Depression

Why is it Important to Treat Depression?

Like anxiety disorders, depression is one of the most common mental health disorders and is very treatable. Although treatable, the statistics of its occurrence does not change over time. For two consecutive weeks during the time frame 2013 to 2016, only 8.1% of Americans aged 20 and over had depression. Women’s percentages (10.4%) doubles that of men (5.5%). These percentages are consistent over different age groups for both men and women. From 2007 to 2016, the percentage of adults with depression had little change. Depression affects Hispanic more than Non-Hispanic people. It is also more likely to increase as family income decreases (Brody, et al., 2018).

These statistics concerned me, and so I chose depression to be an area of focus in my clinical practice. Not only is depression common, it can also negatively affect the individual, family, community, and nation. Furthermore, it can cause health problems that increase medical costs, resulting financial hardship.

About 50% of adults with depression have some difficulty with work, home, and/or social activities. 30% of adults with depression have reported moderate to severe problems in these same areas. There were limited gender differences in these statistics. These statistics are based on the general population rather than the clinical population or those who are in mental health facilities (Brody, et al., 2018).

There can be many reasons why the statistics of depression have not changed. Some people may not recognize the symptoms. Some may confuse their symptoms, thinking they are the result of a medical condition. Some people may recognize it, but feel too embarrassed or ashamed to seek counseling. Others have little faith that they can get better so they do not try counseling. Low self-esteem and fear of failure are symptoms that keep people from seeking counseling. Other hindrances are isolation, lack of energy, and lack of motivation. Those who do go to counseling may not see results right away, and become discouraged. This can lead them to stop their efforts for better mental health.

Symptoms of Depression

Educating people about depression helps them recognize their symptoms. It motivates them to take part in counseling. The goal is to reach them before depression begins to affect their work, family, and social lives, or it leads to suicidal thoughts. Most people feel some symptoms of depression at some point in their life. It is usually a response to a negative experience such as unemployment, the death of a loved one, or a biological condition. I recommend regular counseling sessions even when symptoms only last a week or two. This is even more important if there are many symptoms and there is a chronic level of depressed mood.

There are biological, cognitive, emotional, and social symptoms of depression. These may include loss of energy, unexplained body aches and pains or persistent lethargy. Eating difficulties as well as changes in sleep patterns are also common. I have noticed that my clients with depression experience physical symptoms differently. Eating difficulties may be low appetite, large appetite, or a significant increase or decrease in weight. Those with sleeping difficulties may have trouble falling asleep or staying asleep. They may wake up too early, or struggle with all three, resulting in no sleep (insomnia). These physical symptoms, coupled with depressed mood, can cause difficulty in concentration, memory, and indecisiveness. I have observed cognitive changes when someone becomes depressed and have negative thoughts about themselves, about others, as well as feelings that things will never get better. If my clients with depression are not pessimistic, they have feelings of indifference and loss of motivation and interest in life. There are behavioral changes that occur with depression limiting social interaction. Depressed mood and low self-esteem lead to isolation and loss of interest in activities that once gave pleasure. The emotional symptoms of agitation, irritability, and anger can cause conflict in relationships. Other emotional and behavioral symptoms of depression include prolonged sadness and crying spells. These negative effects contribute to feelings of guilt, worthlessness, and low self-esteem. Without medication and/or counseling, these thoughts can lead to reoccurring thoughts of death and suicide. Then in its most chronic stage, to suicidal attempts, and suicide/death. (DSM-5, 2013).

I have noticed that symptoms of depression can co-occur with other mental health illnesses such as anxiety disorders, eating disorders, and substance use disorders. It can be the result of medical problems and conditions, physical injury, or dementia in old age.

Types of Depression

There are 12 major types of depression (DSM, 2013; Palleri, 2017):

  • Major Depressive Disorder
  • Subsyndromal Depression
  • Persistent Depressive Disorder (PDD)
  • Psychotic Depression, Bipolar Depression
  • Treatment Resistant Depression
  • Premenstrual Dysphoric Disorder (PMDD)
  • Post-Partum Depression (PPD)
  • Seasonal Affective Disorder (SAD)
  • Substance Induced Mood Disorder
  • Depression Due to Illness
  • Disruptive Mood Dysregulation Order (DMDD).


Major Depressive Disorder

My clients with this type of depression have at least five of the following symptoms of depression over a two-week period: Loss of energy, appetite, or interest in pleasurable activities, changes in sleep, feelings of sadness, hopelessness, worthlessness, guilt, and/or emptiness.

  • There are two types of Major Depressive Disorders:
    • Atypical Depression - Usually young adults have this type of depression. They eat and sleep a lot, as well as are often very anxious and emotionally reactive.
    • Melancholic Depression - Usually older adults have this type. They have trouble sleeping and ruminate over guilt-ridden thoughts.
  • Both major depression types are treatable with medication and counseling.

Subsyndromal Depression

This diagnosis is based in on a person’s overall functioning. My clients with this type of depression have three or four symptoms rather than five. They have had the symptoms for one week rather than two. However, they have trouble functioning at home, work, or in social situations. Some of my clients with these limited symptoms do not follow through with counseling.

Persistent Depressive Disorder (PDD) (Dysthymia)

My clients with this type of disorder have low level of sadness and two other symptoms of depression lasting two years or more. Counseling and antidepressants are the recommended treatment and have been very effective.

Psychotic Depression

My clients with Psychotic Depression have chronic depression and psychosis. They have five depression symptoms. They also have hallucinations (seeing or hearing things that are not there) or delusions (having thoughts that are not real or valid). The recommended treatment includes counseling and both antidepressants and antipsychotics medication. A psychiatrist or the client's physician would prescribe these.

