Sadness

Sadness

When is sadness a more serious problem?

When it interferes with your ability to function, and continues for more than a couple of weeks, it's very likely depression, which is a common mood disorder.

There are many kinds of mood disorders, all of which include some aspect of a Major Depressive Episode or Manic Episode (see below for more). Some mood disorders, such as Dysthymic Disorder, affect people for a long period of time, often years. Other mood disorders only occur once or twice, and people don't even know they had a significant problem until later, if at all.

What is the actual definition of Clinical Depression?

When someone is depressed, that person has several symptoms nearly every day, all day, that last at least 2 weeks. You can use the chart to check ([X]) off any symptoms you have had for 2 weeks or more:

  • Loss of interest in things you used to enjoy, including sex
  • Feeling sad, blue, or down in the dumps
  • Feeling slowed down or feeling restless and unable to sit still
  • Feeling worthless or guilty
  • Changes in appetite or weight loss or gain
  • Thoughts of death or suicide; suicide attempts
  • Problems concentrating, thinking, remembering, or making decisions
  • Trouble sleeping or sleeping too much
  • Loss of energy or feeling tired all of the time

Other symptoms include:

  • Headaches
  • Other aches and pains
  • Digestive problems
  • Sexual problems
  • Feelings of pessimism or hopelessness
  • Being anxious or worried

If you have had five or more of these symptoms, including at least one of the first two symptoms listed, for at least 2 weeks, you may be struggling with Major Depressive Disorder, or a similar mood disorder that requires treatment. Now is the time to see your health care provider for a diagnosis.

If you have only some depressive symptoms, and are still having difficulty, you should also tell your health care provider. Sometimes a few symptoms can go on to become a more serious depressive disorder. Other forms of depression are milder, but persistent or chronic. Chronic symptoms of depression also need treatment.

So, depression is a very real and treatable disorder?

Depression is not just "feeling blue" or "down in the dumps." It is more than being sad or feeling grief after a loss. Depression is a medical disorder (just like diabetes, high blood pressure, or heart disease) that day after day affects your thoughts, feelings, physical health, and behaviors.

Depression may be caused by many things, including:

  • Family history and genetics.
  • Other general medical illnesses.
  • Certain medicines.
  • Drugs or alcohol.
  • Other psychiatric conditions.

Certain life conditions (such as extreme stress or grief), may bring on a depression or prevent a full recovery. In some people, depression occurs even when life is going well. Depression is not your fault. It is not a weakness. It is a medical illness. Depression is treatable.

How is depression typically treated?

There are two major ways to treat depression, and they work best together. The first is through the use of medication, many of which are quite effective - although there can be side effects, and lots of people don't feel comfortable taking medicine for extended periods of time. Starting a medication involves speaking with your primary care doctor or health care practitioner, or a psychiatrist (a medical doctor specializing in the treatment of mental illnesses). The second approach is through psychotherapy, which involves seeking out the root cause of the depression itself, changing the person's approach, and finding solutions. This is where Ward Halverson comes in.

What is therapy for depression?

Psychological treatment of depression is approached in various ways. First, supportive counseling helps ease the pain of depression, and addresses the feelings of hopelessness that accompany depression. Second, cognitive therapy changes the pessimistic ideas, unrealistic expectations, and overly critical self-evaluations that create depression and sustain it. Cognitive therapy helps the depressed person recognize which life problems are critical, and which are minor. It also helps him/her to develop positive life goals, and a more positive self-assessment. Third, problem solving therapy changes the areas of the person's life that are creating significant stress, and contributing to the depression. This may require behavioral therapy to develop better coping skills, or Interpersonal therapy, to assist in solving relationship problems.

Unfortunately, many poorly trained counselors never move beyond providing supportive counseling. This alone will not eliminate the depression. As a result, the depression, and the therapy, continues indefinitely, with little improvement. Supportive counseling "feels" helpful, and as part of the overall treatment plan does help. But, unless the depressed person makes critical life changes, the depression will continue. These changes are both internal and external. Internal changes are usually needed in problem assessment, self-evaluation, the evaluation of others, and the expectations the depressed person has for himself/herself, others and about life. External changes may be needed in problem solving skills, stress management, communication skills, life management skills, and the skills needed to develop and sustain relationships. Ward Halverson is a licensed, experienced psychotherapist - not just a supportive counselor, and he is quite focused clinically on helping people solve the deeper problems of the depression, not just feel better about themselves.

