Treating Depression
Depression comes in all forms, and no one is exempt from occasional periods of “the blues.” However, when one goes from being down occasionally, to an excessively prolonged period of depression, it’s time to seek help.
There are many different types of diagnosable depression. There can be depression with Post Traumatic Stress Disorder (PTSD); depression that is situational, but even so, can be debilitating; depression that cycles, such as with bipolar disorder, or cyclothymic disorder; and single or recurrent depressive disorder. Depression can also be recurrent but mild, in which case, medication is not indicated, by psychotherapy is. Excessive stress for a prolonged period of time can also change one’s neurochemistry and cause depression. What is actually going on leads to an accurate diagnosis, which then allows more specific treatment plans. Getting a professional assessment is important, as many variables go into an assessment, including lifestyle, diet, sleep, medical history, diet, social history, etc.
Medication is not indicated in all cases, and appropriate application should be carefully assessed. Many people have strong feelings about whether or not they will take medication, and these feelings are very important and must be respected. Moreover, anti-depressant medication can have significant side effects and should be monitored carefully. When we look at remission of symptoms as a goal, using only medication, or using only psychotherapy, both yield approximately the same results: about 50% of people experience successful relief of symptoms from psychotherapy without medication; and about 50% of people have success from medication without psychotherapy. However, recent research indicates that treatment for depression has superior results when both psychotherapy and pharmacology are combined, and in cases where medication is indicated. The preferred psychotherapeutic approaches are interpersonal psychotherapy (IPT), insight therapy, and cognitive behavioral therapy (CBT) and mindfulness CBT, and the preferred frequency is once or twice a week at first, and then as needed. Contact can be in person, by phone, and also by email.
All studies indicate that, if psychopharmacology is indicated, it should be combined with psychotherapy for the most effective outcome. Indicators for medication would be: severely depressed mood, persistent anhedonia, physical symptoms (anergia, malaise, appetite suppression, prior depressive episodes, prolonged dysthymia); and indicators for psychotherapy would be: suicidal thinking, social withdrawal, interpersonal dysfunction, psychosocial stressors, self-defeating cognitions. These are examples and by no means a complete list of indicators.
When medication works, your neurochemistry has readjusted back to a more normal state. This is when you can most effectively work on your life issues that may have caused the depression. This is one reason that both pharmacology and psychotherapy can produce such superior results.
Dr. Susannah Smith is a licensed practicing clinical psychologist and organizational development consultant, with offices in Telluride and Ridgway. She is licensed in Colorado, California, Louisiana, Mississippi, and Texas. If you would like to contact her, she can be reached at www.creativeteamconsulting.com; shas14@gmail.com; or 970-728-5234.