Bipolar Depression

My clients with Bipolar Disorder experience mania and depression to an extreme level. A person with this depression has had at least one episode of mania. Manic symptoms range from elation, thoughts of grandiosity, high energy, fast talking, racing thoughts, and/or doing or thinking many things at once. It usually occurs in young adulthood. There is no difference in the statistics of diagnosis between men and women. However, men have more mania symptoms than women, and women have more depressive symptoms than men. Symptoms worsen without counseling and medication management of mood stabilizers and antipsychotics medication.

Treatment Resistant Depression

These clients have depression symptoms and do not respond easily to counselling or medications. They have a history of many medication adjustments such as changes in types of medications or increases in doses of the same medication. They may also have had antidepressant or antipsychotic medications added to treatment intervention. An accurate diagnosis is only made when other psychiatric and medical diagnoses have been ruled out.

Premenstrual Dysphoric Disorder (PMDD) (Premenstrual Syndrome)

These clients are women of childbearing years. They experience extreme premenstrual syndrome symptoms including sadness, anxiety, and irritability. Hormonal changes that take place before a woman’s period trigger these symptoms. Occurrence of symptoms can hinder daily functioning. Antidepressants such as serotonin reuptake inhibitors has been an effective treatment. They are taken two weeks before menstruation or throughout the month.

Postpartum Depression (PPD)

Postpartum Depression causes intense feelings of sadness, anxiety, and fatigue upon the birth of a child. It occurs in four out of 10 women and one out of eight men. The causes in women are hormonal changes. Men experience symptoms due to the lifestyle changes, increased responsibilities, and financial demands. PPD can affect overall functioning and can lead to thoughts of harm to themselves or the newborn. Treatment consists of antidepressants and counseling.

Seasonal Affective Disorder (SAD) (Seasonal Depression)

Clients with SAD have reoccurring depression which usually occurs during fall or winter months. Symptoms include: low energy, eating and sleeping too much, cravings for carbohydrates, weight gain, and isolation. Fewer daylight hours results in less serotonin. This causes depression and more of the sleep hormone melatonin. Low levels of vitamin D associated with SAD may contribute to the low energy. Treatment for SAD includes daily light therapy and at times, medication.

Substance-Induced Mood Disorder

Drinking too much alcohol, using controlled substances or illegal drugs such as opiate painkillers or anti-anxiety benzodiazepines in large amounts (or frequently) can lead to anxiety and depression. This is particularly true when the drug is discontinued, and physical withdrawal symptoms are felt. To properly diagnose substance-induced disorders, other diagnoses of depression must be ruled out. Additionally, the depression must have negative effects on functioning.

Depression Due to Illness

Physical diseases and conditions that affect the immune systems, cause changes in the brain and contribute to depression symptoms. Heart disease, multiple sclerosis, HIV/AIDS, and cancer are but a few of these. Both antidepressant medications and counseling can aid clients. They can improve their functioning, and help in dealing with their physical and mental health symptoms.

Disruptive Mood Dysregulation Disorder (DMDD)

This type of disorder occurs in children aged 6-18. DMMD is a recently recognized condition and there are specific criteria for diagnosis. It includes: recurrent temper outbursts that are out of proportion in intensity or duration to the situation or provocation. They occur three or more times a week, on average. The mood between the outbursts is generally irritable and angry. For diagnosis, the behavior needs to be present in at least two of the following three settings (home, school, peers). (DMS-5, 2013)

Causes of Depression

Everyone feels sadness or some depression for a temporary time. These feelings are usually a response to situational factors such as early childhood trauma, life transitions, financial stress, or the death of a loved one. Yet, sadness becomes clinical depression when more symptoms occur, occur for longer periods of time, and with more frequency. When symptoms of depression affect daily functioning, the result can be problems with health, employment, family, and social interaction. At this point, it is considered to be pathological and counseling and/or medications are recommended.

Clinical depression can be a result of biological factors, too. These internal, biological factors include genetics, chemical imbalances in the brain, hormonal changes. Other factors may include seasonal changes, drug or alcohol abuse, and other psychiatric and physical diseases. Depression can be a symptom of other mental health disorders such as anxiety disorders and personality disorders.

Counseling Interventions for Depression

low motivation and lost interest in pleasurable activities are major symptoms of depression. Using Motivational Enhancement Techniques, I examine how the depressed client lost their motivation. With medication management, my counselling would include regaining or finding new activities that promote purpose and enjoyment. Both Cognitive-Behavioral Techniques (CBT) and Dialectical Brief Therapy (DBT) are effective in treating depression. Negative thoughts about self, others, or the world can cause depressed mood and depression symptoms. I have found that clients diagnosed with depression have extreme negative thoughts. For example, they may think they or the world is all bad and there is no hope. Feelings and behaviors change. When negative thoughts are challenged, they can change into realistic, positive ones. I use psychodynamic methods to discover how past childhood experiences contribute to the negative self-statements and pessimism. This helps the client realize that past associations do not apply to present situations. DBT methods, mindfulness, meditation, and breathing relaxation exercises aid the client in focusing on present pleasurable events rather than past negative experiences. The modality or counseling intervention I use will be unique to each client. It is dependent on the type, severity, and cause of the depression.


References

Brody D.J., Pratt LA, Hughes J. (2018). Prevalence of Depression Among Adults Aged 20 and Over: United States, 2013–2016. NCHS Data Brief, no. 303. Hyattsville, MD: National Center for Health Statistics.

Diagnostic and Statistical Manual of Mental Disorders. (2013). American Psychiatric Association, Fifth Edition.

Pallari, Karen. (2017). 12 Types of Depression and What You Need to Know About Each. Retrieved from http://www.health.com/depression/types-of-depression