by Dr. Janis Rosenberg, Ph.D.
Many clients who come to private practice therapists have been suffering from anxiety and/or depression, and come with a range of well known symptoms of these disorders. Symptoms range from feeling blah or nervous, which may have been there for a long time, to more severe debilitating symptoms.
Everyone can feel depressed, down, and feel irritable or easily upset for a few days or a week. If things remain this way or get worse over several weeks, it is a more serious problem. Some people with anxiety or depression ruminate about worries or negative beliefs and can't get these painful thoughts to stop.
Most clients who get concerned enough to get counseling for their mood problems are usually suffering a great deal and don't seem able to get out of it. People feel hopeless, stuck, like they are in a hole. They may not be able to get up in the morning, get out of bed except to do the minimal to survive. Some are able to stay at work or school while others can't even handle their normal tasks. Other symptoms of concern are thinking about dying or hurting yourself, under or overeating, procrastinating, sleeping a lot or very little.
Without getting help, symptoms may worsen with Major Depressive Disorder, which is the more serious type of depression. With chronic underlying depression, sometimes called "the blues" or "the blahs", clients may have adapted to living a depressed lifestyle, with little activity or motivation to change.
Either way, treatment can help. A combination of psychotherapy and medication can be instrumental in helping patients get better fairly quickly. Even though the combination of psychotherapy and medication has been found to help mood disorders, many physicians will only prescribe medication. It's easier to get a patient to take a pill than to convince her to see a therapist.
Charles Barber, a Yale psychiatry lecturer, discusses the rise of depression and medication use in an article in Scientific American Mind.
"Martin Seligman, past president of the American Psychological Association and one of the more influential researchers in psychology, states the lifetime prevalence of depression used to be about 1 to 5% before World War II. If you were born during the 1960's, it seemed to be between 10 and 15 percent, and this is with lives incomplete." He states age of onset in getting younger, from "average age or 34 or 35 to the mean age for the first bout of depression to be 14 years old."
"In 2002, more than one in three doctor's office visits by women involved the prescription of an antidepressant, either for the writing of a new prescription or for the maintenance of an existing one, according the Center for Disease Control and Prevention.
Between 1987 and 1997, while the rate of pharmacological treatment for depression doubled, the number of psychotherapy visits for depression decreased, as citied in a study in the January 9, 2002, issue of the Journal of the American Medical Association. These days only about 3 percent of the population receives therapy from a psychiatrist, psychologist or social worker, according to a 2006 study in the Archives of General Psychiatry."
- "The Medicated Americans" by Charles Barber in Scientific American Mind, Feb., Mar. 2008 p. 48
Barber tries to explain why close to 10 percent of Americans are now taking drugs to combat a depression and wonders if depression is really on the rise, or if "many doctors conflate conventional sadness-as from the loss of a loved one or a life-changing event such as a divorce-with the more serious and life-quashing condition of clinical depression."
Obviously most clinicians agree that medication can be extremely helpful, even necessary with Major Depression, and helpful when the diagnosis is an Adjustment Disorder with Depression, since the symptoms can create intense suffering.
However, without being able to make meaning of the situation, learn from the suffering, learn how to think and believe differently when stressful situations happen, people will continue to be sensitive to life's blows.
The combination of medication and psychotherapy is the most effective way to treat depression. Many research studies have shown the effectiveness of Cognitive Behavioral Therapy and Interpersonal Therapy. Most "good" therapists use these methods, and form an healthy alliance with the client to motivate movements toward healthy thoughts, behaviors and emotions.
EMDR (Eye Movement Desensitization and Reprocessing) has also been proven to improve mood through changing negative beliefs and working through old trauma-based ideas about oneself.
While medication can help improve depressive symptoms, it can't change the ability to have a more positive outlook, overcome negative beliefs and low self-esteem, or resolve past hurts that have caused the a depressive outlook. A positive therapy experience is needed for these kinds of changes.
