A Guide to Depression Counseling
There’s only one mental health condition that can seem to reduce all the wonderful, rich, complex things that make up you and your life to a singular agony, and that’s major depression. According to the National Institute of Mental Health (NIMH), almost 20 million U.S. adults experience at least one episode of major depression each year. Depression affects all ages, genders, races, nationalities, and socioeconomic classes. It can hit once out of the blue, appear intermittently, or last a lifetime if untreated. And it can be devastating, sometimes impairing one’s ability to perform the basic functions of life.
But the good news is that major depressive disorder (MDD) is highly treatable and can usually resolve within months. The vast majority of people with depression will experience a full recovery. If you’re reading this and you feel hopeless, remember: You can learn to manage, overcome, and prevent depressive episodes with the compassionate support and expertise of a mental health professional.
What Are the Types of Depression?
Many forms of depression have overlapping symptoms. But certain treatment approaches are better suited for different subtypes of mood disorder, so an accurate diagnosis still matters.
- Mild depression
- Major depressive disorder (MDD)
- Bipolar disorder (manic depression)
- Bipolar II disorder
- Cyclothymic disorder
- Postpartum depression (PPD) or perinatal depression (PND)
- Persistent depressive disorder (PDD) or dysthymia
- Premenstrual dysphoric disorder (PMDD)
- Situational depression
- Psychotic depression
- Atypical depression
- Seasonal affective disorder (SAD)
What Causes Depression?
Depressed emotions can be a normal, adaptive human response to stress and suffering. But when a low mood becomes persistent, extreme, and dysregulated, major depressive disorder might be to blame. Neuroscientists, psychologists, and psychiatrists are still trying to understand all the nuances of this mental health condition, but they have identified the following risk factors that may contribute to depression:
- Genetics. A family history of depression is like a family history of alcoholism or heart disease: It’s a warning to take care of yourself and to avoid physical and emotional triggers.
- Neurochemistry. Depression is associated with neurochemical imbalances and changes in neurocircuitry, which can often be addressed through medications like selective serotonin reuptake inhibitors (SSRIs).
- Chronodisruption. Depression is associated with circadian rhythm and sleep disturbances. Chronotherapies like bright light therapy and advanced sleep phase therapy have been shown to improve the mood of people suffering from various types of depression.
- Temperament and personality. Depression is associated with negative affectivity (NA), which pertains to poor self-perception and how you experience negative emotions. People with high levels of NA appear more likely to develop depressive episodes in response to stressful life events. Neuroticism is also a personality characteristic associated with depression.
- Environment. Adverse events, major life changes, and stressful situations can play a significant role in the development of major depressive episodes. A childhood trauma, the loss of a loved one, or a troublesome work atmosphere are just a few examples of environmental stressors that may lead to the experience of depression.
- Other major mental health disorders. Nearly all of the big, non-mood-related mental health disorders increase the risk of depression. Anxiety, substance abuse, and borderline personality disorders are potential course modifiers that can lead to major depressive symptoms, as are chronic or debilitating medical issues. Depression is known for having multiple comorbidities (overlapping disorders). This can sometimes make it difficult to identify the right types of treatment.
What Is Major Depressive Disorder?
Major depressive disorder, also called clinical depression or simply depression, is a mood disorder characterized by intense, enduring feelings of sadness (negative affect) lasting longer than two weeks. MDD can interfere with daily life, severely affecting everything from relationships to employment to personal goals. It’s an incredibly common disorder, affecting about 280 million people globally, but it can still be a debilitating mental illness. Most mental health professionals have extensive training in diagnosing, treating, and helping to prevent major depression.
What Are the Symptoms of Depression?
Like many psychiatric conditions, a diagnosis of major depressive disorder (MDD) is based on the presentation of symptoms. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists nine symptoms of MDD. At least five of them must be present within the same two-week period to meet the criteria for diagnosis. In addition, to be diagnosed with depression, the individual must exhibit an observable change in daily functioning, and the depression symptoms can’t be caused by another medical condition or substance.
