There are three basic ways to treat depression: psychotherapy, self help, and medication. Many people respond best to a combination of two or more methods.
1. Psychotherapy: Individual treatment exploring one’s beliefs and ways of thinking and relating, and learning new ways of thinking, relating, and behaving. Family and couples therapy are very helpful, especially if one's relationships are affecting one's mood or one's mood is starting affect one's relationships. Relationships matter and the support of family and friends is essential for recovery. Depression often causes isolation, which tends to feed the depression and make it worse. Relief can come through connecting with others. Couple or family therapy can help with this by promoting connection. 2. Self-help: Exploring one’s beliefs and ways of thinking on one’s own. 3. Medication: Altering one’s brain chemistry by taking antidepressant medication. A physician may recommend medication when four conditions exist: 1. The patient’s depression is moderate to severe. 2. The patient has suffered at least one previous depressive episodes. 3. There is a family history of depression. 4. The patient asks for medication only and refuses psychotherapy. There are four types of antidepressant medication available today: • Tricyclic antidepressants (TCAs) • Monoamine oxidase inhibitors (MAOIs) • Selective serotonin reuptake inhibitors (SSRIs) • Other compounds that work with dopamine, and norepinephrine The TCAs and MAOIs have been used for decades. The SSRIs (such as Prozac) and structurally unrelated compounds are newer and are being prescribed more and more frequently. They have fewer and less pronounced side effects than the TCAs and MAOIs. Treatment without Medicine One of the leading methods for treating depression is cognitive therapy. Cognitive therapists help depressed clients feel better by identifying how faulty ways of thinking are making him or her feel bad. The client analyzes his or her thoughts and beliefs, and learns to substitute more healthy ways of thinking and believing. Many mental health professionals believe that the ideal treatment of clinical depression is medication in conjunction with psychotherapy. Meditation and yoga have been found helpful. Emotionally Focused Therapy may also help. Prevention of Depression 1. Identify your risk factors and be aware of where you are vulnerable. Each of us has unique risk factors, such as things we were taught in our families of origin, values we have learned, and the presence or absence of a family history of depression. Anything that has been learned can be unlearned and replaced with something healthier. 2. Learn to manage stress. You can learn proven techniques for calming and relaxing yourself. Consider taking a stress management class or buying a set of relaxation tapes. 3. Learn problem-solving skills. Many people who develop depression never learned problem-solving skills. They need to develop the ability to see problems from many viewpoints and to look for a variety of solutions. 4. Build your life around things you can control. Learn to recognize what you can control and what you can’t. Avoid spending much effort on situations that won’t pay off for you. 5. Learn self-acceptance. Instead of rejecting the parts of yourself you don’t like, learn to manage them more productively. 6. Become aware of selective perception. Observe how you generate ideas and opinions about people and events. Remember that these are just your views, not necessarily objective facts. 7. Focus on the future, not the past. Depressed people tend to be focused on the past. People who set goals and focus on the future tend to be more positive about life. 8. Develop a sense of purpose. Many depressed people lack a sense of purpose or meaning. This means they have no goals and nothing in the future drawing them forward. To prevent depression, develop your sense of purpose and meaning. 9. Strengthen your emotional boundaries and set limits. Boundaries define your role in a social situation. They determine how you will or won’t behave in a given situation. Having clear, strong boundaries is empowering, while boundary violations make you feel victimized and helpless. Setting limits means having and enforcing rules for the behaviors you expect in a relationship. 10. Build positive and healthy relationships. Think about what you need from others in relationships. Learn to read people and trust your instincts about which people are good for you. 11. Avoid isolation. Talk to others about what’s going on with you. If you keep your thoughts to yourself, you may be unaware that your thoughts are distorted. If you share them with another person, you can become more objective. Suggested Reading David D. Burns, M.D., Feeling Good: The New Mood Therapy. New York, Avon Books, 1980. Michael Yapko, Ph.D., Breaking the Patterns of Depression. New York, Doubleday, 1997.
