Depression can change everything. How we think, what we do, and how we feel. It can even make us too pessimistic or downhearted to ask for help. But help is out there, right here in NYC.
Depression can occur for many reasons and can range from mild to debilitating. It needs to be taken seriously; depression can be life threatening at times. Symptoms include:
- frequent feelings of sadness or hopelessness
- change in one’s weight or appetite
- thoughts of death or suicide
- low self worth or excessive guilt
- trouble concentrating,
- enjoying things less that used to be fun
- having less energy — even small things seem like huge tasks
- slower physical movement or thinking than usual.
Major depressive disorder
Major Depressive Disorder (MDD) is a condition marked by one or more episodes of depression lasting at least two weeks, and characterized by most or all of the above-listed symptoms.
Persistent depressive disorder
Not everyone who suffers from depression has most or all of the symptoms described above. Some people will have one or two symptoms, but they will be impactful. Others have a few symptoms that last for years, even though they are not debilitating. People with these issues may have a condition called persistent depressive disorder, also known as dysthymia. Some of the more common symptoms of this condition include low mood, low self-worth, and low interest in enjoyable activities.
Other mental health and medical conditions
There are many conditions that can cause depression. These include hypothyroidism, post-traumatic stress disorder, obsessive-compulsive disorder, brain injuries, personality disorders, certain neurological conditions, and several others. For this reason alone, if you are suffering from depression it is important to be evaluated by a medical or mental health professional. The problem may be different than what you think, and treatment may be more helpful than you imagine.
What causes depression?
There is not one thing that causes depression. Some conditions have a clear cause. For example, genetic factors cause autism and viruses cause colds. The causes of depression are much more complex. Research shows that several factors make some people more vulnerable to depression than others. Relevant factors include genetics, childhood experiences, and the meaning we ascribe to life events or circumstances. Many people assume the life circumstances or events themselves cause depression, but it is far more likely that the way we think about those things causes us to cope well, or to become depressed.
Consider the example of a breakup of a romantic relationship. Breakups can be painful — among the most emotionally painful experiences we have. If your tendency is to think about breakups as proof of your unworthiness as a romantic partner, you are likely to become depressed. On the other hand, if you are someone who tends to expect positive things in life, after a breakup you might anticipate that you’ll be better off.
One factor that can lead to or worsen depression is the way we see ourselves. If we tend to think of ourselves as someone who is hard to like, annoying, or burdensome to others, we will be more vulnerable to depression. Beliefs like these, when considered as a group, are called schemas. We all have schemas — they are not inherently unhealthy or problematic. However, when they end up embodying critical or negative views about ourselves, they can cause depression. One school of thought contends that when our schemas paint a picture of us as helpless, unlovable or incompetent, we are particularly vulnerable to depression and anxiety.
Negative schemas are typically not something we’re born with, although that is difficult to prove through research. The current understanding is that they are shaped through a combination of inborn factors and learned experiences. These experiences can happen in childhood or adulthood. For example, if a college student starts to have a lot of success in school that she didn’t have before, she may start to see herself as smarter and more capable.
Yes! Exercise, getting support from loved ones, and improving sleep hygiene are all good initial steps.
Research shows that effective treatments for depression include medications and psychotherapy.
It’s complicated. The functioning of neurotransmitters in the brain is different in people who are depressed than those who are not. However, it is not at all clear whether these neurochemical differences are caused by depression, are the cause of depression, or neither.
How to help a depressed loved one
First, learn to see the warning signs. Changes to look for include:
- Decreased activity levels or enthusiasm
- Sleeping a lot (or sleeping poorly)
- Increased use of alcohol or drugs
- A pessimistic or bleak tendency that has worsened
- More frequent crying
- Change in appetite or weight
What you can do
If you are concerned that a loved one is suffering from depression, it can be helpful to express your concern for them. Describe the changes you’ve noticed — they may not have been aware of them. Be empathetic, and don’t try to convince them they’ve got no reason to be depressed. (Remember whatever reason they have is real for them.) Express a desire to help.
Remember there is no guarantee that you will be able to get a loved one the help they might need. If they’re an adult, whether to get help or not is ultimately their choice. However, knowing you are concerned can help a lot. It may facilitate them seeking out care if they know you’re in their corner.
One common mistake people make when trying to help a depressed friend or loved one is trying to convince them that they should be happy, or to dismiss what they’re concerned about. A better choice is to express your caring for them through attentive and patient listening. This communicates that you care, that you are not afraid of how they’re feeling, and that maybe you understand where they’re coming from.
If you’re worried about suicide
If you have reason to believe someone is at significant risk to try to end their lives, contact a suicide hotline. The National Suicide Prevention Hotline can be reached at 800-273-8255. For those in New York, NYC Well is a service the NY state department of health that is free, confidential and available around the clock. They offer texting and internet chat service in addition to phone. Their number is 888-NYC-WELL (888-692-9355).
Treatment for depression
The first step in getting treatment for depression is getting an evaluation with a mental health professional. This is necessary for several reasons. For one, depression can be caused by many factors, including other mental health problems. For example, post-traumatic stress disorder, obsessive-compulsive disorder, body dysmorphic disorder and many others can cause depressive symptoms. A professional evaluation is needed to determine what treatment should entail.
Cognitive-behavioral therapy (CBT) for depression can involve efforts to increase certain behaviors that improve mood and decrease behaviors that worsen mood. CBT may also focus on the relationship between one’s thoughts and behaviors. Some people experience low mood that is at least partially fueled by specific thought patterns – for example, negative thoughts about one’s competence or self-worth. No one has total control over which thoughts come into our minds. However, we can exert some control over what we tell ourselves. CBT can help change this mental dialogue in ways that improve one’s mood.
Cognitive-behavioral therapy is different from generic counseling in that you are typically given specific exercises to do between sessions. These exercises are what help you change your mental and behavioral habits and improve your mood. For example, one commonly used exercise in CBT is called a “thought record.” Using a thought record helps people to better understand how their interpretation of events affects their mood. It can then be used to help alter unhelpful patterns of thinking, providing a lasting natural tool against depression.
Research has shown behavioral activation, a version of CBT, to be effective in the treatment of depressive disorders. This approach is partially based on the notion that clinically depressed people have often ceased to do some things that used to bolster their mood. They may not be aware of this change, but by re-engaging with those activities and behaviors, mood improves. Working with a CBT therapist can help people determine if and how such behavior change might be helpful in their efforts to address depression.
Medication can be an important part of the treatment for depression, but is not always necessary. The most commonly prescribed antidepressant medications are known as selective serotonin reuptake inhibitors, or SSRIs. SSRIs have been shown to be helpful, primarily for people with moderate to severe depression. They do have side effects for some people. Consult with your mental healthcare provider about whether medication might be helpful for you.
Last updated: May 15, 2020