Depression is characterized by a group of symptoms that often occur together, primarily feeling fatigued, low mood, and reduced interest, motivation and positive feelings. However, how depression manifests can vary widely from person to person. Some primarily feel sad and down, while others are more affected by apathy, a sense of meaninglessness or irritability. Most individuals experiencing depression harbor negative feelings towards themselves, such as feeling inadequate or worthless. Many are burdened by an excessive sense of guilt and pessimistic thoughts about the future. Depression is often accompanied by poor sleep and decreased appetite, though for some, it's the opposite – they may sleep excessively or eat more than usual as a strategy to cope with distressing emotions. Many withdraw and isolate themselves from friends and family. Some turn to alcohol, gaming or other more or less healthy coping strategies. A significant number have thoughts and fantasies of self-harm or suicide. Some clients also experience concurrent physical ailments related to depression, such as headaches, migraines, joint and muscle pain, tense muscles, irritable bowel, etc.
Approximately one in six people experiences depression at some point in their lives.
Mild, moderate and severe depression
Depression can be described on various spectrums. One spectrum is the intensity of depression, i.e., the number of symptoms and how strongly they are experienced. In mild depression, individuals may be fully able to perform tasks at home and work, but daily life is often characterized by dark thoughts and worries about the future, and they no longer find the energy to engage in activities that were once enjoyable. This is the most common form of depression. In more severe depressions, one often observes a high degree of most symptoms, along with energy loss and a heaviness that makes even basic tasks challenging.
Another spectrum is how frequently one experiences depression. Someone struggling with depression may not feel these symptoms all the time; they can come and go. Perhaps they are particularly depressed for a few hours, days, or weeks at a time. Sometimes seemingly out of the blue, other times in connection with life challenges or internal struggles. Mild depressions will be characterized by more frequent good moments, while those more severely depressed rarely feel particularly well.
Many of those I meet in therapy have mild to moderate depression. However, the term "mild" should be taken with a grain of salt, as this is a psychiatric term to differentiate between patient groups and not mild in the traditional sense of the word. Some with mild depression are not just a bit down occasionally. For those with mild and moderate symptoms, it can take a long time before they seek help because they usually manage to tread water. It is usually during a particularly difficult period, where the symptoms are stronger and last longer than usual, that they gather the courage to seek help. If there is a long waiting time, they may recover sufficiently to decline when an offer to start treatment finally arrives. Such clients can go for many years or decades without help, if they ever receive it. They choose, in a way, to live with recurring issues rather than confront themselves and their depressive cycles. I believe there are many people who, for various reasons, deny themselves therapy, perhaps because they think they're not sick enough to benefit from it, or they don't want to admit they can use some help, or simply find it too difficult to show vulnerability and prefer to go through life with their lows. I find this very sad. My experience with depressed clients is that they are wonderful people who have become stuck. Many depressed individuals who undergo therapy with me discover that they have developed defense mechanisms that at some point in their lives had a positive function, but now lead to depressive symptoms. These are things that we can figure our together.
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How do you treat depression?
There are various ways to treat depression, and for most mild to moderate cases, talk therapy is usually the starting point. My opinion is that one should preferably not resort to antidepressants until at least two types of talk therapies (or therapists) have been attempted. This is because recent research suggests that the effectiveness of antidepressants may not be as significant as previously believed, and the long-term side effects may be underestimated. This doesn't mean that antidepressants should never be used, but they shouldn't be the first treatment attempted for most patients.
When I meet clients with depression, I first assess the specific depressive symptoms present, how long they have been there, whether the individual has experienced depression before, how often, and for how long, among other factors. Some individuals experience many small depressive periods throughout their lives, while others are facing their first real depression or haven't been depressed for many years. Part of the treatment involves developing the ability to have a fairly positive sense of oneself, to wish oneself well, and to help oneself instead of punishing oneself with unjustified shame and guilt. Another aspect involves allowing the feelings and reactions that arise in our daily lives. We often examine situations where the client's symptoms have become particularly evident. A typical example might be something happening at home or work, and afterward, the client feels extra tired, unmotivated, and irritated with themselves. In such cases, fatigue and irritation are seen as a defense mechanism against deeper and unconscious reactions. In other words, something happens that triggers unconscious feelings and reactions within us, but instead of acknowledging these reactions, we might, for example, feel tired, sad, and irritated with ourselves. Sometimes, clients need help in recognizing feelings that date back to something that happened a long time ago, like a sensitive wound lying beneath the surface. The client's and therapist's task is to increase the client's tolerance for these reactions so that the unconscious responses can be brought into awareness, felt, and expressed consciously.
In addition to working together on the emotions and reaction-patterns occurring in the client's life and in the therapy room, we often take a look at how the client is living their life. What is missing or needs to be strengthened for the client to feel loved, find life meaningful, and experience social belonging? Sometimes, clients need a little help in finding suitable challenges for themselves and a push to, for example, pursue a hobby, engage more in social relationships, and similar activities. For those who have become particularly isolated and inactive, the therapist and client work together to agree on a plan for activation, finding appropriate and tailored challenges to help the client get started.