If you’re suffering from depression, then you know it’s an emotional heaviness that can feel like a pervasive black cloud is permeating every part of you, miring you in darkness. And if you’re reading this, then you’ve already made the first step towards getting help. That’s a beautiful thing.

A Little Background On Depression

Depression isn’t something to be taken lightly. We don’t need to tell you (you’re likely already experiencing these symptoms), but depression can affect how you feel, think, and handle daily activities, such as sleeping, eating, or working. But what you might not know is it’s also one of the most common mental disorders in the United States. According to a 2017 survey from the National Institute of Mental Health, an estimated 17.3 million adults in the United States had at least one major depressive episode over the course of a year—that’s 7.1 percent of all U.S. adults.

“Depression tends to do two main things,” says Marc Gironda, PsyD, Chief Psychologist at the Bartky HealthCare Center in Livingston, New Jersey. “It takes away the ability to enjoy things that we usually enjoy, and it takes away our ability to be productive.”

Clinically, there are three kinds of negative thinking that people with with depression usually have—it’s called cognitive triad: negative views about themselves, negative views about the world, and negative views about the future, Dr. Gironda says.

Depression is believed to be caused by a combination of things including genetics, biology, environment, and psychological factors. While it can happen at any age, it often begins to manifest in adulthood. It also occurs more often in women than men, manifesting as sadness, worthlessness, and guilt. In men it can be exhibited as tiredness, irritability, and anger.

You can easily get help by making an appointment with your primary care doctor or general practitioner who can then refer you to a mental health specialist. There are many good resources to learn more about depression and what to do about it. These include: The American Psychological Association, The National Alliance on Mental Illness, The Anxiety and Depression Association of America, and The National Institute of Mental Health.

Now the facts.

How Do You Know It’s Depression?

Just about all of us have had episodes of feeling down, but the difference between an occasional bout of the blues and a major depressive disorder is whether it is interfering with everyday functioning, Dr. Gironda says. “Work productivity is going down, grades are slipping, or relationships are being impacted in some kind of negative way.” And here’s the thing, you don’t have to guess yourself if you think you might be depressed, just talk to a pro. Here are some signs to keep in mind.

  • Persistent sadness
  • Feelings of hopelessness
  • Pessimism
  • Irritability
  • Feelings of guilt or worthlessness
  • Decreased interest in activities
  • Decreased energy or fatigue
  • Restlessness
  • Difficulty concentrating
  • Difficulty sleeping (sleeping too much or waking up too early)
  • Appetite or weight changes
  • Thoughts of death

Major depression is often diagnosed when a person experiences a depressed mood or loss of interest or pleasure in daily activities, along with a majority of these symptoms, for a two-week period, Dr. Gironda says.

How Do You Know What Kind Of Therapist To See?

While there are different approaches to treating depression, research shows that counseling is the best way to maintain therapeutic effects. The nature and severity of your depression will dictate the type of mental health professional you should seek.

  • Licensed psychologists and other mental health professionals have been extensively trained in providing psychotherapy and are generally the types of therapists you would see first.
  • Psychiatrists are primarily involved in medication management, though there are some who will also provide counseling. If you’re working with a mental health professional who determines medication is needed, they will likely refer you to a psychiatrist.

What’s The Best Way To Get A Doctor Referral?

Talk to someone that you trust such as a medical provider—a physician, a pediatrician, an OBGYN—or friend, who could provide a referral for you. You can also contact your state professional psychological association, which has a referral service on hand to help you find a mental health professional in your area.

How Much Will It Cost?

The rates depend on what kind of mental health professional you go to see. A psychiatrist is likely going to be more expensive than a psychologist. According to SimplePractice, a business software pros use to manage their practice, a session can be anywhere from $68 to $250.

How Should You Prepare For Your First Appointment?

Writing down questions ahead of time can help you organize your thoughts and ensure you get all the answers you need so you don’t go home with even more worry. These include:

  • What kind of treatment do you think will be helpful for me?
  • How can my depression affect my daily life?
  • Could other conditions be causing my depression?
  • What kinds of lifestyle changes can help manage my depression?
  • Do I need medication? Do I need a referral for medication?
  • What side effects do antidepressant medications have?
  • Do I have to take medication? Can I get better without it?
  • How often do I have to come in for treatment?

What Questions Will The Doctor Ask You? 

Your doctor may ask you to answer questions to determine your feelings and find out how severe your depression might be. These may include:

  • What is your interest in doing activities you normally like to do?
  • Do you have trouble falling asleep or staying asleep, or are you sleeping too much?
  • Are you tired or have little energy?
  • Are you having changes in your appetite or overeating?
  • Are you having trouble concentrating?
  • Are you feeling poorly about yourself?
  • Are you irritable?
  • Are you feeling excessive guilt?
  • Are you having morbid thoughts?

What Tests Might Be Given? 

While there are no quantitative assessments for depression, “I can’t draw blood and say, okay, this is depression versus not depression; there are rating scales for depression that are sometimes used by clinicians,” Dr. Gironda says. This is a symptom checklist or rating inventory that would categorize where their symptoms are. Some of the inventories follow the diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.

“You can use those scales to look at the severity of the depression by rating things in terms of mild, moderate, or severe; and certainly, if someone is in the severe range, than the clinician would be more likely to refer them for a medication consultation,” Dr. Gironda says.

