Introduction
Depression is a mental state, better considered as a psychotic disorder that is characterized by the presence of pessimistic feelings about the future (Davis, 2011), and a despondent lack of activity. In this state, the person is unable to think and concentrate properly. There could be an increase or decrease in appetite. He or she may also feel dejected and hopeless that may result in suicidal tendencies.
Depression is one of the most common and serious types of psychiatric disorder. Major depressive disorder (described below) is among the most frequently occurring mental disorders in the United States. There are approximately 6.7% cases of adults, who are having major depressive disorder in the U.S. Women are found to have 70% more chances of getting depression as compared to men. Biological factors, hormonal changes, life-cycle, and psychosocial factors are considered to play an important role in the increased chances of depression in women. Non-hispanic blacks have 40% less chances than non-Hispanic whites during the lifetime. This problem usually starts after 32 years of age, but 3.3% of youngsters in the age range of 13 to 18 years can have the serious type of depressive disorder (NIMH, 2014).
Men and women give different responses to depression. There could be an increase in the use of alcohol or drugs in conditions of depression in men. They may also show increased level of anger, reckless behavior, and abusive language. Some men may start working hard in order to get rid of any discussion with family or friends. It has also been found that even though more women attempt suicide in the U.S., but many more men die as a result of suicide (NIMH, 2014).
Depression is not related to common thoughts of sadness. Usually, feelings of sadness are short-lived and move out of the mind after some time, whereas depression can interfere with the normal routine of daily life, and results in the development of pain for both the affected person and the people who care about that person. Luckily, even the most severe form of depression can be treated with medicines, psychotherapies, and other related methods, but many people with depression never go for treatment.
Depression is the problem related to brain, and scientists have found that the brains of people living with depression appear different from those who have no depression. In this case, different parts of the brain that are related to sleep, thinking, appetite, and behavior look different (Nundy, 2010).
Forms of Depression
There are many forms of depression. Some of which are related to the duration of the depression while others are related to the particular condition. Some forms of depression are mentioned below:
Major depression. It usually occurs once in a lifetime of any person, but more often, it may occur more than one time. It has severe types of symptoms that may interfere with the work, study, sleep, and eating patterns.
Persistent depressive disorder. It is the kind of depression that may remain for at least 2 years of life. Symptoms of this disorder are related to those of major depression, but less severe forms of symptoms may also be present. These symptoms usually last for up to 2 years.
Psychotic depression. It is the kind of depression in which symptoms of severe depression are present along with some form of psychosis, which is a severe mental disorder in which contact with reality is lost. In psychosis, there are also high levels of distortions and hallucinations, i.e. the person with psychotic depression may hear or see those things that other cannot.
Postpartum depression. It is the type of depression felt by women after giving birth, It is caused as a result of the overpowering thinking of responsibility of the newborn baby. It has been found that 10% to 15% of women go through the postpartum depression after giving birth.
Seasonal affective disorder. This depression usually affects people during the winter season, when the amount of natural sunlight decreases. Generally, this depression is removed after winter season.
Causes
Depression is usually caused by a combination of psychological, genetic, biological, and environmental factors. Heredity and genetics are also found to have an important role in the development of depression as some types of depression can run in families. Scientists are working on genes that can result in the development of depression. However, research has also shown that there is an interaction of several genes that work along with the environmental and social factors in the development of depression. Moreover, loss of a loved one, a complicated relationship, trauma, or any other stressful situation can result in the development of depression. Sometimes, depression can be developed without any obvious problem or condition.
Beck’s theory of depression
According to Beck’s theory of the causes of depression, people acquire negative schema of the world. This negative schema can be developed in the depressed people as a result of the loss of a parent, bullying, rejection by peers, constant criticism from parents or teachers, or other such negative events in life. When the person with such negative schemas faces a condition that is similar to the original conditions of the acquired schema in some way, his or her negative schemas become activated. Beck’s negative triad also shows that people with depression have negative thoughts about themselves and their future (Beck, Rush, Shaw, & Emery, 1979). Beck also proposed some other cognitive distortions that can result in depression such as selective abstraction, overgeneralization, minimization, magnification, and arbitrary inference (Neale, & Davison, 2001).
Signs and symptoms of depression
A client may report, “It becomes really difficult for me to move out of the bed in the morning. I want to remain alone, and don’t like to talk with anyone. Eating and entertainment are not getting much of my attention, and I have lost any fun in life. Usually, I feel tired but it becomes difficult for me to sleep well at night. I feel that nothing will change or get better.”
However, signs and symptoms may change from one person to another. There is a wide variety in frequency, duration, and severity of symptoms in different people. These signs and symptoms may include,
- Sense of pessimism and hopelessness,
- Restlessness and irritability,
- Constant feelings of sadness and anxiousness,
- Sense of guilt and helplessness,
- Decreased interest in daily activities or hobbies,
- Feelings of exhaustion and reduced level of energy
- Difficulty in sleeping,
- Changes in eating habits, and
- Thoughts of suicide in more serious cases.
Diagnosis of depression
Diagnosis is important and is one of the first steps in starting the treatment. It has to be considered that early the problem is diagnosed, the better it can be treated. Doctors may start diagnosis with physical exam, lab tests, and interviews. This is important as some viruses and a thyroid disorder can also result in the symptoms as that of depression. If the doctor finds no medical problem, he or she may prescribe proper psychological evaluation. Usually, a mental health professional does this evaluation. He or she may take complete history of the problem, and discuss any family history of depression or other related mental disorder. People have to tell clearly about the condition, when it started, how long it lasted, and its severity. Mental health professionals may also ask whether the person is taking some drugs or alcohol, or not. He or she may also ask about thoughts related to death. Checklists and questionnaires as, for example, the Children’s Depression Inventory or the Beck Depression Inventory can be used to check the severity of depression (Kovacs, 1984). Other illnesses that can co-occur with depression are also discussed. Treatment of depression can also help in improving the condition occurring as a result of other co-occurring illnesses.