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Depression: What is it? Depression is a serous illness, not a harmless part of life. It is a complex disorder with a variety of causes. It is rarely caused by just one thing. It may be a result of a mix of factors, including genetic, chemical, physical, and sociological. It is also influenced by behavior patterns learned in the family and by cognitive distortions. Depression affects millions of people in this country. It is always troubling, and for some people it can be disabling. Depression is more than just sadness or “the blues.” It can have an impact on nearly every aspect of a person’s life. People who suffer from depression may experience despair and worthlessness, and this can have an enormous impact on both personal and professional relationships. In this newsletter, I will describe many of the factors that may cause depression, and I will explore strategies for preventing it. Depression Affects the Entire Person When a person suffers from depression, it can affect every part of his or her life, including one’s physical body, one’s behavior, thought processes, mood, ability to relate to others, and general lifestyle. Symptoms of Depression People who are diagnosed with clinical depression have a combination of symptoms from the following list: Feelings of hopelessness Fatigue or low energy Much less interest or pleasure in most life Low self-esteem Feeling worthless Excessive or inappropriate guilt Lessened ability to think or concentrate Indecisiveness Thinking distorted thoughts Having an unrealistic view of life Weight loss or gain without dieting Change in appetite Change in sleeping patterns Recurrent thoughts of death Suicidal thoughts A specific plan for committing suicide A suicide attempt Feelings of restlessness or being slowed down When a person is suffering from depression, these symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning. This means that the person’s family and social relationships, as well as work life, are impaired. Grief, Sadness, and Depression Depression may include feelings of sadness, but it is not the same as sadness. Depression lasts much longer than sadness. While depression involves a loss of self-esteem, grief, disappointment and sadness do not. People who are depressed function less productively. People who are sad or disappointed continue to function. Depression and Socioeconomic Factors Depression does not seem to be related to ethnicity, education, income, or marital status. It strikes slightly more women than men. Some researchers believe that depression strikes more often in women who have a history of emotional and sexual abuse, economic deprivation, or are dependent on others. There seems to be a genetic link as depression is more common among parents, children, and siblings of people who are diagnosed with depression. Physical Causes Many physicians believe that depression results from a chemical imbalance in the brain. They often prescribe antidepressant medication that target specific neurotransmitters. Many people find relief as a result. However, at this point in time there is no reliable test to identify chemical imbalances. It is unknown whether life experiences cause mood changes, which create changes in brain chemistry, or whether it works in reverse. There is some evidence that stress and biological vulnerability work together to create depression. Depression may be associated with physical events such as other diseases, physical trauma, and hormonal changes. A person who is depressed should always have a physical examination as part of the assessment process to determine the role of physical causes. Signs That Professional Treatment Is Needed If you or someone you know is depressed and exhibits any of the following signs, it is extremely important to seek the assistance of a medical or mental health professional. 1.Thinking about death or suicide. This is always dangerous and you should see a professional therapist immediately. 2.When symptoms of depression continue for a long time, you may need professional help. Acute responses to events are normal, but they should not last beyond a reasonable time. 3.Your ability to function is impaired by your depression. Seek help before your life situation deteriorates to a serious level. 4.You have become so isolated that you have no one with whom to check reality. Seek out someone to share your thoughts and feelings with. 5.Depressive symptoms have become severe. Getting Help for Depression: What to do about it?