“Many clinicians use those rating scales as a way of measuring progress over treatment, so they’ll give it to a patient in the first session and then periodically to see if their numbers are getting better,” Dr. Gironda says.

What Types Of Therapy May Be Used? 

  • Cognitive behavioral therapy is the most common type of treatment for depression, Dr. Gironda says. It’s a structured form of therapy that focuses on helping people identify and modify maladaptive thinking and behavior patterns. “The therapist will help you see things in a more realistic way by helping to change your thought patterns,” Dr. Gironda says. “Part of cognitive therapy can sometimes be walking the person through the worst-case scenario and realizing that most of the time, the worst-case scenario is not nearly as catastrophic as they’re making it out to be.” CBT also includes taking steps to do things that might bring you a little bit of pleasure or that make you feel productive in a systematic way. For example, if you usually love to play the piano but you’re not playing the piano anymore, maybe you’ll come up with some kind of agreement that every day, you’ll sit down for five minutes just to get a little bit of that interest back. “It’s about doing something to take control over your depression so that it’s not taking control over you. CBT is not the power of positive thinking necessarily; it’s the power of realistic thinking,” Dr. Gironda says.
  • Interpersonal psychotherapy is another form of therapy that works to reduce depressive symptoms by improving the quality of the patient’s interpersonal relations and social functioning. Because a lot of people with depression do have social isolation, this form of therapy addresses specific strategies to help with social skills and relationship building.
  • Electroconvulsive therapy (ECT) and other brain stimulation therapies may be used in severe cases of depression when standard methods of treatment aren’t working. ECT is a five-to-10-minute procedure done under general anesthesia in which small electric currents are passed through the brain to trigger a small seizure. This causes changes in brain chemistry that can quickly reverse symptoms of severe depression. It’s generally given two-to-three times weekly for three-to-four weeks—for a total of six to 12 treatments.

What Types Of Medication May Be Prescribed?

Antidepressants are prescribed when the physical symptoms such as low energy levels, poor sleep, appetite changes and concentration or suicidal thoughts are interfering with daily functioning. This is for that, can’t-get-out-of-bed-and-never-want-to-again feeling. The tough part is finding the right medication can be a real process of trial and error. And it many take a while (2 to 4 weeks) to see results. There are several types of antidepressants.

  • Selective serotonin reuptake inhibitors (SSRIs) are the most common. They relieve symptoms by blocking the reabsorption of serotonin by certain nerve cells in the brain. This leaves more serotonin available, which improves mood.Yay! Common SSRI medications include Lexapro, Prozac, and Zoloft. Side effects may include insomnia or sleepiness, sexual dysfunction, and weight gain.
  • Serotonin-norepinephrine reuptake inhibitors (SNRIs) increase both the levels of the neurotransmitter serotonin and norepinephrine by blocking their reabsorption into cells in the brain. By stabilizing these neurotransmitters,SNRIs can help improve mood, reduce anxiety, and help alleviate panic attacks. Common SNRI medications include Cymbalta, Effexor, and Pristiq. Side effects may include stomach upset, insomnia, headache, sexual dysfunction, weight gain, and a minor increase in blood pressure.
  • Cyclic antidepressants were one of the earliest class of antidepressants developed, and in certain cases, they may relieve depression when other treatments have failed. They’re generally effective and work much like other antidepressants by blocking the reabsorption of serotonin and norepinephrine and increasing the levels of these neurotransmitters in the brain, which improves mood. However, they also affect other chemical messengers, which can lead to a number of side effects including drowsiness, blurred vision, constipation, weight gain, sexual disfunction, and tremors. Cyclic antidepressants include Elavil, Anafranil, Sinequan, and Tofranil.
  • Monoamine oxidase inhibitors (MAOIs) were the first type of antidepressants available. They’ve largely been replaced by antidepressants that cause fewer side effects but may be prescribed if nothing else is working. MAOIs increase levels of norepinephrine, serotonin, and dopamine in the brain, but in the process, they affect other neurotransmitters in the brain and digestive system, causing side effects like dry mouth, nausea, diarrhea or constipation, headaches, drowsiness, insomnia, involuntary muscle jerks, low blood pressure, sexual side effects or weight gain. Because MAOIs can cause dangerously high blood pressure when taken with certain foods or medications they typically require dietary restrictions and avoiding certain medications. Some common MAOIs include Parnate, Nardil, and Marplan, as well as Emsam, a transdermal skin patch.

How Should You Prepare For Follow Up Mental Health Appointments?

You and your doctor will talk about a specific treatment plan and ways to prepare for the next session. “I encourage my patients to bring a notebook or to take notes on their phone in the session, especially if there’s certain strategies that work or certain coping statements that they feel are going to be helpful for them—or if we make make some kind of action plan together where we’ll say, ‘okay, this is what we’re going to try for the week,’” Dr. Gironda says. “Sometimes the plan can be just reviewing the things that we talked about over the past week, but I do recommend that people keep it going in between sessions. This way, when they come in for their next session, they can talk about what they found helpful or what they didn’t find helpful, or what changes they’ve noticed in their thinking and mood.”

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Last Updated: Aug 13, 2020