Understanding Depression

 People throw around the word depression as a feeling that everyone experiences. However, clinical depression is a lot more than feeling very sad.  Depression is a mental illness that can be treated with psychotherapy, lifestyle changes, and/or medication.  Depression impacts jobs, relationships, physical health, sexual intimacy and social functioning.  There is a stigma around mental illness that sometimes interferes with people getting the help they need for dealing with depression.  The Diagnostic Statistical Manual of Mental Disorders (DSM-5) recognizes 7 specific types of disorders dealing with depression that you can learn more about here.


Depressive Disorders
 Depressive disorders are grouped together by the commonalities of persistent sadness or irritability that interfere with your daily life.  The classifications differ in the amount of symptoms experienced, severity of symptoms, timing, duration, and what contributes to causing them.


Major Depressive Disorder
 Major depressive disorders present in varying length of episodes and often reoccur throughout one’s life.  A depressive episode is someone experiencing a depressed mood or loss of interest or pleasure for most of the day, nearly every day lasting at least two weeks long and is associated with five or more of the following co-occuring symptoms:
• Significant weight loss or weight gain
• Insomnia or hypersomnia
• Psychomotor agitation or retardation
• Fatigue or loss of energy
• Feelings of worthlessness
• Inability to concentrate or indecisiveness
• Thoughts about death and dying or suicidal ideation


Persistent Depressive Disorder (Dysthymia)
 Formerly known from the DSM-IV-TR as dysthymia, persistent depressive disorder is having a depressed mood for more days than not that lasts at least two years or one year in children and adolescents.  Along with a depressed mood, a person with two or more symptoms from the following list could indicate a diagnosis of persistent depressive disorder:
• Poor appetite or overeating
• Insomnia or hypersomnia
• Low energy or fatigue
• Low self-esteem
• Poor concentration or difficulty making decisions
• Feelings of hopelessness


Premenstrual Dysphoric Disorder
 Females experiencing symptoms of depression the week before getting their period that subside the week after may be struggling with premenstrual dysphoric disorder.  This is more severe than premenstrual syndrome and is present for at least one full year’s menstrual cycles.


Disruptive Mood Dysregulation Disorder
Some children experience depression as severe irritability that presents as temper outbursts that are outside of what is expected for the developmental stage.  Temper outbursts occur at least three times per week present consistently for one year, and in at least two different settings.  Children fit criteria for disruptive mood dysregulation disorder between the ages of 6 and 18, but have been experiencing or observed with symptoms before the age of 10.


Bipolar Disorders

 If you think of depressive disorders as a real low, there are also bipolar disorders where people also experience a period of a real high or significant irritability depressive swing.  DSM 5 has separated bipolar disorders from depressive disorders because of the significant difference between symptom presentation, family history, and genetic components that the most recent research has indicated.

Bipolar I
 The main differentiating criteria for bipolar I disorder is the presence of a manic episode lasting at least one week followed by a hypomanic episode or major depressive episode.


 What is a manic episode?
 A period of abnormal and persistent elevated or irritable moods associated with a change in behavior and increase of energy lasting everyday for one week along with at least three or more of the following symptoms:
• Increased self esteem or feelings of grandiosity
• Decreased need for sleep
• More talkative
• Racing thoughts or experiencing a flight of ideas
• Psychomotor agitation or increase in goal-oriented activities
• Behaving in high risk situations (with financial or health consequences)
A hypomanic episode is three or more of the above symptoms lasting at least 4 consecutive days.

Bipolar II
 Bipolar II disorder has been misunderstood in the past as being a more mild form of bipolar I.  However, more research has shown that it is typically displayed more often as symptoms of irritability with shorter duration as in hypomanic episodes than the euphoria of a manic episode as well as a current or past episode of major depressive disorder episode.

Cyclothymic Disorder
 People may experience periods of time where they have hypomanic or depressive symptoms that do not meet criteria for episodes may be struggling with cyclothymic disorder.  The symptoms are present for at least two years with no more than two month periods without symptoms.

 


Depressive, manic, and hypomanic symptoms that may be due to the response of a medical condition, substance abuse, or medication-induced are separate from the depressive and bipolar disorders described above. There are also other types of depression do not meet full criteria for the above listed disorders and may fit into Other Specified or Unspecified Disorders for depressive or hypomanic symptoms.  Sometimes a depressed mood presents in response to stressors in your life that requires more than coping strategies that have worked for you in the past could qualify as an adjustment disorder if lasting than less than 3 months of a stressor.


What Now?


Now that you learned more about the symptoms of depressive or bipolar disorders, there are many more specific strategies written on the website to help you start the work by yourself!


Depression may look different based on your age or the stage of life you are in.  Are you at a point where you do not know who you are anymore, but desire to find your authentic self?

A lot of people struggle with their self esteem or feelings of perfectionism that resemble depression.  Some benefit from working on their positive thinking and other specific strategies to increase their self esteem. Help with your body image?
Are you feeling disconnected from you spiritual self ? 
Relational Distress
Navigating new relationships can be difficult.  Relationships in the social media generation brings a new set of concerns Feeling codependent on your partner?
Are you having difficulty communicating or asserting your needs with you partner?
 Newly married?  Distress also comes from ending relationships.


Parenting
Are you a new parent struggling with the adjustment to parenthood?  You may be worried about your child displaying depressive symptoms.  Your child may benefit from play therapy as a way to work through problems in means that promotes children’s natural resiliency.


Treatment


If you need more help understanding your depression symptoms you do not need to do it alone! A therapist can complete a consultation with a biopsychosocial assessment to better understand what could be going on with you, point out responses that are normal, and form collaborative goals.  Psychotherapy has healing benefits in the brain’s release of the hormone, Serotonin, which is lacking when people struggle with depressive symptoms.  There is also a major benefit is forming a connection based on honesty and trust with your therapist.


Our therapists use diagnoses listed above to inform your care in providing evidenced-based interventions.  The therapists provide services to individual, couples, and families. We believe that people are more than just a diagnosis out of a textbook and will help you identify strengths that will help you come up with solutions to overcome your struggles.  The length of treatment will vary based on the severity of your current symptoms, duration of experiencing them, and your current stage of the problem.


You can expect that your therapist will take a thorough assessment and history of the problem in order to best meet your current needs.  Our therapists are trained in systemic theories that believe that more contextual factors impact problems which may require therapists to understand more about your family history.  This may point out unresolved issues from your past or relationship patterns that have been present for many generations.  A therapist can help you deconstruct the problematic story about your history so you can move forward with greater understanding about yourself and the space to create a new story with the help of narrative therapy.


It is also helpful for a therapist to find out about the style of therapy that will fit best for you based off of where you are stuck and your preferences. Sometimes people get stuck in ways of thinking that are not helpful to them.  Cognitive Behavioral Therapy provides a great framework for decreasing your negative thoughts such as all or nothing thinking.  The thoughts you have about yourself and others navigates what you do so changing the thoughts that are destructive can create more room to rationally think through your choices and make better decisions.


Along with distorting your thoughts, depression can interfere with you ability to manage emotions effectively.  You may need help understanding your feelings or coping with them.  Often times, people have learned ways to push away or externalize their true feelings onto others or bury them down inside until something happens where they explode or do self destructive behaviors.  Dealing with your emotions in more healthy ways can help you make better lifestyle choices and decrease symptoms of depression.


  Entering into therapy is a commitment to work on things that are troubling for you and change is difficult. Find out more about your motivation to change. If you are interested in learning more about ways to make change in your life or understand depression further, contact the Center for Growth!

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