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Q. How do I encourage reluctant people who suffer from depression to seek counseling?
A. If someone you care about is finding their life unmanageable because of their depression and your efforts to get them to seek counseling have failed, ask them to consider: “Is there something more I need to do to improve my quality of life? Am I ignoring cues inside myself that I’m not in a good place?
Q. Why do people get depressed?A. Three reasons: genetics, loss and anger turned inward.
a. Genetics: Some people have a family history of depression. When you see there’s a family history, that lends to a good hypothesis that the person may be more at risk for depression.
b.Loss: A big loss in their life of one sort or another. They get stuck and don’t know how to get out of it. Loss that comes with death, illness, aging, retiring, a relationship breakup, a transition from moving, and the loss of a job. One form of loss comes when children move out; your life changes and now you’re an empty nester. The death of a family member can lead to depression if you didn’t get to say goodbye. Prolonged, all- consuming mourning can turn into melancholia, which is when mourning gets stuck. You didn’t only lose the person; you lost the hope for possibly resolving conflicts in the relationship or for the person becoming who you’d hoped they would be.
c. Anger turned inward: When people feel hurt, they often cover those feelings with anger. Sometimes, with no way to process these feelings with another, they turn it on themselves. Therapy can help them identify this process and find insight into unresolved anger.
Q. How do you treat depression?
A. I look at the family history and how that affects the kinds of relationships people have in the present. I tailor my treatment to the needs of the patient, considering who each person is, what is causing their depression and how they’re responding to their life circumstances.
As a broadly trained therapist, I draw from many schools of thought, including cognitive behavioral therapy (CBT) and psycho-dynamic therapy. Psycho-dynamic therapy is when we use the patient’s past history as a roadmap to the present. When people understand what triggers them, they don’t have to fall into old patterns. Therapy helps patients develop insight so they can make choices. I help patients look at what triggers from their past are being reenacted in the present so they can resolve past issues and live a higher quality of life. Cognitive behavioral therapy, which is strongly supported in the mental health literature as a treatment for depression, addresses the exaggerated thinking that is a centerpiece of depression.
Q. I am on medication for depression. Do I really need therapy?
A. If you have clinical indicators of depression, such as not eating, sleeping, bathing, functioning or crying a lot, you may need medication. For some, having depression is like surfing in the waves. If the waves (distorted thoughts) are coming fast and furious, you can’t ride the waves; you go underwater (become anxious and depressed). You just have to slow those waves down. Medication serves as a foundation on which therapy can take place. Medication helps to slow down the exaggerated thoughts that are part of depression and helps patients identify, name and challenge those thoughts.
Often, therapy is part of treatment for depression. Most of the time, people with depression have something going on in their life that they need to address. If someone is not going to class, not going to work, hasn’t changed their sheets in a month, chronically has dishes piled up in the sink – these are signs of clinical depression. Depression is on a continuum. Some people are depressed, but functioning. Suicidal thoughts can go along with depression, but the absence of them doesn’t mean someone isn’t depressed. Some people with depression need medication as a first step. To get to a healthier state of mind, people may need therapy. Therapy can help people with depression get out of a downward spiral and change the things in their life that they’d like to change.
There are people with depression who don’t need medication. Typically, their depression may be milder and therapy gives them the support they need to get back on track and become fully functional again.
Q. Can I address my depression without medication?
A. It is not uncommon for a person to address their depression without medication. Therapy combined with social support, exercise, healthy diet, sunlight and adequate sleep can be enough for some people with depression.
Q. Is depression something I have to live with? Is there hope that I could live my life without depression?
Maybe yes, and yes. Therapy can give you a framework for understanding yourself. For some, struggling with depression may be something you need to be vigilant about. It may be lurking in the background and you have to be careful how you manage yourself. If you’ve been depressed before and don’t want it to happen again, being mindful of the signs that you’re starting to get depressed is crucial. When you see the early signs, ask yourself how you’re coping, whether your life is manageable, whether you’re comfortable with the way you’re relating to others, and how you’re doing at work or school. Therapy can keep you on track to keep you from falling into depression. Just because you’ve had depression in the past doesn’t mean you’re doomed to a life of depression. Some people benefit from a check-in with a therapist to help them self-assess how they’re doing when they start to show signs of depression.
Q. Do you only work with the individual who is depressed? Do you ever work with the family?
It depends on the age of the patient and whether the family is willing to be involved and whether the patient is willing to involve the family. Involving the family can be beneficial in some cases and not in others.