We can all experience depressed mood from time to time. We may feel sad following a disappointment, for instance, and our thoughts might be more negative, but this usually resolves within a short time.
Major depression, on the other hand, occurs when this low mood turns into a longer episode of at least two weeks, often months. If you are depressed, you might be experiencing some of these symptoms:
The emotional symptoms: feeling sad, despondent, teary, hopeless, guilty, irritable, numb, lost, or worthless.
The cognitive symptoms: difficulty thinking and making decisions, poor concentration and memory, and, of course, seeing things in a negative light, with many negative thoughts about the self, others and/or the future. There can also be thoughts of suicide.
The behavioral symptoms: wanting to isolate, sometimes with the goal of not having to pretend to be ok or not being a burden on others; and at other times simply because of a lack of desire to interact or energy. There is also often a decrease in activity in general, again, often linked to having less motivation, pleasure or energy.
The physical symptoms: fatigue, changes in sleep, appetite (and/or weight) or sexual desire, and in some cases even motor symptoms like slower movement or speech.
If you suffer from depression, you are not alone. Depression is one of the most common mental health disorders, with up to one in four women, and one in eight men, suffering from depression at some point in their life.
Depression can be mild, moderate or severe. When studies compare the effects of antidepressants with CBT, the results show that both are equally effective (as is their combination), and CBT is superior in decreasing the likelihood of experiencing subsequent episodes of depression. This makes sense since, in CBT, tools are learned that increase resilience.
This being said, there are cases where medication is strongly indicated, such as when depression is severe or has a strong biological underpinning, as is the case with bipolar disorder or psychotic depression. Post-partum depression and premenstrual dysphoric disorder also have a strong biological, in this case hormonal, underpinning, and a medical consult is recommended. Finally, hypothyroidism can also cause some of the symptoms associated with depression, and so it is always a good idea to have a medical check-up to rule out and/or treat any potential medical contributor to depression.
Depression is often referred to as a “depressive episode” because, although it can last months or more, it is usually limited in time. A related diagnosis is that of dysthymia, which is a more chronic, but less intense, form of depression (lasting at least two years). It too responds well to CBT.
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Treatment
Changing thoughts: Depression is very closely associated with negative thinking. If you feel depressed, you may be preoccupied with negative thoughts and/or regrets, and feel that life is pointless, will never be good again, or that your current problems are insurmountable. You may look at the world or the future with despair or despondence.
There are biases like “all-or-nothing thinking” or focusing on the negative and discounting the positive, that we all have sometimes. But, in depression, these become pervasive.
The good news is that these can be corrected with cognitive re-structuring techniques, such that negative thoughts (e.g., “I’ve wasted my life.”) can be replaced with more realistic ones (e.g., “I have achieved some of my goals and not others”). It is not about learning to see life through rose-colored glasses, but more like moving away from depression-dark glasses towards more clear ones. Specific issues, like self-criticism, can also be addressed this way.
Changing behaviors: When depressed, we tend to be less active, physically and socially, and engage in fewer of the activities that used to give us pleasure (e.g., watching movies), those that can lead to a sense of mastery (e.g., cleaning, organizing, etc.) or that impart a sense of meaning (e.g., being part of a community). This is understandable because it can seem like everything requires more energy or motivation than before, while also resulting in less pleasure than before. In milder cases, it may be cutting out any activity that is not absolutely necessary; while in more severe cases, even something as simple as taking a shower can seem like climbing a mountain.
Yet, in the same way that negative thoughts and decreased activity maintain low mood, reframing negative thoughts into more realistic ones and increasing activity will gradually cause an uplift in mood. “Behavioral activation” is the term used for increasing activity in a supportive and systematic though CBT. Physical exercise, again, to the extent possible, is also encouraged, as many studies have shown it to be equivalent to taking a small dose of an antidepressant, in terms of its effect on mood.
Optional additional treatment strategies
Working on self-esteem and self-compassion can be helpful if self-criticism plays an important role in the maintenance of depression.
Better identification of needs and values: getting in touch with one’s own values and setting personal goals based on these values.
Improved communication with others: building or strengthening a good social support system.
Better problem-solving, including how problems are perceived (as a welcomed opportunity for personal growth instead of as aversive insurmountable obstacles)
Practicing gratitude
Mindfulness and Acceptance: Learning to be in the here and now, and to suspend judgment (i.e., instead of labeling experiences as “good” or “bad”, accepting them as they are).