Most people feel unhappy, sad, drained, or overwhelmed - sometimes. A rough patch becomes depression when, due to nature or circumstances, it is much more intense, and lasts longer than a “normal” rough patch.

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​WARNINGS: 
* Due to increased danger of suicide, depression is a life-threatening condition! If you suffer from depression, seek professional help! Do not attempt to tough it out, or self-treat with someone else’s medication!
* If you are a child or teen, some medications can make you less tired first, and less sad later. In the meanwhile, you are at risk of suicide. Choose a pediatric psychiatrist: s/he can help you stay safe, while your mood stabilizes
* Never “just stop” taking medication! Stopping certain meds incorrectly can kill you! Work with your doc!

WHAT IS DEPRESSION?
* Depression is a combination of physical, emotional, and mental symptoms that varies from person to person. Which depressive disorder you have depends on what symptoms you get, and how you get them.
For example, Major Depressive disorder causes episodes of intense symptoms lasting for weeks. In remission between episodes, symptoms are much less intense or absent. Dysthymic disorder, on the other hand, makes people “feel kinda blah and gray” all the time, without discrete episodes and remissions. 
* Depression is caused by a combination of heredity (genes), and circumstances. Genes determine how resilient you are. If your life is too rough for you to handle, depression can be triggered. Many people suffering from depression get better with age. We are still working on why that is.

​​You may be depressed if you go through long stretches of 
* Feeling sad, irritable, and/or weepy most of the time, for longer than others might in similar circumstances 
* Sleeping a lot less or a lot more than when you are well
* Eating a lot less or a lot more than when you are well
* Feeling “tired”, “drained”, “sore/achy”, “low energy”, “uninspired”, or “blah” most of the time
* Having trouble recalling happy memories, or plagued by uninvited sad ones
* Feeling a lot more pessimistic than your “normal”
* Judging yourself harsher than you do when you are well
* Avoiding people whose company you enjoy 
* Struggling with intrusive, persistent thoughts of hurting or killing yourself  
You are not necessarily depressed if you are
* Feeling sad, irritable, and/or weepy for awhile, after something bad happened 
* On a strict Ben&Jerry diet following a nasty break-up
* Feeling drained after a grueling work week
* Having several “off-days” in a row during stressful times
* Dreading an upcoming family reunion, just like you always do - because you are introverted

HOW IS DEPRESSION TREATED?
The best way to treat your depression (known as "treatment of choice") depends on your symptoms.
Cognitive Behavioral Therapy (CBT)
* Treatment of choice for mild-to-moderate depression
      * If you are “too paralyzed” to do therapy, a brief course of antidepressants may be helpful in the beginning
* Empirically validated (lab-tested) psychotherapy for depression
* Safe and effective: no known side-effects, drug interactions, addictive potential, or loss of efficacy
* Combined with anti-depressants, treatment of choice for moderate-to-severe depression
* Works best for people who have capacity for insight (self-understanding), and are not intellectually disabled 
      * Modified CBT formats are available for people with poor insight or limited intellect 
* Cognitive Behavioral Therapy helps you to:
      * Understand the interplay of body, thoughts, beliefs, feelings, and moods 
      * Learn to identify and handle your personal warning signs and triggers 
      * Develop skills for managing and tolerating your symptoms, so you can “ride out” the episodes
      * Make your episodes less frequent, shorter, and less intense
* CBT is collaborative: your therapist will treat you as an equal, and expect your active participation in return
* Expect a gentle learning curve. CBT is very user-friendly and intuitive, once you grasp the basics  
​Anti-depressant medications
* Can ease depressive symptoms: sadness, fatigue, aches, despair, and changes in sleep and appetite
* Helpful for people who feel “paralyzed,” and need assistance to participate in therapy 
* Combined with CBT, treatment of choice for moderate-to-severe depression 
* Potential drawbacks of anti-depressants include:
      * Hard to "target": Multiple “trials” of 4-6 weeks may be needed, to find medication that fits you
      * Undesirable side-effects and drug interactions
      * Anti-depressants cause tolerance with prolonged use. As your body adjusts, more drug is needed to 
         achieve the same effect. After highest safe dose is reached, you will have to switch to another medication
      * When used, without therapy, symptoms return after you stop the medication 
Electroconvulsive Therapy (ECT)
* Performed under anesthesia, so you don’t feel a thing (we’ve come a long way since the 1950’s!)
* Causes a controlled seizure that is thought to “re-set” parts of the brain that are stuck in a depressive mode 
* Rapidly reverses symptoms of severe depression
* NOT a one-time cure, although anecdotal evidence exists that repeated ECT can decrease episode frequency
* Repeated use may cause memory problems 

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If you live in CA, and would like to work with me to get a handle on your depression,
use the form to Contact me, or send me a text at 650.416.6463