Therapy for Depression

Posted by on Mar 23, 2012 in Depression | 0 comments

Medical intervention is certainly not the only path. “Talk” therapy has proven to be highly effective. A variety of therapies are available and are provided by psychiatrists, psychologists, marriage and family therapists, social workers, and pastoral and mental health counselors.

Therapy has historically been thought of as a long-term process, but it is usually completed in 6-10 sessions. Surprisingly, the largest number of people come for only one session! Clients report that changes they receive from therapy peak around 10 sessions with only moderate improvements after that.

Managed Care has also had a hand in modifying the delivery of therapy, requiring therapists to provide shorter term treatment that also shows a high degree of consumer satisfaction. Several effective short-term or “brief therapy” models are available now.

The models of therapy most frequently suggested for the treatment of depression are:

Interpersonal Therapy
A short-term treatment (12 to 16 sessions) developed specifically for treating major depression. It focuses on correcting current social dysfunction rather than unconscious phenomena and on “here-and-now” factors that directly interfere with social relationships.

Cognitive Behavioral Therapy
This form of therapy states that the patient’s excessive self-rejection and self-criticism causes major depression. The therapist attempts to help change these negative thoughts or “dysfunctional” attitudes. (Critics of this form of therapy argue that the depressed patient’s pessimistic thoughts are a result of the depression, not a cause.)

Family Therapy
The depressed member is viewed as part of a “system” in the overall well being of the whole family. The family or system developed around the problem is the focus of this type of therapy.

Narrative Therapy
The focus in narrative therapy is less on individual pathology and concentrates on the larger socio-cultural factors that have led people into a depressed “lifestyle”. This type of therapy helps people “re-author” their lives based on how they prefer to be in the world. A therapist who practices narrative therapy attends to factors such as gender inequality, poverty, racism, corporate stress, the ever-present messages that help people to feel less than worthy (as described in A Pro-Anorexic Culture), as well as the culture of perfectionism, community isolation, and lack of connection.

In solution-oriented therapy, the focus is on what is working or going well in people’s lives, and on the times they are not depressed. The therapeutic conversation builds on these problem-free moments, on what factors contribute to these moments, to help the depressed person create more of these times and expand them into other parts of their lives.

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Depression and Suicide

Posted by on Mar 23, 2012 in Depression | 0 comments

“Some medications must be stopped gradually to give the body time to adjust.”

Depression And Suicide

“The SSRIs and other newer medications that affect neurotransmitters such as dopamine or norepinephrine generally have fewer side effects than tricyclics.”

“Through verbal exchange with the therapist, as well as homework assignments between therapy sessions, CBT helps patients understand their depression and resolve problems related to it.”

Sometimes depression can cause people to feel like putting themselves in harms way, or killing themselves. Although the majority of people with depression do not die by suicide, having depression does increase suicide risk compared to people without depression.

If you are thinking about suicide, get help immediately:

  • Call your doctors office.
  • Call 911 for emergency services.
  • Go to the emergency room of the nearest hospital.
  • Ask a family member or friend to take you to the hospital or call your doctor.
  • Call the toll free, 24 hour hotline of the National Suicide Prevention Lifeline at 1 800 273 TALK (1 800 273 8255) to be connected to a trained counselor at the suicide crisis center nearest you.

Lithium has for many years been the treatment of choice for bipolar disorder, as it can be effective in smoothing out the mood swings common to this disorder, but its use must be carefully monitored, as the range between an effective dose and a toxic one is small.

Psychotherapy can generally be considered ineffective if a trial of three months has not produced a measurable and noticeable improvement.

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Possibilities for Change

Posted by on Mar 23, 2012 in Depression | 0 comments

There is good news: depression is treatable. However, the person who is suffering must be wary of quick fixes. The levels of depression are incredibly high in number, as are the numbers of individuals and companies who peddle instant cures. As one well-known depression expert recently stated “Because of the nature of the problem, there can be no sure-fire cure for depression, but the corporations are smart enough to realize that peddling

‘hope-inside-a-pill’ is like a license to print money.

