Treatment of Depression
Obtaining a detailed history in cases where depression treatment is the presenting problem is essential. Individuals who report that they are depressed sometimes have a history of hospitalizations, suicidal thoughts or attempts at suicide. These are important events that require clarification. Also, depression sometimes runs in families where there may be an inherited tendency to develop depression. In treating patients who initially report that they are depressed, it is not unusual to find that they are more anxious than depressed. High anxiety often looks like depression so getting a history of the problem and the exact details about how the patient is experiencing their emotions is most helpful in diagnosis. Often the therapist finds him/herself treating anxiety in older adults instead of or in addition to depression.
Depression is a relatively complicated condition because there are different causes for depression and of course different levels of severity, requiring different treatment.
Causes of Depression
- Depression can occur independently or as part of a Bipolar Disorder. Both of those types of depression appear to be, most often, physiological in nature. That is, the tendency to become depressed or to develop Bipolar Disorder is often inherited and runs in families. Also, it tends to come and go independently from life events, becoming more frequent with age. Individuals suffering from Major Depressive Episodes often identify sad or traumatic life events as the cause for their depression, but the cause of Clinical Depression is not known.
- Some factors that may increase an individual’s chances of becoming depressed are: family history of depression or Bipolar Disorder, early childhood trauma and/or stress, alcohol and/or drug abuse and hormone imbalances such as hypothyroidism.
- Psychological factors, particularly obsessive thinking, can either precipitate or contribute to making depression more severe. Thinking about negative events or berating oneself for perceived failings obsessively is a major contributor to depression. In fact, Martin Seligman, a psychologist who has written extensively about depression, is convinced that negative obsessive thoughts are an essential condition for depression to exist.
- Depression can develop secondarily to anxiety. Individuals who experience high anxiety often have short bouts of depression lasting from a couple to several days at a time. This is a different type of depression, with some symptoms that are opposite to those of other types.
Symptoms of Depression
- Feeling that there’s no hope for the future
- Loss of the ability to enjoy anything
- Feeling sad or irritable most of the day, nearly every day
- Feeling less interested in most activities, even those once enjoyed
- Suddenly losing weight/loss of appetite
- Having difficulty falling asleep and/or waking during the night
- Feeling unusually tired and having a lack of energy
- Feeling worthless or guilty, often about unimportant things
- Displaying symptoms of OCD such as obsessing about upsetting things for most of the day
- Having difficulty concentrating, thinking, or making decisions.
- Thinking about harming oneself or committing suicide
- Moving and thinking slowly
Symptoms of Anxiety Caused Depression
Depression that results from high anxiety is also sometimes called Atypical Depression because some of the symptoms are different or even opposite to those experienced with a Major Depressive Episode.
- Depression secondary to anxiety tends to last a couple to a few days as compared to other types of depression which last at least 3 weeks and often considerably longer.
- For anxiety related depression, the ability to enjoy food, sex and some favorite activities remains, whereas with other types of depression the individual usually has no interest in and cannot enjoy any activity.
- For anxiety related depression, wanting to sleep more than usual is typical
- For anxiety related depression, weight gain is more likely than weight loss. This is particularly pronounced in people who are experiencing panic attacks.
How will Dr. Schwartz Treat My Depression?
Research has shown that depression is best treated with a combination of medication and cognitive behavioral therapy. The decision to add medication to your treatment plan depends on a number of factors, such as the severity, type of depression and the assessment as to your ability to follow the treatment plan without needing medication. Medication might be prescribed later if you do not improve with therapy alone. Medication is most often indicated in cases of severe depression and when the suicidal thoughts are a concern.
In addition to being very well informed about medication, it’s effects and side effects, treatment with me will include very specific techniques, such as:
- You will be taught “Thought Stopping” to reduce obsessive thinking and to help you get a night’s sleep.
- You will be given positive sentences to say to yourself to replace the negative and self-deprecating thoughts that have helped to upset and depress you.
- You will be asked to plan simple, positive activities, to look forward to doing and enjoying them. Depression is to a great extent caused by a lack of positive reinforcement in your life and a feeling of loss of control of your life. Planning positive activities deals with both issues.
- You will be taught ways to better handle the events and people in your life that repeatedly cause you to become anxious or angry. These are simple techniques that change your emotional reactions and behaviors in situations that you have not dealt with well in the past.
A Warm and Inviting Environment
Our practice offers a warm and inviting environment for our patients to meet with Dr. Merny Schwarz. Our office is conveniently located off the B & Q subway lines in the Flatbush-Ditmas Park area of Brooklyn, NY.
Dr. Merny Schwartz, PhD