Psychotherapy for Depression
and Mood Disorders

What is depression?

Depression is a clinical term used by psychiatrists to describe a period of time when a person feels very sad to the point of feeling worthless, hopeless and helpless. Everyone experiences unhappiness at some time in his or her life, and many people may become depressed temporarily when things do not go as they would like. When a depressed mood persists however, and begins to interfere with everyday living, it may be the sign of a serious state of depression that requires professional help.

What causes depression?

There is no single cause of depression. Stressful and discouraging situations naturally overwhelm and have the potential to become serious. Experiences of failure commonly result in temporary feelings of worthlessness and self-blame, while personal loss causes feelings of sadness, disappointment and emptiness.

The onset of depression may sometimes be attributed to some of these factors:

• a genetic predisposition

• death or illness of friend/family member

• financial difficulties

• difficulties with job or personal relationship

• poor self-esteem

• seasonal or hormonal changes

• addictions

Researchers believe that a deficiency of certain chemicals in the brain and/or genetics may also affect how likely we are to develop an ongoing or serious depression. Any of the factors listed above may act as triggers to release disturbances in brain chemical function.

What are the symptoms?

Depression can change the way a person thinks and behaves, and how his or her body functions.

Some of the signs to look for are:

• feelings of despair and hopelessness

• feeling detached from life and those around you

• continued fatigue or loss of energy

• feelings of sadness – crying for no apparent reason

• inability to concentrate or make decisions

• thoughts of suicide

• changes in eating or sleeping patterns

• persistent or recurring headaches or frequent gastrointestinal upsets

What can friends and family do?

It is important to know that depression is an illness and no individual or family member should feel responsible for the depression. The depressed person should not be blamed or told to 'pull themselves up by their boot straps'. Some people who are depressed keep to themselves, while others might not want to be alone. Listen and offer support rather than trying to contradict or talk an individual out of it. It is important that you let them know that it is all right to talk about their feelings and thoughts. Ask them how you can help and go with them to their family doctor or a mental health professional. Most of all, do not do it alone – get other people to provide help and support.

What are the treatments?

Depression is a treatable illness. No one has to suffer endlessly. Most people with clinical depression feel a sense of relief when they learn the facts about this illness; they realize depression is not a personal weakness, and most importantly, they learn they are not alone.

Each case of depression is unique, so people may require different methods of treatment. The most common and successfully used treatments for depression are psychological counselling in combination with anti-depressant medication. Support from family, friends and self-help groups can also make a big difference.

Where can one go for help?

Remember you are not alone. You will be taking a major step toward recovery when you begin to seek help.

Seasonal Affective Disorder (SAD)

How is a "seasonal pattern" of depression defined?

Seasonal affective disorder (SAD) is a subtype of major depression characterized by onset at a certain time of year, usually the winter. First defined in 1984, SAD is also called 'seasonal depression,' 'winter depression,' or 'major depression with a seasonal pattern.' Each of these terms refers to a subtype of major depressive disorder.

SAD is characterized by the following four central features:

• Recurrent major depressive episodes that start at approximately the same time every year (e.g., September-October) and end around the same time every year (e.g., March-April).

• Full remission of symptoms during the unaffected period of the year (e.g., May-August). To be considered a full remission, symptoms of the seasonal episode must be absent for at least two consecutive months.

• Over the lifetime course of the illness, there are more seasonal depressive episodes than non-seasonal episodes of depression.

• Seasonal depressive episodes occur in at least two consecutive years.

What are the symptoms of depression in SAD?

Individuals suffering from SAD have all the typical symptoms of depression, including low mood, reduced interest, decreased concentration, low energy and fatigue. In addition, however, they also tend to have a specific symptom cluster comprised of

increased sleep (70-90 percent of people with SAD)

increased appetite (70-80 percent of people with SAD)

unacceptable weight gain (70-80 percent of people with SAD)

carbohydrate/sweets craving (80-90 percent of people with SAD).

Is the diagnosis of SAD stable over time?

Long-term follow-up studies of SAD have found that over 60 percent of individuals diagnosed with the disorder continue to demonstrate a seasonal disturbance of mood and/or behaviour over time. Approximately 20 percent of people with SAD can have complete remission within several years of first diagnosis. The stability of the diagnosis of SAD seems to be similar to the long-term stability of the diagnosis of major depression itself (i.e., 44 to 76 percent of individuals with major depression maintain the diagnosis over several years of follow-up).

Do SAD patients frequently have bipolar illnesses?

