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Depression

What is Depression?
Everyone occasionally feels blue or sad. But these feelings are usually short-lived and pass within a couple of days. When you have depression, it interferes with daily life and causes pain for both you and those who care about you. Depression is a common but serious illness. Many people with a depressive illness never seek treatment. But the majority, even those with the most severe depression, can get better with treatment. Medications, psychotherapies, and other methods can effectively treat people with depression.
The different forms of Depression:
There are several forms of depressive disorders. Major depressive disorder, or major depression, is characterized by a combination of symptoms that interfere with a person's ability to work, sleep, study, eat, and enjoy once-pleasurable activities. Major depression is disabling and prevents a person from functioning normally. Some people may experience only a single episode within their lifetime, but more often a person may have multiple episodes. Depression is a common but serious illness. Most who experience depression need treatment to get better.
Dysthymic disorder, or dysthymia, is characterized by long-term (2 years or longer) symptoms that may not be severe enough to disable a person but can prevent normal functioning or feeling well. People with dysthymia may also experience one or more episodes of major depression during their lifetimes.
Minor depression is characterized by having symptoms for 2 weeks or longer that do not meet full criteria for major depression. Without treatment, people with minor depression are at high risk for developing .
Some forms of depression are slightly different, or they may develop under unique circumstances. However, not everyone agrees on how to characterize and define these forms of depression. They include:
  • Psychotic depression, which occurs when a person has severe depression plus some form of psychosis, such as having disturbing false beliefs or a break with reality (delusions), or hearing or seeing upsetting things that others cannot hear or see (hallucinations).
  • Postpartum depression, which is much more serious than the "baby blues" that many women experience after giving birth, when hormonal and physical changes and the new responsibility of caring for a newborn can be overwhelming. It is estimated that 10 to 15 percent of women experience postpartum depression after giving birth.
  • Seasonal affective disorder (SAD),which is characterized by the onset of depression during the winter months, when there is less natural sunlight. The depression generally lifts during spring and summer. SAD may be effectively treated with light therapy, but nearly half of those with SAD do not get better with light therapy alone. Antidepressant medication and psychotherapy can reduce SAD symptoms, either alone or in combination with light therapy.
Bipolar disorder also called manic-depressive illness, is not as common as major depression or dysthymia. Bipolar disorder is characterized by cycling mood changes—from extreme highs (e.g., mania) to extreme lows (e.g., depression).
What causes depression?
Most likely, depression is caused by a combination of genetic, biological, environmental, and psychological factors. Depressive illnesses are disorders of the brain. Longstanding theories about depression suggest that important neurotransmitters—chemicals that brain cells use to communicate—are out of balance in depression. But it has been difficult to prove this. Brain-imaging technologies, such as magnetic resonance imaging (MRI), have shown that the brains of people who have depression look different than those of people without depression. The parts of the brain involved in mood, thinking, sleep, appetite, and behavior appear different. But these images do not reveal why the depression has occurred. They also cannot be used to diagnose depression.
Some types of depression tend to run in families. However, depression can occur in people without family histories of depression too. Scientists are studying certain genes that may make some people more prone to depression. Some genetics research indicates that risk for depression results from the influence of several genes acting together with environmental or other factors. In addition, trauma, loss of a loved one, a difficult relationship, or any stressful situation may trigger a depressive episode. Other depressive episodes may occur with or without an obvious trigger. Research indicates that depressive illnesses are disorders of the brain.
How do women experience depression?
Depression is more common among women than among men. Biological, life cycle, hormonal, and psychosocial factors that women experience may be linked to women's higher depression rate. Researchers have shown that hormones directly affect the brain chemistry that controls emotions and mood. For example, women are especially vulnerable to developing postpartum depression after giving birth, when hormonal and physical changes and the new responsibility of caring for a newborn can be overwhelming. Some women may also have a severe form of premenstrual syndrome (PMS) called premenstrual dysphoric disorder (PMDD). PMDD is associated with the hormonal changes that typically occur around ovulation and before menstruation begins. During the transition into menopause, some women experience an increased risk for depression. In addition, osteoporosis—bone thinning or loss—may be associated with depression.Scientists are exploring all of these potential connections and how the cyclical rise and fall of estrogen and other hormones may affect a woman's brain chemistry. Finally, many women face the additional stresses of work and home responsibilities, caring for children and aging parents, abuse, poverty, and relationship strains. It is still unclear, though, why some women faced with enormous challenges develop depression, while others with similar challenges do not.
