Cognitive Therapy of Depression

Everyone knows what depression feels like. Everyone feels the blues at times. Sadness, disappointment, and fatigue are natural parts of life. There is a correlation between the blues and clinical depression, but the difference is like the difference between the sniffles and pneumonia.

Depressive disorders are whole person illnesses; they concern the body, feelings, thoughts, and behavior. The depression itself can make us feel as if it’s hopeless to try to find help. The excellent news is that 80 to 90 percent of people with depression can be treated successfully, but the bad news is that only one sufferer in three seeks treatment. More bad news is that almost half the American public see depression as a character defect, rather than an illness or emotional disorder. In addition, only half of all cases of depression are correctly diagnosed, and only half of those get satisfactory treatment.

We tend to confuse depression, sadness, and grief. But the opposite of depression is not happiness, but vitality – the ability to experience a full range of emotion, including happiness, excitement, sadness, and grief. Depression is not an emotion itself. It’s not sadness or grief, it’s an illness. When we feel at our worst, sad, self-absorbed, and helpless, we are experiencing what people with depression experience, but they don’t recover from those moods without help.

The trademark of depression is a unrelenting sad or empty mood, sometimes experienced as tension or anxiety. Life shortage of pleasure. People with minor depressions may go through the motions of eating, sex, work, or play, but the activities appear shallow; people with more severe depression withdraw from these activities, feeling too drained, tense, or hostile to contribute. There is often a nagging fatigue, a sense of being powerless to focus, a feeling of being ineffective.

People with depression usually experience a lowered self-esteem. In a depression, you may feel that you are a helpless victim of fate, but also feel that you don’t deserve any better. Feelings of guilt, dishonor, and misery are common.

There are often a host of physical symptoms, of which sleep disturbances are key. People may have difficulty falling asleep or may get up early without feeling refreshed. Others may sleep excessively, again without feeling rested. Appetite may increase or decrease. There may be difficulty in sexual functioning. There may be harassing aches and pains that don’t respond to medical treatment. But there are physical illnesses that cause symptoms like depression – Lyme depression, diabetes, thyroid conditions, anemia – and depressions can cause physical symptoms like other diseases.

If you are feeling depressed, it is important to be sure that an underlying health problem does not exist, and you should see your physician for a checkup. At the same time, if you know you have a health problem and are feeling depressed, don’t imagine you will feel better once the health problem is under control.

There is a sequential process in the recognition of depression. First is a stage of confused pain in which the sufferer knows he suffers, but doesn’t know why. People often blame circumstances. Adolescents blame their home lives, married people blame their spouses, and employees blame their bosses. But there is acknowledgment that the pain is not ordinary.

The second stage is recognition that something is definatley amiss. It may be that external circumstances have changed but the pain keeps on going, or it may be a gradual recognition that the suffering is so dangerous that circumstances can’t be blamed. This is a painful recognition that often takes years. It is an acknowledgment of a damaged self. But because of the nature of depression, the self-blame and guilt that are manifestations of the disease, this acceptance does not always lead to searching for help.

People then may move to the third stage, a crisis that habitually leads to professional intervention and diagnosis. It is often a suicide attempt or psychiatric hospitalization. The diagnosis often supplies hope, that treatment or a cure is possible, and explanation, a way to understand what has only been confusion before. The fact is that this is a diagnosis of a mental illness, with all the shame and stigma that that entails.

The fourth stage involves acceptance of an illness identity. Depression comes to be seen as an outside agent invading the self, rather than as a manifestation of the self.

It is essential that anyone suffering from depression gets good help from a competent, qualified professional. If the warning signs are obvious, always seek a professional diagnosis. Going to a health professional with your troubles could prove, at worse, embarrassing, if the problem is really just a seasonal case of the blues that can be dealt with without medical intervention, but the potential cost of failing to diagnose a serious case of depression should far outweigh any concern about potential embarrassment.

Lots of people undergo from depression, and it’s not something that anyone need be embarrassed of. This is an essential starting point for those who are in need of treatment. Depression should be treated like any other physical illness, and like other physical illnesses it can often be fixed with prescription drugs. Having said that, it can also often be dealt with without drugs, through psychotherapy.

Psychotherapy unfortunately also has a stigma surrounding to it in the minds of various people, but it is nothing more than a method of counselling where the depressed person is given an occasion to discuss about life and the way they feel. The very procedure of being able to talk about pain and unhappiness in a non-judgemental atmosphere can have an extremely healing effect, especially for those who are suffering mild or moderate cases of depression. Severely depressed persons do not typically benefit from psychotherapy and counselling to the same extent. Severe depression generally requires supplementing counselling with other depression treatments. Even so, counselling is not only a good starting point in the process, but a professional counsellor will generally be the best person to provide advice as to the need for further treatment.

Severe depression needs medication and sometimes hospitalisation. Even then, it can frequently take some time to get treatment right, as there are a collection of antidepressant drugs available on the market and some of them can have risky side-effects.

Part of the reason for the popularity of antidepressants such as Prozac or Zoloft is that they usually have few and far between side-effects, apart from a regular decrease of libido, and hence are relatively safe to prescribe. However such drugs do not work at all for some people who may require ‘tricyclics’ such as Vivactil, Norpramin or Pamelor. The problem with tricyclics is that it can cause problems for those already suffering with heart disease, and getting the precise dosage right is far more complex than with Prozac or Zoloft. People certainly have been known to gravely overdose on tricyclics.

These issues highlight the need for antidepressant medication to be administered by a trained psychiatrist and not by a general practitioner. A good psychiatrist will also be the best person to decide if the subject requires hospilisation.

For those who need to be hospitalized, electric shock therapy (ECT) is another form of treatment that has proven very advantageous to some people. This is generally only used with people who have rare and acute symptoms of depression and who have become manic. ECT is normally only considered for those who have not been successful on antidepresasnt medication and when all other methods of treatment have failed to make the symptoms of the depression less serious.

ECT involves electrical stimulation that causes the brain to seizure in order to ease the depression. While this sounds awful, this treatment should not be connected with the torturous forms of shock therapy often portrayed in the cinema. Today, patients who are given ECT you are also given muscle relaxants so as to get rid of all discomfort and pain. ECT is generally used in conjunction with both antidepressant medication and counselling. Sometimes the ECT will allow a person to become free of a depressive episode after which they will be able to keep up their equilibrium through the use of normal antidepressants.

Dealing successfully with depression can evidently be very tough, and the cost (financially as well as physically) can be high, but these costs generally pale in comparison to the toll taken by depression that is left untreated.