Decoding Depression

GoodTherapy.org

Depression—a sad or discontented mood—can leave a person feeling lethargic, unmotivated, or hopeless. In some cases, depression can lead to suicidal ideation. Depression may occur in a severe form, as in major depression, or in a more chronic, mild-to-moderate form, as is the case with persistent depressive disorder.

Understanding Depression

Depression is a serious, but common, illness: One in 10 adults report experiencing depression, and the condition is the most common cause of disability in the United States. The lifetime risk of any individual person becoming depressed is around 17 percent, and most people have their first bout of depression in their late teens or early twenties. The condition is slightly more common among women, but some researchers speculate that this may be because men are less likely to seek help or because their symptoms are more likely to manifest as anger than sadness.

Both environmental and physiological factors can cause depression. Most mental health experts now agree that brain chemistry plays a major role. The level of neurotransmitters such as dopamine and serotonin in the brain can affect a person’s risk of becoming depressed. However, life experiences affect brain chemistry, and some people become depressed after experiencing a trauma or stressful life change such as a separation or divorce, the death of a spouse, being laid off from a job, financial instability, relocation, or a decline in health. Everyday stressors, like social isolation, domestic violence, and the presence of other psychological conditions, can also contribute to depression. Sometimes depression arises as a defense mechanism in order to avoid experiencing painful emotions. Women who have recently given birth may struggle with postpartum depression in the days, weeks, or months following childbirth.

Depression’s symptoms are distinct from the symptoms associated with grief, when feeling emotionally overwhelmed is normal and temporary. Depression may be indicated when feelings of sadness and despair disrupt daily life and persist for more than two weeks.

Those who have experienced trauma or are prone to anxiety may be more likely to experience depression than those who have not, and research suggests that some people may be biologically predisposed to depression due to neurochemical abnormalities. A family history of depression can lead to a person’s inheriting or learning these traits.

Signs and Symptoms

Depression’s symptoms can vary greatly from person to person and may even change throughout the course of the illness. Symptoms may also vary depending on an individual’s gender, culture, or age. Adolescents experiencing depression might appear irritable and agitated, and women may be more likely to admit to depression than men, while certain cultural groups might mask their feelings or display them differently. Common symptoms of depression include:

• Frequent crying and overwhelming feelings of sadness.
• Feelings of hopelessness and worthlessness.
• Changes in sleep such as excessive sleeping or the inability to sleep.
• Anxiety.
• Anger.
• Difficulty enjoying previously-enjoyed activities.
• Unexplained physical ailments such as headaches or muscle pain.
• Difficulty concentrating.
• Changes in weight or eating habits.
• Thoughts of suicide.

A person experiencing depression is likely to encounter difficulty coping with daily stressors and may feel helpless and alone. In fact, sometimes the most mundane of activities—getting out of bed, bathing, and dressing—can feel like an impossible feat. These challenges can influence one’s susceptibility to a decline even when in a positive mood, resulting in a negativity bias that informs all experiences.

Depression is associated with emotions such as anger, shame, and fear, and sometimes these emotions can manifest in the body in the form of aches, pains, nausea, and other complaints. Depression may cause feelings of tension or irritation and may lead to weepiness, and it is not uncommon to feel intensely fatigued without relief. In severe cases, a person may express no emotion whatsoever, and suicidal thoughts or behaviors are not uncommon.

• Is It Depression If I Don’t Feel Sad?
• Hidden Depression Among Us

Seeking Therapy for Depression

Depression is one of the most common reasons people seek therapy, and the condition is highly treatable. Unfortunately, though, stigma surrounding depression inhibits many people from seeking treatment. Because an individual with depression may be viewed as flawed or weak, that person is likely to feel shame regarding his or her condition, and he or she may fear the consequences of disclosing the experience to employers, health care providers, family, and friends.

Depression is one of the most common reasons people seek therapy, and the condition is highly treatable.There are a number of therapeutic approaches that have demonstrated effectiveness in treating depression, including mindfulness-based cognitive therapy and psychodynamic therapy. Regardless of the approach, a trained therapist can help a person view a depressive state with curiosity and without judgment, in an effort to understand and heal the source of the depression. In fact, many times simply identifying the source of depression can enhance treatment outcomes and provide some relief from depression. Therapy also helps people to recognize and access their strength, autonomy, and capacity for change.

Group therapy and support groups have proven helpful to many people experiencing depression. The camaraderie of being supported by a social group can help to alleviate the symptoms of isolation or loneliness that are common in depression.

Medication and Other Treatments

Medications are often employed in the treatment of depression, particularly when the symptoms are severe, and several classes of medications have been developed to improve mood. All antidepressants are associated with certain side effects that may or may not improve with time; many times the side effects are considered by the person in treatment to be a worthwhile compromise, particularly when depression is severe enough to include suicidal thoughts or self-harm behaviors. While antidepressants alone cannot address the emotional and psychological causes of depression, they may help improve talk therapy treatment outcomes.

Other treatments and lifestyle changes that might alleviate symptoms of depression—especially when used in combination with psychotherapy or medication—include a variety of complementary and alternative medicine therapies (CAM), such as acupuncture, herbal remedies, and supplements as well as aerobic exercise, which boosts endorphins, improves mood, and relieves stress.

