blue. A major, negative event can cause sorrow at any stage of life. When a job, a cherished dream, or a loved one is lost, we expect to feel deep sadness. The feeling usually heals with time, but if the grieving is unusually complicated or prolonged, it may reflect clinical depression.
Other, less familiar circumstances can cause depression to go unrecognized and untreated. Also, medical conditions such as hypothyroidism or the side effects of medication, psychoactive substance use or abuse can cause a depressed mood or be a factor in the seriousness of the distress. These factors should always be included in the overall evaluation of a patient.
The good news is that depression is one of the most treatable mental conditions. A qualified health professional will conduct a thorough evaluation before mapping out a course of treatment that meets the individual’s particular needs. Various approaches are available. For instance, psychotherapy is extremely helpful in treating depression and is the treatment of choice when psychological or social factors are predominant. Psychologists use various forms of therapy: cognitive-behavioral, interpersonal, or psychodynamic. As depression is a multidimensional condition, most experienced therapists use a combination of approaches tailored to meet the needs of the particular person. In other cases, a biochemical imbalance, may be dominant. Then it is appropriate to supplement psychotherapy with anti-depressants such as Prozac, Zoloft, and Paxil. For bipolar disorder, different drugs, including lithium, may be prescribed.
Depression, even very severe depression, is treatable, but it continues to cause much unnecessary mental anguish. In any six-month time period, 9.4 million people in America experience depression. It directly affects women twice as often as men. According to the American Psychiatric Association one in four women and one in 10 men suffers from depression at some point during a lifetime.
Depression doesn’t focus on a single event. It spreads in ripples, causing a negative outlook about oneself, the world and one’s future. These views and the dark thoughts they trigger may become so familiar that one comes to believe them absolutely, then feel and act accordingly. People with depression often feel they are unworthy of a higher quality of life. They believe any efforts to change their lifestyle would be doomed to failure, and miss out on fine opportunities for further growth.
The following examples (with names and circumstances altered) illustrate the difficulties depression can cause. Mary tells a counselor that she is depressed, because she is about to lose her job. To avoid the humiliation of being fired, she plans to resign immediately. But when the therapist suggests she ask herself, “What is the evidence that my boss wants to fire me?”, Mary can cite no actual proof. The therapist helps her to see her work situation differently, and finding other reasons for her employer’s actions, she no longer interprets them as indicative of low regard . To her amazement, Mary later receives a large raise and a promotion. Her depression had prevented her from grasping the positive aspects of the job situation. Had she resigned, she would needlessly have handicapped her career.
Joe says he is upset because his wife has become very boring: she’s lost her sense of humor, developed annoying habits and is no longer attractive to him. He feels hopeless about himself and his marriage. He blames himself for marrying such a woman and is seeing a lawyer about a divorce. After a thorough psychological evaluation followed by psychotherapy and couples counseling, it is determined that Joe suffers from depression. The onset of depression was the major cause of his distress. Although there were issues to be worked out in the marriage, the condition had caused Joe to see his wife through dark glasses and attribute his unhappiness to her. As he challenged his tendency toward negative thought patterns, he substituted more optimistic ways of viewing himself, his wife and their relationship.
A psychotherapist helps people make positive changes in their thoughts, feelings and actions. In counseling, patients can learn to understand the underlying life stressors that contributed to their distress. Then they can determine how to remove or reduce these factors. Or if the situation is unalterable, the patient may be able to find a less upsetting way of viewing it.
With a therapist’s guidance, people like Mary learn to recognize negative thought patterns that distort reality and lead to despair. Therapists can also help their patients challenge and talk back to hyper-punitive “internal critics.” Or, like Joe, a patient in counseling may identify the events that trigger certain maladaptive behavior. they will find more positive ways of behaving and of affirming themselves. A therapist may also be able to suggest increased or broadened activities for their patients that will encourage them to find new, more satisfying ways to interact with others in their world.
Most important, in psychotherapy people can explore new goals and develop new interests or hobbies. In the end, the patient usually has a life that is richer and fuller than they knew prior to the onset of depression.
Symptoms of depression
Depression occurs with differing degrees of severity. One may have major depression in these cases. The disruption of mood … * lasts two weeks or more * represents a change from a previous level of functioning * interferes seriously with one’s feelings, thinking processes and behavior * causes adverse consequences in major areas of life such as family, work, or interpersonal relations.
Someone with major depression may experience some of the following symptoms nearly every day: * greatly diminished ability to experience pleasure or interest in formerly enjoyed activities; * a deep sense of unhappiness, unworthiness, powerlessness, hopelessness or inappropriate guilt; * marked loss or gain of weight; an increase or decrease in appetite; * insomnia or oversleeping; agitation or a marked slowing down of physiological systems; * fatigue; * confusion or difficulty in concentration; * indecisiveness; and thoughts of suicide, with or without a specific plan .
Suicide is of course a major complication of major depression. An evaluation by a health professional is essential when there is any threat or talk of suicide. Suicidal thoughts must be taken seriously whether or not there is a specific plan, or if there is any family or personal history of suicide attempts.
Dr. Alice Goodloe Whipple holds a doctorate in rehabilitation counseling. She is a licensed psychologist in private practice in Princeton. Kate O’Neill collaborated with Dr. Whipple on writing this article.
(If you are looking for a therapist and would like a referral, you can find help through a friend or through your family physician.
You may also call the referral service at the New Jersey Psychological Association: 1-800-281-6572.)