The majority of people with SAD have unipolar depression, but as many as 20 percent may have or go on to develop bipolar depression. Typically the manic or hypomanic episodes occur in the spring and summer, and it is critical that these episodes be distinguished from the improved mood related to the remission of SAD for that season. There are important treatment differences for individuals with bipolar as compared with unipolar illness.

What is the prevalence of SAD?

In Canada, the prevalence rate of SAD is between 2 and 3 percent. In the United States, however, the rate is less than 1 percent. European community-based studies have estimated the prevalence of SAD to be between 1.3 and 3 percent of the European population, whereas studies in Asia report rates of 0 to 0.9 percent of their population.

What is the female to male ratio?

Women are more likely to suffer from SAD than are men, with an average ratio of approximately 1.8 to 1. However, some studies place the female to male ratio much higher, at 4 to 1.

What is the prevalence with respect to age?

The lifetime prevalence of SAD increases with age until people are in their fifties. After the age of 50 to 54, prevalence rates decline dramatically, and the occurrence of SAD in people over the age of 65 is very low.

For every woman, having a baby is a challenging time, both physically and emotionally. It is natural for many new mothers to have mood swings after delivery, feeling joyful one minute and depressed the next. These feelings are sometimes known as the 'baby blues', and often go away within 10 days of delivery. However, some women may experience a deep and ongoing depression which lasts much longer. This is called postpartum depression.

References to postpartum depression date back as far as the 4th century BC. Despite this early awareness, it has not always been recognized as an illness. As a result, postpartum depression continues to be under-diagnosed. It is an illness that can be effectively treated. The sooner the condition is diagnosed, the more effective the treatment. It is important to recognize and acknowledge the symptoms of postpartum depression in yourself or another as soon as possible. This can be difficult, since the depressive feelings often involve intense and irrational feelings of fear. The mother may fear she is losing her mind or fear that others may feel she is unfit to be a mother.

Women with postpartum depression may feel like they are bad mothers and be reluctant to seek help. It is important to remember that hope and treatment are available to women in need.

Defining postpartum depression

Researchers have identified three types of postpartum depression: baby blues; postpartum depression and postpartum psychosis.

The 'baby blues' is the most minor form of postpartum depression. It usually starts 1 to 3 days after delivery, and is characterized by weeping, irritability, lack of sleep, mood changes and a feeling of vulnerability. These 'blues' can last several weeks. It's estimated that between 50% and 80% of mothers experience them.

Postpartum depression is more debilitating than the 'blues.' Women with this condition suffer despondency, tearfulness, feelings of inadequacy, guilt, anxiety, irritability and fatigue. Physical symptoms include headaches, numbness, chest pain and hyperventilation. A woman with postpartum depression may regard her child with ambivalence, negativity or disinterest. An adverse effect on the bonding between mother and child may result. Because this syndrome is still poorly defined and under studied, it tends to be under reported. Estimates of its occurrence range from 3% to 20% of births. The depression can begin at any time between delivery and 6 months post-birth, and may last up to several months or even a year.

Postpartum psychosis is a relatively rare disorder. The symptoms include extreme confusion, fatigue, agitation, alterations in mood, feelings of hopelessness and shame, hallucinations and rapid speech or mania. Studies indicate that it affects only one in 1000 births.

Causes and risk factors

The exact cause of postpartum depression is not known. One factor may be the changes in hormone levels that occur during pregnancy and immediately after childbirth. Also, when the experience of having a child does not match the mother's expectations, the resultant stress can trigger depression. Studies have also considered the possible effects of maternal age, expectations of motherhood, birthing practices and the level of social support for the new mother.

There is no one trigger; postpartum depression is believed to result from many complex factors. It is important, however, to communicate to women with postpartum depression that they did not bring it upon themselves.

One certain fact is that women who have experienced depression before becoming pregnant are at higher risk for postpartum depression. Women in this situation should discuss it with their doctor so that they may receive appropriate treatment, if required. In addition, an estimated 10% to 35% of women will experience a recurrence of postpartum depression.

The amount of sick leave taken during pregnancy and the frequency of medical consultation may also be warning signs. Women who have the most doctor visits during their pregnancy and who also took the most sick-leave days have been found to be most likely to develop postpartum depression. The risk increases in women who have experienced 2 or more abortions, or women who have a history of obstetric complications.

Other factors which increase the risk of postpartum depression are severe premenstrual syndrome (PMS), a difficult relationship, lack of a support network, stressful events during the pregnancy or after delivery.

How is postpartum depression treated?

