Depression can be a confusing and scary experience. One can look fine, with no outward appearance of any problem, yet may be unable to do the most routine and simple chores. Approximately 20% of the U.S. population (15 million people) develop depression every year. It is one of the most common mental health problems Americans face. Depression is also considered the leading cause of alcoholism, drug abuse and other addictions.Though depression appears to strike across all racial and ethnic boundaries, women suffer from it twice as often as men. Depression is second only to heart disease in causing lost work days in America. The stigma of depression can cause almost as much suffering as the illness itself.

It is important to remember is that depression is an illness, just like any other. It is not something one just "snaps out of" and it is not a personal weakness. Like many illnesses, it requires treatment and, about 80% of the time, will be resolved.

I work primarily with people experiencing depression related to an Adjustment Disorder. Adjustment disorders are defined as follows;
A. A reaction to an identifiable psycho social stressor (or multiple stressors) that occurs within three months of onset of the stressor(s).
B. The maladaptive nature of the reaction is indicated by either of the following:
      1. impairment in occupational (including school) functioning or in usual social activities or relationships with others.
      2. symptoms that are in excess of a normal and expectable reaction to the stressor(s).
C. The disturbance is not merely one instance of a pattern of overreaction to stress or an exacerbation of one of the mental disorders previously described (throughout the DSM).
D. The maladaptive reaction has persisted for no longer than six months.
E. The disturbance does not meet criteria for any specific mental disorder and does nor represent Uncomplicated Bereavement.

In most cases, my clients can point to some incident or condition which they believe is responsible for their depression. The actual life events that occur in connection with depression vary, but there appears to be one consistent feature that seems to occur repeatedly in many cases: loss of self-determination and self-esteem. This often includes diminished abilities or activities that a person identifies as an integral part of who they are. In other words a life transition, often caused by events beyond one's control, damages the structure that gave life meaning.

The ability of a person to respond to such an event will depend on many factors, including genetic predisposition, support from friends and family, physical health, even the weather. It can also depend on internal psychological factors which may best be explored in counseling.

The important thing to remember is that you are not alone and there is effective help readily available. After evaluating the extent and kind of depression a client is experiencing, effective treatment can be established.

My approach to adjustment related depression is bi-modal. We work on the causes of the depression while attacking symptoms behaviorally. If the depression is severe, consultation with a psychiatrist is retained to further evaluate the depression and for medication. There are many new and effective anti-depressants available and with competent evaluation and treatment, this can substantially reduce symptoms while counseling proceeds.

It is important to address the shame and guilt associated with depression while attempting to build new coping mechanisms. Reading and other homework is assigned with this purpose in mind. "The Depression Workbook" by Mary Ellen Copeland, M.S. is a great adjunct to counseling and gives clients something tangible to refer to in between sessions. Journaling is another effective tool that allows one to chronicle their improvements and vent feelings. Finding ways to do the very things the depression is preventing someone from doing is paramount. We accomplish this in small, structured steps utilizing any and all available resources. Significant others are educated as to the nature of their loved one's illness and appropriate ways of providing support are discussed. Ways of coping with a loved one's depression is also an important part of the over-all treatment. Those living with and having consistent contact with someone who's depressed requires special skills and support as well.

Causal factors would continue to be addressed in therapy sessions and may involve family of origin, self-esteem, relationship and career issues.

Below is a list of other assignments I have found effective in treating someone with adjustment related depression. They are designed to help a person regain a sense of control and accomplishment as their counseling proceeds.

* Make a list of all the coping skills you wish to utilize and ways to implement them. This can be done in therapy and creates an instant resource when you feel stuck or immobilized.

* Get Up! One of the hardest things to do when you're depressed is to motivate yourself to do the things you know will help you. Bargain with yourself to do small, manageable activities then reward yourself with rest or a nurturing activity. This establishes continuity, increases feelings of hope and helps to keep from feeling overwhelmed.

* Break tasks and activities down into small, more easily achievable parts. Even though its frustrating to feel you can't just get up and do things the way you used to, its extremely important to forgive yourself for that and do what you can.

* Nurture Yourself! Baths, Good Music, Rest, Good Food, Inspirational and Funny Reading, Movies and TV, Good Company, Beautiful Surroundings, Small Gifts To Yourself, Flowers and anything else, within reason, that enriches and comforts you will help to ease symptoms.

* Affirmations. Because depression can lower self-esteem and generate negative thinking, create a list of positive things about yourself and you life and read through it several times a day. Make sure you add to the list that this is a temporary condition, that things will get better and that you have the power to positively impact the ultimate outcome of this problem.

* Forgive Yourself. Your depression is not your fault, anymore than if you had diabetes or broke your leg. Its very frustrating to be depressed and its hard not to feel guilty about it. This is unproductive thinking and will worsen symptoms and lengthen recovery.

* Thought-Stopping. In counseling, discuss ways to block negative thinking and transition to positive thoughts and activities. It takes practice, but can be very effective at reducing shame and hopelessness.

* Do not make any major life decisions when you're depressed. Negative thinking and hopelessness will cloud you're judgment and can lead to decisions that make a difficult situation even worse.

In conjunction with psychotherapy and/or anti-depressant medication, adjustment related depression can be managed and, in most cases, conquered. It takes time, professional help and effort on your part just like anything else important in one's life. Don't give up! Don't isolate yourself and access the resources necessary to overcome your depression. You may come out of it feeling stronger, with more insight and better coping skills than you had before. We must try to see all aspects of our lives, even the negative ones, as opportunities to learn, grow and improve ourselves.

For more information about depression, check out the Resources and Books pages, contact a mental health provider in your area or contact the
National Depressive and Manic-Depressive Association
NDMDA, 730 N. Franklin, #501, Chicago, IL 60610.
Call 800-826-3632 or (312)642-0049; FAX:(312)642-7243.
Online Contact: http://www.ndmda.org/

Article Updated 1/18/01