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General Information for Prospective Patients |
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Depression
Depression is a serious disorder that needs a careful diagnosis. It can be a result of a physical disorder or a medication problem, an imbalance of brain chemistry, or the result of external events. Also the duration of the illness is important, as all people tend to experience bouts of depressed mood that disappear in a few days. Severe depression can last for weeks, months or years. Major depression is characterized by a series of symptoms which include several of the following:
1. Depressed mood most of the day
2. A reduction in interest in pleasurable activities
3. Changes in appetite
4. Changes in sleep pattern
5. Lack of energy most days
6. Feelings of guilt or worthlessness
7. Feelings of agitation
8. Inability to concentrate
9. Recurrent thoughts of death or suicide
Behavioral strategies
Depressed patients tend to exhibit specific behaviors which tend to enhance the depression. They usually exhibit poor social skills, engage in few pleasant activities, experience many negative events, and think in depressing and ruminative ways. Behavioral treatments attack these problems with a variety of strategies. These usually involve some form of self-monitoring of activities in order to make the patient more aware of the relationship between mood and activity. The treatments emphasize the importance of structured activity, helping the patient learn that he or she can get some control over the environment. Social skills training is important, as the depressed person's behavior tends to lead to social isolation, with an erosion of social skills and an increasing feeling of social inadequacy. Building a structured program so that the person can increase the number of rewards in life is also essential, as depression tends to result in reduced activity and, as a consequence, a lack of reinforcers. Treatment tends to be conducted weekly, with many programs lasting on the order of 12 to 20 sessions.
Cognitive strategies
Cognitive procedures for handling depression involve both verbal and behavioral exercises. The patient is first taught how to be aware of the connection between one's cognitions, mood, and behavior. By means of written homework, the patient monitors the negative thought patterns, examines the evidence for or against the distorted conclusions, and learns how to substitute more reality-oriented beliefs. The procedure has the patient keep a log of daily activities and mood. The patient is also encouraged to complete a series of challenging tasks, starting with very easy ones, and working up to more difficult ones. Structured programs tend to last on the order of 16 sessions.
Cognitive/behavioral techniques
Many therapists tend to combine the cognitive and behavioral techniques into one single package for the patient, customizing it to the needs of the individual. Studies have shown that these strategies can be very effective with a large number of unipolar or "neurotically" depressed patients. For bipolar or psychotic depressions, medication tends to be more often the treatment of choice.
Medication
The treatment of depression has taken on many forms, with the most rapid and effective treatment being medication. The medications most commonly used today are the tricyclics, such as Imipramine, the SSRIs, such as Prozac, or the MAOIs, such as Nardil. These medications can produce rapid results in many sufferers, with improvement occurring in several days in many cases. There are now well-proven cognitive and behavioral strategies that can be used for relieving depression in many individuals. These techniques can be used in conjunction with medication.
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