There are three basic ways to treat depression: psychotherapy, self help, and medication. Many people respond best to a combination of two or more methods. 1. Psychotherapy: Individual treatment exploring one’s beliefs and ways of thinking and relating, and learning new ways of thinking, relating, and behaving. Family and couples therapy are very helpful, especially if one's relationships are affecting one's mood or one's mood is starting affect one's relationships. Relationships matter and the support of family and friends is essential for recovery. Depression often causes isolation, which tends to feed the depression and make it worse. Relief can come through connecting with others. Couple or family therapy can help with this by promoting connection. 2. Self-help: Exploring one’s beliefs and ways of thinking on one’s own. 3. Medication: Altering one’s brain chemistry by taking antidepressant medication. A physician may recommend medication when four conditions exist: 1. The patient’s depression is moderate to severe. 2. The patient has suffered at least one previous depressive episodes. 3. There is a family history of depression. 4. The patient asks for medication only and refuses psychotherapy. There are four types of antidepressant medication available today: • Tricyclic antidepressants (TCAs) • Monoamine oxidase inhibitors (MAOIs) • Selective serotonin reuptake inhibitors (SSRIs) • Other compounds that work with dopamine, and norepinephrine The TCAs and MAOIs have been used for decades. The SSRIs (such as Prozac) and structurally unrelated compounds are newer and are being prescribed more and more frequently. They have fewer and less pronounced side effects than the TCAs and MAOIs. Treatment without Medicine One of the leading methods for treating depression is cognitive therapy. Cognitive therapists help depressed clients feel better by identifying how faulty ways of thinking are making him or her feel bad. The client analyzes his or her thoughts and beliefs, and learns to substitute more healthy ways of thinking and believing. Many mental health professionals believe that the ideal treatment of clinical depression is medication in conjunction with psychotherapy. Prevention of Depression 1. Identify your risk factors and be aware of where you are vulnerable. Each of us has unique risk factors, such as things we were taught in our families of origin, values we have learned, and the presence or absence of a family history of depression. Anything that has been learned can be unlearned and replaced with something healthier. 2. Learn to manage stress. You can learn proven techniques for calming and relaxing yourself. Consider taking a stress management class or buying a set of relaxation tapes. 3. Learn problem-solving skills. Many people who develop depression never learned problem-solving skills. They need to develop the ability to see problems from many viewpoints and to look for a variety of solutions. 4. Build your life around things you can control. Learn to recognize what you can control and what you can’t. Avoid spending much effort on situations that won’t pay off for you. 5. Learn self-acceptance. Instead of rejecting the parts of yourself you don’t like, learn to manage them more productively. 6. Become aware of selective perception. Observe how you generate ideas and opinions about people and events. Remember that these are just your views, not necessarily objective facts. 7. Focus on the future, not the past. Depressed people tend to be focused on the past. People who set goals and focus on the future tend to be more positive about life. 8. Develop a sense of purpose. Many depressed people lack a sense of purpose or meaning. This means they have no goals and nothing in the future drawing them forward. To prevent depression, develop your sense of purpose and meaning. 9. Strengthen your emotional boundaries and set limits. Boundaries define your role in a social situation. They determine how you will or won’t behave in a given situation. Having clear, strong boundaries is empowering, while boundary violations make you feel victimized and helpless. Setting limits means having and enforcing rules for the behaviors you expect in a relationship. 10. Build positive and healthy relationships. Think about what you need from others in relationships. Learn to read people and trust your instincts about which people are good for you. 11. Avoid isolation. Talk to others about what’s going on with you. If you keep your thoughts to yourself, you may be unaware that your thoughts are distorted. If you share them with another person, you can become more objective. Suggested Reading David D. Burns, M.D., Feeling Good: The New Mood Therapy. New York, Avon Books, 1980. Michael Yapko, Ph.D., Breaking the Patterns of Depression. New York, Doubleday, 1997. ![]() In August I will celebrate practicing yoga for eight years. As a result of this practice, I have received many emotional and physical benefits. I feel strong, alert and calm during and after I practice. I have also met a lot of really nice people. As I get older, practicing is not always easy but it is always rewarding. Technology is getting better and anecdotal evidence regarding the benefits of yoga is now documented by research. Very cool to know the science behind what I feel. Here is a great video from uplift connect.com showing the science behind yoga. One study has shown yoga helps decrease depression and anxiety. What good news for sufferers of these maladies! Hope you enjoy this clip. This is an incredibly informative Ted Talk. If you don't have time to listen to this talk, I am listing the bullet points for you here.
