If you are wondering if you have depression, you are not alone with this question. We are bombarded with ads for antidepressants, which tell us that depression is due to chemical dysregulation, which pharmaceuticals pronounce treatable by chemistry. I believe depression is both underdiagnosed and overdiagnosed, and it is both undertreated and overtreated.

Depression is the major reason people seek psychotherapy from psychologists and other therapists. According to the National Institute of Mental Health, 20.9 million adults suffer from depression, and children and teens can have depression, too.

Depression is more than just feeling “blue,” and it can happen to anyone, including bright people, celebrities, and millionaires, too. Depression is an ongoing, overwhelming feeling of sadness and helplessness that interferes with one’s normal day to day life. People overcome by depression often withdrawal from family, friends, and activities that they once enjoyed. Depression also affects sleep patterns, weight, and concentration.

Sometimes people who are feeling depressed think about or even attempt suicide. For some people, the thought of suicide is really an indication that the person desperately wants or needs something to change in life; the underlying thought may be, “I just can’t go on living like this.” This thought may be a signal that there needs to be a readjustment in life circumstances, or a readjustment in thinking. If you or someone you know is serious about suicide, call 911 or go to the nearest emergency room. Better to be safe than sorry.
What are the Signs of Depression?

The National Institute of Mental Health has this checklist for Depression:

I am really sad most of the time.

I don't enjoy doing the things I've always enjoyed doing.

I don't sleep well at night and am very restless.

I am always tired. I find it hard to get out of bed.

I don't feel like eating much.

I feel like eating all the time.

I have lots of aches and pains that don't go away.

I have little to no sexual energy.

I find it hard to focus and am very forgetful.

I am mad at everybody and everything.

I feel upset and fearful, but can't figure out why.

I don't feel like talking to people.

I feel like there isn't much point to living.

I don't like myself very much. I feel bad most of the time.

I think about death a lot. I even think about how I might kill myself.

If you checked several boxes, call me (301-596-5916 or 410-381-7551) or another psychologist.

What causes depression?
Pharmaceutical companies write articles for psychiatric journals, which say, of course, that a “chemical imbalance” is the cause of depression and that—no surprise—their products can give the person a better life through chemistry. In the Myth of Depression as Disease: Limitations and Alternatives to Drug Treatment, Leventhal and Martell write:
“No such definitive findings or measurements exist of a chemical imbalance in the blood or brains of people with mental disorders when compared with normal people. Thus, in this analogy, a theory has been presented as if it is an established finding when it is not and does not fit the facts as we know them. Mental health practitioners, physicians, and the general public have been persuaded by a great deal of hype that something exists when there is, as least as yet, no good scientific basis for the claim.” (p. 24).

There does seem to be a genetic basis for some depression.

Psychologists, on the other hand, have come to believe that dysfunctional beliefs and negatively biased information processing fosters and maintains depression (Beck & Beck, 1995). For example, the person with depression sees “the glass half empty” and may catastrophize or jump to conclusions. In psychotherapy, treatment helps patients learn to think more adaptively and thereby experience improvements in affect, motivation, and behavior.

Avoidance, generally due to anxiety, can cause depression. It is understandable that a person avoids anxiety-provoking situations, particularly after something very negative has happened (such as a major rejection or job loss). This avoidance, however, makes the person feel more and more helpless and robs the person of self-esteem and also of pleasure. Therefore, one of the causes of depression can be avoidance of situations. Leventhal and Martell explain this in depth in The Myth of Depression as Disease. Peter Lewinsohn in 1974 published a method of treatment for depression called “behavioral activation.” Basically, he and his colleagues demonstrated that including positive events in one’s schedule could alleviate depression.

Other disorders often lead to depression. For example, anxiety often comes first and then depression follows. Similarly, people who compulsively pull their hair (trichotillomania) and those who have obsessive-compulsive disorder (OCD) have high rates of depression. Children and adults with ADHD have a high incidence of depression.

