Psychotherapy for Depression

Depression is a serious and sometimes fatal medical condition that affects 17 million American adults each year. It is characterized by intense feelings of sadness, hopelessness, apathy, lack of enjoyment, negative thoughts, and physical symptoms, like tiredness, aches and pains, and weakened immunity. Depression has been documented for centuries. The Greeks described the state, and it was one of the first firmly established mental illnesses. Historically, the primary treatment for depression was psychotherapy. Pharmaceutical treatments for depression are a product of the last 50 years. Even with the advances made in treating depression with drugs, research has demonstrated that talk therapy can significantly reduce depression and prevent future problems.

What is Depression?

The American Psychiatric Association recognizes several different depression diagnoses:

  • Major Depressive Disorder (MDD) or Unipolar Depression: In MDD, patients must present with at least 5 of 9 identified symptoms, including depressed mood most of the day and nearly everyday, anhedonia (diminished interest and pleasure), significant weight loss or gain, lack of sleep or too much sleep, agitation, fatigue, feelings of worthlessness, impaired thinking and concentration, and thoughts of suicide. These symptoms must have been present at an almost daily intensity for at least 2 weeks.
  • Bipolar Depression or Manic Depression: Bipolar Depression includes the symptoms discussed above, but in bipolar individuals, these symptoms alternate, and sometimes overlap, manic states. Mania is characterized by an elevated or irritated mood that lasts at least one week. During that time, the Bipolar individual must also demonstrate 3 of 7 potential manic symptoms, including: inflated self-esteem and grand plans, decreased need for (or absence of) sleep, increase in talkativeness/pressured speech, racing thoughts, poor concentration, high activity levels, and excessive behaviors, such as drug use, hypersexuality, and excessive spending.
  • Dysthymia: Dysthymia is a type of depression that is less intense than Major Depressive Disorder (MDD), but has a more chronic, rather than episodic course. To qualify for a diagnosis of dysthymia, an individual must demonstrate 2 of 6 symptoms for at least 2 years (with no more that 2 months symptom-free). Symptoms of dysthymia include: poor appetite or overeating, too little or too much sleep, low energy level, low self-esteem, difficulty making decisions, and feelings of hopelessness.
  • Cyclothymia: Cyclothymia resembles a less intense and more chronic version of Bipolar Disorder. Cyclothymic individuals don’t experience full-blown mania, they experience hypomanic episodes, lasting 4 to 5 days where they demonstrate manic symptoms, but at a lower intensity than seen in full mania. In between these hypomanic episodes, these individuals experience mild depressions. In order to formally diagnose Cyclothymia, these mood variations must have been present for at least 2 years.

What Causes Depressive Disorders?

Depressive illness is caused by the interaction of several factors – in other words, it’s important to note that there is no single cause of depression. Scientists know that depressed individuals show deficits in the levels of certain key brain chemicals (called neurotransmitters). They also know that the brain of someone experiencing depression looks very different than the brain of a normal person in regard to how much activation there is, and in which areas. Research has also made preliminary links between depression and certain genes, and there is strong evidence from family studies that depression is partly hereditary.

Other research has focused on environmental factors. Decades of research have demonstrated a link between growing up in poverty and the development of depression. Also well established is the link between the quality of early life relationships (in particular, the parent-child relationship) and later risk for depression. The presence of mental illness in parents is also a risk, as is the presence of drug and alcohol abuse. Certain parenting styles, those that are rejecting or neglecting, abusive, and even those that are overly-intrusive, have been linked to increased susceptibility for depression. Because of the multi-faceted nature of depression, each case must be evaluated individually.

What is Psychotherapy?

Psychotherapy, commonly referred to as “therapy” or “counseling,” consists of different “talk therapies.” The first of these modern therapies, psychoanalysis, was developed by Sigmund Freud. Psychoanalysis depends on interpersonal communication between the qualified psychotherapist and the patient. During this verbal exchange, the patient is free to talk about what is on his or her mind with minimal intervention from the therapist. Freud had methods by which he interpreted the meaning of the patient’s thoughts. It was Freud’s belief that, by recounting troubling memories, the patient would re-experience emotions associated with the memories, and release these pent-up emotions; Freud called this experience catharsis.

Psychotherapy in general strives to restore a patient to a healthy mental state. To do this, the therapist will explore the following areas in discussion:

  • Examination of life problems: Individuals are encouraged to examine both past and current life problems and understand where these problems came from and what they are connected to. Psychotherapy can help depressed clients generate potential solutions for solvable problems.
  • Examinations of Negative/Distorted patterns of thought: Depressed individuals tend to think negatively about themselves, their lives, and the world. Through psychotherapy, depressed clients learn to challenge these negative thought patterns and create new, more realistic patterns.
  • Examinations of maladaptive (counterproductive) behavior patterns: Individuals are encouraged to explore the ways they cope with stressful situations. Some ways of coping may be helpful; some may just add to their problems. Psychotherapy can help depressed clients understand why certain behaviors aren’t helpful and learn to behave in new ways.
  • Examinations of social relations: In psychotherapy, the patient is forming an intimate relationship with the therapist. They are disclosing difficult feelings and are depending on the therapist to help them resolve complex issues. Often, the issues that patients present involve troubles in their major relationships, and in the general way they relate to others. Examining these issues in the context of a trusting and intimate relationship with a therapist helps depressed clients in two ways: 1) patients begin to see their own unique relational problems, and 2) these problems are partially addressed by the reparative nature of the relationship they form with their therapist.

There are many different types of psychotherapy (i.e., cognitive-behavioral therapy, interpersonal therapy, etc.) and contemporary research is helping us understand which types of therapy work best for which individuals.

Additional Resources

American Psychological Association
American Psychiatric Association
National Alliance on Mental Illness
Depression and Bipolar Support Alliance

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