I have been treating people who are dealing with depression through counseling and psychotherapy services for over 25 years as a licensed clinical psychologist, counselor and psychotherapist. You can find my offices for depression treatment in New York City and White Plains, NY as well as Greenwich, CT, convenient for therapy near Stamford, Connecticut.
No single psychotherapy philosophy or depression treatment method appears to work for everyone who is clinically depressed. I find the best approach to psychotherapy and counseling for depression is to tailor treatment to meet the individual's particular therapeutic needs. My eclectic, solutions focused treatment approach for clinical depression and bipolar disorder draws upon a variety of effective psychotherapy and counseling strategies for pursuing better clinical outcomes.
Sadness, Depressed Feelings and Clinical Depression
Feeling somewhat sad on occasion is part of life. Then, there are times when we may be feeling depressed or down for some or all of the day. When depressive symptoms impact one's functioning, a person is said to be clinically depressed, or suffering from clinical depression.
Acute depression refers to the initial, very distressing, stage of a depressive disorder, when symptoms of depression are impacting functioning. Chronic depression refers to the ongoing presence of symptoms and their chronic impact on personality, functioning and lifestyle. By contrast, episodes of recurrent depression tend to go away much sooner, but they do come back.
A reactive depression is primarily due to the impact of external events, such as a death in the family. An endogenous depression is due primarily to internal neurochemical conditions.
Symptoms of Depression and Depressive Disorders
Depressive disorders are persistent psychological conditions characterized by low mood, diffuse anxiety and negativity. Being clinically depressed effects a person's sense of well being and self esteem. Signs of depression include:
- Severe guilt, dread; restlessness, irritability, indecisiveness, apathy
- Reduced mental focus, memory, frustration tolerance
- Disturbances in sleeping, eating; weight loss or gain
- Loss of energy, pleasure, motivation, social or sexual interest
- Negative self involvement, including unpleasant obsessions and social withdrawal
- Diffuse medical complaints, e.g., headaches, digestive disorders
- Preoccupation with depressing thoughts including loss or death; suicidal thoughts, gestures or attempts
Depression may be accompanied by another psychological disorder, by a chemical or behavioral addiction, or by a medical condition. Complications of depression and its related disorders need to be carefully treated.
Types of Depressive Disorders
Depressive disorders vary in the severity and variety of symptoms of depression and in their impact on physical, interpersonal and professional functioning. Some common types of depression include adjustment disorder with depressed mood, dysthymic disorder, major depressive disorder, and bipolar disorder.
Adjustment Disorder with Depressed Mood
Adjustment disorder with depressed mood is an acute depressive reaction (a reactive depression) to one or more usually identifiable stressors. Usually more temporary but nonetheless unsettling, the symptoms of adjustment disorder with depressed mood can interfere with interpersonal or professional functioning.
Dysthymic Disorder (Dysthymia)
Dysthymic disorder is more severe than adjustment disorder with depressed mood. Depression is almost daily, and colors one's existence but must of two year's duration for this diagnosis to apply. Symptoms may include sleeping or eating disturbances (in either direction), diminished sexual and social interest, and loss of mental focus. Persistent symptoms like poor self-esteem and social disengagement may impair happiness and damage relationships and careers. People with dysthymic disorder are especially vulnerable to episodes of major depressive disorder.
Major Depressive Disorder (Major Depression)
People with major depression may suffer acute symptoms of depression including weight loss, insomnia, agitation, emotional torment and despair of such severity that they can not take care of themselves. Severe depression may or may not be accompanied by psychotic depression.
Major depression may destroy relationships and careers and pose a threat to life itself. Often recurrent or chronic, Major depressive disorder may require ongoing, psychological and psychiatric treatment. Major depressive disorder offers the appearance and the consequences of the depressed phase (only) of bipolar disorder (manic depression).
Bipolar Disorder (Manic-Depression)
People with manic-depression experience a cycle of acute highs (mania) and/or lows (depression) in mood, oftentimes with normal periods in between. if there is a depressed phase, the person may appear to be suffering from major depression or dysthymic disorder. If a manic phase is present, people may engage in behavior that is highly unusual for them. Propelled by manic energy and/or delusional ideas, they may make rash business or personal decisions or engage in wild episodes of shopping, gambling, drinking or sexual behavior, etc.
Clinical Factors in Depression and Depressive Disorders
Stress, loss, and insufficient supports are key psychological factors in susceptibility to depression:
- Chronic or acute stress, trauma, abuse
- Abandonment, personal loss
- Toxic or neglectful relationships or situations
- Lack of emotional support, connectedness, meaning, purpose
- Lack of loving others, betrayal of the self, self defeating actions
A family history of clinical depression or depressive disorders may increase one's vulnerability to depression. This family risk factor may due to a combination of psychological or constitutional factors.
Understanding The Psychology of Depression
Why do we get depressed rather than simply indifferent, anxious or enraged? Are there multiple causes of depression? Different branches of psychology provides a number of interesting suggestions.
Physiological Psychology: Depression is an adaptive response to stress
The psychology and physiology of the "depressive response" is opposite to the more familiar "fight or flight response" which releases energy to meet a sudden threat, such as a physical assault. When the fight or flight response goes to far, we are susceptible to severe rage or panic responses.
