Understanding Depression and Effective Treatment
From the American Psychological Association (APA)
Everyone experiences sadness from time to time. But depression lasts longer, interferes with daily life and can cause physical pain. Fortunately, depression is highly treatable, and getting effective treatment is crucial. This question and answer guide explains depression and how it can be treated successfully.
How does depression differ from occasional sadness?
While everyone occasionally feels sad or "blue," these feelings tend to pass rather quickly. By contrast, someone with depression experiences extreme sadness or despair that lasts for at least two weeks or longer. Depressed individuals tend to feel helpless and hopeless and to blame themselves for having these feelings. Depression interferes with activities of daily living — such as working or concentrating on tasks, or even eating and sleeping. Other possible symptoms of depression include chronic pain, headaches or stomach aches. Some people may feel angry or restless for long periods. People who are depressed may become overwhelmed and exhausted and stop participating in certain everyday activities altogether. They may withdraw from family and friends. Some depressed individuals may have thoughts of death or suicide.
What causes depression?
A combination of genetic, chemical, biological, psychological, social and environmental factors likely contributes to the disorder. Depression is often a signal that certain mental, emotional and physical aspects of a person's life are out of balance. Chronic and serious illness such as heart disease or cancer may be accompanied by depression.
Significant transitions and major life stressors such as the death of a loved one or the loss of a job can help bring about depression. Other more subtle factors that lead to a loss of self-identity or self-esteem may also contribute. The causes of depression are not always immediately apparent, so the disorder requires careful evaluation and diagnosis by a trained mental health care professional.
Sometimes the circumstances involved in depression are ones over which an individual has little or no control. At other times, however, depression occurs when people are unable to see that they actually have choices and can bring about change in their lives.
Can depression be treated successfully?
Absolutely. Depression is highly treatable when an individual receives competent care. Licensed psychologists are highly trained mental health professionals with years of experience studying depression and helping patients recover from it. There is still some stigma or reluctance associated with seeking help for emotional and mental health problems, including depression. Unfortunately, feelings of depression often are viewed as a sign of weakness rather than as a signal that something is out of balance. The fact is that people with depression cannot simply "snap out of it" and feel better spontaneously.
Persons with depression who do not seek help suffer needlessly. Unexpressed feelings and concerns accompanied by a sense of isolation can worsen a depression.
Getting quality treatment is crucial. If depression goes untreated, it can last for a long time and worsen other illnesses. Even people with severe depression benefit from treatment.
What evidence supports the use of psychotherapy for treatment?
Many research studies have demonstrated that psychotherapy, or talk therapy, is effective for treating depression and relieving symptoms experienced by individuals who suffer from depression. Psychological treatments may prevent a person with milder depression from becoming more severely depressed. And although a past history of depression increases the risk of future episodes, there is evidence that ongoing psychotherapy may lessen the chance of recurrence.
How does psychotherapy help people recover?
There are several approaches to psychotherapy — including cognitive-behavioral, interpersonal and other kinds of talk therapy — that help individuals recover from depression. Psychotherapy helps people identify the factors that contribute to their depression and deal effectively with the psychological, behavioral, interpersonal and situational contributors.
Skilled health and mental health professionals such as licensed psychologists can work with individuals who are depressed to:
· Pinpoint the life problems that contribute to their depression, and help them understand which aspects of those problems they may be able to solve or improve. A licensed psychologist can help depressed patients identify options for the future and set realistic goals that enable them to enhance their mental and emotional well-being. Psychotherapy also can assist individuals who have been depressed in the past with identifying how they have successfully dealt with similar feelings.
· Identify negative or distorted thought patterns that contribute to feelings of hopelessness and helplessness that accompany depression.
· Develop skills to relieve suffering and prevent later bouts of depression. Skills may include developing or strengthening social networks, creating new ways to cope with challenges and crafting a personal self-care plan that includes positive lifestyle changes.
In what other ways do psychologists help individuals suffering from depression, and also help their loved ones?
Living with a depressed person can be very difficult and stressful on family members and friends. The pain of watching a loved one suffer from depression can bring about feelings of helplessness and loss.
Family or couples therapy may be beneficial in bringing together all the individuals affected by depression and helping them learn effective ways to cope together. This type of psychotherapy can also provide a good opportunity for individuals who have never experienced depression themselves to learn more about it and to identify constructive ways to support a loved one who is suffering from depression.
The support and involvement of family and friends can play a crucial role in aiding someone who is depressed. Individuals in the "support system" can encourage a depressed loved one to stick with treatment and practice the coping techniques and problem-solving skills he or she is learning through psychotherapy.
