So you have symptoms of depression . Is it Major Depressive Disorder, Dysthymia or an adjustment disorder ? First I recommend you see a professional and make sure you have the problem you think you have. Remember this is a general description of the treatments available; I can’t diagnose or treat you over the internet. If you need treatment this is not a do it yourself project, see a professional.
First stop should probably be a medical doctor.
1. Primary Care Physicians
Some mental illnesses look like psychical problems and vice versa. Most people who commit suicide have been to see a primary care doctor in the 30 days before they attempt. When you feel bad it is natural to think there is something medically wrong with you. Most people are surprised to find out they are depressed or have Dysthymia.
Many doctors will spot Major Depression; sometimes they identify other mental illnesses. They can be especially helpful in ruling out things like brain tumors or heart problems. If you do have a medical illness treating that issue will often reduce or eliminate the problem, but not always. You could have a physical issue and a mental illness.
More than half of all the psychiatric medication prescribed is prescribed by primary care doctors. If you get a prescription for anti-depressants and you didn’t really need them, most of the articles I have read say taking them won’t hurt you. It just may not help. But if you do have serious depression the meds alone are rarely enough. If you don’t change your circumstances or your thinking, eventually the meds may stop working. The medication will help you work on your problems; the meds won’t solve problems for you.
We hope doctors take seriously the presentations and if after checking the person out they decide this is more likely a psychiatric problem than a physical one, they may try you on an anti-depressant. If that does not help, most likely they will make a referral for you to see another professional.
In my experience medication is absolutely essential for someone with a psychosis . It is highly recommended for anyone with Bipolar Disorder . People with Major Depression respond well to medication but need therapy or the meds stop being helpful after a while. The research seems to tell us that meds are not all that helpful for Dysthymia.
2. The primary doctor may refer you to see a psychiatrist.
Psychiatrists specialize in treating mental illnesses. They have lots of knowledge about psychiatric medication; they know which meds could make a physical problem you have, like high blood pressure worse. They also known about new medications and can prescribe medication a primary doctor would not want to prescribe. For psychosis or Bipolar Disorder a psychiatrist is highly recommended.
A psychiatrist will probably not be enough. They are trained to prescribe medication. Few if any will have the time or the inclination to spend more than a few minutes with you. Ten or fifteen minute med check appointments are the rule. If you need someone to help you deal with your problems day to day, the psychiatrist will probably refer you to a counselor or therapist.
3. What treatments will a counselor use that the doctor didn’t?
In a previous post I wrote about the differences between Therapists, Counselors and Social workers . What is important to you, if you have depression, is finding someone, preferably knowledgeable and licensed, who known how to help you with your problem. The therapist will probably use on of the theoretical approaches below.
Cognitive Behavioral therapy (CBT)
This is my preferred method for treating Depression and a lot of other things. Not all therapists use this but there is a whole lot of research data to recommend this approach.
CBT is based on the idea that a change in thinking can change your feelings; a change in feelings will change your behavior. This works in reverse also, so if you begin to make small changes in your behavior, your feelings will start to change and eventually your thinking will change. A change in thinking will result in a change in the neurochemicals in your brain.
In CBT the therapist helps you see your problems from different viewpoints, helps you perform experiments or do homework and in effect they coach you through becoming able to change yourself. This is sometimes called getting a “new pair of glasses” or simply cleaning the glasses you have.
If you are looking out on the world through dirty glasses, then of course the world will look dirty and gray.
Dialectic Behavioral Therapy (DBT) is a close cousin to CBT
DBT adds skills training to the CBT. It can include mindfulness techniques, meditation, relaxation, or any other calming skill. Other skills can be included as needed. My understanding of this approach is sometime we get so caught up in the problem or the crisis of the day that we forget to work on learning the skills to have a better life. DBT combines the change-your-thinking part with the learn-a-new-skill part.
DBT is especially helpful if you have multiple problems, several mental illnesses or a personality disorder on top of your depression.
Most of us have a “story” we tell ourselves about who we are. If you keep telling yourself you are a failure, you will become one. Some of us bought into negative “stories” about ourselves as children and we keep retelling these. A narrative therapist helps you write a new story and tell it. If you tell your new story enough, parts of it start coming true.
Psychodynamic or “Client centered” therapy.
I hear the most complaints about these approaches. This is the therapist who lets you talk and says nothing much in return. I recognize some people have a lot of stuff they need to tell about childhood and that sometimes just talking it out is helpful, but it frustrates me and a lot of clients to have to be in pain that long.
This is most likely to be helpful if you have lots of unfinished business from childhood. Victims of abuse or molestation may need to move more slowly and take more time to get things out.
Groups are like “way powerful” when it comes to recovering from depression. Groups run by a profession are at the top of the list but self-help groups can be very helpful also. In person groups are the best but on line groups are useful also. Groups are hard to find sometimes but worth the search.
Fad treatments worry me. The nutritional supplement or spiritual retreat of the week help some people but mostly they end up back at the doctor or the counselor’s office in a few weeks when the weekend collides with the real work week.
6. Electro Convulsive or Shock Therapy (ECT)
I am not a fan of Electro shock therapy as it has large risks. It is called Convulsive for a reason.
It has helped some people who had found no other help, but the risks are high enough that I suggest you try all the other options first. This is used ONLY with extremely severe Major Depressive Disorder. It is not recommended for Dysthymia, Adjustment Disorder or milder depressions.
Some clinicians, me included, wonder if ECT should ever be used.
There are some thoughts on possible treatments for depression and Dysthymia, questions as always, are welcome.