Education About Depression

Janet Klosko, Ph.D.

What is depression?

According to the 1994 Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), the book that professionals use to diagnose emotional problems, the symptoms of depression are as follows. If you are depressed, you probably have most (but not necessarily all) of these symptoms.

• 1. Feeling depressed.
  Most of the time you feel down, sad, empty, discouraged. You may cry a lot, or you may feel like crying but be unable to cry. Feeling irritable is also common.
  
  
• 2. Loss of interest.
  You have a loss of interest and pleasure in life, so that you have to push yourself to do things you used to enjoy. This often includes a loss of interest in sex. It becomes difficult for you to anticipate that anything might be pleasurable.
  
  
• 3. Change in appetite for food.
  The most usual picture is that you lose your appetite. Food doesn't interest you. You have to push yourself to eat, and you may lose weight. Sometimes people eat more when they are depressed. They use food as a source of comfort or as a way to fill a sense of emptiness. If this is true of you, you may gain rather than lose weight.
  
  
• 4. Disturbed sleep.
  You sleep much less or much more than normal. If you are sleeping less, perhaps you can't fall asleep, or you keep waking up during the night, or you wake up too early and can't go back to sleep. If you are sleeping too much, you may be taking long naps during the day or sleeping longer during the night.
  
  
• 5. Feeling agitated or slowed down.
  Your body, your mind, and your speech are either going too fast or going too slow. Either you are agitated and restless, or you are sluggish.
  
  
• 6. Loss of energy
  . You feel tired and drained. Even small tasks seem exhausting. In extreme cases, you find it hard to do the normal activities of everyday life, such as showering, dressing, shopping, and preparing meals.
  
  
• 7. Feelings of worthlessness or guilt.
  Your self-esteem is low. You may feel worthless or bad, and even hate yourself. You may believe that your depression is a punishment you deserve. You are probably angry at yourself about the depression as well -- about how much you let the depression interfere with your personal and work life.
  
  
• 8. Difficulty thinking.
  You can't think as well as you can normally. You have trouble concentrating and making decisions.
  
  
• 9. Thoughts abut suicide
  Most likely you feel hopeless. You may have thoughts that life is not worth living or you would rather be dead. You may believe that others would be better off without you. You may fantasize about committing suicide, and may actually develop a plan for where, when, and how you might do it.
  
  

It is important that you share with your therapist all your thoughts about suicide. If at any point during treatment you feel that you might attempt suicide or any form of self-harm, contact your therapist immediately. If you cannot reach your therapist, contact the doctor-on-call for your therapist.

Depression may occur in one or more intense episodes ("major depression"), or it may underlie your life at a less intense level most of the time for years ("dysthymia"). Twice as many women have depressive episodes as men. However, girl children and boy children are equally likely to have depressive episodes. Depression tends to run in families. However, rates of depression are not related to ethnic group, level of education, income, or marital status.

Depression can begin at any age (the average age is the mid-20s). Without treatment, episodes of depression usually last six months or longer. Following first episodes of depression, many people return to normal and never experience depression again. However, many other people remain depressed. They have recurrent episodes or they become dysthymic (or both). If you are experiencing chronic depression, it is important that you undergo treatment.

Before going through therapy for your depression, you should rule out possible physical causes. Your depression may be due to a substance you are abusing (e.g., alcohol, cocaine), or to a prescribed medication (e.g., steriods,tranquillizers). Some medical treatments can trigger depression, as can some medical problems (e.g., thyroid problems, stroke), and some toxins in the environment. When there is a direct physical cause for your depression, there may be a direct physical cure -- stopping the drug abuse, consulting your doctor about possible changes in your medication, correcting the medical condition, removing the toxin. You should explore all these avenues carefully before relying on therapy. We recommend that you have a thorough physical examination before beginning therapy for depression. We also recommend that you tell your physician that you are entering therapy, and list the symptoms for which you are seeking treatment.

There are a number of symptoms that tend to occur with depression. You may feel irritable or anxious. You may have stress-related physical problems such as stomaches or headaches. You may have an additional problem such as substance-abuse, an eating disorder, or an attention-deficit disorder. Some depressed people also go through episodes of mania, in which they feel sped up. Women often become more depressed on the days before menstruation. Be sure to inform your therapist if you have any of these problems.

Research has shown the cognitive-behavioral therapy is as good or better than other treatments, including antidepressant medication. Cognitive-behavioral therapy is particularly effective in the long run because it provides you with tools which you carry forward from treatment and continue to use. With medication alone, there is a higher risk of relapsing once the medication is discontinued.

See Clinical Applications for a detailed review of the evidence supporting the efficacy of cognitive therapy for depression.

Cognitive Therapy Center of Long Island ~ 11 Middle Neck Rd, Suite 312 ~ Great Neck, NY 11021
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