***Depression: What It Is and What to Do about It

There are three basic ways to treat depression: psychotherapy, self-help, and medication. Many people respond best to a combination of two or more methods.

1. Psychotherapy: Exploring one’s beliefs and ways of thinking, and learning new ways of thinking and behaving, with the guidance of a professional.
2. Self-help: Exploring one’s beliefs and ways of thinking on one’s own.
3. Medication: Altering one’s brain chemistry by taking antidepressant medication.

A physician may recommend medication when four conditions exist:

1. The patient’s depression is severe.
2. The patient has suffered at least two previous depressive episodes.
3. There is a family history of depression.
4. The patient asks for medication only and refuses psychotherapy.

There are four types of antidepressant medication available today: • Tricyclic antidepressants (TCAs) • Monoamine oxidase inhibitors (MAOIs) • Selective serotonin reuptake inhibitors (SSRIs) • Structurally unrelated compounds The TCAs and MAOIs have been used for decades. The SSRIs (such as Prozac) and structurally unrelated compounds are newer and are being prescribed more and more frequently. They have fewer and less pronounced side effects than the TCAs and MAOIs. Treatment without Medicine One of the leading methods for treating depression is cognitive therapy. Cognitive therapists help depressed clients feel better by identifying how faulty ways of thinking are making him or her feel bad. The client analyzes his or her thoughts and beliefs, and learns to substitute more healthy ways of thinking and believing. Many mental health professionals believe that the ideal treatment of clinical depression is medication in conjunction with psychotherapy. Prevention of Depression Depression can often be prevented. It is especially important to take preventive action if you are aware that you have predisposing factors such as those mentioned in the last newsletter.

1. Identify your risk factors and be aware of where you are vulnerable. Each of us has unique risk factors, such as things we were taught in our families of origin, values we have learned, and the presence or absence of a family history of depression. Anything that has been learned can be unlea ed and replaced with something healthier.
2. Learn to manage stress. You can learn proven techniques for calming and relaxing yourself. Consider taking a stress management class or buying a set of relaxation tapes.
3. Learn problem-solving skills. Many people who develop depression never learned problem-solving skills. They need to develop the ability to see problems from many viewpoints and to look for a variety of solutions.
4. Build your life around things you can control. Learn to recognize what you can control and what you can’t. Avoid spending much effort on situations that won’t pay off for you.
5. Learn self-acceptance. Instead of rejecting the parts of yourself you don’t like, learn to manage them more productively.
6. Become aware of selective perception. Observe how you generate ideas and opinions about people and events. Remember that these are just your views, not necessarily objective facts.
7. Focus on the future, not the past. Depressed people tend to be focused on the past. People who set goals and focus on the future tend to be more positive about life.
8. Develop a sense of purpose. Many depressed people lack a sense of purpose or meaning. This means they have no goals and nothing in the future drawing them forward. To prevent depression, develop your sense of purpose and meaning.
9. Strengthen your emotional boundaries and set limits. Boundaries define your role in a social situation. They determine how you will or won’t behave in a given situation. Having clear, strong boundaries is empowering, while boundary violations make you feel victimized and helpless. Setting limits means having and enforcing rules for the behaviors you expect in a relationship.
10. Build positive and healthy relationships. Think about what you need from others in relationships. Learn to read people and trust your instincts about which people are good for you.
11. Avoid isolation. Talk to others about what’s going on with you. If you keep your thoughts to yourself, you may be unaware that your thoughts are distorted. If you share them with another person, you can become more objective.

Signs That Professional Therapy Is Needed

1. Thinking about death or suicide. This is always dangerous and you should see a professional therapist immediately.
2. When symptoms of depression continue for a long time, you may need professional help. Acute responses to events are normal, but they should not last beyond a reasonable time.
3. Your ability to function is impaired by your depression. Seek help before your life situation deteriorates to a serious level.
4. You have become so isolated that you have no one with whom to test reality. Seek someone out to share your thoughts and feelings with.
5. Depressive symptoms have become severe.

Here are two books that we have found to be very helpful and informative: David D. Burns, M.D., Feeling Good: The New Mood Therapy. New York, Avon Books, 1980. Michael Yapko, Ph.D., Breaking the Patterns of Depression. New York, Doubleday, 1997.