Depression seems to be something different to everyone who dwells with it.
Let me help you stop dwelling with it.
I want to find out how you individually are experiencing depression, and then start collaborating to find the treatments that work best for you.
Sometimes its low energy and motivation. Other people sleep very little — or way too much. Some people are more irritable, short-tempered, or even agitated than sad. Some people gain or lose weight. The lengths of depressions vary by days, weeks, and months. I’ve had several clients say “oh I’m always down in the winter” — apparently never stopping to think this might be a problem (seasonal affective disorder – very treatable).
A lot of people don’t like the word depression. “I’m not depressed — I’m lonely” (or “misunderstood”, or “grieving”, or “just tired”, or “unmotivated”).
Ultimately the label we stick on feelings and conditions is only useful if its one that’s meaningful to us. If we want a condition assigned to us because then we are relieved to know what’s wrong and that counseling knows how to treat it, then a diagnosis of major depressive disorder is welcome. If we are afraid or embarrassed or angry to have a “mental health condition” — or just feel that depression is a normal part of life and resent everything being pathologized — then we have any number of alternatives to describe ourselves (“misunderstood”, “lonely” etc. as above).
I rarely care what label we do or do not give something as long as we identify the symptoms you personally experience and find effective ways to address them.
For the sake of completeness, here’s the list of common depression symptoms listed in the diagnostic manual that most counselors refer to (there are others). Depression is characterized by having most of these symptoms most days for at least two weeks. There are various exceptions and rule-outs for other conditions:
- Depressed mood. Could feel empty, sad, or irritable. May be tearful or cry easily. Oddly enough, actually feeling sad is not an absolute requirement of depression.
- Loss of interest and pleasure in most activities, even some that are favorites.
- Large weight gain or weight loss (when not dieting)
- Trouble sleeping or sleeping too much most days. Sleep pattern changes such as sleeping all day and staying up all night.
- Agitated or sluggish movements. Trouble relaxing for long periods of time.
- Low dragging energy. Feeling tired.
- Feeling inappropriately or excessively guilty. Feeling worthless.
- Sluggish fuzzy thinking. Trouble concentrating or making decisions. Memory impairment.
- Reoccurring thoughts about death, and/or thoughts about suicide (with or without an actual plan or intention to follow-through).
Here are some of the ways that my clients and I typically work on the symptoms labeled as depression. I started to put these techniques under the labels of Mind, Body, & Soul (to emphasize my holistic orientation) but several of them fit many categories so I’m just listing them.
Our Relationship — A lot of counselors’ only technique is the relationship itself. I reject this as the only approach — I have specific tools (methods, theories, books, cards, exercises, etc.) that address specific symptoms. But its just critically important that we connect. That I can hold a safe and comfortable space for you. I have many clients who just need someone to listen, care, and bounce ideas off of. I believe in respecting my client’s choices and background, and mutual collaboration towards goals. Knowing you are not alone can help depression.
Pacing of Treatment — There are a number of techniques we can try together listed on this page. They can seem overwhelming. It’s important to move at the correct pace, slowly helping someone who is depressed regain hope. Sometimes just showing up at therapy is enough effort to start.
Cognitive-Behavioral Therapy — Refers to how thoughts effect feelings. Thoughts are tools. Most people don’t think of them this way and view thoughts as uncontrollable things that fill their heads. This is not true. The thoughts you choose to have influence how you feel about yourself and the world. My clients and I often work through several methods of changing thought patterns to ones that are more useful and true. With some clients I use workbooks and charts. Others prefer to just talk and then watch their thoughts informally and report back experiences.
Meditation — I use this tool more often with anxiety — but anxiety, stress, and depression are so closely intermingled that these are worth listing here. Meditation is about focusing on the here & now and about feeling a sense of peaceful connection — both to yourself and to the greater world and universe beyond. Its also about training the “monkey mind” (that part of your mind always looking for the next problem to chatter about) to quiet down. Indeed, its partly about just realizing that you can train your mind to stop and redirect (which short-circuits depressive and anxious thoughts). Depression tends to focus sadly on the past. Anxiety has a worried future focus. Changing both the thought patterns and the time focus with meditation can be very powerful.
Body-Oriented Approaches — I frequently urge my clients to take a look at more physical factors like exercise, sleep, medication, herbalism, nutrition, and vitamin supplements. Frequently I give referrals to other medical professionals with expert credentials in these areas (I’m the talk therapy guy). Exercise early in the morning has research showing its beneficial effects on depression. Helping clients return to a regular sleep pattern has frequently helped stabilize their moods. Nutrition and herbs can play a huge role in depression (and most other problems). Not everyone needs to do everything on this list. I am not anti-psych meds although I am holistic in my approach. Some people need anti-depressants or anti-anxiety medication. I think talk therapy is critical in making the positive changes in mood stick. I think alternative approaches to medication should be seriously considered whenever possible. I often work with clients who which to avoid medication and try other routes instead.
Meaning, Purpose, and Spirituality — These are just critical in the treatment of both depression and anxiety. When people’s live are out of synch with what is meaningful to them, they get depressed at their lack of connection to purpose. They get anxious that they are not completing their life’s work. Some of my clients are highly religious (I work with all religions) and we talk about how they can get reconnected with the best aspects of their religion. Other clients are spiritual rather than religious and we work to reconnect them in appropriate ways. A simple example would be someone who feels spiritually connected to nature yet has stopped taking weekly walks by the river. (You can guess what their homework assignment might be!) An agnostic or atheist might find meaning through helping people, researching family genealogy, doing their best quality work, painting, or any number of other possibilities. My clients and I work hard using specific tools to figure out what feels right to the client.
Social Relationships — Depressed people are often socially isolated. We’ll work on ways to connect you up with a supportive network of friends and family (as appropriate).
Full-blown depression is very treatable. So are the component symptoms of it. Please email or call so I can help.