Therapy, support networks and medicines such as antidepressants are used to treat postpartum depression. Psychotherapy has been shown to be an effective treatment, and an acceptable choice for women who wish to avoid taking medications while breastfeeding.

Coping with postpartum depression

First, remember that you are not alone - up to 20% of new mothers experience postpartum depression. Equally important is remembering that you are not to blame. Here are some suggestions for coping:

• Focus on short-term, rather than long-term goals. Build something to look forward to into every day, such as a walk, a bath, a chat with a friend
• Look for free or inexpensive activities; check with your local library, community centre or place of worship
• Spend time with your partner and/or close friends
• Share your feelings and ask for help
• Consult your doctor and look for a local support group

If you think a friend or family member is suffering from postpartum depression, offer your support and reassurance. You may be able to direct them towards useful sources of information about postpartum depression. Easing the isolation they feel is an important step.

Bipolar Disorder 

(formerly known as Manic Depression)  

What is bipolar disorder?

Bipolar disorder is characterized by opposing moods which accompany the illness. People with bipolar disorder experience great highs (manic stage) and great lows (depressive stage). Bipolar illness often begins with a depression in adolescence or early adulthood, although the first manic episode may not occur until several years later.

Bipolar disorder affects 1% of the population

The first major depression usually occurs during a person’s 20s

Depression is 4 to 5 times higher in people between ages 18-44

If untreated, 20% of depressive episodes can last for up to two years

What causes bipolar disorder?

There is no single cause of bipolar disorder. Researchers believe however that biological factors such as genetics and the brain’s chemistry seem to play a major role in producing the illness. One’s personality, along with stresses in the environment, may also play a part in bringing on an acute episode of mania or depression. Stress management along with medication has been very helpful in controlling manic and depressive episodes.

What are the symptoms?

An individual who has bipolar disorder experiences both mania and depression. Attacks of mania come on very quickly, sometimes within a single day, or can build slowly. Manic episodes can last for hours, weeks or months.

Symptoms of the manic phase (some or all may be present):

a sudden onset of exhilaration and giddiness that increases in intensity – the individual’s mood seems excessively good; expressions of unwarranted optimism and lack of judgment – self-confidence can reach the point of grandiose delusions, including beliefs such as having a special connection with God

the individual may think that nothing, not even the laws of gravity, can prevent the accomplishment of a goal – as a result, the person may think it possible to step off a building or out of a moving car without being hurt (hallucinations may occur)

excessive plans or participation in numerous activities – the individual fails to recognize that there is not enough time in the day to complete all his or her tasks

mania can result in reckless driving, spending sprees, increased intake of alcohol or other drugs, foolish business investments or sexual behavior unusual for the person

flight of ideas – thoughts race uncontrollably and words spill out in a non-stop rush

ideas change abruptly from topic to topic – in a severe manic episode, loud rapid speech becomes difficult to interpret because thoughts are so disorganized and incoherent

decreased need for sleep – the individual can go for days with little or no sleep without feeling tired

distractibility – attention is easily diverted to inconsequential or unimportant details

sudden irritability, rage, paranoia – when the individual’s grandiose plans are thwarted or excessive social overtures are refused, an emotional outburst may ensue.

Without treatment the manic phase can last for about 4 months. The individual may then have a period of normal mood and behaviour, but the depressive stage soon sets in. In some people, the depressive mood occurs immediately or within a few months. For others a long interval of a few years may precede the next manic or depressive interval. Depressions come and go more slowly.

Symptoms of the depressive phase (some or all may be present):

• feelings of worthlessness, hopelessness, helplessness, total indifference, and/or guilt
• prolonged sadness or unexplained crying spells
• jumpiness, irritability
• withdrawal from formerly enjoyable activities, social contacts, work, sex
• inability to concentrate or remember things
• thoughts of death or suicide
• loss of appetite or noticeable increase in appetite
• persistent fatigue or lethargy
• insomnia or noticeable increase in the amount of sleep needed

What are the treatments?

Bipolar disorder responds well to treatment once the illness has been diagnosed. The diagnosis should be made by a physician who is familiar with bipolar disorder and depression, since the symptoms of bipolar disorder can be confused with other illnesses. There are many different types of medication that can be used to help manage an individual’s mood swings. Through a combination of psychotherapy and medication, an individual can lead a full, productive life. Any medication must be monitored carefully by a trained physician.

Where can one go for help?

Remember, you are not alone. You will be taking a major step toward recovery when you begin to seek help.  

Click below to read about
Psychotherapy to Relieve the Pain of Depression
Psychotherapy from Ingrid Dresher, R.N.

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