Relationships and Depression

Depression can make it difficult for a person to accept comfort from others, which is sometimes based on the belief that they do not deserve it or that the affection is insincere. Similarly, the lethargy, irritability, and hopelessness experienced by the partner who is depressed may make expressions of love nearly impossible. Depression can also interfere with communication and sexual intimacy in a romantic relationship. Some people may become more distant during depression, while others appear more needy or dependent on their partners.

The intimate partners and families who share their lives with loved ones who experience depression may benefit from couples counseling or family therapy to learn how to best support the person with depression and themselves.

Correlated Psychological Issues

Other mental health concerns, such as anxiety, are commonly linked to depression. Depression is also a major characteristic of bipolar, schizophrenia, and posttraumatic stress disorder (PTSD). Depression is also associated with substance abuse, especially with alcohol and other central nervous system depressants. In addition, people may self-medicate with alcohol or other substances to manage depression, potentially making their symptoms worse in the long term.

Case Examples

• Depression over breakup: Tommy, a 21-year-old college student, was referred to the university counseling center by his roommate, who noticed Tommy was sleeping most of the day, missing class, and skipping meals. Tommy goes to his first appointment reluctantly, but because herecognizes that he hasn’t been the same lately, he agrees to keep meeting with his therapist. In therapy Tommy recognizes that his depression began immediately following a breakup with his college sweetheart, Lynn, who had feelings for another man. In future sessions, Tommy identifies feelings of grief, betrayal, and hidden feelings of inadequacy. Tommy has a breakthrough insight when he discovers that his depression has been helping him avoid these painful feelings. The recognition itself helps the depression begin to loosen its grip. Tommy continues therapy for about a dozen sessions in which he identifies and cares for parts of himself that have felt inadequate since childhood. This increases Tommy’s confidence and self-esteem and causes his depression to lift entirely.
• Feelings of inadequacy and depression: Rudy, 38, cries and cries during the first interview with his new therapist and cannot say why. His life is, on the surface, everything anyone could want. He is married, with two healthy children and a sufficient income, and he claims to love his job as a financial analyst, or at least, that he used to love it. Lately, he does not seem to enjoy anything. Sports, which once gave him pleasure, now seem empty and meaningless. He feels distant from his wife and family. His job feels pointless and tedious. He has also been drinking alcohol, secretly, to numb himself. Treatment reveals hidden feelings of guilt and shame about Rudy’s perceived inadequacy as a son and now as a husband and father. His rigidly punitive parents instilled in him a perfectionism impossible to fulfill. Rudy has long buried his anger about this, and it takes a good deal of work for him to begin challenging his own rigid beliefs. Quitting drinking turns out to be easier than Rudy thought it would be, once he is able to talk openly with both his wife and his therapist about his deep shame and fear. Rudy asks for medications and is given a referral to a psychiatrist who prescribes a selective serotonin reuptake inhibitor (SSRI). Rudy reports it helps him get through the work day, but after six months he decides the side effects are not worth it, and based on his strong progress, his therapist and psychiatrist agree stopping would be fine. Though his mood diminishes for a few weeks, he is soon feeling more optimistic, closer with his wife, and more motivated at work.
• Grief, transitions, and depression: Mindy, age 63, is depressed to the point of near delirium, verbalizing confused thoughts and demonstrating a loss of focus and cognitive organization. She has no history of psychiatric treatment, but her partner reports she has always been somewhat gloomy and anxious. This episode is different, as she has been unable to work, is tearful most of the day, isolates herself, and feels lethargic—behaviors that are totally out of character. An interview reveals that retirement looms ahead, a new boss has replaced one that Mindy liked much better, and she has not fully grieved her mother’s recent death. Treatment includes normalizing feelings of grief and identifying life-stage changes that triggered the diminished mood. After eight sessions, Mindy is able to confront deeply held fears and beliefs, communicate more effectively with her partner—from whom Mindy desires more physical affection—and make a plan for her transition to retirement. Mindy’s depression begins to dissipate, and she returns to her job with more hope, if not enthusiasm.

References:

1. An estimated 1 in 10 adults report depression. (2011, March 31). Centers for Disease Control and Prevention. Retrieved from http://www.cdc.gov/features/dsdepression.
2. Depression. (n.d.). Anxiety and Depression Association of America. Retrieved from http://www.adaa.org/understanding-anxiety/depression.
3. Harold, G. T., Rice, F., Hay, D. F., Boivin, J., van, d. B., & Thapar, A. (2011). Familial transmission of depression and antisocial behavior symptoms: Disentangling the contribution of inherited and environmental factors and testing the mediating role of parenting. Psychological Medicine, 41(6), 1175-85. doi:http://dx.doi.org/10.1017/S0033291710001753.
4. Monteith, L. L., & Pettit, J. W. (2011). Implicit and explicit stigmatizing attitudes and stereotypes about depression. Journal of Social and Clinical Psychology, 30(5), 484-505 doi:http://dx.doi.org/10.1521/jscp.2011.30.5.484.
5. O’Connor, R. (2001). Active treatment of depression. New York, NY: Norton.
6. O’Grady, M. A., Tennen, H., & Armeli, S. (2010). Depression history, depression vulnerability, and the experience of everyday negative events. Journal of Social and Clinical Psychology, 29(9), 949-974. doi:http://dx.doi.org/10.1521/jscp.2010.29.9.949.