Depression
Depression (or depressive disorder) is a common mental health disorder and can be a complex psychological condition. It is characterised by persistent feelings of sadness, loss of interest in activities that were once enjoyable, and a significant decrease in overall functioning.
Depression has a significant impact on quality of life, affecting not only mental health but also physical health and the ability to socialise and work.
Depression is a complex psychological condition because it has many possible causes and may be underpinned by different internal unconscious psychological conflicts. Various factors can contribute to its development, making it a unique experience for each individual.
Psychotherapeutic treatment represents the first-line approach to treating depression and is considered preferable to antidepressants, which normally have a secondary or supportive role and are also associated with adverse effects.
Depression, when referring to depressive disorder, needs to be distinguished from depression in a wider sense. It's important to understand that depression doesn't necessarily present itself as a standardised, standalone mental health disorder, such as depressive disorder, but may rather be a symptom of deeper-rooted psychological issues, like personality disorder or dependency. This is why, when depression is being treated with psychotherapy, it's essential for the therapist to conduct a proper diagnosis and assessment of the roots of the depressive symptoms.
Common Symptoms of Depression (Depressive Disorder)
Recognising the signs of depression (as a depressive disorder) is crucial for optimal psychological intervention and successful psychotherapeutic treatment. People with depression often experience a wide range of symptoms that can affect their emotions, thoughts, experiences, and physical symptoms. Symptoms of depression can vary in their manifestation and severity.
Some of the common symptoms include:
Persistent sadness: Feeling extremely sad or hopeless for a long period.
Loss of interest: Not enjoying activities that used to bring pleasure.
Appetite changes: Significant weight loss or gain without trying.
Sleep disturbances: Having trouble sleeping or sleeping too much.
Fatigue or loss of energy: Feeling tired all the time and lacking energy.
Feelings of worthlessness or excessive guilt: Having low self-esteem and feeling guilty about everything.
Difficulty thinking, concentrating, or making decisions: Struggling with focus, memory, and decision-making.
Psychomotor agitation or retardation: Being restless or moving/speaking more slowly than usual.
Feelings of hopelessness
Issues with concentrating
Diagnosing Depression (Depressive Disorder)
Issues and Controversies with the Medical Model of Diagnosis
Depression can be diagnosed in mental health settings using diagnostic manuals like DSM, which categorises different types of depressive disorders. However, it is important to note that this medical model diagnosis is not the sole or most beneficial method for diagnosing depression or other mental health disorders. It has limitations, such as viewing mental health conditions as separate disorders without considering their underlying psychological causes, as well as controversies, for instance in relation to diagnosing personality disorders that often coexist with depression.
While the medical model provides a structured framework for identifying and treating mental disorders, it has faced criticism for its reductionist approach and potential limitations. Some key concerns include oversimplifying complex human experiences, the risk of pathologising, and the potential overreliance on pharmaceutical interventions. Additionally, the medical model has been criticised for its lack of consideration for social, cultural, and environmental factors that may contribute to mental health challenges. These controversies have led to calls for a shift in mental health diagnostic process. This also needs to be kept in mind when diagnosing depression and its co-morbid disorders.
Challenges in the Diagnosis of Depression
Diagnosing depression can be challenging because its symptoms may overlap with other mental health conditions, making it difficult to identify depression as the primary issue. Clinical experience in treating depression through psychotherapy indicates that depression is often a symptom of an underlying mental health condition or disorder, such as personality disorder, dependency, bipolar disorder, or complex PTSD (C-PTSD). Therefore, it is crucial to accurately diagnose depression and any co-occurring or underlying mental health issues in order to provide appropriate treatment. Depression is also linked to a higher risk of self-harm, suicide, substance abuse, and other forms of addiction.
Cultural factors and personal hesitance to seek help when one experiences depressive symptoms can also make it challenging to diagnose. This may also include denial that what an individual is experiencing is, in fact, depression.
The Link Between Depression and Other Mental Health Issues
Depression often does not exist in isolation. Individuals with depression are at an increased risk of mental health disorders, with a notable prevalence of comorbidity. Anxiety disorders, for example, frequently coexist with depression. Research shows that nearly half of those with major depressive disorder also meet the criteria for an anxiety disorder.
The intertwining of depression with substance abuse is another significant concern. Individuals may turn to alcohol or drugs as a form of self-medication to alleviate the pain and heaviness of depression, setting off a cycle that can worsen both conditions. Substance use often complicates the clinical picture, requiring nuanced treatment strategies to address both issues simultaneously.
When considering comorbidity with personality disorders, the complexity deepens. For example, depressive symptoms are very common among those with borderline personality disorder (BPD), whilst emotional dysregulation and turbulent relationships can amplify feelings of emptiness and despair. It's imperative to recognise these patterns since the approach to treatment may differ from depression without personality disorder features. In fact, research shows that, for instance, treatment of depression that occurs with borderline personality disorder (BPD) is less responsive to treatment with antidepressants than depression that occurs as a standalone disorder.
The Role of Psychotherapy in the Treatment of Depression
Psychotherapy is considered as the first-line approach in the treatment of depression when we refer to depression as a depressive disorder. Various psychotherapeutic approaches and interventions have proven to be effective and useful in the treatment of depression. Effective psychological treatments include behavioural activation, cognitive behavioural therapy (CBT), interpersonal psychotherapy, problem-solving therapy. Transactional analysis (TA) has also proven useful in the treatment of depression.
It is important to note that while these psychotherapeutic treatments may be effective for treating depression as a primary disorder, the same may not apply when depression is a symptom of another mental health condition. Therefore, when addressing depression as a symptom through psychotherapy, it is crucial to distinguish between addressing the symptom and addressing the underlying cause.
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