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Depression Counseling

Dr. Wesley and New Leaf Center views depression as a normal response to human experience and survival. While many improve with medications, for maximum help, treatment often includes both medications and psychotherapy. Rather than covering up the depression, the therapists with New Leaf Center approaches a person’s depression with intense curiosity in an effort to help the person to understand and heal the source of the depression. There are many psychological and emotional reasons for depression. Whatever the cause, depression can be improved, if not resolved completely, with counseling. Indeed, research shows that some people may be more predisposed than others to develop depression in response to life events. The familial inheritance identified in depression is both genetic and learned. Whether one is predisposed to depression or not, there is nonetheless a great benefit in addressing depression with therapy.

Depression and Different Stages of Life

Depression should not be confused with normal grief in the aftermath of a major loss, although extended grief may lead to true depression. Depression that is mild and chronic, with fewer symptoms, is known as dysthymia. Depression may present differently based on age or cultural factors. Adolescents tend to show an irritable and agitated depression; older adults may or may not be irritable; certain cultural groups may mask their feeling to varying degrees; women are known to be more likely to admit to depression than men. Depression is one of the most common reasons people seek therapy.

Depression’s Effect on the Body

Those experiencing depression may have great difficulty mustering the energy necessary for even the most basic tasks, such as getting out bed, preparing food, or bathing. Depression often includes intense, unrelievable fatigue. Depression may be somaticized, leading to complaints about back pain, muscle aches, nausea, and headaches. Depression may lead to sudden tearfulness without an apparent trigger.

Depressive Thoughts

Depression always includes negative thoughts, sometimes with great severity. Individuals who are depressed may perseverate on thoughts like “I’m no good,” “no one cares about me, “life is pointless,” or “I’ll never feel better.” People with depression may have great guilt or shame, sometimes with an identifiable etiology, sometimes not. Worries are frequently present. In the most severe cases, thinking may be minimal, and the person with depression may border on a comatose state. Suicidal ideation is common.

Feelings of Depression

Depression involves the emotions of sadness and grief, and often anger, fear, shame, and other negative emotions. Affect may be strong, with tearfulness, tension, and possibly anger may be present, or affect may be restricted and in severe cases, flat.

Relationships & Depression

Depression usually interferes with a person’s ability to communicate, express emotion, and to experience emotional and sexual intimacy in relationships. A person who is depressed may be unable to receive comfort from others, believing they do not deserve it or it is insincere. Their lethargy, irritability, or anhedonia may make giving love near impossible. Depressed people often isolate; at the other end of the spectrum they may be overly dependent, attached, or needy. Depression may have passive-aggressive elements that disrupt relationships. Depressed people are often uninterested in normally pleasant social activities, and may be unable to work due to lethargy or fearfulness.

Correlated Psychological Issues

Depression may co-occur with any other mental disorder, and is commonly linked with anxiety. Depression may alternative with manic or hypomanic states in Bipolar disorder or schizoaffective disorder. Depression is often linked to a lack of social support, recent loss, financial stress, and familial depression. Suicide risk is always a concern and must be assessed frequently. Depression must be distinguished from appropriate, short-term grief in the face of loss. Depression can be a major symptom of post-traumatic stress. Depression is also associated with substance abuse, especially with alcohol and other central nervous system depressants. People may self-medicate with such substances to manage depression, making their symptoms worse in the long term.

Medication for Depression

The most popular medical treatment of depression is medication. Several classes of medications have been developed to improve mood. All have a good chance of significant side-effects, in some cases including insomnia and sexual problems. For severe depression, medications can be helpful in stabilizing a person, helping one to get out of bed in the morning, and making talk therapy more effective. Medication can be a lifesaver, for those who have been considering suicide. However useful these medications may be at symptom reduction, they fail to address the emotional and psychological causes of depression, which often underlie the formation and maintenance of anxiety.

DSM and Depression:

Criteria for Major Depressive Episode includes the following:

A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

(1) depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). NOTE : In children and adolescents, irritability may be observed.
(2) markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)
(3) significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. NOTE:  In children, consider failure to make expected weight gains.
(4) insomnia or hypersomnia nearly every day
(5) psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
(6) fatigue or loss of energy nearly every day
(7) feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)
(8) diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)
(9) recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

B.  The symptoms do not meet criteria for a Mixed Episode.
C.  The symptoms cause clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
D.  The symptoms are not due to the direct physiological effects of a substance
(e.g., a drug of abuse, a medication) or a general medical condition (e.g.,
E.  The symptoms are not better accounted for by Bereavement, i.e., after the
loss of a loved one, the symptoms persist for longer than 2 months or are
characterized by marked functional impairment, morbid preoccupation with
worthlessness, suicidal ideation, psychotic symptoms, or psychomotor

© 2013 New Leaf Center
Counseling, Supervision and Training