Here are the symptoms of MDD as outlined in the DSM:
- A depressed mood (e.g., feelings of sadness, emptiness, and/or hopelessness) most of the day, nearly every day, as indicated by either subjective report or observation from others (e.g., the person appears tearful).
- Changes in appetite, often leading to unintentional weight loss or gain (e.g., the person’s body weight changes more than 5% in a month).
- Insomnia, hypersomnia, or other sleep disturbances nearly every day.
- Loss of interest or pleasure in all or most activities throughout the day (anhedonia), nearly every day, as indicated by subjective or objective accounts.
- Psychomotor retardation (slowed-down movements and thoughts) or agitation (sped-up or restless actions).
- Extreme fatigue or loss of energy nearly every day.
- Feelings of worthlessness or excessive/inappropriate guilt (which may be delusional) nearly every day.
- Diminished ability to think, concentrate, or make decisions nearly every day.
- Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation about a specific plan, or a suicide attempt or a specific plan for committing suicide. If you are experiencing suicidal thoughts, please call 911 or visit the nearest emergency room.
People with depression may also experience irritability (more common in men), hallucinations, memory problems, changes in libido, as well as physical aches or chronic pain. Social isolation and substance abuse can sometimes indicate depression as well, as people struggle to cope with their distress in the best ways they know how. Mental health professionals can explore all these symptoms and their potential causes in the safe, nonjudgmental environment of therapy.
What Is the Outlook for People with Major Depression?
Major depression can lead to negative outcomes in life, but the outlook is highly favorable for people who receive depression treatment, especially for those who seek intervention early in the course of their illness. The longer you leave cases of depression untreated, the more likely they are to interfere with your work or schooling, your relationships, and your goals. Untreated depression can also lead to compounded life problems as people may try to avoid their distress through drugs, alcohol, or isolation. Untreated depression is also associated with a variety of medical problems such as acute coronary syndrome.
How Can Counseling Help Depression?
Professional counseling can help depressed people take control of their symptoms and get back on track to achieving their goals. Skilled counselors take the whole person into account, not just the diagnosis of depression. That means that mental health providers treat your mood experience as unique instead of taking a one-size-fits-all approach to therapy.
In your first counseling sessions, your provider may want to discuss the following elements to get a better sense of your struggle and how they can help:
- Your specific depression symptoms
- Your and your family’s medical history
- Potential causes of your depression
- Your psychosocial environment
- Lifestyle factors (nutrition and exercise habits)
- Your needs and goals for treatment
This comprehensive therapeutic assessment may not take place all at once, especially when clients are in acute distress, but it’s important for your provider to gather as much information as possible over time. This can help a counselor develop an effective treatment plan that’s personalized around your needs. Providers utilize a number of evidence-based treatment options to help their clients live happier, healthier lives. Recovery might include weekly sessions with a therapist, monthly follow-up sessions with a psychiatrist, or support as needed if episodes reoccur. It all depends on what’s best for the individual.
Which Form of Therapy Is Most Effective for Major Depression?
The form of therapy that will be most effective for treating depression always depends on the client. That being said, there are numerous, evidence-based approaches to the treatment of mood disorders. These modalities can be used by themselves or in tandem.
- Psychotherapy (an umbrella term for any talk therapy approach)
- Cognitive behavioral therapy (CBT)
- Psychiatric medication like antidepressants
- Dialectical behavioral therapy (DBT)
- Acceptance and commitment therapy (ACT)
- Lifestyle interventions addressing nutrition, nature, and exercise
- Gratitude practices
- Art/creative therapy
- Self-care and self-compassion
- Solution-focused therapy (SFT)
- Trauma therapy
- Family therapy or couples counseling
- Eye movement desensitization and reprocessing (EMDR)
- Light therapy
- Person-centered psychotherapy (talk therapy)
- Strength-based approaches
- Psychosocial interventions to find community support for the depressed person