Treatment and Management of Depression
What is depression? Per the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), “depressive disorders include disruptive mood dysregulation disorder, major depressive disorder (including major depressive episode), persistent depressive disorder, premenstrual dysphoric disorder, substance/medication-induced depressive disorder, and depressive disorder due to another medical condition. The common feature of all of these disorders is the presence of sad, empty, or irritable mood, accompanied by related changes that significantly affect the individual’s capacity to function (e.g., somatic and cognitive changes in major depressive disorder and persistent depressive disorder). What differs among them are issues of duration, timing, or presumed etiology.”
Major depressive disorder (MDD) is characterized by symptoms such as depressed mood most of the day, diminished interest or pleasure in activities, weight loss or weight gain, insomnia or hypersomnia, slowing down (mentally or physically), or agitation. Other symptoms may include fatigue, feelings of worthlessness or guilt, impacted thinking or concentration, and recurrent thoughts of death. Not all of these symptoms have to be present for a diagnosis, however; usually, there needs to be a minimum of five. In addition, these symptoms must impact important areas of functioning, such as work or school. If these symptoms persist for at least two years, then a diagnosis of persistent depressive disorder (PDD) may be appropriate.
I like to begin with a thorough description of a diagnosis and its associated symptoms, as oftentimes, many people don’t realize that depression is not just about feeling depressed. There are many ways that depression can present itself in various people. In addition, the DSM-5 is not a perfect or full-proof method of describing someone’s experience, and I use it merely as a guide. If your symptoms do not fit into the above criteria, this does not mean that your experience is not valid or significant.
So you think you might have depression, now what?
If you’ve read my previous blog, you know what I am about to say. Get curious about your experience. Take a moment to reflect on what you are feeling. How long have you had these symptoms? What happened before and after the onset of the depression? What have you tried? When have you noticed that your symptoms were better? When did they become worse? This is all a part of becoming attuned to your experience. The next step is to become attuned to your body and sensations. In somatic therapy, I help people tune into their body and emotions. I teach people what non-judgmental self-acceptance is through a safe and welcoming environment and therapeutic approach.
You can practice this on your own by gently becoming aware of your experience, environment, body, and sensations. Just take note of what you observe without having any kind of expectations or opinions. Sometimes, this alone can provide relief of symptoms. However, if you are used to not experiencing your sensations, it may take a while to first become aware of them and then to practice non-judgment of whatever you may notice. In addition, depression can make it more challenging to become in tune with your sensations and feelings at first.
There are some other considerations that warrant clinical consideration. For example, if your depressive symptoms have been persisting for an extended period of time or have increased in severity, there may be something more going on that would be best addressed with the help of a specially trained clinician. The DSM-5 qualifies MDD if the symptoms last most of the day, nearly every day, for at least two weeks. If your symptoms last longer than this period, something more serious may be going on.
When I work with clients, I find it important to ask about any trauma or history of traumatic events, more recently or in their childhood. Sometimes clients are unable to remember significant events and will only recall them as treatment progresses and their access to memories shifts. Depressive symptoms can be a result of traumatic experiences or an incomplete trauma response. Tapping into this can help you complete the freeze cycle or trauma response and promote healing.