Chronic stress or trauma, abuse, personal loss, etc. can overwhelm us and drain the energy and mental resources we need for survival. Depression is an adaptive psychological shutdown mechanism which forces us to sit down and conserve energy. This gives us an opportunity to consider how to adapt to a problem that has been stressing and draining us. In clinical depression, this coping strategy miscarries and a learned, maladaptive pattern becomes entrenched.
Evolutionary Psychology: Depression is a psychosocial signal for help
We are a highly social species that has survived through working together and helping each other. When we need assistance, sadness is a distress signal that instinctively evokes empathy and/or a helpful response from most people. while a good support system can help with many problems, it can only go so far. If a person's depressive symptoms persist or get worse, and he or she develops a chronic clinical depression, friends and family tend to experience burnout and may reduce support.
Positive Psychology: Depression is due to learned helplessness
When life teaches us "there is no sense in trying," we may adopt an attitude of negativity and pessimism that leads to a self perpetuating pattern of passivity, failure and feeling of hopelessness. This attitude can be reinforced by a lack of real or perceived opportunities or social supports, or by fear of failure.
Cognitive Behavioral Psychology: Depression is due to depressing thoughts and reinforcement of symptoms
Depressing thoughts, role models, or experiences can produce clinical depression. Regardless of its initial cause, experiences which reward or reinforce clinical depression symptoms can cause one to remain in a depressive psychological position. Cognitive Behavioral Therapy for Depression is discussed further elsewhere in this web site.
Psychoanalytic Psychology of Depression: internalization, anger turned inward, complications in mourning
We may take in (or internalize) hostility or negativity directed towards us. When we are angry with others but unable to confront them (or even ourselves) with our true feelings, we may turn these feelings against ourselves and become more vulnerable to depression. We are also more likely to become depressed when we lose someone emotionally significant to us having left important (often painful) things unsaid.
Interpersonal Psychology of Depression: insecure, compromised relationships
People need to experience a substantial sense of connection in significant relationships. We get depressed when we can not figure out how to communicate or interact effectively with people and get our needs met. It is depressing when a relationship is bad for us, and we must choose between the security it provides versus our sense of self-worth.
Humanistic-Existential Psychology of Depression: a sign that personal development is stalled
When our emotional, social or professional growth is thwarted, by external circumstances or by our own actions, depression can subtlety arise. When we are "bored" n our jobs, relationships, or other important areas in life. We may place too much reliance on superficial, passive, non creative activities, or inauthentic relationships. We may live too much for others or through others. We may relate to others and our work primarily for our own satisfactions and gains without feeling the need to give back or even appreciate what we have taken or received. These choices will eventually fail to support us, and we may face feelings of emptiness, bewilderment, and depression.
Treating Depressive Disorders and Clinical Depression
Clinical Depression is a complex condition which requires an informed, eclectic treatment approach tailored to a client's particular clinical needs. People with depression make more rapid gains when presented with a clear understanding of their problem and with useful tools, ideas and information to overcome it.
My solutions-focused approach to psychotherapy and counseling for depression, which includes cognitive behavioral therapy (CBT) techniques, helps by:
- Quickly assessing the problem, relieving depressive symptoms and restoring functionality
- Disarming behavioral, emotional and psychological triggers to depression
- Actively addressing relevant stressors, difficult life issues and situations
- Identifying and resolving key emotional issues, conflicts and life challenges
- Increasing self confidence by identifying, working through, and overcoming challenges
Antidepressant Medication Treatments for Depression
Some people may be more susceptible to clinical depression than others due to constitutional factors, but some internal and external causes seem to be at work in most cases. It is sometimes difficult to determine what is due to environmental (psychological) factors versus genetic or constitutional factors. This old distinction is has become simplistic because we now know that stressful experiences can change our brain chemistry and make us vulnerable to clinical depression and depressive disorders.
Antidepressant medications may play a useful or even key role as an adjunct to counseling and psychotherapy for depression. Depression medications may provide relief from the upsetting or disabling symptoms of clinical depression. Depression drugs can often restore enough mental energy and focus to enable us to work through the psychological, relationship, situational or other issues which cause or maintain depression. Drugs for depression can be tapered down and discontinued in most cases.
Cognitive, Behavioral, and Holistic Counseling Tips for Depression
The following suggestions may be helpful whether you are dealing with depressed feelings or with a Depressive Disorder:
- Remind yourself that you will get through this sad or stressful time
- List and dispute automatic negative thoughts that bring you down
- Avoid unnecessary stressors, negative people or harmful substances
- Reserve some energy for vital self care and key responsibilities
- Avoid isolation. Do the things and be with people who give you energy
- Aggressively schedule in daily activities, good nutrition, exercise, recreation
- Read about depression, educate your family, and let them help
If these measure do not help enough, consider seeking professional consultation.
Find Help and Get Therapy for Clinical Depression in New York City, Greenwich CT or White Plains, NY
My New York City psychology practice is located in midtown Manhattan on Park Avenue at 38 Street. The NYC location is a short walk from Grand Central Station. I also practice clinical psychology in Westchester county, from my White Plains, NY office. This location is a short drive from Greenwich, Connecticut, Stamford. I am pleased to announce my newest psychotherapy and counseling practice in downtown Greenwich, CT. Family therapy, marriage counseling and individual psychotherapy for depression in Greenwich are available as are group therapy and anger management counseling.
You are welcome to explore this website or to call me and to find how psychotherapy and counseling for depression can help.