How Therapy Can Be Used to Treat Depression
The COVID-19 pandemic has hit many people in Nashville hard. Not only have unemployment rates skyrocketed, but more Americans than ever are reporting symptoms of depression.
In the summer of 2020, 28% of respondents to a survey from JAMA Network Open stated they were experiencing a depressive episode.
Even before the novel coronavirus changed most Americans’ way of life, depression was one of the most common mental disorders in the United States; a 2017 study found that 6.7% of all adults in the U.S. had experienced a prolonged depressive episode, according to the National Institute of Mental Health.
Yet, despite its prevalence, depression is often misunderstood. People who have not experienced it are often dismissive of the condition and downplay its impact.
If clinical depression is so widespread, why is it often mischaracterized? And how can people overcome the stigma and get help?
Depression is More Than Sadness
Sadness and grief are vital emotions, and essential to the human experience, but they are not “depression.” Depression, sometimes referred to as “major depressive disorder” or “clinical depression,” is a mood disorder that can severely impact a person’s ability to carry out their daily activities.
The 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) uses a set of symptoms to identify a depressive episode.
A therapist will use these indicators as a guideline when evaluating a client. If a person experiences at least 5 symptoms during a 2-week period and they significantly affect the person’s social life, capacity to perform their job, and ability to enjoy life, then they may be experiencing depression.
The symptoms, as outlined in the DSM-5, are:
- A depressed mood for most of the day, almost daily
- Diminished interest in or gratification from activities that used to be enjoyable
- Significant weight loss or gain and/or significant changes in appetite
- Slowing of thought processes and a decrease of physical movement (must be observable to others)
- Near daily fatigue or loss of energy
- Feelings of worthlessness or excessive guilt
- Inability to think or concentrate, indecisiveness
- Persistent thoughts of death, suicidal ideation, planning to commit suicide, or a suicide attempt
These symptoms must not be caused by substance abuse or an underlying medical condition.
If you are depressed, it is important to realize that it is not your fault.
The symptoms of depression – such as feelings of worthlessness, lack of energy, fatigue, and inability to focus – can make you believe that you are lazy, or your problems are self-imposed. Nothing could be further from the truth.
Depression is a medical condition that can be diagnosed by a doctor, psychologist, or licensed counselor. There are treatment methods that are proven to lessen the effects of this disorder, and with the help of a professional, you can find relief.
What Causes Depression?
Depressive episodes sometimes begin in response to a major life event or significant loss. The death of a loved one, job loss, or a traumatic event can be the catalyst for such a period.
But oftentimes, there is no one cause for depression, or any direct triggers at all.
Psychologists are not sure exactly what causes depression, but theorize that a few factors can make a person more likely to have at least one major depressive episode:
- Brain chemistry
Research suggests that some people’s brains create fewer chemicals known as “neurotransmitters.” Most medications for depression seek to balance brain chemistry by creating more of this substance.
Sudden hormone changes, as happen during puberty, pregnancy, and menopause, can potentially lead to mood disorders. Some medical problems that affect one’s organs, like the thyroid, can also cause a hormone imbalance.
- Hereditary traits
Depression occurs more commonly in people whose immediate family members have also struggled with the disorder. Scientists are working on mapping genes that could determine a person’s likelihood for developing depression.
The presence of any one of these factors can make a person more susceptible to major depression. Typically, if a person has one significant depressive episode, they are likely to have multiple ones.
Environmental factors can also contribute to depression. LGBTQIA+ teenagers are more likely to experience depression, as their struggles are often unrecognized by peers and/or family. Substance abuse can also lead to mood disorders.
Psychologists theorize that the uptick in depression during the COVID-19 pandemic is due to widespread social isolation. Social distancing measures are making it difficult for many people to see friends and family.
It is important to take steps to lessen the transmission of the novel coronavirus, yet people also require human connection. The open-ended nature of “quarantine” is worsening depression across society.
How Can Therapy Lessen Depression?
Unfortunately, there is no one “cure” for depression. Even medication – an important instrument in fighting mood disorders – is not a perfect solution. Instead, you will need to develop a metaphorical toolbox of techniques to combat this disease.
One of, if not the most important, tool in this arsenal is a therapist or counselor you can trust.
Garrette DeBord, LPC, LADAC II, is a licensed therapist in Nashville at The Becoming. He describes therapy as a place where you don’t have to “censor what you say or how you feel.”
Your therapist will not know your family, friends, colleagues, or your boss. What you share with them is confidential and protected by HIPPA – nothing you tell them will get around to anyone you know.
A therapist or counselor is an unbiased person who will listen to your frustrations, your fears, your goals and your dreams. You don’t have to worry that they will get sick of your complaints or will call you “crazy.”
Often, a person struggling with depression feels ashamed of themselves; they feel lazy or helpless. Your counselor will not judge you, and in a society that pushes people to judge each other – whether over social media or in a competitive job market – that kind of release can be invaluable.
I Know I Want to See A Therapist. How Do I Find the Right One?
Finding a counselor can be daunting, especially if you are in the throes of a depressive episode. Depression can sap a person’s energy, and make tasks seem even more onerous than they already are.
