| Depression
Depression is one of
the most common problems in mental health. Research shows that one of every five people
will experience a clinically significant depression during their lifetime (serious enough
that it interferes with life and should receive professional treatment).
Depression can occur in response to significant losses, or seemingly
out of nowhere. It can vary in severity: Some depressed people feel blue but struggle
through their days, others are unable to get out of bed. Depression can occur by itself,
or as part of a pattern of extreme highs and lows, as in Bipolar Disorder
(Manic-Depression). Some people experience a chronic, relatively mild form of depression
called Dysthymic Disorder, which is not incapacitating but makes for a rather sad and
unsatisfying life.
Depressive symptoms also can occur in response to some physical
conditions, such as hypothyroidism, so it is a good idea to have a physical exam if you
are feeling depressed. Also, people who abuse alcohol or other drugs can develop symptoms
of depression, which are unlikely to abate as long as the substance abuse continues.
Common symptoms of
depression are described below, along with specific information about depression in
children and adolescents. We also discuss the role of psychologists in diagnosing and
treating depression.
Symptoms of Depression
Here are some common
symptoms of depression:
- Unhappy, sad, blue, or irritable much of the time
- Loss of interest or enjoyment in things you used to like
- Life feels like a strain, getting through the day is a struggle
- Loss of appetite (or increased eating)
- Insomnia (or sleeping much more than usual)
- Lack of energy, fatigue
- Forgetfulness, or difficulty concentrating, thinking, or making decisions
- Doing things much slower than usual (or being too agitated to sit still)
- Feeling excessively guilty or remorseful, ruminating, or excessively focusing on your
mistakes, weaknesses, and failures
- Feeling worthless, low self-esteem, strong feelings of inadequacy
- Feeling pessimistic or hopeless about the future
- Withdrawal from others
- Decreased productivity or effectiveness in work, school, chores, etc.
- Repeatedly thinking about death, wishing you were dead, or thinking about ways to die*
*If
you are seriously thinking about killing yourself or planning how to end your own life,
you should seek help immediately through a professional caregiver or the Emergency
Department of your local hospital. In addition, avoid the use of alcohol or other
unprescribed drugs because these can increase the risk of impulsive self-harm.
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Depression in Children and Adolescents
In children, depression
may manifest in surprising ways.
For example, you might see behavior problems, including anger, temper
tantrums, and aggressive behavior. Young children, in particular, have trouble expressing
sadness verbally, so it comes out in their behavior.
Although we usually see inertia and psychomotor slowness in depressed
adults, in children you might paradoxically see overactivity.
You also can see some
of the "classic" symptoms of depression, like sadness, insomnia, suicidal
thoughts and comments, and low self-esteem (statements like, "I'm so dumb" or
"Nobody likes me").
In teenagers,
especially, but also in children, you might see social withdrawal, less involvement in
activities they previously enjoyed, apathy (e.g., frequently saying, "I don't
care"), hypersomnia (sleeping way too much), trouble with peer relationships, and a
decline in school performance.
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The Role of the Psychologist
Diagnosis:
Psychologists help
people overcome depression by, first, identifying the disorder and any contributing
factors in the person's life. Usually, the depression can be identified by the
psychologist using a clinical interview. In some cases, psychological testing can be
helpful in defining the disorder and its severity.
Because depression in children and adolescents can be masked by other
types of problems, evaluation by a psychologist with expertise in child and adolescent
development and mental health is all the more essential.
Treatment:
Psychologists use
psychotherapy to treat depression, which has been shown to be as effective as medications
in treating this disorder. Psychotherapy has the benefit of teaching new skills for
managing depression, which can help reduce future problems with the disorder, but
medications sometimes work faster. Because the combination of psychotherapy and
medications can be better than either alone, psychologists will often refer their clients
for medication.
One common approach to treating depression involves learning how
automatic thoughts can contribute to the person's depressed mood. These automatic thoughts
occur at a subconscious level, so they have their impact without the person ever realizing
it. For example, a person might receive a compliment, but he tells himself that he really
didn't do so well and should have done better. Instead of feeling good about the
compliment, he gets aggravated with himself for being a failure.
There are a number of ways that depressed people distort their
experiences. The psychologist identifies those distortions and questions them. As the
person learns to catch himself in these automatic distortions and develops the ability to
challenge them, the depression generally improves.
Sometimes, there are other issues that contribute to the depression:
Real losses cause considerable grief -- things like the death of a
loved one, breakup of a relationship, loss of health, or job loss. The psychologist helps
the person by supporting him during his adjustment to the loss and works to prevent a
prolonged, destructive response to the loss.
People who have suffered abuse often struggle with depression (along
with anxiety, difficulty trusting, relationship problems, substance abuse, etc.). Often,
it is enough to work on the cognitive distortions/automatic thinking that develops from
the abuse. Sometimes, however, there is a need for in-depth exploration of the abuse and
its effects before those cognitive distortions can be realistically challenged.
In general, the skilled
psychologist will tailor the treatment to the specific needs of the client.
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