When looking at the causes of depression, we must acknowledge that women are twice as likely to be depressed for men. What could that mean in terms of the etiology of depression? Moods of women can indeed be linked to the menstrual cycle, which can be hard to admit due to jokes about PMS. However, for many women, PMS is a serious reality and for some, their depression worsens with the cycle. Menstrual cycle research is complex and so the jury is still out on this. Postpartum depression is also a reality, and it is not rare. On the other hand, infertility also often leads to depression. Many women become depressed at menopause or just before menopause, but this incidence could be due to “empty nest” issues or midlife identity issues, rather than due purely to hormonal changes.

Additionally, the American Psychological Association’s National Task Force on Women and Depression in Women and Depression: Risk Factors and Treatment Issues, noted some of the social issues which may contribute to depression in women. For example, women are more likely to be physically or sexually abused as children or teens. Therefore, depression could be an effect of posttraumatic stress syndrome for many women. Secondly, when there are marital problems, women are much more likely to feel depressed than men. Third, women with small children are vulnerable to depression. It is unclear why they are more likely to be depressed than women without children, but it may be due to stress. Fourth, women are more likely than men to live in poverty in the U.S., and poverty can be a “pathway to depression.” Finally, we should not forget that depression is almost always ignored in the elderly, and that most of this population is women. Their depression can be a result of losses, chronic pain, isolation, biochemical changes, and facing the onset of dementia and other illnesses.

How Depression Is Treated
Rather than quickly turning to “pills,” if you (or your loved one) are not suicidal, why not try therapy first? Your insurance company will not like this approach, simply because antidepressants are cheaper (for them) than psychotherapy. However, the side effects of antidepressants are something to consider, particularly when compared to psychotherapy. And the research indicates that psychotherapy is generally just as effective as medication for depression! If you are suicidal or unable to work or to go to school, then you might need both antidepressants and psychotherapy in order to get back on track.
In psychotherapy, you will learn to question your negative and catastrophic thinking and also to re-engage in activities, which you have avoided. We can use interpersonal psychotherapy to help you look at and develop social relationships, to work on assertiveness, and to enhance your communication skills. The kind of therapy that works for depression offers more than support and “ah-hah’s.” This therapy requires, whether from me or from someone else, an active engagement so that we can help you restructure your thinking so that the dark cloud starts to float away.

Speaking of dark clouds, hypnosis can be helpful for depression if you able to learn to use it. Most people can use it. If you are open to this, please ask me about it. We can use the imagery of hypnosis as a dark cloud or however else you imagine hypnosis and then work with your imagery to help you feel more like yourself again.

If there are disorders which came before the depression, they need to be addressed. For example, if you have OCD, you will likely feel much more empowered and less depressed after you have “kicked back” your OCD with behavior therapy. However, if the depression is severe, it may need to be treated prior to the other disorders because psychotherapy requires energy, which you may not have due to depression. If there are marital issues, these may need to be addressed prior to treating the depression.

Group therapy can be very helpful for depression. It offers the opportunity (at less cost than individual sessions) to gain interpersonal awareness as well as support. One group which can be helpful if you are depressed due to financial stress is the group I am forming for “money issues.” Feel free to call me about this or therapy opportunities.

There is some interesting research to suggest that “light and sound equipment” can alter a depressed mood. This equipment consists of lights which are similar to rhythmic strobe lights and sounds which are heard through headphones. Research in over 30 studies indicates that this kind of equipment can generate positive changes in brain waves (and mood) by increasing serotonin and endorphin levels and decreasing plasma cortisol levels (which measures stress. There is also an increase in cerebral blood flow. More information on this kind of equipment can be found at http://www.neuro-advantage.com.

Finally, depression can be treated by antidepressants. Antidepressants fall in several categories: Tricyclic Antidepressants, SSRIs (Serotonin Specific Reuptake Inhibitors), and Unclassified Antidepressants. SSRIs are most of often used and include Prozac, Zoloft, Celexa and Paxil. The Unclassified Antidepressants include Effexor, Serzone, and Remeron. Side effects of medication can include: fatigue, dry mouth, constipation or other gastrointestinal problems, lowered blood pressure, urinary retention, headaches, weight gain, nervousness, insomnia, and sexual dysfunction (Penzel, 2003).