The length of treatment will vary, according to the severity of the depression, and the number and kind of life problems that need to be addressed. Most people will begin to experience some relief with 6 to 10 sessions, and approximately 70-80% of those treated notice significant improvement within 20-30 sessions. Mild depression may be treated in less sessions, and more significant depression may require extended treatment. Treatment sessions are usually scheduled once per week, although they may be scheduled more frequently initially, or if the person is experiencing significant life crises.

At first glance, this may seem like several different therapies being used to treat depression. However, all of these interventions are used as part of a cognitive treatment approach. Some psychologists use the phrase cognitive-behavioral therapy and others simply call this approach, cognitive therapy, or an offshoot of Solution-focused Therapy. In practice, both cognitive and behavioral techniques are used together.

Once upon a time, behavior therapy did not pay any attention to cognitions, such as perceptions, evaluations or expectations. Behavior therapy only studied behavior that could be observed and measured. But psychology is a science, studying human thoughts, emotions and behavior. Scientific research has found that perceptions, expectations, values, attitudes, personal evaluations of self and others, fears, desires, etc. are all human experiences that affect behavior. Also, our behavior, and the behavior of others, affects all of those cognitive experiences as well. Thus, cognitive and behavioral experiences are intertwined, and must be studied, changed or eliminated, as an interactive pair.

What about medication? Are they a good idea?

Except in the more severe depressions, and bipolar depression, medication is usually an option, rather than a necessity. Antidepressant medication does not cure depression; it only helps you to feel better by controlling or reducing certain symptoms. If you are depressed because of life problems, such as relationship conflicts, divorce, loss of a loved one, job pressures, financial crises, serious medical problems in yourself or a family member, legal problems, or problems with your children, taking a pill will not make those problems go away.

However, some symptoms of depression, such as sleep and appetite disturbances, significant concentration problems, and chronic fatigue, interfere with your ability to make the life changes necessary to eliminate the depression. In more serious depression, suicidal thoughts and urges, and preoccupation with death, may require medication in addition to psychotherapy. Antidepressant medication can help relieve those symptoms, and allow you to make needed life changes. The decision to take medication, in addition to participating in psychological treatment, should be discussed with your treating psychologist and your primary care physician. Your thoughts and feelings regarding medication, after considering information about both the benefits and risks involved, are an important part of a collaborative treatment approach between psychologist and patient. If medication is part of your treatment, either your primary care physician or a psychiatrist will supervise the medical part of your treatment, while you continue psychotherapy with a psychologist or psychotherapist. If you have a chronic medical condition or a serious illness, and you are taking medication for that condition, then the medical specialist treating that problem should be involved in your treatment. The medical specialist may supervise all of your medications, or coordinate the medical treatment with the physician providing the antidepressant medications.

Self-medication can be dangerous. Interpretation of both the signs and symptoms of depression, and identification of possible side effects, are jobs for the professional. The prescription and management of medication, in all cases, must be done by a responsible physician working closely with the patient, his/her psychologist, and sometimes the patient's family. This is the only way to ensure that the most effective use of medication is achieved with minimum risk of side effects or complications. Is medication for everyone?

Anyone can develop depression. But, treatment is effective in about 80% of identified cases, when treatment is provided. Psychotherapy and medication are the two primary treatment approaches. Antidepressant medications can make psychotherapy more effective, for some people. Someone who is too depressed to talk, for instance, can't get much benefit from psychotherapy or counseling; but often, the right medication will improve symptoms so that the person can respond better.

What are the major medications used to treat depression?

This list pairs the trade names of antidepressants, along with their generic names. Sometimes you can find additional information about a medication under its generic name that might not be listed under its trade name. This is good material to speak with your doctor or primary care specialist about, or to research on the Internet.