How do men experience depression?
Men often experience depression differently than women. While women with depression are more likely to have feelings of sadness, worthlessness, and excessive guilt, men are more likely to be very tired, irritable, lose interest in once-pleasurable activities, and have difficulty sleeping. Men may be more likely than women to turn to alcohol or drugs when they are depressed. They also may become frustrated, discouraged, irritable, angry, and sometimes abusive. Some men throw themselves into their work to avoid talking about their depression with family or friends, or behave recklessly. And although more women attempt suicide, many more men die by suicide in the United States.
How do older adults experience depression?
Depression is not a normal part of aging. Studies show that most seniors feel satisfied with their lives, despite having more illnesses or physical problems. However, when older adults do have depression, it may be overlooked because seniors may show different, less obvious symptoms. They may be less likely to experience or admit to feelings of sadness or grief. Sometimes it can be difficult to distinguish grief from major depression. Grief after loss of a loved one is a normal reaction to the loss and generally does not require professional mental health treatment. However, grief that is complicated and lasts for a very long time following a loss may require treatment. Researchers continue to study the relationship between complicated grief and major depression. Older adults also may have more medical conditions such as heart disease, stroke, or cancer, which may cause depressive symptoms. Or they may be taking medications with side effects that contribute to depression. Some older adults may experience what doctors call vascular depression, also called arteriosclerotic depression or subcortical ischemic depression. Vascular depression may result when blood vessels become less flexible and harden over time, becoming constricted. Such hardening of vessels prevents normal blood flow to the body's organs, including the brain. Those with vascular depression may have, or be at risk for, co-existing heart disease or stroke. Although many people assume that the highest rates of suicide are among young people, older white males age 85 and older actually have the highest suicide rate in the United States. Many have a depressive illness that their doctors are not aware of, even though many of these suicide victims visit their doctors within 1 month of their deaths. Most older adults with depression improve when they receive treatment with an antidepressant, psychotherapy, or a combination of both. Research has shown that medication alone and combination treatment are both effective in reducing depression in older adults. Psychotherapy alone also can be effective in helping older adults stay free of depression, especially among those with minor depression. Psychotherapy is particularly useful for those who are unable or unwilling to take antidepressant medication.
How do children and teens experience depression?
Children who develop depression often continue to have episodes as they enter adulthood. Children who have depression also are more likely to have other more severe illnesses in adulthood. A child with depression may pretend to be sick, refuse to go to school, cling to a parent, or worry that a parent may die. Older children may sulk, get into trouble at school, be negative and irritable, and feel misunderstood. Because these signs may be viewed as normal mood swings typical of children as they move through developmental stages, it may be difficult to accurately diagnose a young person with depression. Before puberty, boys and girls are equally likely to develop depression. By age 15, however, girls are twice as likely as boys to have had a major depressive episode. Depression during the teen years comes at a time of great personal change—when boys and girls are forming an identity apart from their parents, grappling with gender issues and emerging sexuality, and making independent decisions for the first time in their lives. Depression in adolescence frequently co-occurs with other disorders such as anxiety, eating disorders, or substance abuse. It can also lead to increased risk for suicide.

Exploring your depression treatment options

Just as no two people are affected the exact same way by depression, there is no “one size fits all” treatment that cures depression. What works for one person might not work for another. The best way to treat depression is to become as informed as possible about the treatment options, and then tailor them to meet your needs.
Depression treatment tips:
  • Learn as much as you can about your depression. It’s important to determine whether your depression symptoms are due to an underlying medical condition. If so, that condition will need to be treated first. The severity of your depression is also a factor. The more severe the depression, the more intensive the treatment you're likely to need.
  • It takes time to find the right treatment. It might take some trial and error to find the treatment and support that works best for you.For example, if you decide to pursue therapy it may take a few attempts to find a therapist that you really click with. Or you may try an antidepressant, only to find that you don't need it if you take a daily half hour walk. Be open to change and a little experimentation.
