Depression is a condition which can affect anyone – it does not discriminate. For some people, depression may come on quite suddenly, and for other people, it might creep up on them over time. Depression might occur after particular changes in your life, or, after stagnation in your life. It includes symptoms of: feeling down and depressed most of the time, low motivation, lethargy, sleep and appetite changes, weight changes, thoughts of death or suicide, feelings of worthlessness or guilt, difficulties thinking, irritability, social isolation, and loss of enjoyment in activities.
When we feel down for a day or two, we can often pull ourselves out of that low mood with relative ease. However, when feelings of depression occur for more than two weeks, you may need treatment to overcome the more significant changes to your mood, brain, and overall behaviour. This article will briefly look at the different treatments available for depression, with a focus on psychological treatments.
Psychological Treatments For Depression
Psychological therapies are often referred to as “talking therapies”. However, it is important to note that, while talking can be cathartic in itself, the “therapy” part of “talking therapies” is actually much more than simply talking about one’s problems. Psychological therapies aim to assist people in identifying and adjusting to unhelpful thoughts, behaviours, lifestyles, and decision making processes which have often become unhelpful over time.
There are a number of psychological treatments for depression which have good outcomes, supported by a large number of academic research investigations, including; Cognitive-Behavioural Therapy (CBT), Behavioural Therapy / Behavioural Activation, Interpersonal Therapy, and Mindfulness-based Cognitive Therapy. However, there are key shared aspects of the different psychological treatments which are targeted with treatments.
Therapy is usually matched and modified to the specific needs of each person, and often a mixed type of therapy is used to best suit the person and their particular needs. Treating depression is less about trying one thing and hoping that it improves mood, but rather an intentional adjustment of each and every area which is contributing to depression for a person. Let’s look at some of the key areas that may need adjusting within a person’s psychology to overcome depression.
Depressive episodes are often accompanied by negative thoughts and it can be hard to see the more positive areas ofyour day or life during these times. Depression can cause individuals to become more self-critical, have negative expectations for the future or in finding enjoyment in their life, and a sense of hopelessness, helplessness, and even worthlessness can develop. Regardless of the cause of these thoughts, treatment will address these unhelpful thinking patterns and your psychologist will work with you to overcome depressive thinking patterns and offer a more objective view which can be difficult to achieve on your own, during depression.
Often particular difficulties are present and even amplified during periods of depression anddepression can be an important cue for you that there may be problems or areas in your life that are making you unhappy and need changing. Your therapist will help you to identify problems contributing to your depression and at a time in your life when depression, negative thoughts, and hopelessness are making it difficult to see a resolution, your therapist can help you to come up with a step-by-step plan for change to overcome the problems in your life.
During periods of depression we withdraw from activity and from socialising. Yet these are often the parts of life which provide positive feedback and a sense of enjoyment. With low motivation, feelings of lethargy, negative thoughts and negative self-talk, it can make it difficult to engage in activity again.
Within the treatment process, it is important for you and your psychologist to increase your activity to spark more positivity. This will occur while managing the negative thoughts and will be done in small steps. Unfortunately, the motivation to do these activities does not usually come prior to doing the activity, but rather, afterwards. That is why it is important to work through small steps with your psychologist and slowly gain momentum for your mood.Healthy sleep, appetite and exercise are all important in improving and maintaining mood, and these areas will be adjusted with you throughout treatment.
Our mood can be reflective of the quality of our relationships in our life. Psychological treatment will seek to explore your relationships and identify ways of improving those relationships through improved communication, conflict resolution skills, relationship boundary adjustments, and acceptance, depending on your situation. We are social beings, and so it is important to reflect upon, and adjust our relationships to the important people in our lives.
Due to the complexities of life, our upbringings, and a range of other difficult situations that we have had to overcome in our lives, we can all be left with behaviours which are now dysfunctional – yet perhaps played a purpose at the time. All psychological treatments will assist at understanding these behaviours and slowing breaking these patterns to lead to a more functional life. This is especially true for depression, where old behaviours may have been functional many years ago, now maintain a depressed mood.
Psychological Treatment Process
It is important to remember that the treatment process can take time. It is important to be patient, however, committed to making change. Each small change you make will build with the next small change, and build a better quality of life that suits you. Your psychologist will be non-judgemental and will not give up on you or your progress, even when your depression wants you to.
It is always helpful to engage in regular health checkups with your Doctor, to ensure that your mood is not impacted by physical ailments such as hormone imbalances, nutritional deficiencies, along with medical ailments such as: hypothyroidism, diabetes, hypoandrogenism, and more.
Depression can be the result of significant changes in life such as; grief and loss, the ending of significant relationships, and other life changes. This is referred to as ‘reactive depression’, and it may resolve upon its own. Reactive depression is recommended to be treated with psychological therapies first, and medications would only usually be used, in conjunction, if the person’s depression is not responsive to the psychological treatment.
Antidepressant medication is useful for aiding the treatment of moderate to severe depression, even if it is reactive depression, or when there are clear organic underlying factors maintaining the depression. Antidepressant medications have been used since the 1950s, and currently there is a range of classes of antidepressant medications. All classes of antidepressants have potential for side effects; however, the newer generations of antidepressants, such as Selective Serotonin Reuptake Inhibitors (SSRI), serotonin-norepinephrine reuptake inhibitors (SNRI), generally have fewer side effects.
There are a range of other medications used for treatment other different forms of depression which do not fall under the antidepressant classification. Interestingly, different people may have different responses to antidepressants and their side-effects. It is important to work with your General Practitioner or Psychiatrist to find an antidepressant that maximises the benefits with minimal side-effects. It is essential to use medications as directed by your doctor. Importantly, if medications are used as part of treatment, they should be used in conjunction with psychological treatments to make changes in your behaviours and psychology to improve your mood so that you have more control around preventing future episodes of depression. This approach is most effective, as medications may achieve a reduction in symptoms, however, psychological therapy may also assist in achieving a remission of the depression.
Electro-Convulsive Therapy (ECT)
ECT is a ‘last resort’ treatment for severe and chronic depression that is unresponsive to other treatments. All other treatments such as psychological treatments, and medication based treatments should always be trialled in their full entirety before ECT. ECT is a medical procedure which induces seizures to produce an effect on the brain. ECT treatment has changed over the past 70 years and is now less dramatic and safer than older stereotypes. ECT produces a short-term improvement in depression symptoms for about 50 percent of patients. Unfortunately, about half of those 50 percent will relapse across the next 12 months, with further relapses occurring further in to the future. Short term side effects do occur with ECT treatment, such as confusion and short-term memory loss, however, generally resolve. Occasionally, ECT can lead to irreversible memory loss of some memories. As with all medical procedures, it is recommended that you ask questions and make a decision about ECT treatment, only after you have all of the information and have had all of your questions adequately answered.
Depression can be debilitating to a person’s quality of life. The earlier that treatment is accessed, the better the outcomes of treatment usually are. For reactive depression, psychological treatment is recommended and often sufficient. Unfortunately, there are not any reliable predictors to guide whether a person is going to respond to antidepressants.
If people are unresponsive to psychological treatment or their depression is severe or worsening, then medications are often recommended under the guidance and clinical judgement of a General Practitioner or Psychiatrist. When depression is severe, long lasting, and unresponsive to psychological treatments and medications, then ECT may be prescribed. ECT can be effective, however, like medications, have particular side-effects that are worth exploring with your doctor before engaging in treatment.
Finally, whatever the level of medical intervention, it is recommended to engage a psychologist for treatment at the same time to make the changes in your life and functioning, which you have more control over and you can learn how to prevent episodes of depression in the future.
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