Life is a series of ups and downs. We get promotions, find love, reconnect with old friends, and have unexpectedly pleasant Sunday afternoons of doing absolutely nothing but recharging. We also get fired, experience breakups, drift apart, and occasionally have one of those terrible, no good, very bad days that are hard because lots of small things go wrong. Feeling sad or down is a normal emotion to feel. When something very bad happens, it’s also normal to grieve. But, when more days feel down than up, it can cause a person to wonder. When does being bummed out turn into sadness, and when does sadness grow into clinical depression? Even though feelings can be blurry, professional diagnoses are not.
Depression is not unusual, and it remains very treatable. In fact, most people see improvements in their symptoms when treated with medication, psychotherapy, or a combination of the two.
But treatment should be personalized because what works for one person might not necessarily work for another. There are many treatments, but therapy for depression is by far the most common and effective.
But first, how do you even know if you have depression?
Depression (major depressive disorder) is a common, yet serious medical illness that negatively affects how you feel, think and act. This disorder causes feelings of sadness and/or a loss of interest in activities previously enjoyed. It can be seen in a variety of emotional and physical signs that notably decrease a person’s ability to function at work and at home. Depression symptoms can vary from mild to severe and can include feeling sad or having a depressed mood, loss of interest or pleasure in activities once enjoyed, changes in appetite — weight loss or gain, trouble sleeping or sleeping too much. Even more specifically, depression can lead to an increase in purposeless physical activity (e.g., hand-wringing or pacing) or slowed movements and speech (actions observable by others), feeling worthless or guilty, difficulty thinking, concentrating or making decisions, and in some extreme cases, houghts of death or suicide
It’s also important to consider other medical conditions (e.g., thyroid problems, a brain tumor or vitamin deficiency) can mimic depression symptoms. Depression affects an estimated one in 15 adults (6.7%) in any given year. And one in six people (16.6%) will experience depression at some time in their life. Depression can strike at any time, but on average, first appears during the late teens to mid-20s. It’s also been observed that women are more likely than men to experience depression.
For some people, grief can lead to depression. For instance, the death of a loved one can bring on major depression. Losing a job or being a victim of a physical assault or a major disaster can absolutely bring on a depressive episode. Unfortunately, when grief and depression coexist, the grief is more severe and lasts longer than grief without depression. Despite overlap between grief and depression symptoms, they remain different diagnoses. Distinguishing between the two can help people find the help, support or treatment they need.
You must be experiencing symptoms for at least two weeks for a clinical diagnosis of depression. But before a diagnosis or treatment is given, a physician should conduct a thorough diagnostic evaluation, including an interview and possibly a physical examination. In some cases, a blood test might be done to rule out any medical conditions. The evaluation will help identify specific symptoms, medical and family history, cultural factors and environmental factors to arrive at a diagnosis and plan a course of action, which will usually involve some type of therapy for depression.
Symptoms caused by major depression can vary, so some clinicians may evaluate for more specifiers to help come up with a more targeted treatment plan. A specifier means that you have depression with specific features, such as anxious distress — depression with unusual restlessness or worry about possible events or loss of control, mixed features — simultaneous depression and mania, which includes elevated self-esteem, talking too much and increased energy, or even something like seasonal pattern — depression related to changes in seasons and reduced exposure to sunlight.
Once a patient has been properly diagnosed for depression by a physician, it’s time to explore clinical depression treatments. As mentioned above, the more specific a diagnosis, the easier it is to choose the right treatment for the individual case. Typically, clinical depression treatments include a combination of medication and therapy.
Though it should be noted that some types of depression may respond well to other forms of treatment. For example, light therapy can be effective for those with SAD (seasonal affective disorder) and, in severe cases, a doctor may recommend a form of brain stimulation therapy, such as electroconvulsive therapy or transcranial magnetic stimulation. Often a doctor can recommend non-invasive healthy lifestyle adjustments to support depression treatment like diet, exercise and adopting mindfulness techniques.
It’s very common for a physician or psychiatrist to prescribe an antidepressant medication to a patient suffering from depression. Luckily, there are many different options available because people vary in their response to different drugs, and there is often a period of trial and error before the right medication or combination of medications is found. Types of antidepressants include:
Though not as commonly prescribed, other medications that can be helpful in clinical depression treatments include anti-anxiety drugs, antipsychotics, and mood stabilizers.
Though, with any medication, Individuals should discuss the benefits and potential risks of antidepressant use with their doctor.
However, medication alone is rarely the answer. Psychotherapy, or talk therapy, can be an effective clinical depression treatment for depression with or without medicative support. Psychotherapy can help people adjust to their life circumstances, challenge negative thoughts, and learn healthier ways to deal with stress. Therapy can also give people the awareness to identify issues that contribute to their depression and the space to set life goals. Therapy usually happens 1:1 in person, but it can also happen in support groups and even online communities. With any treatment, therapy is most effective when people find the most suitable style of therapy and the right therapist for them.