1. The problem: We have not evolved fast enough to keep up with all the changes and fast pace of our current world. This puts our body in chronic fight or flight mode, which eventually causes inflammation. We also used to socialize more, sleep more regular hours, and move around much more. As well, our food sources were more balanced. All of these change factors contribute to the rise in depression. 2. The solution recommended: a. Omega 3s- EPA 1000mg daily/ DHA 500mg daily . . . consult your MD of course. Fish oil and flax seed are great sources. b. Exercise at least 3 times a week for 1/2 hour . . . get your heart rate up. c. Make sure you get a good nights sleep, no excuses. d. Hang out with you friends and family, often. Laugh, love, play! e. Watch your thoughts . . . rumination feeds depression. If you find yourself ruminating, call a friend, switch gears. f. Finally, get some sunlight, without sunglasses. Our ancestors were outdoors much more than we. g. Since this Ted talk I have found research that concludes that curcumin, which is found in turmeric, may be as helpful as prozac. I suggest looking it up on the internet. Great news for people who can't medication. 10. Lastly, many people have a gene mutation that affects mental health. It causes methylfolate deficiency. It is called the MTHFR mutation. If you have chronic depression, you may want to discuss this with your PCP. Click here for more information. Information on Amino Acids and Emotions Ann Marie, a student, approached me about learning more about teens and depression. To consolidate her learning, we decided to put together an information video. It was fun to do, a learning process. The NIH notes the signs and symptoms as follows:
This year I am a mentor to a High School student who is studying Major Depressive Disorder. We just finished working on an informative YouTube with her for her senior project. Oh, what a bit of work! While we were doing the research we found a copy of the BECK's Depression Inventory online, which is a great resource for people to take to see if they are feeling depressed. If one has a good idea that he or she is clinically depressed they can take action and get help. I have posted a copy of it on my forms page.
According to National Institute of Health, Major Depressive Disorder affects approximately 14.8 million American adults. This is about 7% of the population age 18 or older. When you add in Dysthymic Disorder or Persistent Depressive Disorder, chronic low grade depression that does not quite fit the bill for major depression, the percentage of sufferers goes up to almost 9%. My guess is that there are many people limping around with chronic low grade depression who don't really even know they are suffering. So maybe the percentage is even a bit higher? I do not know. But it is alarming to me that almost 10% of the United States is struggling with a very painful set of symptoms we call depression. The NIH notes the signs and symptoms as follows:
These symptoms are nothing to take lightly. They can be debilitating and even cause disability. It is not completely clear what causes depression, but it appears when looking at brain scans of a depressed person that they look different from a non-depressed person's. As with many things in life, depression is probably initiated by a combination of interacting factors and systems including genes, biology, environment (stress and trauma), and psychology (inner thoughts and views of self, perception and sense of purpose and meaning). Many illnesses, including thyroid disorders, cause depressive symptoms. Until recently, nobody really considered the impact our relationships have on our mood and maybe even our brains. This is changing. Researchers such as Jim Coan, Ph.D., Sue Johnson, Ed.D, Wayne Denton, M.D., and others are all looking into this. It appears that relationships and attachments can greatly affect our moods and life, and improving them may help decrease depression. It is exciting to me to know that we have one more option (traditional options are medication and/or individual counseling) to offer people as part of the basic treatment plan for those suffering from depression: family, couple, or relationship counseling. For more information check out this great article by Russell Collins: Are Relationships the New Prozac? Good relationships and social support are nature's antidepressants. Who knew? Deep down inside, I think we all did . . . and do. Depression is a serious problem affecting many people. Having a supportive and loving spouse, in my opinion can help in recovery. I want to say I think depression is complex and probably caused by many factors. Relationship quality perhaps being one possible factor affecting the sufferer. NPR notes some research around this. Something to reflect upon.
There are three basic ways to treat depression: psychotherapy, self help, and medication. Many people respond best to a combination of two or more methods.
Depression is a serous illness, not a harmless part of life. It is a complex disorder with a variety of causes. It is rarely caused by just one thing. It may be a result of a mix of factors, including genetic, chemical, physical, and sociological. It is also influenced by behavior patterns learned in the family and by cognitive distortions.
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