Expert Advice

Depression is sometimes referred to as the “common cold” of mental health problems.  Statistics vary, but the Center for Disease Control recently reported that approximately 9 percent of adults suffer from depression. 

According to the DSM-IV-TR—the official listing of all mental conditions—lifetime risk for depression runs from 10-25 percent in women and from 5-12 percent in men.  No one is certain what causes this disorder and it is critical that we recognize depression as a serious disease.  It can lead to job loss, divorce, substance abuse and damaged relationships.  It is also a potentially life-threatening condition (15 percent of people die from depression due to suicide).  Fortunately, although there is no consensus on cause, multiple treatment options are available. 

Psychotherapy

It is well-documented that psychotherapy (or talk therapy) is a viable treatment for depression.  There are different types of psychotherapy, the most common for depression being cognitive-behavioral therapy.  This approach works to help patients make modifications to thought patterns that are assumed to be driving the depression and uses an active approach to help patients be as engaged in their lives as possible.  Other talk therapies, such as Freudian-based psychotherapy, focus more on early childhood experiences and how they may relate to present feelings of depression.  These insights can help patients understand their current thoughts and feelings and make adjustments to them.

Interestingly, the type of therapy used in the treatment of depression isn’t nearly as important as the therapist with whom the patient is working.  The greatest predictor of success in therapy is known as the “therapeutic alliance,” which is essentially how well a patient and therapist work together.  A good therapist for depression is often one who is warm, empathic and confident, an excellent listener and who is knowledgeable about depression and its symptoms.

Medication

Anti-depressants are commonly used in the treatment of depression.  Selective serotonin reuptake inhibitors (SSRI’s) are a very popular group of medicines with a strong track record of success.  They often work within a few weeks and can be prescribed by any physician and, in some parts of the United States, physician assistants and nurse practitioners.

Psychotherapy and Medication

Most mental health professionals advocate the aforementioned treatments be used in combination.  This approach tends to produce the best results in both the short and long-term.

Anyone considering the above options should consult with a local mental health professional to discuss details regarding side effects, as well as length and cost of treatment.

Unfortunately, not everyone responds to the three types of treatments above, or at least not completely (for example, some people notice improvements in their mood, but not sleep or appetite; for others, the opposite may occur).   It is not clear why this is.  It bears mentioning that depression is a condition that leads people to feel hopeless, to believe they will never feel better.  It is critical not to surrender to these thought processes because these simply worsen the depression.  Some patients join support groups as an adjunct to their traditional treatment, others work with their doctors and try various combinations of medicines.  The important thing is to not stop fighting, to recognize any and all gains made through treatment, and to be sure to engage in pro-mental health activities.  These include, but are certainly not limited to, cardiovascular exercise, a balanced diet, adequate sleep, limited alcohol consumption and maintaining a strong social support system. Work with your mental health professional and/or physician to exhaust every option available to you.  This will give you the greatest chance of success.  Best of luck to you!

Dr. Rob Dobrenski is a licensed Psychologist in New York City and is the author of the book “Crazy: Notes on and Off the Couch.”  Visit him at ShrinkTalk.net.