  • Don’t rely on medications alone. Although medication can relieve the symptoms of depression, it is not usually suitable for long-term use. Other treatments, including exercise and therapy, can be just as effective as medication, often even more so, but don't come with unwanted side effects. If you do decide to try medication, remember that medication works best when you make healthy lifestyle changes as well.
  • Get social support. The more you cultivate your social connections, the more protected you are from depression. If you are feeling stuck, don’t hesitate to talk to trusted family members or friends, or seek out new connections at a depression support group, for example. Asking for help is not a sign of weakness and it won’t mean you’re a burden to others. Often, the simple act of talking to someone face to face can be an enormous help.
  • Treatment takes time and commitment. All of these depression treatments take time, and sometimes it might feel overwhelming or frustratingly slow. That is normal. Recovery usually has its ups and downs.
Lifestyle changes: An essential part of depression treatment
Lifestyle changes are simple but powerful tools in treating depression. Sometimes they might be all you need. Even if you need other treatment, lifestyle changes go a long way towards helping lift depression. And they can help keep depression at bay once you are feeling better.
Lifestyle changes that can treat depression:
  • Exercise. Regular exercise can be as effective at treating depression as medication. Not only does exercise boost serotonin, endorphins, and other feel-good brain chemicals, it triggers the growth of new brain cells and connections, just like antidepressants do. Best of all, you don’t have to train for a marathon in order to reap the benefits. Even a half-hour daily walk can make a big difference. For maximum results, aim for 30 to 60 minutes of aerobic activity on most days.
  • Nutrition. Eating well is important for both your physical and mental health. Eating small, well-balanced meals throughout the day will help you keep your energy up and minimize mood swings. While you may be drawn to sugary foods for the quick boost they provide, complex carbohydrates are a better choice. They'll get you going without the all-too-soon sugar crash.
  • Sleep. Sleep has a strong effect on mood. When you don't get enough sleep, your depression symptoms will be worse. Sleep deprivation exacerbates irritability, moodiness, sadness, and fatigue. Make sure you're getting enough sleep each night. Very few people do well on less than 7 hours a night. Aim for somewhere between 7 to 9 hours each night.
  • Social support. Strong social networks reduce isolation, a key risk factor for depression. Keep in regular contact with friends and family, or consider joining a class or group. Volunteering is a wonderful way to get social support and help others while also helping yourself.
  • Stress reduction. Make changes in your life to help manage and reduce stress. Too much stress exacerbates depression and puts you at risk for future depression. Take the aspects of your life that stress you out, such as work overload or unsupportive relationships, and find ways to minimize their impact.
Ruling out medical causes of depression
If you suspect that you may be depressed, and lifestyle changes haven’t worked, make an appointment to see your primary care doctor for a thorough checkup. If your depression is the result of medical causes, therapy and antidepressants will do little to help. The depression won’t lift until the underlying health problem is identified and treated.
Your doctor will check for medical conditions that mimic depression, and also make sure you are not taking medications that can cause depression as a side effect. Many medical conditions and medications can cause symptoms of depression, including sadness, fatigue, and the loss of pleasure. Hypothyroidism, or underactive thyroid, is a particularly common mood buster, especially in women. Older adults, or anyone who takes many different medications each day, are at risk for drug interactions that cause symptoms of depression. The more medications you are taking, the greater the risk for drug interactions.
Finding a therapist to treat your depression.
If there is no underlying medical cause for your symptoms of depression, then finding a mental health specialist is the next best step for treatment. Although there are many types of mental health professionals, one of the most important things to consider when choosing a therapist is your connection with this person. The right therapist will be a caring and supportive partner in your depression treatment and recovery.
There are many ways to find a therapist. Word of mouth is one of the best ways to find a good therapist. Your friends and family may have some ideas, or your primary care doctor may be able to provide an initial referral. National mental health organizations can also help with referral lists of licensed credentialed providers. If cost is an issue, check out local senior centers, religious organizations, and community mental health clinics. Such places often offer therapy on a sliding scale for payment.
Psychotherapy for depression treatment
Talk therapy is an extremely effective treatment for depression. What you learn in therapy gives you skills and insight to help prevent depression from coming back.
There are many types of therapy available. Three of the more common methods used in depression treatment include cognitive behavioral therapy, interpersonal therapy, and psychodynamic therapy. Often, a blended approach is used.