Antidepressant Medications

Trade Name

Generic Name

Adapin

doxepin

Anafranil

clomipramine

Asendin

amoxapine

Aventyl

nortriptyline

Desyrel

trazodone

Effexor

venlafaxine

Elavil

amitriptyline

Ludiomil

maprotiline

Luvox (SSRI)

fluvoxamine

Marplan (MAOI)

isocarboxazid

Nardil (MAOI)

phenelzine

Norpramin

desipramine

Pamelor

nortriptyline

Parnate (MAOI)      

tranylcypromine

Paxil (SSRI)

paroxetine

Pertofrane

desipramine

Prozac (SSRI)

fluoxetine

Remeron

mirtazapine

Serzone

nefazodone

Sinequan

doxepin

Surmontin

trimipramine

Tofranil

imipramine

Vivactil

protriptyline

Wellbutrin

bupropion

Zoloft (SSRI)

sertraline


Are there special considerations to consider about anti-depressant medication?

Children, the elderly, and pregnant and nursing women have special concerns and needs when taking psychotherapeutic medications. Some effects of medications on the growing body, the aging body, and the childbearing body are known, but much remains to be learned. Research in these areas is ongoing.

With children, studies consistently show that about 15 percent of the US population below age 18, or over 9 million children, have been diagnosed with a psychological problem that compromises their ability to function. In children, these disorders may present symptoms that are different or less clear-cut than the same disorders in adults. Younger children, especially, may not talk about what's bothering them, but this is sometimes a problem with older children as well. For this reason, having both a physician and specialized therapist evaluate the child is especially important.

There are many psychological treatments that can help children. These include psychotherapy, behavioral therapy, social skills training, parental and family therapy, group therapy and medications. The treatment, or combination of treatments, used for an individual child is based on the child's diagnosis and individual needs. When your child appears to have a psychological problem, it is very important to consult with a specialist to determine what should be done. If a decision is reached that a child should take medication, active monitoring by all caretakers (parents, teachers, others who have charge of the child) is essential. Children should be watched and questioned for side effects (many children, especially younger ones, do not volunteer information). They should also be monitored to see that they are actually taking the medication and taking the proper dosage.

What about medications and the elderly?

Persons over the age of 65 make up 12 percent of the population of the United States, yet they receive 30 percent of prescriptions filled. The elderly generally have more medical problems and often are taking medications for more than one of these problems. In addition, they tend to be more sensitive to medications. Even healthy older people eliminate some medications from the body more slowly than younger persons and therefore require a lower or less frequent dosage to maintain an effective level of medication.

The elderly may sometimes accidentally take too much of a medication because they forget that they have taken a dose and take another dose. The use of a 7-day pill box is especially helpful to an elderly person.

The elderly, their friends, relatives, and caretakers, need to watch for adverse (negative) physical and psychological responses to medication. Because the elderly often take more medications (prescribed, over-the-counter drugs, and home or natural remedies), the possibility of negative drug interactions is higher.

What about medications and pregnant, nursing, or childbearing-age women?

In general, during pregnancy, all medications (including psychotherapeutic medications) should be avoided where possible, and other methods of treatment should be tried.

A woman who is taking a psychotherapeutic medication and plans to become pregnant should discuss her plans with her doctor; if she discovers that she is pregnant, she should contact her doctor immediately. During early pregnancy, there is a possible risk of birth defects with some of these medications, and for this reason:

  • Lithium is not recommended during the first 3 months of pregnancy.
  • enzodiazepines are not recommended during the first 3 months of pregnancy.

The decision to use a psychotherapeutic medication should be made only after a careful discussion with the doctor concerning the risks and benefits to the woman and her baby. Small amounts of medication pass into the breast milk; this is a consideration for mothers who are planning to breast-feed. Also, a woman who is taking birth-control pills should be sure that her doctor is aware of this. The estrogen in these pills may alter the breakdown of medications by the body, and/or reducing their efficacy to relieve symptoms of anxiety.

For more information, speak with Ward Halverson directly, talk to your doctor or health care practitioner, consult your local public library, write to the pharmaceutical company that produces the medication, or contact:
US Food and Drug Administration
5600 Fishers Lane
Rockville, MD 20857

Overall, what are the treatment success rates?

Combining medication with psychotherapy, success rates are about 65%, generally within 10 treatment sessions.

Who gets depressed?

Major depressive disorder, often referred to as depression is a common illness that can affect anyone. About 1 in 20 Americans (over 11 million people) get depressed every year. Depression affects twice as many women as men.

What should I do if I have these symptoms?

