Understanding Depression
What is depression?
It is estimated that more than 17% of the adults in the United States have been significantly depressed at some point in their lives. Sadly, despite its prevalence, the nature, causes, and effects of depression remain misunderstood by most people, even by those who are depressed. Some common misperceptions are that depression is caused by laziness or a lack of willpower; that depression means that a person is crazy or insane; even that depression is a punishment from God. None of these myths is true.

So, then what is depression exactly? Depression can be best understood as an illness that has multiple and interconnected causes with various manifestations and symptoms. Depression comes in different “types” and can be treated successfully in different ways. Types of depression include dysthymia, major depression, and manic depression (bipolar disorder).

Dysthymia is the mildest but often the most insidious type of depression. It is insidious because it frequently remains undiagnosed, and thus, untreated. It typically has an early onset, beginning in childhood, adolescence, or early adulthood, and is chronic. The most common symptoms that people experience are feelings of inadequacy, feelings of guilt or brooding about the past, feelings of irritability or excessive anger, generalized loss of interest or pleasure, decreased activity, effectiveness, or productivity, and social withdrawal. While dysthymia tends to be longstanding, major depression is more acute and its symptoms more severe, and is therefore more likely to be identified and treated. Often people experience extreme sadness and emptiness during most of the day and find themselves tearful or crying for extended periods of time. Other symptoms can include difficulty sleeping or prolonged sleeping nearly every day, extreme fatigue, changes in appetite, significant weight gain or loss, excessive worry and anxiety, feelings of guilt and worthlessness, decreased ability to concentrate or make decisions, recurrent thoughts of death or suicide, or suicide attempts. In addition, it is not unusual for a depressed person to have frequent physical pain, such as headaches or upset stomach.

Manic depression, or bipolar disorder, differs from major depression in two significant ways. Firstly, during depressed periods, depressive symptoms are often more severe and last longer. Secondly, a person with manic depression not only experiences many of the symptoms of depression, he or she also has periods of extremely elevated moods called mania or manic episodes. Manic symptoms include inflated self-esteem, decreased need for sleep, pressured speech, racing thoughts, and excessive involvement in pleasurable activities that have a high potential for painful consequences. During a manic episode, a person often feels “on top of the world” and literally is on top of the world in his or her ability to accomplish many things with a high level of energy and often an extraordinary creativity. However, during these periods, a person’s life eventually spirals out of control due to the reduced insight and impaired judgment that always accompany mania.

How is depression treated?
While depression in all of its forms is a serious condition, the good news is that it can be very treatable. There are several ways to treat depression, however, recent studies have shown that the most effective treatments combine both medication and counseling.
Medication can help alter the biochemical components of depression while counseling helps the person deal with underlying and present stressors, and facilitates the learning of coping strategies.

During the past 15 years, modern medicine has made tremendous progress in the development of antidepressants. While older generations of antidepressants typically had uncomfortable side effects, newer medications like the selective serotonin re-uptake inhibitors, commonly known as SSRIs, such as Prozac, Paxil, and Zoloft, and atypical antidepressants such as Welbutrin, work very well in most people with very mild side effects. However, it is important to note that each person’s chemistry is different, therefore a medication that works well for one person might not be the best medication for another individual. Also, it can take time for a physician to find the right medication(s) and the right dosage. Once the right combination is found, it is imperative that the individual continues to take the medication for an appropriate length of time (as determined by the physician). The primary reason for an antidepressant not working is that the person does not stay on it for a long enough period of time.

Many types of counseling prove to be very effective in helping a person recover from an episode of depression. Supportive and interpersonal counseling focuses on gaining insight as to how an individual’s social and family environment may be affecting his or her depression, while cognitive-behavioral counseling teaches how to challenge distorted thoughts and change self-defeating behaviors. Most counselors use a combination of styles and techniques. The most important thing is to find a qualified counselor who you like and trust.


Adelaide Palermo, MAEd., LPC, is a therapist who counsels with individuals and couples on a variety of issues.