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 highly treatable, the statistics of its occurrence does not change over time. Over the course of 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 occurs more with Hispanic than Non-Hispanic people, and depression is more likely to increase as family income decreases (Brody, et al., 2018).
These statistics are concerning, and therefore I chose depression to be an area of focus in my clinical practice. Not only is it common, and there has been less improvement in these numbers, depression can also negatively affect the individual, family, community, and nation. Eighty percent of adults with depression in the United States have some difficulty with work, home life, and/or social activities. It can also cause health problems that negatively affect medical costs, causing financial problems. About 50% of adults with depression have some difficulty with work, home, and/or social activities because of their symptoms, and 30% of adults with depression have reported moderate to severe problems with work, home, and/or social activities. 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. It could be that some people are unaware of their depression because they do not recognize the symptoms. They may confuse their symptoms, thinking they are the result of a medical condition. Some people with depression may recognize it, but feel too embarrassed or ashamed to seek counseling. Other people with depression have little faith that they can get better, and therefore, do not try counseling. Low self-esteem and fear of failure are symptoms that hinder people from seeking counseling. Other symptoms that hinder participation in counseling are isolation, lack of energy, and lack of motivation. Those who do attend counseling may not feel the positive affects right away, and become so discourage that they discontinue their efforts for better mental health.
Symptoms of Depression
My counseling interventions include educating people about depression, helping them recognize their symptoms, and motivating them to participate in counseling. The goal is to reach them before they feel more depressed and it negatively affects their work, family, and social functioning, or it leads to suicidal thoughts. Most people feel some symptoms of depression at some point in their life and it is usually a response to a negative experience such as unemployment, the death of a loved one, or a biological condition. Even when the duration of symptoms is just a week or two, I strongly recommend regular counseling sessions, particularly if there are many symptoms and there is a chronic level of depressed mood.
There are biological, cognitive, emotional, and social symptoms of depression. Loss of energy, unexplained body aches and pains, fatigue or persistent lethargy, significant changes in appetite and weight, as well as significant changes in sleep patterns. I have noticed that my clients who have been diagnosed with depression experience physical symptoms differently. Eating difficulties may be low appetite, large appetite, or a significant increase or decrease in weight. Sleeping difficulties include: difficulty falling asleep, staying asleep, early morning awakenings, or all three, where no sleep is attained (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 negative communication and conflict in relationships. Other emotional symptoms and behavioral symptoms of depression are prolonged sadness and crying spells. I believe that these negative effects of depression contribute to feelings of guilt, worthlessness, and low self-esteem. Without medication and/or counseling intervention, these thoughts can lead to reoccurring thoughts of death, suicidal thoughts, and then to suicidal attempts, and suicide/death in its most chronic stage (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: 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, and Disruptive Mood Dysregulation Order (DMDD). (DSM, 2013; Palleri, 2017).
- 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, and 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 Persistent Depressive Disorder have low level of sadness and two other symptoms of depression lasting two years or more. Counseling and antidepressants are recommended for treatment and have been effective.
- Psychotic Depression: My clients with Psychotic Depression have chronic depression and psychosis. Along with 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). Along with counseling, both antidepressants and antipsychotics medication are recommended and prescribed by a psychiatrist or their physician.
- Bipolar Depression: My clients with Bipolar Disorder experience two main symptoms of 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 and 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 including changes in types of medications, increases in doses of the same medication, or an 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): This diagnosis is experienced by women of childbearing years who experience extreme premenstrual syndrome symptoms including sadness, anxiety, and irritability. The symptoms are triggered by hormonal changes just before a woman’s period. Occurrence of symptoms can hinder daily functioning. Antidepressant such as serotonin reuptake inhibitors taken two weeks before menstruation or throughout the month has been an effective treatment.
- Postpartum Depression (PPD): Clients with Postpartum Depression will experience 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, whereas men experience symptoms due to the lifestyle changes, increased responsibilities, and financial demands. Along with affecting overall functioning, it can lead to thoughts of harm to themselves or the newborn. Treatment consists of antidepressants and counseling.
- Seasonal Affective Disorder (SAD) (Seasonal Depression): My clients diagnosed 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. Due to less daylight hours, there is less serotonin, which causes depression and more of the sleep hormone melatonin. Low levels of vitamin D associated with SAD may contribute to the low energy. SAD is treated with a daily light therapy, and at times medication.
- Substance-Induced Mood Disorder: Drinking too much alcohol, using controlled substances or illegal drugs such as opiate pain killers or antianxiety 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. Other diagnoses of depression must be ruled out and the depression must have negative effects on functioning to properly diagnose substance-induced disorder.
- Depression Due to Illness: Physical diseases and conditions such as: heart disease, multiple sclerosis, HIV/AIDS, cancer, and others that affect the immune systems, cause changes in the brain and contribute to depression symptoms. Both antidepressant medications and counseling can aid clients in improving their functioning, and in dealing with the physical and mental health symptoms.
- Disruptive Mood Dysregulation Disorder (DMDD): This type of disorder occurs in children aged 6-18. There are specific criteria for diagnosis and DMDD is a relatively newly recognized condition. It includes: recurrent temper outbursts that are grossly out of proportion in intensity or duration to the situation or provocation, and occur on average three or more times a week. 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, and these feelings are usually a response to situational factors such as early childhood trauma, developmental or life stage transitions, job loss, financial stress, or death of a loved one. However, sadness becomes clinical depression when more symptoms occur, it occurs for longer durations of time, and with more frequent symptoms or episodes. It is considered to be pathological, and counseling and/or medications are recommended when symptoms of depression affect daily functioning, resulting in problems with health, employment, family, and social interaction.
Along with environmental or external situational factors, clinical depression can be a result of biological factors. These internal, biological factors include genetics, chemical imbalances in the brain, hormonal changes, seasonal changes, drug/alcohol abuse, and substance withdrawal and effects of 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
Utilizing Motivational Enhancement Techniques, I examine how the depressed client lost their motivation as low motivation and lost interest in pleasurable activities are major symptoms of depression. 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 modalities 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 such as thinking they or the world is all bad and there is absolutely no hope. Feelings and behaviors change when negative thoughts are challenged and change into realistic, positive ones. I use psychodynamic methods to discover how past childhood experiences contribute to the negative self-statements and pessimism, and help 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 is dependent on the type, severity, and cause of the depression.
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