Depression

Depression is one of the most common mental health concerns. Almost everyone has either been depressed or knows someone who has been depressed. It's also one of the most serious concerns that come up in therapy. Severe depression and the accompanying hopelessness can lead to suicidal thinking. Most people who attempt or complete suicide are depressed.


The DSM classifies depression as a mood disorder. Mood disorders also include mania which is at the other end of the spectrum. Bipolar disorder is a mood disorder that includes periods of depression that swing into periods of mania.


Drowning in depression
Drowning in depression


What causes depression?

There are many reasons why people become depressed. It seems to run in families although it isn't clear how much of that is genetic or learned. From a psychoanalytic perspective, depression occurs when people either take in messages from their environment that lead them to lose hope or belief in themselves, or when people are empty inside because of a sense that the world is unreliable and unable to meet their needs and then depend upon others to stabilize their mood. Behavioral therapies tend to see depression as being caused by negative thinking and/or genetic factors.


What are the symptoms of depression?

A depressed mood is the main symptom of depression, obviously. This mood can include lingering sadness, heaviness, fogginess, irritability, and anger. People with suicidal ideation or planning are considered to have severe depression. Severe depression can be diagnosed without suicidality, but any depressive episode with suicidality should be considered severe. People who are depressed many times have lost interest in life and no longer take pleasure from previously meaningful activities. They may even lose interest in activities like sex. Symptoms of depression may also include so called [dual diagnosis](https://en.wikipedia.org/wiki/Dual_diagnosis "dual diagnosis") symptoms such as alcoholism and drug use.


How is depression treated?

Depression is treated many different ways depending upon the approach of the therapist. Psychodynamic approaches will want to explore a person's past and understand how their upbringing may have brought about the depression. Feelings and beliefs will be explored to help the client resolve conflicts and get in touch with unconscious feelings. A third-wave cognitive behavioral approach is called [behavioral activation](https://en.wikipedia.org/wiki/Behavioral_activation "Behavioral activation"). This approach turns the therapist into more of a coach who helps the person suffering from depression to reengage with life. The idea is that when people wait to engage in meaningful activities until after they are depressed, they are depriving themselves of the mood boosting experiences that can help to ease the depression. By getting people's bodies moving, even if it's difficult, the person's natural ability to boost mood can be accessed. A CBT approach to depression will include challenging thoughts and beliefs. Since alcoholism and substance use commonly occurs with depression, treatment may also include addressing the substance use.

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