Too often people do not get help for their depression because they don't recognize the symptoms, have trouble asking for help, blame themselves, or don't know that treatments are available. Family practitioners, clinics, or health maintenance organizations are often the first places that people go for help. These health care providers will:

  • Find out if there is a physical cause for your depression.
  • Treat the depression with medication, when approved by you.
  • Refer you to a mental health specialist for further evaluation and treatment.


If you do not have a regular health care provider, contact your local health department, community mental health clinic, or hospital. University medical centers also provide treatment for depression. Ward Halverson can be reached at (315) 868-1000.

How will treatment help me?

Treatment reduces the pain and suffering of depression. Successful treatment removes all of the symptoms of depression and returns you to your normal life. The earlier you get treatment for your depression, the sooner you will begin to feel better. As with other medical illnesses, the longer you have the depression before you seek treatment, the more difficult it can be to treat.

Most people who are treated for depression feel better and return to daily activities in several weeks. Because it takes several weeks for medication treatment to work fully, it is important to get treatment early before your depression gets worse.

As with any medical condition, you may have to try one or two treatments before finding the best one. It is important not to get discouraged if the first treatment does not work. In almost every case, there is a treatment for the depression that will work for you.

Again, the major treatments for depression are:

  • Antidepressant medicine
  • Psychotherapy
  • Antidepressant medicine combined with psychotherapy

In some cases of depression, other treatments, such as electroconvulsive therapy (ECT) and light therapy, are also useful.

Thoughts of suicide or death are often a part of depression. If you have these thoughts, tell someone you trust now. Ask them to help you find professional help right away. Once your depression is properly treated, these thoughts will go away.

Who should see a mental health specialist?

Many people with depression can be successfully treated by their general health care provider, often with informal counseling and the use of medication. This is a good short-term solution. However, some people need specialized treatment because the first treatment does not work, because they need a combination of treatments, or because the depression is severe or it lasts a long time. Many times, a second opinion or consultation is all that is needed. If the mental health specialist provides treatment, it is most often on an outpatient basis (not in the hospital, i.e. seeing Ward Halverson at his office in Herkimer). If you think you need to see a mental health specialist, tell your health care provider, or contact Ward Halverson directly at (315) 868-1000. Who treats depression?

The following health care providers all treat depression:

General Health Care Provider

  • Physician -- A medical health care provider who has some training in treating mental or psychiatric disorders.
  • Physician Assistant -- An individual with medical training and some training in treating mental or psychiatric disorders.
  • Nurse Practitioner -- A registered nurse (R.N.) with additional nursing training and some training in treating mental or psychiatric disorders.

The health care providers listed above can refer you to one of the health care providers specializing in mental health listed below:

Mental Health Specialists

  • Psychiatrist -- A physician who specializes in the diagnosis and treatment of mental or psychiatric disorders, and generally just uses medicine to help.
  • Psychologist -- A person with a doctoral degree (Ph.D. or Psy.D.) in psychology and training in counseling, psychotherapy, and psychological testing.
  • Social Worker -- A person with a degree in social work. A social worker with a master's degree often has specialized training in counseling.
  • Psychiatric Nurse Specialist -- A registered nurse (R.N.) usually with a master's degree in psychiatric nursing who specializes in treating mental or psychiatric disorders.

Is there another form of depression with periods of feeling "manic" as well?

Some people with depression have mood cycles. They have terrible "lows" (depression) and inappropriate "highs" (mania) that can last from several days to months. In between the highs and lows, they feel completely normal. This condition is called bipolar disorder and used to be known as manic-depressive disorder.

Bipolar disorder affects about 1 in 100 people. Just as eye or hair color are inherited, bipolar illness in most cases is inherited. It can also be caused by other general medical problems, such as head injury, or neurological or other general medical conditions.

You can use this list to learn the symptoms of mania and to check ([X]) off any you might have. "

  • Feeling unusually "high," euphoric, or irritable
  • Needing less sleep
  • Talking a lot or feeling that you can't stop talking
  • Being easily distracted
  • Having lots of ideas go through your head very quickly at one time
  • Doing things that feel good but have bad effects (spending too much money, excessive sexual activity, foolish business investments)
  • Having feelings of greatness
  • Making lots of plans for activities (at work, school, socially, or sexually) or feeling that you have to keep moving

If you have had four of these symptoms at one time for at least 1 week, including the first symptom, you may have experienced a manic episode. Tell your health care provider about these episodes. There are effective treatments for this form of depression as well.