Depression has provided the medical profession and the pharmaceutical industry with a billion-dollar industry. Recently, the media has gotten into the act and focused its attention on pharmaceuticals as ‘the latest miracle cure.’ Drugs such as Prozac, Zoloft, Paxil and Luvox are basking in the limelight.

These anti-depressant medications belong to a family of pills called selective serotonin re-uptake inhibitors (SSRIs) and have gained so much notoriety they’ve been featured on the covers of both Time and Newsweek; books on the subject have also become bestsellers. These pills are also convenient for the people who take them because they require only one daily dose.

However, side effects are common and they may include:

  • nausea
  • headaches
  • diarrhea
  • insomnia
  • sexual difficulties.

In one study, about 20 percent of the people who tried Prozac stopped taking it as a result of its side effects.

The NIMH compared the success rates of psychotherapy versus antidepressant drug therapy in the treatment of major depression and concluded the following:

“It takes weeks before antidepressant drug therapy starts to work, thus these patients desperately need a caring professional who will emotionally support them and their family until their body recovers.”

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Depression And Cancer

Posted by on Mar 23, 2012 in Depression | 0 comments

“Some people with milder forms of depression may do well with psychotherapy alone and people with moderate to severe depression most often benefit from antidepressants, but most do best with combined treatment: medication to gain relatively quick symptom relief and psychotherapy to learn more effective ways to deal with life’s problems, including depression.”

“A less severe type of depression, dysthymia (or dysthymic disorder), involves long lasting, chronic symptoms that do not seriously disable, but keep one from functioning well or feeling good.”

“Persons with cancer, their families and friends, and even their physicians and oncologists (physicians specializing in cancer treatment) may misinterpret depression’s warning signs, mistaking them for inevitable accompaniments to cancer.”

Depression and Cancer

Research has enabled many men, women, and young people with cancer to survive and to lead fuller, more productive lives, both while they are undergoing treatment, and afterwards. As with other serious illnesses, such as HIV, heart disease, or stroke, cancer can be accompanied by depression, which can affect mind, mood, body and behavior. Treatment for depression helps people manage both diseases, thus enhancing survival and quality of life.

About 9 million Americans of all ages are living with a current or past diagnosis of cancer. People who face a cancer diagnosis will experience many stresses and emotional upheavals. Fear of death, interruption of life plans, changes in body image and self-esteem, changes in social role, lifestyle, and medical bills are important issues to be faced. Still, not everyone with cancer becomes depressed. Depression can exist before the diagnosis of cancer or may develop after the cancer is identified. While there is no evidence to support a causal role for depression in cancer, depression may impact the course of the disease and a person’s ability to participate in treatment.

Despite the enormous advances in brain research in the past 20 years, depression often goes undiagnosed and untreated. While studies generally indicate that about 25 percent of people with cancer have depression, only 2 percent of cancer patients in one study were receiving antidepressant medication. Persons with cancer, their families and friends, and even their physicians and oncologists (physicians specializing in cancer treatment) may misinterpret depression’s warning signs, mistaking them for inevitable accompaniments to cancer. Symptoms of depression may overlap with those of cancer and other physical illnesses. However, skilled health professionals will recognize the symptoms of depression and inquire about their duration and severity, diagnose the disorder, and suggest appropriate treatment.
Depression Facts

Depression is a serious medical condition that affects thoughts, feelings, and the ability to function in everyday life. Depression can occur at any age. NIMH-sponsored studies estimate that 6 percent of 9- to 17-year-olds in the U.S. and almost 10 percent of American adults, or about 19 million people age 18 and older, experience some form of depression every year. Although available therapies alleviate symptoms in over 80 percent of those treated, less than half of people with depression get the help they need.

Depression results from abnormal functioning of the brain. The causes of depression are currently a matter of intense research. An interaction between genetic predisposition and life history appear to determine a person’s level of risk. Episodes of depression may then be triggered by stress, difficult life events, side effects of medications, or other environmental factors. Whatever its origins, depression can limit the energy needed to keep focused on treatment for other disorders, such as cancer.