Psychotherapy is an expansive practice and, as mentioned above, there are several types of therapy for depression. Psychotherapy is often called "talk therapy" because it involves an individual and a psychotherapist sitting in a room talking but, as a treatment, it is more nuanced than that. Psychotherapists have training in a variety of techniques and often specialize in treatments for various mental illness and personal issues.
How does therapy help in the treatment of depression? Psychotherapy can be an effective treatment for depression because it can help a patient delve into underlying triggers for depression and learn new coping skills. Many common therapeutic modalities have evidence supporting their benefit in treating depression. Several studies suggest, however, that the combination of an antidepressant and psychotherapy is the best approach, because of the biopsychosocial origins of most mood disorders.
There are many different types of therapy that can be effective in treating depression. The kind that is right for you can depend on a variety of factors including the severity of your symptoms, your own personal preferences, and therapy goals.
Cognitive therapy is based on the idea that our thoughts can affect our emotions. For example, if we choose to look at experiences more positively, we will be more likely to feel good as opposed to if we only focus on the negative. This is a helpful approach because, naturally, negative thoughts can contribute to and exacerbate depression. A constant loop of negative thoughts is difficult to break. Cognitive therapy helps people learn to identify common patterns of negative thinking and techniques to turn those negative thought patterns into more positive ones. Cognitive therapy is usually short-term and goal-focused, with an expectation to do "homework" practice outside of therapy.
Where cognitive therapy is focused on the negative thoughts that contribute to depression, behavior therapy is centered on actually changing behaviors that impact emotions by helping patients engage in activities that will enhance their feelings of well-being.
Both cognitive and behavioral therapies work well together to help combat depression and anxiety disorders so much that the two are often combined in an approach called cognitive
-behavioral therapy (CBT). As the name implies, CBT focuses on addressing both the negative thought patterns as well as the behaviors that contribute to depression.
For example, a therapist may ask their patient to keep a journal to track the events that happen in the week and any negative reactions. Habitual negative responses to events (known as automatic negative reactions) are just one pattern of thinking that might be addressed over the course of CBT. Other common response patterns include all-or-nothing thinking and overgeneralization.
Identifying the negative action is half of the therapy, the other task is to work with the therapist to learn new thinking patterns and ways of responding, such as positive self-talk. Like cognitive and behavioral therapy, CBT is usually brief and goal-oriented. It generally involves between five to 20 structured sessions centered around addressing specific concerns. Research suggests that CBT can be effective in the treatment of depression and that it may have lasting effects that prevent future relapse of depressive symptoms.
Another approach to clinical depression treatment is psychodynamic therapy, which is focused on the assumption that depression can occur because of unresolved, and potentially, unconscious—conflicts, often from childhood. Unlike some of the other treatment approaches for depression, psychodynamic therapy tends to be less goal oriented and longer-term. This approach can be useful for finding connections in past experiences and seeing how those events might contribute to understanding feelings of depression in the present.
Interpersonal conflict and poor social support can also trigger a depression beyond feeling typical upset. Interpersonal therapy is a type of therapy that hones in on these issues by addressing past and present social roles and interpersonal interactions. Treatment is fairly targeted with the therapist generally choosing one or two problem areas in the person's present life to focus on. This type of therapy is usually brief and involves examining social relationships with important people in your life like your partner, friends, family, and co-workers. The goal is to identify the role these relationships play in your life and find ways of resolving conflicts that exist.
Psychotherapy can also be delivered in a number of different ways. In some cases, your treatment may incorporate two or more forms, such as meeting individually with your therapist followed by the occasional group session where you can practice new skills.
Finding the right therapist for depression is critical to treatment outcomes. The most important thing to look for is that you feel comfortable with whomever you choose because you’ll need to be able to speak openly and honestly with this person about very private and sensitive subjects and feelings. The first step is to look at your personality and determine what it is you need exactly. For instance, are you the sort of person who benefits from someone who tells you what to do or do you need someone with a good ability to listen and who will talk through things with you? It’s important to know whether you need someone who will provide directive or non-directive therapy.
It’s also important to also consider with whom you might feel most comfortable with: a man or a woman; someone about your age, or someone younger or older; someone with lots of experience, or someone who is relatively new with fresh ideas. Once you narrow it down, you can start looking for potential therapists who meet your criteria.
Alison LaSov, LMFT
Alison LaSov is a Licensed Marriage & Family Therapist with experience treating clients struggling with anxiety and depression. She predominantly focuses on mental health intervention for children and adolescents, particularly those who are in crisis. She has worked within the Los Angeles education system treating students with Individualized Education Plans (IEPs), as well as supervised a non-profit Teen Crisis Hotline out of Cedars-Sinai Hospital. Alison earned her B.A. from UCLA and M.A. from Pepperdine University. She is a native to Los Angeles and co-founder at Advekit.