Depression

Dynamics of Depression

Depression is psychologically rooted in loss. Some losses are tangible, like losing friends, family members, or a job. Others are internal, like losing a sense of direction or self-regard. Self-esteem injuries are one of the most common causes of depression. Feeling rejected or abandoned is another. Some depressions reflects an anger turned inward. When this is the case, a person become self-attacking, self-critical, and sometimes self-destructive. 

Although often due to external events, sometimes depression doesn't appear connected to anything going on in a person's life. This is called endogenous depression, which is believed to be biological, and might be especially responsive to medication. Some people have a more persistent, chronic depression, called dysthymia, which is tied to personality. Another type of depression, agitated depression, describes a condition in which a person is depressed, but also paradoxically activated. They are irritable, restless, unable to sleep, sometimes with racing thoughts. This is a dangerous state to be in because it increases impulsivity and can lead a person to act on self-destructive thoughts.

Treatment for Depression

• Psychodynamic therapy, cognitive-behavioral therapy (CBT), interpersonal psychotherapy (IPT), and acceptance and commitment therapy (ACT) are about equally effective in treating depression. Research indicates mindfulness-based cognitive therapy (MBCT) might be especially helpful for recurring depression. 

• There are many medications for depression, including SSRIs, SNRIs, and atypical antidepressants like Wellbutrin. Sometimes medications like Abilify are prescribed alongside an antidepressant to augment its effectiveness.

• Research indicates combining psychotherapy and medication can yield the most benefit.

• Transcranial magnetic stimulation (TMS) is a newer treatment, with minimal risks or side effects. Electroconvulsive therapy (ECT) is very effective, especially for agitated depression or depression with psychotic features.

• Exercise improves depression. Research indicates it's probably as effective as medication for mild to moderate depression.

• When people have vegetative symptoms, like trouble sleeping, loss of appetite, or psychomotor slowing, medication might be especially helpful.

• When depression is chronic, like in dysthymia, and looks to be personality-based, psychotherapy is the treatment of choice.