Cancer Facts

Cancer can develop in any organ or tissue of the body. Normally, cells grow and divide to produce more cells only when the body needs them. But sometimes cells keep dividing when new cells are not needed. These extra cells may form a mass of tissue, called a tumor. Tumors can be either benign (not cancerous) or malignant (cancerous). Cells in malignant tumors are abnormal and divide without control or order, resulting in damage to the organs or tissues they invade.

Cancer cells can break away from a malignant tumor and enter the bloodstream or the lymphatic system. This is how cancer spreads, or “metastasizes,” from the original cancer site to form new tumors in other organs. The original tumor, called the primary cancer or primary tumor, is usually named for the part of the body in which it begins.

Cancer can cause a variety of symptoms. Some include:

  • Thickening or lump in the breast or any other part of the body
  • Obvious change in a wart or mole
  • A sore that does not heal
  • Nagging cough or hoarseness
  • Changes in bowel or bladder habits
  • Indigestion or difficulty swallowing
  • Unexplained changes in weight
  • Unusual bleeding or discharge

When these or other symptoms occur, they are not always caused by cancer. They may also be caused by infections, benign tumors, or other problems. It is important to see a doctor about any of these symptoms or about other physical changes. Only a doctor can make a diagnosis. One should not wait to feel pain; early cancer usually does not cause pain.

Treatment for cancer depends on the type of cancer; the size, location, and stage of the disease; the person’s general health; and other factors. People with cancer are often treated by a team of specialists, which may include a surgeon, radiation oncologist, medical oncologist, and others. Most cancers are treated with surgery, radiation therapy, chemotherapy, hormone therapy, or biological therapy. One treatment method or a combination of methods may be used, depending on each person’s situation.

Get Treatment for Depression

At times it is taken for granted that cancer will induce depression, that depression is a normal part of dealing with cancer, or that depression cannot be alleviated for a person suffering from cancer. But these assumptions are false. Depression can be treated and should be treated even when a person is undergoing complicated regimens for cancer or other illnesses.

Prescription antidepressant medications are generally well-tolerated and safe for people being treated for cancer. There are, however, possible interactions among some medications and side effects that require careful monitoring. Therefore, people undergoing cancer treatment who develop depression, as well as people in treatment for depression who subsequently develop cancer, should make sure to tell any physician they visit about the full range of medications they are taking. Specific types of psychotherapy, or “talk” therapy, also can relieve depression.

Use of herbal supplements of any kind should be discussed with a physician before they are tried. Recently, scientists have discovered that St. John’s wort, an herbal remedy sold over-the-counter and promoted as a treatment for mild depression, can have harmful interactions with some other medications.

Treatment for depression can help people feel better and cope better with the cancer treatment process. There is evidence that the lifting of a depressed mood can help enhance survival. Support groups, as well as medication and/or psychotherapy for depression, can contribute to this effect.

Treatment for depression in the context of cancer should be managed by a mental health professional, for example, a psychiatrist, psychologist, or clinical social worker, who is in close communication with the physician providing the cancer treatment. This is especially important when antidepressant medication is needed or prescribed, so that potentially harmful drug interactions can be avoided. In some cases, a mental health professional that specializes in treating individuals with depression and co-occurring physical illnesses such as cancer may be available.

While there are many different treatments for depression, they must be carefully chosen by a trained professional based on the circumstances of the person and family. Recovery from depression takes time. Medications for depression can take several weeks to work and may need to be combined with ongoing psychotherapy. Not everyone responds to treatment in the same way. Prescriptions and dosing may need to be adjusted. No matter how advanced the cancer, however, the person does not have to suffer from depression. Treatment can be effective.

Other mental disorders, such as bipolar disorder (manic-depressive illness) and anxiety disorders, may occur in people with cancer, and they too can be effectively treated. For more information about these and other mental illnesses, contact NIMH.

Remember, depression is a treatable disorder of the brain. Depression can be treated in addition to whatever other illnesses a person might have, including cancer. If you think you may be depressed or know someone who is, don’t lose hope. Seek help for depression.

Electroconvulsive therapy (ECT) is another treatment option that may be particularly useful for individuals whose depression is severe or life threatening, or who cannot take antidepressant medication.