Treatment strategies for depression
After diagnosis of depression, it can be treated with medicines or psychotherapy or the combination of both. Electroconvulsive therapy, also known as shock therapy and other brain stimulation therapies can also be used for the treatment of depression.
Medicines for the cure of depression
Medicines may include antidepressants such as selective serotonin reuptake inhibitors (e.g. Fluoxetine and citalopram), tricyclic antidepressants (e.g. nortriptyline and imipramine), and monoamine oxidase inhibitors (e.g. Selegiline and Phenelzine).
Psychotherapy for depression
Psychotherapy or talk therapy includes two main types of therapies; Cognitive-behavioral therapy for depression and Interpersonal therapy. With the help of cognitive-behavioral therapy, negative thought patterns are restructured. This thing helps people in better interpretation of the environment and interacting with it in a positive and realistic manner. On the other hand, Interpersonal therapy works on the interpersonal relationships that can cause depression or worsen it.
Psychotherapy is considered as the best option for mild to moderate type of depression, but in case of severe forms of depression medications are also required along with psychotherapy.
Cognitive therapy for depression. Cognitive therapy for depression is based on the Beck’s cognitive theory of depression proposed by Beck (1967). This method of treatment is active, problem-focused, structured, and time-limited manner based on the idea that depressive episodes are caused by negative schemas and disturbed beliefs. This therapy is designed in such a way that the patients of depression would start thinking more productively and adaptively, thereby feelings of improvements in the behavior and motivation would come in their life.
In this treatment strategy, patients are guided with the help of many structured experiences of learning. During therapy, patients are guided to check and note down negative thoughts, experiences, and mental imagery to identify the relation between their behavior, feelings, thoughts, and physiology. They are taught to assess the strength and usefulness of these cognitions, empirically analyze them, and alter disturbed cognitions to show an elevated adaptive point of view. During the course of therapy, patients are taught to recognize, assess, and change the underlying thoughts and disturbed beliefs that are probably responsible for some sort of depressive reactions. Therapist may also help the patient in adaptive coping strategies and skills such as decision-making with the help of cost-benefit analysis, and breaking down large problems or issues into smaller ones that could be managed better. Self-monitoring of pleasure and mastery, activity scheduling, and task homeworks or assignments are used in the initial stages of treatment perdio to help patients in overcoming the times of inactivity and inertness. This can also help patients in exposure to some rewarding feelings, thereby reducing the symptoms of depression.
Sessions of cognitive therapy for depression have a structure or design including a concise and conceptual check on the signs and symptoms such as mood, agenda or program setting, making association with the previous sessions, reviewing the self-help tasks of patients, discussion of different issues in the program or agenda, setting some new assignments (homeworks), and summarizing the session. It is also important to get feedback from the patient related to the session. Cognitive-behavioral therapists take help from a number of different techniques to assist the depressed person in psychoeducation, detailed question and answer session, guided discovery, behavioral experiments, and role playing.
Usually, eight sessions of cognitive-behavioral therapy are required by the patient to achieve mastery with the available models and skills. Good level of improvement in conditions can be found in the beginning of the therapy. Remaining sessions help in the evaluation and modification of disturbed beliefs that can disturb the functioning of different activities of the patient. These sessions are also helpful in telling the patient about the future depressive episode, and helping him or her in coping with them.
Usually, patients show decreased symptoms in 8-12 sessions of therapy, but full treatment may take from 14-16 sessions. In severe cases, the number of sessions can also be increased. Booster sessions after the termination of sessions can also be used to maintain the good condition in the coming years (Beck, 1995).
Concluding remarks
Counseling is among the best options to treat depression. Moreover, clients can also be taught to have some form of self-help in order to cope with the symptoms of depression. One of the first things that can be done is the start of evaluation and treatment of depression as soon as the person knows that he or she is getting depression. A good level of activity and exercise can also help in moving out of the problems of depression. Going to a movie, sport or any other related activity can also help in getting some enjoyment and getting rid of symptoms of depression. Patients have to set realistic goals that are achievable. This thing can help in keeping the depression at a distance. People can break large tasks or goals into smaller ones that are easily achievable. It can also help in keeping the depression at a distance. People can also spend good time with other people especially relatives, and take help from their experiences in different aspects of life. Don’t take important decisions such as changing of job and getting married as they can worsen the condition. It has to be considered that immediate improvement is not possible as problems of depression are removed gradually. Last but not the least; keep on learning about depression and its symptoms as it can help a lot in getting rid of depression.
References
Beck, A. T. (1967). Depression: Clinical, experimental, and theoretical aspects (Vol. 32). University of Pennsylvania Press.
Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive Therapy of Depression. New York: The Guilford Press.
Beck, J. S. (1995). Cognitive therapy. John Wiley & Sons, Inc.
Davis, S. (2011). Community Mental Health in Canada: Policy, Theory, and Practice: UBC Press.
Kovacs, M. (1984). The Children's Depression, Inventory (CDI). Psychopharmacology bulletin, 21(4), 995-998.
Neale, J. M., & Davison, G. C. (2001). Abnormal psychology. New York: John Wiley & Sons.
NIMH. (2014). What Is Depression? Retrieved from http://www.nimh.nih.gov/health/topics/depression/index.shtml
Nundy, S. (2010). Stay Healthy at Every Age: What Your Doctor Wants You to Know: Johns Hopkins University Press.