Are medications useful for treating depression?
Medications are helpful for reducing symptoms of depression in some people, particularly when their depression is severe. Some health care professionals treating depression may favor using a combination of psychotherapy and medications. Given the side effects, any use of medication requires close monitoring. Psychotherapy is often recommended as a first line of treatment for children and adolescents, especially those with mild to moderate depression. Further, some adults with depression may prefer psychotherapy to the use of medications if their depression is not severe. By conducting a thorough assessment, a licensed and trained mental health professional can help make recommendations about an effective course of treatment for an individual's depression.
Depression can seriously impair a person's ability to function in everyday situations. But the prospects for recovery are good for individuals with depression who receive appropriate professional care.
The American Psychological Association gratefully acknowledges the assistance of Daniel J. Abrahamson, PhD, Lynne M. Hornyak, PhD, and Lynn P. Rehm, PhD, in developing the original version of this fact sheet on depression.
HOW STRESS AFFECTS YOUR HEALTH
From the American Psychological Association (APA)
Stress: We've all felt it. Sometimes stress can be a positive force, motivating you to perform well at your piano recital or job interview. But often — like when you're stuck in traffic — it's a negative force. If you experience stress over a prolonged period of time, it could become chronic — unless you take action.
A natural reaction
Have you ever found yourself with sweaty hands on a first date or felt your heart pound during a scary movie? Then you know you can feel stress in both your mind and body.
This automatic response developed in our ancient ancestors as a way to protect them from predators and other threats. Faced with danger, the body kicks into gear, flooding the body with hormones that elevate your heart rate, increase your blood pressure, boost your energy and prepare you to deal with the problem.
These days, you're not likely to face the threat of being eaten. But you probably do confront multiple challenges every day, such as meeting deadlines, paying bills and juggling childcare that make your body react the same way. As a result, your body's natural alarm system — the “fight or flight” response — may be stuck in the on position. And that can have serious consequences for your health.
Even short-lived, minor stress can have an impact. You might get a stomach-ache before you have to give a presentation, for example. More major acute stress, whether caused by a fight with your spouse or an event like an earthquake or terrorist attack, can have an even bigger impact.
Multiple studies have shown that these sudden emotional stresses — especially anger — can trigger heart attacks, arrhythmias and even sudden death.1 Although this happens mostly in people who already have heart disease, some people don't know they have a problem until acute stress causes a heart attack or something worse.
When stress starts interfering with your ability to live a normal life for an extended period, it becomes even more dangerous. The longer the stress lasts, the worse it is for both your mind and body. You might feel fatigued, unable to concentrate or irritable for no good reason, for example. But chronic stress causes wear and tear on your body, too.
Stress can make existing problems worse.2 In one study, for example, about half the participants saw improvements in chronic headaches after learning how to stop the stress-producing habit of “catastrophizing,” or constantly thinking negative thoughts about their pain.3 Chronic stress may also cause disease, either because of changes in your body or the overeating, smoking and other bad habits people use to cope with stress. Job strain — high demands coupled with low decision-making latitude — is associated with increased risk of coronary disease, for example.4 Other forms of chronic stress, such as depression and low levels of social support, have also been implicated in increased cardiovascular risk. And once you're sick, stress can also make it harder to recover. One analysis of past studies, for instance, suggests that cardiac patients with so-called “Type D” personalities — characterized by chronic distress — face higher risks of bad outcomes.5
What you can do
Reducing your stress levels can not only make you feel better right now, but may also protect your health long-term.
In one study, researchers examined the association between “positive affect” — feelings like happiness, joy, contentment and enthusiasm — and the development of coronary heart disease over a decade.6 They found that for every one-point increase in positive affect on a five-point scale, the rate of heart disease dropped by 22 percent.
While the study doesn't prove that increasing positive affect decreases cardiovascular risks, the researchers recommend boosting your positive affect by making a little time for enjoyable activities every day.
Other strategies for reducing stress include:
Identify what's causing stress. Monitor your state of mind throughout the day. If you feel stressed, write down the cause, your thoughts and your mood. Once you know what's bothering you, develop a plan for addressing it. That might mean setting more reasonable expectations for yourself and others or asking for help with household responsibilities, job assignments or other tasks. List all your commitments, assess your priorities and then eliminate any tasks that are not absolutely essential.
Build strong relationships. Relationships can be a source of stress. Research has found that negative, hostile reactions with your spouse cause immediate changes in stress-sensitive hormones, for example.7 But relationships can also serve as stress buffers. Reach out to family members or close friends and let them know you're having a tough time. They may be able to offer practical assistance and support, useful ideas or just a fresh perspective as you begin to tackle whatever's causing your stress.
