What is Depression?

How Therapy Works

Goals of Therapy:

• Recognize and challenge negative thought patterns
• Improve emotional regulation
• Strengthen interpersonal relationships
• Promote self-compassion and self-efficacy
• Prevent relapse

Evidence-Based Therapies:

1. Cognitive Behavioral Therapy (CBT)

• Identifies and reframes distorted thinking
• Encourages behavioral activation and routine building

1. Interpersonal Therapy (IPT)

• Focuses on resolving interpersonal issues contributing to depression
• Addresses role transitions, grief, and social conflicts

1. Mindfulness-Based Cognitive Therapy (MBCT)

• Combines cognitive therapy with mindfulness practices
• Helps prevent relapse in recurrent depression

1. Dialectical Behavior Therapy (DBT)

• Useful in managing emotional dysregulation and co-existing conditions
• Teaches mindfulness, emotion regulation, and distress tolerance

1. Psychoeducation

• Empowering clients and families by educating them about depression

Enhances treatment adherence and relapse prevention

Treatment for Depression

Depression is a highly treatable condition. An individualized approach that integrates psychotherapy, medication, and lifestyle changes results in favorable outcomes.

1. Medication

Prescribed by a psychiatrist, antidepressants are often used as part of treatment:

• Selective Serotonin Reuptake Inhibitors (SSRIs), such as Fluoxetine and Sertraline.

• Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) – e.g., Venlafaxine, Duloxetine

• Tricyclic Antidepressants (TCAs) – e.g., Amitriptyline

• Atypical antidepressants – e.g., Bupropion, Mirtazapine

• Sometimes combined with anti-anxiety medications or mood stabilizers

2. Psychotherapy

Therapeutic support enables individuals to understand their emotions, improve coping mechanisms, and build a healthier mindset.

Assessment and Diagnosis

Clinical Interview and History Taking

• Mental health professionals assess emotional symptoms, their impact on daily life, and potential triggers
• Exploration of family history and psychosocial context

Diagnostic Criteria (DSM-5-TR)

• Diagnosis is based on meeting the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders
• Requires at least five symptoms present nearly every day for a minimum of two weeks

Psychological Assessments and Tools

• Beck Depression Inventory (BDI)
• Patient Health Questionnaire-9 (PHQ-9)
• Hamilton Depression Rating Scale (HDRS)
• Center for Epidemiologic Studies Depression Scale (CES-D)

Medical Tests

• Rule out medical conditions like hypothyroidism, vitamin deficiencies, or neurological issues
• Blood tests or imaging, if necessary

Causes

The development of depression is influenced by a combination of biological, psychological, and environmental factors.

Biological Factors

• Neurochemical imbalances (e.g., serotonin, dopamine, norepinephrine)
• Hormonal changes (e.g., thyroid issues, postpartum changes)

Genetic Factors

• Susceptibility is increased by a family history of depression or other mood disorders.

Psychosocial and Environmental Factors

• Early childhood trauma or neglect
• Chronic stress or exposure to adversity
• Significant life changes (e.g., divorce, job loss, bereavement)
• Social isolation or lack of support
• Substance use

Signs & Symptoms

Depression manifests in emotional, physical, and cognitive symptoms that can vary in severity and duration.

• Persistent low mood or sadness
• Fatigue or decreased energy
• Significant changes in appetite or weight gain or loss
• Insomnia or excessive sleeping
• Feelings of worthlessness, guilt, or helplessness
• Difficulty thinking, concentrating, or making decisions
• Irritability or restlessness
• Physical discomfort and pain without a definitive medical explanation
• Thoughts of death, self-harm, or suicide

Types of Depression

Major Depressive Disorder (MDD): Characterized by at least one major depressive episode lasting two weeks or more, affecting daily functioning.

Persistent Depressive Disorder (Dysthymia): A Chronic form of depression with symptoms lasting for at least two years, often less severe but more enduring.

Premenstrual Dysphoric Disorder (PMDD): Severe depressive symptoms linked to the menstrual cycle.

Postpartum Depression: Occurs after childbirth, involving intense sadness, exhaustion, and anxiety.

Seasonal Affective Disorder (SAD): Depression linked to seasonal changes, commonly during the winter months.

Depression with Psychotic Features: Severe depression accompanied by delusions or hallucinations.

Substance/Medication-Induced Depressive Disorder: Triggered by the use or withdrawal of substances or medications.

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