What are the causes of depression?

Major depressive disorder is not caused by any one factor. It is probably caused by a combination of biological, genetic, psychological, and other factors. Certain life conditions (such as extreme stress or grief) may bring out a natural psychological or biological tendency toward depression. In some people, depression occurs even when life is going well.

Drinking too much alcohol or using drugs can sometimes cause depression. When drug and alcohol use is stopped, the depression usually goes away. Talk to your health care provider if you have a problem with drugs or alcohol. It can be treated.

Remember, major depressive disorder is not caused by personal weakness, laziness, or lack of will power. It is a medical illness that can be treated.

How is depression diagnosed by my health care provider?

Before depression can be treated, it must be accurately diagnosed. Your health care provider will:

  • Ask about your symptoms
  • Ask about your general health
  • Ask about your family history of general medical and mental disorders
  • Give you a physical examination
  • Conduct some basic laboratory tests.

What about hospitalization? Can that happen to me?

Most people with depression get their treatment through regular visits to a health care provider, therapist, or both. However, sometimes treatment in the hospital is needed. This is because other medical conditions could affect your treatment. Another reason is that people with severe depression may need hospital care (for example, to adjust medicine). Also, people who are at great risk for suicide are hospitalized until those feelings pass and treatment begins to work. If you must go to the hospital for treatment, it is often only for a few days or a week or two. Early treatment, before the depression becomes severe or chronic, can lower the chances of hospitalization.

Why is it so important that depression be treated?

Without treatment, a major depressive episode can last 6 to 12 months. In between the episodes, most people feel better or are completely well (without symptoms).

Even though some people are able to struggle through an episode of depression without treatment, most find that it is much easier to get some help for their pain and suffering. It is important to get treatment for your depression because:

  • Early treatment may help to keep the depression from becoming more severe, or chronic.
  • Thoughts of suicide are common in depression, and the risk of suicide is increased when patients are not treated and the depression recurs. When depression is successfully treated, the thoughts of suicide will go away.
  • Major depressive disorder usually comes in episodes lasting 6 to 12 months. In between the episodes most people feel better or are completely well (without symptoms)
  • Between episodes, about 1 out of 4 people with depression will still have some symptoms and trouble doing their daily activities. These people, if not treated, have a greater chance of having another episode of depression.
  • Treatment can prevent recurrences of depression. The more episodes of depression you have had, the greater the chance that you will have another. About half of the people who have one episode of depression will have a second. Without treatment, after two episodes, the chances of having a third episode (recurrent depression) are even greater. After three episodes, the chances of having a fourth are 90 percent.
  • Depression hurts loved ones - family members, siblings, partners, and spouses will be confused, frustrated, and frightened by the symptoms.

What should you do if you have concerns about the treatment?

If at any time you are worried about your treatment or you don't think that things are going well, tell someone about your concerns. You can:

  • Talk to your health care provider
  • Ask for a second opinion
  • Talk to someone you trust

Health care providers and mental health specialists are interested in your concerns and will help you. This may mean getting a second opinion or even finding another health care provider.

How do I talk to other about depression?

When people have major depressive disorder they often have difficulty at work, school, and with family. With treatment, almost everyone returns to their normal life. Some jobs (where the safety of others is involved) require that you report treatment for medical illnesses (including depression). You and your health care provider should talk about how and what to tell your supervisor, teacher, or friends.

Your Family and Friends: Ask your friends for their support, understanding, and patience during your depression. It may be helpful to talk to your friends about your feelings and treatment, and to spend time with friends in social activities. Keep the name and phone number of people that you can talk to and to ask to help you. Some people find it difficult, almost a burden, to interact with people during this time. If you feel this way, do whatever lifts your mood and makes you feel better. If you find yourself alone and unable to interact with others, tell your health care provider. Many people find that family members are very supportive and helpful, especially those who have received education about depression.

Your children: Parents often worry about whether depression is inherited. Most children of people with depression will not get this illness. Overall, research shows that only about 1 in 7 children with one parent who has had several episodes of major depressive disorder or bipolar disorder will develop major depressive disorder. Another 1 in 7 children with one parent who has bipolar disorder will develop bipolar disorder. If you have questions about your child's mental health talk to a health care provider.