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Etan Ben-Ami, LCSW
Caring, effective, short-term psychotherapy for Depression
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34 Atlantic Avenue, Suite 202
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(516) 880-4173
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Lynbrook, NY 11563
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etan.benami@gmail.com
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Depression:
it's more than the blues.
Depression comes in different colors and flavors. It can occur
in reaction to major life events, physical changes, or for no apparent
reason at all. Depression is often combined with anxiety, and the
anxiety symptoms can predominate. In fact, you can be severely
depressed without any feeling of sadness at all.
So how do you know whether your problem is depression? The best
advice is to let a trained therapist make the diagnosis. Self-diagnosis
is never 100% accurate. That said, here is a list of the most common
types of depressive disorders and their symptoms.
Major Depressive Disorder (MDD) is the most commonly
diagnosed form of depression. To be diagnosed, a patient needs to
have either (1) a notably sad mood, or (2) a loss of interest or ability to
feel pleasure from all or nearly all things previously enjoyed. These
symptoms have to persist most of the day, nearly every day, for at
least two weeks. In children and adolescents, irritability can substitute
for sadness, but it must be a marked change from normal.
In addition to those emotional symptoms, a patient must have four or
more symptoms from the following list, during the same time period.
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a significant gain or loss of body weight not related to dieting
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insomnia or hypersomnia (excessive sleep)
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observable restlessness or being slowed down
(eg slowed reactions, slowed pace)
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fatigue or loss of energy, most of the day, nearly every day
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feelings of worthlessness or inappropriate guilt
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problems thinking, concentrating, or making decisions
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recurring thoughts or feelings about death, or an actual
suicide attempt
There are other criteria that distinguish major depressive disorder
from reactions to drugs, illness, or bereavement. If you have even a
partial match to these criteria, you should seek help now.
Treatment works.
Seasonal Affective Disorder (SAD)
is a type of major depression (see above)
that follows a seasonal pattern. Usually people get this problem when
the days shorten in the fall or winter and recover in the spring.
However, even with a seasonal pattern, treatment helps greatly.
Post Partum Depression is a type of major depression
(see above) that
begins shortly after a woman gives birth to a child. Though it begins
with a hormonal change, it can worsen and persist for many months.
Dysthymia is similar to Major Depressive Disorder. The
difference is that dysthymia is chronic and less severe. To be
diagnosed with dysthymia, a patient must have a depressed mood
most of the day, most days for at least two years. In children,
irritability can substitute, and the required period is one year.
During this time period at least two of the following symptoms must be
present.
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poor appetite or overeating
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insomnia or hypersomnia (excessive sleep)
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poor concentration or difficulty making decisions
During the two-year period (1 year for kids) many patients have ups
and downs. To be diagnosed with dysthymia a patient's longest
symptom-free, 'up' time, cannot be longer than two continuous months.
Also, the patient must not have met criteria for Major Depression
during the first two years.
Bereavement can be very similar to Major Depressive
Disorder. In response to the death of a loved one, severe grief is
considered 'normal' for at least two months. Still, patients
come in seeking help for symptoms, especially if they believe that a
only a short mourning period is allowed or that their grief is excessive.
A well-trained therapist can distinguish between grief and depression,
and can help a mourner cope with his or her reactions.
Adjustment Disorder occurs in response to a stressful
situation, such as job loss, financial problems, divorce, or illness.
To meet this diagnosis, the symptoms of depression must either be
out of proportion to the source of stress or cause a major decline in
the person's ability to function. The loss of ability to function can either
be at work or in the person's role as a family member or socially.
This can become a chronic problem if the source of stress continues
and the person continues to be unable to cope.
Adjustment Disorder is not diagnosed if the person's symptoms are
severe enough to qualify for Major Depressive Disorder, Dysthymia,
or Bereavement (see above).
Only a trained professional can truly distinguish between these
disorders. If you are feeling suicidal or having thoughts of
suicide, GET HELP NOW.
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Short-term Therapy for Depression
Depression robs you of your energy and your ability to function. Your
enjoyment of life can be all but nonexistent and you can become
isolated from the people who care about you the most. Your
self-esteem drops into a pit and you feel that there are no solutions to
your problems. If you are going through this, remember:
short-term treatment for depression works. Effective treatment
usually takes less than six months.
Major Depressive Disorder (MDD):
MDD can be a vicious cycle. You feel awful, and as a result, you tend to
do little and isolate yourself. This makes you feel worse, resulting in even
less activity and further isolation (either real or emotional).