You can start by asking trusted friends and family if they have therapists that they would recommend. Alternatively, you can ask your primary care physician.
If you have insurance, try using your provider’s website. Most insurance carriers have a “Doctor’s Search” available to policyholders.
You can also search through your local or state psychological association, or by contacting a local mental health center.
When you are looking, remember that there are several different kinds of mental health professionals that can offer therapy.
Try searching for each of these terms in order to maximize your results:
- Psychiatrists are medical doctors who assess both the mental and physical health of their patients. Psychiatrists are able to prescribe medications and tend to focus their practices on the chemical causes of mental illness. While they may offer some counseling, they are likely to refer a client to another specialist for ongoing treatment.
- Psychologists specialize in emotional and mental processes. While they are not medical doctors, they must complete a master’s degree as well as a doctorate in psychology. Psychologists mainly use talk therapy to treat their clients.
- Counselors can include Licensed Professional Counselors, Licensed Marriage and Family Therapists, and Licensed Clinical Social Workers. These professionals must earn a master’s degree and approval from a licensing board. They also use talk therapy, and may work in an independent practice, hospital, group home, or treatment center.
While researching doctors and counselors, look to see if they have a website with a biography. This can help you get a feel for their personality. When choosing a therapist, it is important to find someone you trust and can feel comfortable around.
Therapy Is Not One-Size-Fits-All
As you are researching, you may see terms describing the kinds of therapy each counselor practices. Most people are familiar with talk therapy but may not realize that there are different approaches used under this umbrella term.
- Cognitive Therapy: This approach is based in the idea that one’s thoughts impact their emotions. The theory states that changing your thought patterns can positively impact your mood.
Negative thinking can be like a self-fulfilling prophecy; if you expect the worst and bad things happen, your brain receives a subconscious message that negative thoughts are “correct.” Cognitive therapy is intended to help a person identify negative thought patterns (or cognitive distortions) and replace them with more positive ones.
- Behavioral Therapy: As the name suggests, behavioral therapy centers around changing behaviors that negatively impact emotions. You and your therapist will discuss your lifestyle, and they will make recommendations to your routines. Your counselor will help you find activities that improve your overall mood and lessen the impact of mood disorders.
- Cognitive-Behavioral Therapy: This is probably the most well-known therapeutic approach. Because cognitive and behavioral therapy often have significant overlap, this method combines the two into a single theory: CBT.With CBT, you will work on dismantling negative thought patterns and removing behaviors that have a negative impact on your mood.
A common negative thought pattern that appears in anxiety disorders is known as “catastrophizing.” This thought pattern causes a person to expect a negative outcome from every scenario – they imagine a “catastrophe” around every corner. Even if negative outcomes do not occur, the individual is constantly bracing themselves for bad news. This leads to increased stress and negative self-talk.
CBT will help a client recognize this pattern, and actively replace the negative expectations with positive ones. This takes a lot of practice, both in therapy and between appointments. The client may use a journal to write down their negative expectations or imagine the positive outcomes to a situation.
- Dialectical Behavior Therapy: This technique is based in CBT and asks the client to acknowledge and accept their negative thoughts.
The theory here is that many people are depressed because they have valid struggles – they may have lost a loved one, or be struggling with addiction, or be worried about the negative effects of public policy on their communities. DBT says that these painful experiences may not fade anytime soon, but they also do not need to rule a person’s mood.
Mindfulness is key to DBT. Clients practice using their senses to ground themselves in the present moment, and release fears that cannot be immediately addressed. Mindfulness can help people cope with stress and experience fewer mood swings.
- Psychodynamic Therapy: Sometimes called psychoanalytic therapy, this practice area focuses on unpacking past trauma. The theory behind this method is that unconscious memories (usually from childhood) can affect a person’s present mood.
This approach is especially useful for clients who are ashamed of “difficult” emotions. Your therapist will help put your emotions into perspective and help you to express new feelings.
- Interpersonal Therapy: This methodology seeks to heal depression and anxiety by examining social roles and interpersonal interactions. Isolation and social conflict can compound mood disorders, and this treatment can help people overcome the social dynamics that keeps them separated from other people.
This type of therapy is usually short-term. You and your therapist will examine important relationships – with parents, friends, co-workers, teachers, etc. You will discuss how these relationships impact you, and what role you feel you play with each person.
Interpersonal therapy can improve a person’s communication and conflict resolution skills. This can lead to stronger relationships and improved support systems.
Go It Alone? Or Follow the Crowd?
The word “therapy” may conjure images of a person lying on a couch, speaking to an analyst. But that 1970s stereotype is not how most people experience counseling. Therapy also doesn’t have to be a solo affair – many clients enjoy group therapy.
Did you know that group therapy exists for depression? It’s true. If meeting alone with a therapist is intimidating, group sessions may be beneficial.
These groups can make a client feel less alone. Depression can be an isolating experience, and hearing other people discuss their struggles is often validating.
Another benefit is that each person in group therapy is at a different point in their journey. If you are at a low point, it can be comforting to see another person who’s faced similar struggles is now in a better place.
