Problems that Usually Need Psychotherapy or Psychiatry Treatment


Depression is a feeling similar to sadness, but it does not have to be related to an event that would make someone feel sad. Depression can also be experienced as a feeling of emptiness. It usually comes with a loss of motivation and energy to do things, and a lack of interest in things that are usually enjoyable or fun. Crying or feeling like crying is common with depression, as are feelings of hopelessness, low self-esteem, and guilt. In more severe cases people can have changes in their sleep patterns (including sleeping too much or unable to sleep), physical agitation (feeling irritable or cranky, difficulty sitting still), loss of interest in and capacity for sex, changes in eating (eating much more or much less than normal), and suicidal thoughts. The intensity of depression can range from unpleasant to extremely painful, and in the worst cases can be so painful that people kill themselves.

Severe depression is a serious medical problem that requires professional care, and treatment is often very successful. Unfortunately, the feelings of hopelessness can often make sufferers think that help for their condition is impossible. This is wrong, and if you or a loved one suffers from depression, it is important to recognize that this hopelessness is actually part of the illness, and it does respond well to treatment. You or your loved one should deal with depression the same way you would deal with chest pain or a broken leg:  see a doctor, and get it fixed.

There are two main types of depression. The first is chronic, mild-to-moderate depression. It often starts at an early age and either continues or comes back over and over throughout life if not treated.  This used to be called dysthymia, and is now considered a milder form of Persistent Depressive Disorder. It is quite common, and psychotherapy can be very helpful since this kind of depression is often related to early life experiences and the emotional reactions that came with these experiences. Medication may also be helpful.

The second type is very severe depression, which often appears suddenly, that can happen once or several times throughout life. This is called a Major Depressive Episode, or Major Depression. This type is more likely to have physical symptoms, such as changes in eating, sleeping, and sexual interest and performance. Loss of appetite and weight loss are common with Major Depression, as well as severe problems staying asleep (insomnia) or wanting to sleep too much (hypersomnia), and a loss of sex drive. Significant anxiety is often also a problem, as well as a lack of energy or interest in doing things and physical agitation (difficulty staying still and calm).

The emotional pain from this type of depression can be very intense, and suicidal thoughts and impulses often occur as a result of this pain and a lack of hope that things can get better. If someone suffering from depression is actively suicidal and has the intent or a plan to commit suicide, then hospitalization is recommended. Severe major depression may also cause auditory hallucinations, which are experienced as hearing voices talking when no one is there. These auditory hallucinations (hearing voices) are hostile or rude, often critical of the person hearing them, and at times give commands to harm oneself or others.   Such hallucinations are usually a symptom of very severe depression, and not schizophrenia.

Major depressive episodes generally should be treated with psychiatric medication, such as anti-depressants, and possibly with other medications such as tranquilizers or sleep aids. Psychotherapy may also be helpful, but medication is key. Major depressive episodes are quite different from chronic, mild-to-moderate depression, and usually involve a chemical imbalance of some kind that psychotherapy alone is unlikely to resolve.

Although both Major Depressive episodes and Persistent Depressive Disorder are most often a result of life experiences, brain chemistry imbalances, or both, occasionally these symptoms are caused by other disorders. In addition to Bipolar Disorder and Seasonal Affective Disorder, discussed below, depressive symptoms can also be caused by medications, nutritional deficiencies, and hormonal disorders. One of the more common hormonal causes of depressive symptoms is hypothyroidism (underactive thyroid), which is when the thyroid does not produce enough hormones. Common symptoms of hypothyroidism include dry/brittle hair and nails, hair loss, fatigue and increased need for sleep, weight gain, and cold intolerance. If you are feeling depressed you see may want to see a medical doctor before consulting with a psychiatrist or psychotherapist, and discuss all your physical and emotional symptoms, as well as all medications/supplements you are taking (both prescription and over the counter) to rule out all other causes of your symptoms.

Some other types of depression deserve mention. People suffering from bipolar disorder very often experience depression similar to that of major depression. The difference is that they also experience periods of unusually elevated mood as well. This is best treated with psychiatric medication and psychiatrists are trained to know the difference between major depression and bipolar disorder, and to treat accordingly.  Please see the section on Bipolar Disorder for more information. In addition, Grief due to the loss of a loved one or romantic relationship can feel much like depression. However, grief usually feels less intense over time, but if the grief has not improved significantly within 6 months of the loss, it may have turned into major depression. In that case, one should seek treatment.

Another form of depression that is common, especially in northern states and countries, is Seasonal Affective Disorder or SAD, sometimes called winter depression. This is a lowering of mood and energy level during the winter months, caused by a lack of sunlight stimulating the eyes. It can be treated effectively by phototherapy, or exposure to strong, full-spectrum light that imitates sunlight, since there is much less natural sunlight during the shorter daylight hours in winter. You can treat condition this at home or work with phototherapy by buying a lightbox, which is a lamp specifically designed to produce the full-spectrum light to treat SAD. Type the words “lightbox for depression” into your favorite search engine (e.g. google, yahoo) and you will get a list of stores and organizations that provide information and have lights available for purchase. Even those who are just more tired and lethargic in the winter can benefit from this. I borrowed a lightbox to show it to patients, and my own energy level went up so much that my wife ran out and bought me one!

Thomas B. Hollenbach, Ph.D.

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