Cognitive-Behavioral Therapy (CBT) addresses these problems by
breaking the cycle. On the behavioral side, I give my patients homework
using a number of clinically proven interventions to increase their activity,
their sense of competence, and to make them more aware of the small
pleasures they can still feel.
On the cognitive (thinking) side of things, we work to discover how their
thinking patterns reinforce their sense of helplessness and hopelessness.
These patterns of thinking can be actively countered and changed,
again using tried and proven interventions.
In repeated clinical trials, CBT has been shown to be as effective as
medication, in the same amount of time, without any of the side effects.
Better yet, patients who receive cognitive behavioral therapy have been
proven to have a lower relapse rate than patients who receive medication
in six-month follow up studies.
That said, some will require medication to get better. These are usually
people who are too depressed to handle CBT when they start treatment.
The combination of CBT plus medication is very effective.
Many patients experience anxiety in addition to their depressive symptoms.
Sometimes their anxiety triggers their depression. In these cases, I usually
have to make a judgment call about how to integrate the two types of
treatment. Therapy is usually still short-term, but may take a bit longer.
You should also know that some patients experience depression as a
worsening of a long-term dysthymia. Treatment takes longer. See below
for my section on dysthymia.
Seasonal Affective Disorder (SAD) seems to be triggered by
reduced exposure to sunlight and activity during the winter. If you've ever
felt a bit down on a gloomy day, just imagine the same feeling becoming
more intense each day through the season.
I usually treat SAD with a combination of light therapy, exercise,
increased social or family activity and the same Cognitive Behavioral
Therapy (CBT) interventions used for non-seasonal Major Depressive
Disorder.
Rarely, in the most severe cases, patients may be referred for
medication. SAD is much easier to treat if a patient recognizes their
problem and comes in before it becomes too severe.
Post-Partum Depression: is triggered by hormonal changes.
However, these hormonal effects should end in a few weeks, at most.
It truly becomes a form of Major Depression when the depressive cycle
takes over. Post-Partum Depression is treated just like Major Depressive
Disorder, using Cognitive Behavioral Therapy (CBT). Patients may also
be sent to their Ob/Gyn doctor to check that there are no ongoing
hormonal problems, requiring medical treatment. Treatment is almost
always on the shorter side of short-term (eg 15 weeks).
Dysthymia is the toughest problem I treat within the depressive
spectrum of disorders. It often points to a lifelong pattern of negative
thinking about self, others, and the world.
My approach to dysthymia has two parts. First, I work with the patient to
alleviate their worst symptoms and prove that there is real hope for
getting better. We then work to uncover the patterns of thinking that lead
to a dysthymic outlook on life. These are almost always learned in
childhood, as a result of exposure to difficult (but often not extraordinary
events) that have been understood and interpreted from the perspective
of a child.
I use a combination of Beck's therapy for distorted core beliefs and Young's
Schema Therapy to address these problems. Therapy often takes more
than six months when the problem is dysthymia. However, most patients
begin to get significant relief after a short-term (six month) period.
Patients with dysthymia are also likely to have a combination of problems,
particularly anxiety or recurrent depression with periods of dysthymia in
between. The initial anxiety or depression is treated first, then the
dysthymia.
Patients with dysthymia usually experience few, if any physical symptoms
such as changes in appetite, sleep, energy, or concentration. As a result,
medication is usually not very effective in treating dysthymia.
Bereavement is almost always treated on a short-term basis.
Normal grief is self-limiting. We never completely get over the deaths of
those we love the most, but we learn to cope with the loss. Therapy is
usually supportive, stressing the normal grieving process and addressing
depressive symptoms with brief Cognitive Behavioral Therapy (CBT)
interventions.
Adjustment Disorder can be simple or complex to treat. It all
depends on the nature of the cause. I help people learn how to cope
better with stress, using techniques like breathing exercises, visualizations,
meditation, and thinking exercises. This is usually short-term.
Treatment becomes long term when the problem is chronic and severe.
Often the situation is something that anyone would find really stressful.
If the problem is completely unavoidable (eg health) I help support the
person in their struggle to cope. If the stress is something that can be
changed (eg an abusive boss) I help them develop a plan for getting out
from under it.
A final note:
There are several other types of depressive problems, and many of them
look alike to the layman. You can give yourself depression first-aid by
increasing your activity. Daily, vigorous exercise can help almost as much
as an anti-depressant. Also, try going back to any activities you've
dropped as a result of feeling depressed.
Remember that depression can be truly devastating, even fatal.
It's best treated by an expert. Also try to remember: short-term
therapy works. There is no good reason to suffer endlessly when you
can be on the road to getting well.
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