Understanding your depression and finding answers to its symptoms may help restore your motivation, vitality and self-esteem

Unlocking Depression

Do you struggle with depression? Depression can feel like an insurmountable burden. It has as many faces as it has causes. For some it can feel like a crushing weight, for others a sense of floating or emptiness. Some people may become angry, irritable, or agitated when they’re depressed, while others may feel passive, hopeless or withdrawn.

Whether mild or severe, depression can lock one’s frame of mind in a different cast. It can affect motivation and, if serious enough, become completely debilitating.

Everybody can get depressed at some time or another.

People can be more vulnerable to depression when they experience disappointment, loss, or life change – as well as for seemingly inexplicable reasons. In some cases, depression can be more a function of biological or genetic vulnerability, independent of life circumstances.

No two people’s depression is exactly the same. Understanding the unique “footprint” of a person’s depression demands a careful and methodical exploration of its nature, its underlying causes and its severity. Psychotherapy provides an informed, structured setting in which a skilled psychologist can work closely with the individual to learn and uncover the sources of deep or lingering depression.

The Symptoms of Depression

The symptoms of depression can come and go, persist over a long period of time, or for some, all the time, and can significantly impact one’s normal functioning. When a pattern of depressive symptoms appears together, it could signal clinical depression, also known as Major Depression. Conversely, individuals who experience one or more symptoms of depressions persistently, such as low self-esteem or difficulty finishing projects, may not be suffering clinical depression at all but rather experiencing depression as one aspect of a broader psychological issue.

Common Symptoms of Depression

• Sadness or depressed mood
• Hopelessness, helplessness or pessimism
• Change in appetite or weight
• Sleep problems or waking unusually early
• Difficulty concentrating
• Difficulty making decisions
• Anxious, restless or jumpy
• Guilt or self-recrimination, self-criticism and self-doubt
• Loss of interest and pleasure
• Social withdrawal or avoidance of others
• Feeling behind or unable to keep up, feeling overwhelmed
• Lack of libido or interest in sex
• Thoughts about suicide

The Causes of Depression

The cause of depression can range from a person’s genetic makeup to a life event. People with a family history of serious depression may themselves be vulnerable to it. Personality and temperament may predispose someone to depression. Something may be happening in an individual’s body or health, such as illness or physiological change that may trigger it, such as postpartum depression. A life stressor like losing a job or a friendship, or even environmental factors like weather and pollution can contribute to depression.

How Therapy for Depression Works

Psychotherapy is the first line of treatment for depression, along with, when appropriate, psychopharmacological interventions (drugs). Research indicates that the most robust treatment for serious depression is a combination of therapy and drugs. Therapy can help those going through depression gain insight into why they may be depressed, which may inform the way out of depression. It may also help with long-term resistance to recurring depression.

Other treatment goals for depression include:

• Identifying patterns of thinking that perpetuate depression
• Developing skills to change depressive thinking and feeling repertoires
• Identifying triggers and factors leading to depression
• Discerning psychological and biological influences in an individual’s depression
• Recognizing when your depression is a result of recent or long-term factors, and internal (psychological) or external (social or life stressor) factors.

For therapy to work, it is important to be able to identify what can be changed, which problems can be solved, and when situations may be improved. It is key to work with a professional who can help you to discern a path to change, as well as what can be worked on in terms of yourself – and to set realistic goals and timing in doing so. A qualified therapist will also help you to explore different repertoires of behavior, as well as explore the quality of your relationships to reduce stress and increase the rewards of positive connections.

Treatment Approaches for Depression

Cognitive Behavioral Therapy (CBT)

Cognitive Behavioral Therapy or CBT is perhaps the most commonly used therapeutic model for the treatment of depression. Some treatment goals of CBT are:

• Identify thinking patterns contributing to depression and hopelessness, such as black and white thinking, catastrophizing, personalizing.
• Learn to challenge rather than perpetuate unwholesome thinking habits.
• Gently introduce more positive psychology to reduce noxious effects of negative thoughts.

Mindfulness Based Therapy and Mindfulness Based Cognitive Therapy (MBCT)

MBCT adds mindfulness to cognitive behavioral therapy (CBT) and is particularly important to counteract the automatic and reactive quality of depressive mental repertoire. MBCT helps people not only to be more aware of what they are thinking and feeling, but also not to feel so bothered by it and not to feel so helpless and stuck. Other goals of MBCT include:

• Raising awareness of negative mental patterns, thereby decreasing their power.
• Mindfulness strengthens the muscle that loosens a person’s identification with negative states of mind so that they do not escalate
• Mindfulness helps to reduce tension which greatly amplifies suffering.
• Mindfulness cultivates positive states of mind that in and of themselves work as antidotes to depression, guilt, anger and anxiety.
• Learning to be more tolerant, accepting and compassionate which can weaken the forces of self-criticism, frustration and other negative states.
• Increase vital engagement with moment-to-moment experience rather than worrying about the future or regretting the past.

Psychodynamic

Psychodynamic psychotherapy for depression incorporates techniques used in cognitive behavioral and mindfulness-based therapies, such as becoming aware of your thoughts and feelings, and thus reducing the likelihood of being trapped in them. In treating current problems, it is a modality that takes into account deeper emotional patterns of longstanding duration. It is also an interpersonal approach to therapy with a keen interest in the quality and nature of interactions and relationships with other people as a way of understanding both cause and the way out of depression.

Dr. Wu’s Approach to Depression Treatment.

Depression is debilitating; treatment can be life changing. Dr. Wu’s treatment for depression starts with a thorough evaluation of a patient in her Boston office, followed by a treatment recommendation. This may include psychotherapy, including psychodynamic therapy or elements of mindfulness-based therapies such as MBCT (mindfulness-based cognitive therapy), through medications, or a combination of these approaches.