Walk away when you're angry. Before you react, take time to regroup by counting to 10. Then reconsider. Walking or other physical activities can also help you work off steam. Plus, exercise increases the production of endorphins, your body's natural mood-booster. Commit to a daily walk or other form of exercise — a small step that can make a big difference in reducing stress levels.
Rest your mind. According to APA's 2012 Stress in America survey, stress keeps more than 40 percent of adults lying awake at night. To help ensure you get the recommended seven or eight hours of shut-eye, cut back on caffeine, remove distractions such as television or computers from your bedroom and go to bed at the same time each night. Research shows that activities like yoga and relaxation exercises not only help reduce stress, but also boost immune functioning.8
Get help. If you continue to feel overwhelmed, consult with a psychologist or other licensed mental health professional who can help you learn how to manage stress effectively. He or she can help you identify situations or behaviors that contribute to your chronic stress and then develop an action plan for changing them.
The American Psychological Association's Practice Directorate gratefully acknowledges the assistance of David S. Krantz, PhD, Beverly Thorn, PhD, and Janice Kiecolt-Glaser, PhD, in developing this fact sheet.
1 Krantz, D.S., Whittaker, K.S. & Sheps, D.S. (2011). “Psychosocial risk factors for coronary artery disease: Pathophysiologic mechanisms.” In Heart and Mind: Evolution of Cardiac Psychology . Washington, DC: APA.
2 Kiecolt-Glaser, J. & Glaser, R.
3 Thorn, B.E., Pence, L.B., et al. (2007). “A randomized clinical trial of targeted cognitive behavioral treatment to reduce catastrophizing in chronic headache sufferers.” Journal of Pain 8 , 938-949.
4 Krantz, D.S. & McCeney, M.K. (2002). “Effects of psychological and social factors on organic disease: A critical assessment of research on coronary heart disease.” Annual Review of Psychology, 53 , 341-369.
5 Denollet, J., et al. (2010). “A general propensity to psychological distress affects cardiovascular outcomes: Evidence from research on the type D (distressed) personality profile.” Circulation: Cardiovascular Quality and Outcomes, 3, 546-557.
6 Davidson, K.W., Mostofsky, E. & Whang, W. (2010). “Don't worry, by happy: Positive affect and reduced 10-year incident coronary heart disease: The Canadian Nova Scotia Health Survey.” European Heart Journal, 31 , 1065-1070.
7 Kiecolt-Glaser, J. & Glaser, R.
8 Kiecolt-Glaser, J. & Glaser, R.
Just Do It!
By Laurie Appel, PsyD
“You must do the thing you think you cannot do” – Eleanor Roosevelt
We have all felt it – a fear that is not based in reality, a fear that is exaggerated, a fear that has no significant risk attached to it. Ultimately, a fear that is based on some imagined calamity that will occur – i.e. if I am rejected by a love interest, I will “die” or, if I make a mistake or fail, people will laugh at me and I will never recover. The event may occur, but not the outcome we project on to it. That is, we have all experienced rejection and we will all make mistakes or fail at something, but we will not die or fail to recover from these events. This type of fear is at the root of a statement I often hear from clients when encouraging them to face a fear: “I just can’t do it.”
This past year, I decided to face my own “I just can’t” illogical fear (practicing what I preach). After a lifetime of saying “I can’t” play piano in front of an audience, I resolved to do the thing I could not do. The origin of this fear is likely some residue from childhood, but its origin at some point became irrelevant. What remained relevant is to “do the thing.” But how? These are some strategies that I recommend for clients (and that I used myself to overcome my fear): tell people of your goal and set a date to do “it” so you are accountable (I used an upcoming public recital as a deadline date); practice to gain confidence (rehearse a speech in front of a mirror); use visualization – imagine the worst, but reassure yourself that the worst isn’t as bad as you imagine (yes, I probably would make a mistake, but the audience was unlikely to “boo” me off the stage); form a network of people with similar issues in order to bond and provide mutual encouragement; and get support from family and friends who can cheer you on.
So, how did I fare? Of course I made mistakes and, of course, no one cared but me. I am still afraid, but perhaps less so and I will keep challenging myself to become even less afraid. After all, fear is overcome in steps, not leaps and bounds. Allow yourself to feel the fear, but do it anyway. Why? Because facing these kinds of fears can bring about positive outcomes, such as the realization that you can do things you are afraid of and increased bravery in the face of all those things you want to do, but think you cannot do.