Therapy and "the big picture" in depression treatment
One of the hallmarks of depression is feeling overwhelmed and having trouble focusing. Therapy helps you step back and see what might be contributing to your depression and how you can make changes. Here are some of the “big picture” themes that therapy can help with:
  • Relationships. Understanding the patterns of your relationships, building better relationships, and improving current relationships will help reduce isolation and build social support, important in preventing depression.
  • Setting healthy boundaries. If you are stressed and overwhelmed, and feel like you just can’t say no, you are more at risk for depression. Setting healthy boundaries in relationships and at work can help relieve stress, and therapy can help you identify and validate the boundaries that are right for you.
  • Handling life’s problems. Talking with a trusted therapist can provide good feedback on more positive ways to handle life’s challenges and problems.
Individual or group therapy for depression treatment?
When you hear the word “therapy” you might automatically think of one-on-one sessions with a therapist. However, group therapy can be very useful in depression treatment as well. What are the benefits of each? Both group and individual therapy sessions usually last about an hour. In individual therapy, you are building a strong relationship with one person, and may feel more comfortable sharing some sensitive information with one person than with a group. You also get individualized attention.
Don’t rule out group therapy, however. Listening to peers going through the same struggles can validate your experiences and help build self-esteem. Often group members are at different points in their depression, so you might get tips from both someone in the trenches and someone who has worked through a challenging problem. As well as offering inspiration and ideas, attending group therapy can also help increase your social activities and network. When the going gets tough in therapy... As with remodeling a house, when you take apart things that haven't worked well in your life, it often makes them seem worse before they get better. When therapy seems difficult or painful, don't give up. If you discuss your feelings and reactions honestly with your therapist, it will help you move forward rather than retreat back to your old, less effective ways. However, if the connection with your therapist consistently starts to feel forced or uncomfortable, don’t be afraid to explore other options for therapy as well. A strong trusting relationship is the foundation of good therapy.
Medication treatment for depression
Depression medication may be the most advertised treatment for depression, but that doesn’t mean it is the most effective. Depression is not just about a chemical imbalance in the brain. Medication may help relieve some of the symptoms of moderate and severe depression, but it doesn’t cure the underlying problem, and it’s usually not a long-term solution. Antidepressant medications also come with side effects and safety concerns, and withdrawal can be very difficult. If you're considering whether antidepressant medication is right for you, learning all the facts can help you make an informed decision.
If you are taking medication for depression, don’t ignore other treatments. Lifestyle changes and therapy not only help speed recovery from depression, but also provide skills to help prevent a recurrence.
Should you get antidepressants from your family doctor? Family doctors might be the first professionals to recognize your depression. However, while they can prescribe antidepressants, it’s a good idea to explore your options with other mental health professionals who specialize in depression. Ask for a referral. You might end up working with a therapist and not needing medication at all. If you do need medication, a psychiatrist has advanced training and experience in depression, treatments, and medications.
Alternative and complementary treatments for depression
Alternative and complementary treatments for depression may include vitamin and herbal supplements, acupuncture, and relaxation techniques, such as mindfulness meditation, yoga, or tai chi.
Vitamins and supplements for depression treatment
The jury is still out on how well herbal remedies, vitamins, or supplements work in treating depression. While many supplements are widely available over the counter, in many cases their efficacy has not been scientifically proven. If your depression symptoms are in part due to nutritional deficiency, you may benefit from vitamin supplements, but this should be on the advice of your healthcare professional.
If you decide to try natural and herbal supplements, remember that they can have side effects and drug or food interactions. For example, St. John’s Wort—a promising herb used for treatment of mild to moderate depression—can interfere with prescription drugs such as blood thinners, birth control pills, and prescription antidepressants. Make sure your doctor or therapist knows what you are taking.
Other alternative depression treatments
  • Relaxation techniques. As well as helping to relieve symptoms of depression, relaxation techniques may also reduce stress and boost feelings of joy and well-being. Try yoga, deep breathing, progressive muscle relaxation, or meditation.
  • Acupuncture.Acupuncture, the technique of using fine needles on specific points on the body for therapeutic purposes, is increasingly being investigated as a treatment for depression, with some research studies showing promising results. If you decide to try acupuncture, make sure that you find a licensed qualified professional.