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Therapy for Depression

 

(Note: Nothing below should be considered “treatment” for depression or any other mental health problem, though some of it may be helpful to you or others.  If you have significant distress that you are not able to resolve on your own, you are encouraged to see a qualified therapist or other health provider.)

Information about Depression

Most people have some idea what “depression” means, and many who are “depressed” know it – though perhaps surprisingly, not all (keep reading!).  However, “depression” is actually a broad term that may reflect any of a number of specific mental health diagnoses (see Types of Depression, below).

Identifying “Depression”, and Some Gender Differences

What people refer to as “depression” almost always involves feeling “down,” glum, sad (or numb or empty), and/or a decrease in motivation and/or enjoyment.  Women tend to recognize that they are “depressed” more than men do, for several reasons.  First, most studies suggest that women experience more depression than men do.  However, they also may be more inclined to experience the emotional component of “depression”: the “depressed” feeling of sadness, often accompanied by tearfulness, that is the easiest sign to identify as depression.  Men may be less aware of feeling “sad” and less tearful.  For men, “depression” may show up more as a loss of motivation, interest, or enjoyment, social withdrawal, and/or an increase in irritability or anger.  (Men may also react to being “depressed” by drinking, which further obscures the depression and related feelings.)  As a result, men may be less inclined to recognize if/when they are “depressed.”

Types of Depression

Technically, there are a number of different diagnoses involving “depressive” symptoms: different types of “depression.”  These include “Major Depressive Disorder” (perhaps the “classic” clinical depression: two or more weeks of a number of significant symptoms, typically reflecting a significant change/deterioration from a person’s “normal” or baseline mood and level of functioning); “Dysthymic Disorder” (a milder form of depression but that endures a minimum of two years); and Adjustment Reaction/Disorder with Depressive Symptoms (technically not quite a “depressive disorder,” but related symptoms – e.g., sadness and some insomnia – that seem clearly related to a triggering situation: e.g., marital conflict or disappointment about not getting a job promotion).  Depressive symptoms may also be part of a “Bipolar Disorder,” which involves depressive symptoms that alternate over time with (or sometimes occur at the same time as) “manic” symptoms, which involve having too much energy.

Assessment

If you come to see me for help with what you believe may be depression, I would do some assessment, including of your symptoms (e.g., sadness, loss of motivation/interest, change in appetite and/or sleep, and in some cases suicidal thoughts); past history (generally, and whether there have been past “episodes” of depression (or other altered mood states, such as “mania”), and if so, the course of such episodes); and possible “triggers” – events or circumstances that may play a role in bringing on your depression (e.g., a recent loss (or anniversary of one), disappointment, or conflict).  Sometimes I may go through a questionnaire with you that quantifies depressive symptoms, which can be helpful both in diagnosis and in keeping track of severity and improvement.

Helping You via Therapy for Depression

Research indicates that psychotherapy and antidepressant medication are both effective – and roughly equally effective – in treating depression, except in the most severe cases, where medication may be necessary.  (There is some controversial research suggesting that a big part of the “benefit” of antidepressant medication in mild-to-moderate cases of depression is due to “placebo” – i.e., to the patient’s expectation of being helped by the medication, rather than a result of the biophysiological effects of the medication on the body.)  Medication and psychotherapy are also often combined.  If you are considering seeing me, you are probably looking for psychotherapy help for your depression.  If appropriate or warranted, I will also discuss the option of adding medication to your treatment.  (I am not a medical doctor and therefore do not prescribe medication.  If medication was warranted and you were interested in trying it, I would refer you to your primary care doctor (primary care doctors prescribe the bulk of antidepressants in the US), or to a psychiatrist if you preferred or if the complexity of your depression warranted the expertise of a specialist.)

Therapy for depression or depressive symptoms often starts helping within the first several sessions (especially if the symptoms reflect an Adjustment Disorder related to a particular stressor or situation, and/or are mild), and even in other cases there is often significant improvement within several months. 

Psychotherapy for depression, as for other psychological and emotional problems, starts with a good relationship, in which you feel understood and supported by your therapist. Beyond this critical foundation, I use an “eclectic” approach (i.e., involving a mix of orientations), but with lots of “cognitive-behavioral” aspects, in which I would help you (i) to identify “negative cognitions” – unrealistically negative ways of perceiving, interpreting, and reacting to things (events, other people, and yourself: e.g., “I lost my job, which confirms that I’m a loser and will never have professional success”), (ii) to recognize such cognitions, when they occur, for what they are: your automatic but not necessarily objective or helpful ways of perceiving and reacting  to things, (iii) to stop treating such automatic thoughts/reactions as “worth listening to”, or as “the truth,” and (iv) to come up with alternative, more helpful ways of thinking and reacting. 

Such “cognitive-behavioral” interventions are examples of application of what I refer to as my “bumper sticker summary of psychotherapy”: “Don’t believe – or buy into – everything you think:” in this case, to your initial automatic – and unrealistic, negative, and unhelpful – “depressive” thoughts.

At the same time, I would encourage you to do things (part of the “behavioral” part of “cognitive-behavioral” therapy) that we know help people with depression: (i) get more physical activity or exercise of some sort; (ii) increase social activity and interaction, especially with people who care about you and are understanding and sympathetic (see * below); and (iii) especially if your depression has included loss of motivation and interest in activities: develop a structure or schedule of daily and weekly activities.

Please read this: A common part of depression is loss/lack of motivation; and many of you who read the above may react with the thought of, “But I just don’t feel like doing those things.”  A critical part of helping you with therapy for depression is by providing support and encouragement, including to do things that you don’t feel like doing.  This is another example of applying (a modification of) the “bumper sticker summary of psychotherapy”: “Don’t believe (or listen to) everything you think.” In this case, it is important not to heed the thought, “Since I don’t feel like doing it, I won’t,” or the thought, “It’s okay, I’ll settle for just doing what I feel like.”  One of the most important “teachings” of psychotherapy for depression is the importance of not settling for doing what you feel like, and rather availing yourself of my – or another therapist’s – support and encouragement to do what we know has a better chance of helping you to feel better, even when you don’t feel like doing so.

In any event, if you are having problems that you think may involve depression in the Madison WI area, good for you for considering getting help.  Feel free to call me: I would be happy to meet with you and try to help.

*There is an approach to therapy for depression that is wholly focused on (i) the impact of depression on interpersonal relationships and of interpersonal relationships on the depression, and (ii) using relationships to help the depressed person feel better.