Depression | Brentwood Psychotherapist Dr. Bill Cloke

Depression – The disorder that causes itself.

If you feel down most of the time, most of every day, if you feel worthless, guilty, shamed, experience concentration problems, or nothing feels pleasurable, or have ideas of death or suicide you are probably suffering from depression. The most common symptoms of depression are sadness, a down feeling, fatigue, anxiety and insomnia. Depression creates depression. Depression is very difficult to completely cure but you can learn how to manage your depression with professional help and medication. Not everyone needs medication to relieve their symptoms but it can be helpful to remove the worst aspects of the depressed mood. Once the worst part of the depression is removed activities that can actually be helpful to gain a foothold toward feeling better can be achieved. The most difficult aspect of depression is that it inhibits one’s own ability to relieve it.

Over 20 million people suffer from depression. Are their skills that people have that serve to insulate them from depression? Are these skills learnable, teachable? Can we demonstrate that when people learn these skills that they will improve? There are definite treatment modalities for depression that work but there are no simple answers for the management of depression. There are many people who do not get depressed when difficulties arise in their lives and others who will respond to losses and rejections by becoming depressed. It is not the event; it is how each person deals with it. The coping patterns that each person has or does not have are what determine the risk factors for depression. One of the strongest risk factors for depression is a depressed parent. Depression is contagious. Not in a viral sense but in a social sense. Depression is transmitted socially. Not simply a biological imbalance, although biology does have a role in depression. Medication is only a partial solution. The highest success rate for depression includes the combination of psychotherapy and medication.

There are five major factors that predict depression:

1. Self Criticism, self loathing, anger turned inward.
2. Helplessness.
3. Hopelessness.
4. Absence.
5. Loss.

Other causes of depression:

Cognitive distortion: Errors in the way we process information. If a person processes life events in a way that causes them to believe that they are undeserving, unlovable and a loser chances are they will be depressed. Most depressed people suffer from the effects of humiliation, rejection, isolation. How each of us processes these experiences will determine their level of depression.

Lack of social rewards: Not getting praise and admiration. The largest populations of depressed people are stay at home mothers with two children. There are very few external rewards for being a mother. Other factors are low income, low self esteem, death of a family member, job loss, and health problems.

Social inequities: The forces that lead to a sense of victimization. Victimization is a reliable pathway to depression. We live in a culture of blame, of victimhood. You cannot recover from depression from the standpoint of being a victim. Responsibility and action are required to help relieve the symptoms of depression.

Cultural and familial influences: Psychiatric Anthropologists study depression in different cultures. Often in tribal groups the structure surrounds a focus on community where everyone matters. In our culture the social rewards are based on a focus on the self. The more you focus on yourself the more depressed you will be. People who are attached to something greater than themselves fair better with depression.

There is a genetic predisposition for depression. If a person grows up in an environment where perfectionism is the standard, the child will be prone to depression. Perfection is the strongest predictor for depression.

Ruminative style: People with a ruminative response style think receptively and passively focus on their symptoms of distress without taking proper action to correct what is not going well in their lives. Whatever you focus on you amplify. You can focus too much on your feelings. There are times when it is important to focus on feelings and time when it is detrimental. The over-examined life can create depression. It is important to focus on what will make things better in the world rather than ruminate on the past or the possibility for failure in the future which inhibits action and increases depression.

Discrimination strategies: Your ability to distinguish according to context what the most effective response is. How do you know if it’s A or if it’s B? How do you know if it is useful analysis or useless rumination? How do you know when to listen to your feelings and when to override them? How do you know when to disclose and when to keep your thoughts and feelings to yourself? How do you know when your expectations are realistic or not? How do you know when something is in your control and when it isn’t? How do you know when to but in or when to but out? One of the main causes for depression is when people cannot discriminate between what they need to do for themselves and what is reasonable to do for others. Without the ability to act on issues that matter creates depression.

Depression cannot always be cured but it can be managed. If you know what to do when you feel depressed you will cope with mood changes so that they can be neutralized and a state of well being can be achieved. Working out a positive cognitive style is essential to overcoming depression. Often people do not know what their feelings mean and what they are telling them about what is happening inside. Developing an emotional vocabulary is very helpful in working through depressed feelings.

There are a myriad of treatments for depression such as: cognitive therapy, psychotherapy, structured therapy, medication and exercise. All of these modalities have proven to be successful in the treatment of depression. One of the most difficult aspects of depression is that it causes people to not want to do anything because nothing feels good. Encouraging depressed people to build positive structures like a pleasure/mastery schedule helps them to break the negative cycle of depression. Mastery means things that someone does well and pleasure means activity, creativity, friends, rest and exercise.

Things you can do:

• Exercise daily.
• Do not drink alcohol or take non-prescription drugs.
• Seek some form of psychotherapy and be evaluated for the need for medication.
• Make a pleasure/mastery schedule that includes something new every half hour.
• Work on your own negative thinking patterns so that you can distinguish life from a broader perspective and more realistically.

These actions will help, but there is no substitute for talking with someone who understands.

Feel free to contact Dr. Bill Cloke with any questions.