by Alan Brandis, Ph.D.

Depression is something that most people experience at some time in their life. It can be part of a normal, natural reaction to a loss, a major life change or a tragedy, in which case it is classified as a "Reactive Depression." As the grieving process proceeds, over the next few weeks or months the depressed feelings should fade and life should go on, with less and less time spent thinking about the loss and feeling sad about it. Although situation-specific counseling may be helpful in getting through such a period of depression, and while there may be a brief (days or weeks) period of grieving in which normal daily activities are suspended, most reactive depressions resolve themselves within 1 to 3 months and normal functioning returns.

In cases where the reactive depression does not resolve "naturally" and within a reasonable period of time, the depression is said to be "chronic" and becomes a cause for concern. Chronic depressed conditions are sometimes associated with certain chemical changes in the brain, specifically with low levels or low sensitivity to certain chemicals, called neurotransmitters, used to transmit nerve impulses. It is a "chicken and egg" problem as to whether the depressed feelings "cause" the chemical changes, or vice versa, and it really does not matter because once a person has chronic depression, the depressed feelings and the chemical changes can both be present.

Depression can also be present in the absence of a triggering event, in which case it is called an "Endogenous Depression" because it evolves from within the individual rather than from an external event. Both Reactive and Endogenous Depressions have been successfully treated with several types of interventions. A Psychologist or therapist can best help you determine which of the intervention approaches might benefit you the most.

Cognitive-Behavioral Therapy: This approach starts with the assumption that you are depressed because of the way you perceive and think about things, so it retrains you to think and react to events differently. It uses techniques such as thought-stopping, thought substitution, skill building such as assertiveness training, problem-solving and so on. This approach attacks the depression as a set of symptoms and treats the problem at the symptom level. For many people, it is effective and long-lasting. However, it requires concentration and discipline since it is a structured technique, and some depressed people are not able to follow through on the assignments or in the application of the techniques.

Dynamic Psychotherapy: This approach looks for the roots of depression in early childhood experiences such as emotional, verbal, physical or sexual abuse, or in the young child's interpretation and adoption of the parents' wishes, expectations and values. Through exploring and examining your perceptions of events and relationships from different stages of your life, the therapist helps you to understand how and why you came to perceive things the way you did, and to change your view of yourself and your life. This is what most people think of when they talk about being "in therapy."

Pharmacological Therapy: Medications for depression are abundant and offer the hope that taking a pill will "cure" the depression. Our experience has been that, for a significant number of depressed people, medication can relieve the most severe symptoms of depression, but it rarely does the whole job. Because many people we see have been depressed for a long time, and they have avoided close contact with others, there are a variety of skills (especially interpersonal skills) they may not have learned, and they often need help in sorting out what things mean in their relationships with people at work and in their families. We usually recommend that medication be used while one of the other interventions is also in progress.

Family Therapy: In many cases, the triggering factor in depression is related to the patient's ongoing relationships within their family or love relationship with a partner. So, to go right to the source and attempt to resolve the interpersonal conflict makes sense. A power struggle between parent and child, alcoholism or drug abuse by a family member, infidelity, rage or anger resulting in abuse, and other behavioral problems can cause and sustain a depressive reaction. By bringing these (often hidden) conflicts out, and developing a strategy to resolve them, the source of the depression can often be eliminated.

A study was done in which rats were mildly shocked for several short periods during the day. Some of the rats had levers they could push to shut off the current, and some did not. The rats who could push the levers and shut off the current were essentially normal. The rats who had no levers, but had to endure the shock, developed odd behavior including failure to mate, failure to play in the wheel, reduced food and water consumption, altered waking/sleeping cycles, failure to make nests - in other words, they became depressed. We believe that this demonstrates a truism of human depression: Depression is not caused by being in a bad situation - it is caused by being in a bad situation and believing that there is nothing you can do about it! Successful interventions for depression create the belief that, and provide methods whereby, something can be done to positively affect one's life.

Signs and Symptoms of Depression

  1. In chronic depression, day-to-day functioning is impaired to a greater or lesser extent:
  2. The individual loses interest in formerly important people and/or activities ("anhedonia") and may withdraw from contact with loved ones or friends;
  3. He may obsess or ruminate (have recurring, repetitive thoughts) about the loss or about other things;
  4. He may experience a sleep disorder which could be characterized by insomnia (difficulty falling asleep), hypersomnia (sleeping much or all of the time), early awakening (waking up during the night and being unable to fall asleep again) or constant fatigue;
  5. He may have thoughts of self-harm or of suicide. Suicidality is sometimes assessed by the presence or absence of a specific plan - if a plan has been made, the danger is increased.
  6. There may be memory or concentration problems which affect his ability to work or function in school.
  7. Depressed individuals are more likely to abuse alcohol or drugs, due to their temporary antidepressant effects.
  8. He or she may express negative thoughts, feel discouraged, be "grumpy" or irritable, or express the feeling that "things" or people are against him and are keeping him from doing well or achieving his goals.

If you or a loved one has some or all of these symptoms, it is important that a professional evaluation for depression be scheduled, as soon as possible. If you are in the Atlanta area, we would be glad to help. If you are not, please contact your family physician, insurance company, or local mental health center for a referral.