Setting an Appointment
Try to find several practices you would be willing to visit. When you call their offices, remember to ask about payment – do they accept insurance? Or do they offer a sliding scale of payment options?
You should not ever feel embarrassed to ask a doctor or counselor about the cost of treatment. Mental health professionals understand that their clients must pay for services, and they also know that many people struggle to find the funds for medical appointments.
If you worry about your ability to pay for mental health support, ask the practitioner’s office; they likely have helped many clients in a similar position.
You may want to make appointments with several different practices. Finding the best therapist for you can take some trial and error.
Luckily, telehealth appointments have become more commonplace over the last year. These home appointments make it even easier to interview new counselors.
Clients no longer must get in the car and drive to every therapy appointment. You may be able to find a therapist who will meet with you over video chat. You can now attend counseling on the couch with your favorite blanket and a mug of tea.
DeBord also recommends setting a goal for treatment before your first appointment. What will “recovery” look like for you? Will it be when you can go out with friends and feel fully present? Maybe it will be when you have the energy to complete household chores? Or maybe it will be waking up three days in a row in a good mood?
This goal could be short- or long-term, but it should be measurable. Once you achieve it, you can set a new one and continue working toward better mental health.
Supporting Your Therapeutic Journey
Therapy is an important tool for improving mental health, but it is not a panacea. Therapy works best when combined with other behaviors and treatments.
Lisa Tozer, MA, NCC, a Licensed Professional Counselor in Nashville with The Becoming, stresses the importance of combining counseling with lifestyle changes.
Depression is not exclusively a mental ailment, so it cannot be treated purely mentally. Addressing the physical side of depression is important to overcoming it.
Think of Vitamin D as an essential part of your diet and try to spend at least 15 minutes outside each day. Take a walk or sit outside and drink your morning coffee. If you have a pet, take them around your neighborhood or to the dog park.
Exercise is another excellent tool for fighting depression. You can start small, if you don’t already have a fitness routine. Put on some music and dance in your room for 10 minutes or follow a free yoga video. Yoga with Adrienne is an excellent channel featuring hundreds of videos you can do at home.
Tozer recommends meditation as another fantastic tool for managing depression. Try apps like Calm or Headspace or search for guided meditations on YouTube or Spotify.
It is also important to connect with friends and loved ones. When you are depressed, it can be hard to be around people because you feel like you have to be “on.”
Ultimately, though, avoiding people can make a person feel even lonelier, and thus more isolated. Spend time with people whose presence won’t stress you out and make regular check-ins part of your weekly routine.
FaceTime with a friend, even if for only for 10 minutes. Short conversations keep the lines of communication open, and regular contact will make each call less daunting. It’s much easier to pick up the phone and talk to a friend when you know you don’t have to spend an hour catching-up.
Try calling a friend or family member and saying, “I don’t have much time to talk, but this made me think of you.” Share an anecdote or a movie recommendation, and let them know that you will talk to them again soon.
Medications and Other Treatments
Medications for mood disorders have a bad reputation, but much of the stigma is rooted in decades-old stereotypes.
Studies show that cognitive therapy can be more effective when combined with antidepressants. Most antidepressants are SSRIs, or Selective Serotonin Reuptake Inhibitors. These medications relieve the symptoms of depression by creating the neurotransmitter “serotonin.”
Some SSRIs are mild (like citalopram, often called “the multivitamin of mental health”) and others are more powerful. It can take several weeks for one of these medications to be effective, and each person will react differently to each one.
You may need to try several before you find one that works for you.
Transcranial magnetic stimulation (TMS) uses magnets to invigorate nerves in the brain and improve mood disorders. This noninvasive treatment sends pulses through a magnetic coil placed on one’s forehead.
The biology behind this treatment is still a bit murky, but scientists think it stimulates activity in areas of the brain that experience decreased activity due to depression.
Another misunderstood depression treatment is electroconvulsive therapy (ECT). This therapy received a negative reputation in media over the last several decades, but it is an especially useful therapy for depression.
These days, ECT is performed under general anesthesia. Small electric currents are sent through the brain, causing brain chemistry to shift. This treatment can rapidly reverse the symptoms of depression and other mood disorders.
ECT and TMS are generally not used unless other forms of treatment have been unsuccessful and are only performed in controlled medical settings.
Nashville Mental Health Counselors
Many people are struggling with their mental health right now. The pandemic has changed many people’s way of life, and we can’t necessarily engage with our usual coping mechanisms.
Social activities, like going to dinner with a friend, or heading to a museum, are not always possible while utilizing social distancing.
It is important to remember that depression is treatable. You are not alone on this journey, and there are people who can help you find your way out of the darkness.
If you live in the Nashville area and believe you are experiencing a depressive episode, contact The Becoming right now.
When you are depressed, making decisions and wading through information can feel 10 times harder. Let our Client Coordinators walk alongside you and match you with one of our licensed counselors.
Take the first step and call 615-709-2020 right now. If picking-up the phone feels too difficult at this time, you can send us an email, or contact us through secure, HIPPA-compliant messaging.
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