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The word "depression" is often used as a global term referring to feelings of sadness, disappointment, grief, and fatigue. Everyone experiences all of these emotions to varying degrees, and they can provide important information about how we are reacting to what is happening around us. For example, it is normal to experience sadness if a close friend moves away or disappointment because you received a low grade on a test for which you had diligently prepared.

But when someone experiences these feelings most days for several weeks, these depressive feelings become much more problematic. When this occurs, one may experience problems in interpersonal relationships, school, and/or work. Evidence indicates that nearly 30% of people will experience significant symptoms of depression at some point in our lives, and that percentage rises for persons who have had traumatic life experiences, family members with depression, and/or difficult interpersonal relationships (Kaelber, Moul, & Farmer, 1995).

What are the symptoms of depression?

According to the handbook used by most mental health professionals to arrive at a diagnosis, the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), the major symptoms of depression are:

• Depressed mood most of the day, nearly every day
• Considerably less interest in activities that were once enjoyable
• Significant change in weight
• Inability to sleep, or sleeping too much
• Visibly accelerated or slowed movements and speech
• Fatigue and/or loss of energy
• Feelings of worthlessness
• Excessive and/or inappropriate guilt
• Trouble thinking, concentrating, or making decisions
• Recurring thoughts of death and/or thoughts of suicide*

One does not have to experience all of these symptoms to be depressed. There may be some differences in how people experience depression that are not adequately captured in these criteria. For example, some men label their feeling as agitation rather than sadness (Khan, Gardner, Prescott, & Kendler, 2002). Consequently, they may be less likely to seek treatment for and be subsequently diagnosed with depression. Moreover, persons from some cultural backgrounds may talk about feeling "sick" rather than "sad," and may have physical symptoms (Sue & Sue, 1999).

*If someone is considering taking his or her own life, then it is imperative for him or her to consult a counselor immediately.

Why do I feel this way?

People can experience depression for any number of reasons, ranging from a reaction to current life stressors to a life filled with trauma, abuse, loss, and/or tumultuous relationships with family, friends, and/or partners. Many professionals consider the psychological, social, spiritual, and biological contributions and consequences to a particular person's suffering. Through counseling, you can gain insight into these aspects of your life in order to develop and execute a plan for change.

What can I do about it?

Depression is one of the most common reasons why people seek mental health treatment. The good news is that people with depressive symptoms are usually able to find relief. Currently, there is much debate about whether one should treat depression with antidepressant medication, psychotherapy, or a combination of these. When short- and long-term outcomes (e.g., quality of life and symptom distress), relapse, medication side effects, and dropout from treatment are considered, psychotherapy has been found to be more effective and more cost-efficient than medication alone or medication and psychotherapy combined (Antonucci, Danton, DeNelsky, Greenberg, & Gordon, 1999; Wachtel & Messer, 1997). This is not to say that medication should be avoided, but highlights the need for "talk therapy."

McWilliams (1999) suggested that persons taking medications for psychological problems often still need psychotherapy in order to:

• Feel attached enough to someone in order to increase motivation to take medications (Frank, Kupfer, & Siegel, 1995)
• Learn to better handle life stressors now that their symptoms are under control.
• Work through feelings of being exposed as "defective" (a common feeling among mental health clients) because of a dependency on prescribed medications
• Address the life issues that activated their "genetic predisposition."
• Mourn that they still suffer despite having the "chemical imbalance" rectified.
• Discover ways to improve interpersonal relationships.

What can I expect when I see a therapist?

There are a lot of misconceptions about how a therapist will behave. For example, a new client may wonder if they will be required to lay on the couch and just blurt out whatever comes to mind.

Therapists differ widely in how they think about people, which ultimately affects how they work. For example, therapists calling themselves psychodynamic may be less active in sessions while focusing on feelings, personal history, and the relationship between himself/herself and the client (McWilliams, 1994; 1999). By contrast, a cognitive or cognitive-behavioral therapist generally concentrates on thoughts about self, others, and the world around them as well as specific changes in behavior (e.g., encouraging a client to return to once enjoyable activities or to seek social interaction; Beck, 1995). These are just two very broad categorizations, and many others exist.

Regardless of how your therapist understands depression, in the first session he or she will want to gather information about what brought you to therapy and your personal history. This is not done to be voyeuristic, but rather to gain an appreciation of you as a unique person who has been living in a certain psychological, social, and cultural context. This allows the therapist to better serve your specific needs as an individual as he or she helps you to gain control over your mood, solve current life stressors, and/or work through painful past experiences.

References

• Antonucci, D.O., Danton, W.G., DeNelsky, G.Y., Greenberg, R.P., and Gordon, J.S.(1999). Raising questions about antidepressants. Psychotherapy and Psychosomatics, 68, 3-14.
• Beck, J.S. (1995). Cognitive therapy: Basics and beyond. New York: Guilford.
• Frank, E., Kupfer, D.J., & Siegel, L.R. (1995). Alliance not compliance: A philosophy of outpatient care. Journal of Clinical Psychiatry, 56, 11-17.
• Kaelber, C.T., Moul, D.E., & Farmer, M.E. (1995). Epidemiology of depression. In E.E. Beckham & W.R. Leber (Eds). Handbook of Depression, 2nd ed (pp. 3-35). New York: Guilford.
• Kahn, A.A., Gardner, C.O., Prescott, C.A., & Kendler, K.S. (2002). Gender differences in the symptoms of major depression in opposite-sex dizygotic twin pairs. American Journal of Psychiatry, 159, 1427-1429.
• McWilliams, N. (1994). Psychoanalytic diagnosis. New York: Guilford.
• McWilliams, N. (1999) Psychoanalytic case formulation. New York: Guilford.
• Sue, D.W., & Sue, D. (1999). Counseling the culturally different: Theory and practice. New York: Wiley.
• Wachtel, P.L., & Messer, S.B. (1997). Theories of psychotherapy: Origins and evolution. Washington, DC: American Psychological Association.

For further information, please contact Counseling and Wellness Services at 937-775-3407

This information was compiled by Mitchel Hicks.