A good diagnostic evaluation will include a complete history of symptoms, when they started, how long they have lasted, how severe they are, whether the patient had them before and, if so, whether the symptoms were treated and what treatment was given.

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Living with Depression

Posted by on Mar 23, 2012 in Depression | 0 comments

Imagine feeling so exhausted you can’t muster the energy to walk from one room to the next. Nothing inspires you to take action. Activities that once offered pleasure seem without meaning. You have chronic fatigue although you sleep more. Or perhaps you can’t sleep; you lay awake fitfully throughout the night. Your appetite is sluggish; food tastes like cardboard — or you can’t stop eating. You’ve either lost weight or packed on extra pounds. Sex is the last subject on your mind; or, you’re engaging in risky sexual encounters.

In fact, you’re not able to concentrate on very much. Your life feels narrow and parched and sometimes you get the sensation of falling into a well; sinking fast. Your temper is charged, often for no reason. Or, you feel so apathetic, nothing gets you fired up. You’re like a passenger on a train listlessly watching the scenery pass. You’re disconnected from those around you, but it feels as if you don’t deserve their attention anyway. Nothing matters.

These days, smiling or joining in any social contact is as strenuous as hoisting a 50-pound weight. You’re often so sad you weep spontaneously, sometimes for no apparent reason. And you break down anywhere: in the supermarket, while driving, perhaps while making your morning cup of coffee. Grief streams behind you like a swimmer’s long hair in the water. Behind the curtain of your dark emotions, your chronic state of sadness may also be negatively affecting your physical health.

Researchers at Duke University, for example, tracked heart disease and mood symptoms in 730 men and women over age twenty-seven, and found that people with symptoms of depression were 70 percent more likely to have heart attacks than those who were not depressed.

Scientists surmise that people who feel hopeless may experience surges of stress hormones, which can affect the heart and other internal organs. You may feel drained both emotionally and physically and not have the energy to reach out for help. This endless string of sadness continually pulling at your mind may keep you from moving in any positive direction.

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Types Of Depression

Posted by on Mar 23, 2012 in Depression | 0 comments

“Combined use of medications and psychotherapy at the onset of treatment can confound evaluation of treatment effectiveness and the observed source of change.”

Types Of Depression

“Medications alone appear to be helpful in approximately 50% of the cases.”

“Appropriate treatment, often involving medication and/or short term psychotherapy, can help most people who suffer from depression.”

Just like other illnesses, such as heart disease, depression comes in different forms. This article briefly describes three of the most common types of depressive disorders. However, within these types, there are variations in the number of symptoms, their severity, and persistence.

Major depression (or major depressive disorder) is manifested by a combination of symptoms (see symptoms list below) that interferes with the ability to work, study, sleep, eat, and enjoy once pleasurable activities. A major depressive episode may occur only once; but more commonly, several episodes may occur in a lifetime. Chronic major depression may require a person to continue treatment indefinitely.

A less severe type of depression, dysthymia (or dysthymic disorder), involves long lasting, chronic symptoms that do not seriously disable, but keep one from functioning well or feeling good. Many people with dysthymia also experience major depressive episodes at some time in their lives.

Another type of depressive illness is bipolar disorder (or manic depressive illness). Bipolar disorder is characterized by cycling mood changes: severe highs (mania) and lows (depression), often with periods of normal mood in between. Sometimes the mood switches are dramatic and rapid, but usually they are gradual. When in the depressed cycle, an individual can have any or all of the symptoms of depression. When in the manic cycle, the individual may be overactive, over talkative, and have a great deal of energy. Mania often affects thinking, judgment, and social behavior in ways that cause serious problems and embarrassment. For example, the individual in a manic phase may feel elated, full of grand schemes that might range from unwise business decisions to romantic sprees and unsafe sex. Mania, left untreated, may worsen to a psychotic state.

Although available therapies alleviate symptoms in over 80 percent of those treated, less than half of people with depression get the help they need.

John’s wort, an attractive bushy, low-growing plant covered with yellow flowers in summer, has been used for centuries in many folk and herbal remedies.

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