Depression and Mood Disturbances

We all go through ups and downs in life, and their impact on our mood is often perfectly justified.  Struggling with a relationship, losing a job, or coping with an injury are some experiences that can impact our mood and cause us to feel sad or upset.  There is nothing pathological or unusual about these feelings. If you only ever felt neutral or happy, especially in response to natural and significant stressors, it would be much more unusual!
 

Therapy and counseling exist to address mood disturbances that fall outside everyday emotional reactions. Sometimes, a depressed mood can seem to occur out of nowhere and for no reason. Other times, what started as a normal emotional response to a stressor (e.g., feeling sad about a breakup) sticks around too long, resulting in a depressive episode.

 

When you start therapy, you and your therapist will work together to identify the factors contributing to your depressed mood.  Individuals who have a family history of depression, e.g., those who have a parent or sibling who has been previously diagnosed with a mood disorder, are at a significantly higher risk of developing one themselves.  The same risk factor also applies to individuals with one or more previous episodes of depression.  This does not mean that every person with this type of history will become depressed, just that those with a genetic predisposition might be more likely to be influenced by environmental factors.

 

Alternatively, tangible and persistent stressors can cause a person with no history to experience a depressive episode.  In either case, the goal is to help that person feel better and return to a previous or new state of mood stability and functioning.

 

Because depression occurs as an “episode” and can be entirely resolved with the proper treatment, there is no such thing as a “depressed person.”  Instead, Major Depressive Disorder, the clinical term used when a person has several symptoms co-occurring over an extended period, happens to a person.  There are several treatment modalities that a clinician might use to help a person improve and stabilize their mood.  Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral Therapy (DBT) are common approaches.  These methods explore how a person thinks and how their thoughts influence subsequent emotions and behavior. Distorted or untrue thoughts can trigger unfavorable emotions, leading to behaviors designed to relieve these emotions.  This cycle persists and can lead to depression.  When people learn to examine their thoughts, an ability they may never have known they had, they can replace untrue and unhelpful thoughts with more accurate and truthful statements.

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Imagine having the thought, “I’m not good at anything”. Indeed, such a negative and black-and-white thought is bound to cause emotions such as despair, hopelessness, and humiliation. Who could feel good sitting with these feelings?  The resulting behavior may be to avoid engaging in any activities, even those that may be appealing, for fear of failure or embarrassment.  Activities that might have been enjoyable and offset everyday stressors in a person's life are no longer an option, leaving a person unbalanced.  By exploring the validity of the original thought, which might be identified in a therapy session, a person might find that such a statement is not entirely true.  Perhaps they recognize the thought as an overgeneralization, and when they take the time to think about it, they realize that there are many things they are good at or could be good at if they took the time to practice.  A new, more accurate thought might emerge with a new set of emotions and a different behavior course.  Even a moderate shift of just a few words (e.g., “I’m not good at some things”) can significantly reduce the adverse ripple effect of the thought.  Cumulatively speaking, this has profound implications. Thoughts occur every second of every day.  Once the ability to introspect is acquired, it can be applied consistently, allowing a person to challenge invalid thoughts as they occur in real-time. This prevents the buildup of negative emotions and subsequent compensatory behaviors that can lead to a depressive episode.

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Of course, distorted thoughts alone may not be the sole cause of a depressive episode.  If changes that occur to the landscape of one's life are objectively harmful, feeling upset would be a natural reaction.  If these negative changes persist, the body’s response can include all known symptoms of depression—from losing interest/pleasure to self-harm, including suicidal thoughts and actions.  Difficulty with sleep (sleeping too much or too little), weight changes (gain/loss), difficulty concentrating, low energy, a depressed mood, and excessive guilt are additional symptoms that tend to appear in one capacity or another.

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If, through the course of treatment, it is determined that a person’s environment is a primary factor, therapy may include strategy to help them alter or escape the triggering setting or circumstance. While this might not always be possible, small changes, similar to those made to automatic negative thoughts, can accumulate to make a big difference. That said, for those with moderate to severe depression, making small changes may feel like a considerable undertaking.  Since energy and concentration levels are already low, incorporating any initiative that requires additional effort is usually not appealing.  Furthermore, the apparent ratio of exertion to return may initially appear limited. It can even feel exhausting to call a therapist to begin counseling. In essence, thoughts caused by depression can maintain a person's depressive state. This pervasive, insidious, and self-defeating pattern of thinking and behavior is precisely what therapy aims to identify and treat.

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It is hard to estimate how long a course of therapy can take to resolve a depressive episode entirely, but it is generally good practice to start with a commitment of a few months.  There are also many things that a person can do to augment their talk therapy and help advance progress.  These include giving special attention to their diet, exercising regularly, getting quality sleep for sufficient duration, increasing hobbies and other pleasurable activities, and seeking a medication consultation with a physician.  Although medication is not required for success in psychotherapy, more than a handful of studies suggest that when combined with counseling, there may be an enhanced effect. Eventually, once progress is made and sustained, the frequency of therapy can taper from weekly sessions and ultimately be terminated.  Treatment episodes ideally end in this fashion to provide accessibility should symptoms return (an appointment is already made) and allow time for relapse prevention planning, which is a skill.

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As with many mental health conditions, the social stigma surrounding depression can also make it challenging to initiate therapy.  It is important to remember that depression is a byproduct of brain chemistry and not a commentary on how strong or weak a person is.  While strength will be required to make behavioral changes during treatment, a depressive episode can happen to anyone. It must be looked at from an objective perspective.  It must receive attention and care like any other medical condition.  This is especially true when depression becomes severe, as it can bring thoughts of suicide and self-harm (e.g., cutting or burning oneself).