Treatment of clinical depression.

In a previous post I described the various ways depression can manifest itself and in today’s post I wish 
to focus on ways to cope with or treat clinical depression.

If you think you might be depressed, I have described in this post the steps to take to alleviate this very treatable condition.  To summarize they are:

• consult a mental health professional to obtain a qualified assessment of the degree of seriousness of your mood disturbance

• obtain from this professional a recommendation of what steps you can take to alleviate whatever degree of depression you have
• get actively involved in your recovery program
• develop a “Maintenance program” to maintain your recovery.

Are you experiencing normal sadness or clinical depression?

In the previous post I discussed the ways that ordinary sadness and clinical depression are distinguished.  However this is not always easy.  For example if you have experienced depression over a long period of time, perhaps from childhood, it may seem “normal” to you but it most definitely is not.  Therefore I recommend that you have a “depression check up” from a competent mental health professional such as a psychologist, psychiatrist or social worker. 

If it falls into the range of ordinary sadness or quite mild depression then it might be possible to alleviate it using self help techniques such as stress management or those described in the book “Control Your Depression” by Lewinsohn (other self help resources for depression are given in my website Scottpsychologicalservices.com under client resources). If your poor mood falls in to the clinical depression category then I strongly suggest you get treatment for it from a mental health professional, probably the one who made the original assessment.
 

How does one find a competent mental health professional to treat clinical depression?

Clinical depression is so common (about 20% of the general population will experience depression in the course of their lifetime) that the large majority of mental health professionals have considerable experience helping clients with clinical depression. To obtain contact information about those in private practice you can use the internet or contact the relevant professional association e.g. the Singapore Psychological Society. If cost of initial assessment and treatment is an important consideration, I suggest you consult your local hospital, community centre, or social (family) service centre for information about where you can obtain an assessment and possible treatment for depression at a reasonable cost. Because of the high prevalence of clinical depression, most governments have made affordable services available in the community for this very treatable condition. 

 

Types of therapies available from professionals to alleviate depression

One typical concern many have is what type of treatment is best for alleviating depression.  Duncan et al (2004) in their groundbreaking book “The Heroic Client” state that there are over 400 different types of therapy for psychological problems including depression. I have listed below only a few of the more important that come to my mind:

 

Types of Treatments or Approaches to Alleviating Depression

Psychopharmacological e.g. antidepressant drugs

Cognitive behavioural therapy (CBT) e.g. helping client change habitual maladaptive thoughts/beliefs/behaviours  e.g. I am a failure, There is no hope.

Coda approach (Three A’s which are discussed in a previous post)

Emotionally focussed therapy

Exercise

Eye Movement Reprocessing and Desensitization (EMDR)

Social psychological e.g. increasing social support

Interpersonal

Short term dynamic therapy

Self help e.g. through bibliotherapy

Music therapy

Medical/physical treatments e.g. electroconvulsive (ECT) or transcranial magnetic stimulation (TMS), vagus nerve stimulation for resistant depression

Animal therapy e.g. use of specially trained “therapeutic” dogs

Humour therapy (therapeutic humour) laughing therapy.  Surprising amount of scientific supportive evidence but relatively little used.

Light therapy (phototherapy) which specifically is for Seasonal Affective Disorder (SAD)

 

Faced with so many kinds of treatments, how does one decide which treatment is best?

Fortunately the answer to this question is clear but a bit surprising and does require some explaining.  A vast amount of research, reviewed in “The Heroic Client”, has shown that the type of therapy influences outcome of therapy to a relatively small degree ranging from 15% to as low as 1%!

In other words it is not the specific model of treatment that is important but rather other factors. The most important of these other factors includes the personal characteristics of the client such as persistence and environmental factors such as the presence of positive supportive interpersonal relationships.  Another important factor influencing the effectiveness of therapy is the client’s perception of the quality of the relationship which is established between therapist and client. 

So one of the most important factors for you to consider is how you feel about the therapist, that is the quality of the relationship that develops between you and the therapist.  Is there enough trust developed so that you feel relaxed and comfortable revealing yourself to the therapist?  Is there mutual respect? Do you feel that you and the therapist are connected and working together on your recovery?  Factors such as these are much more important that the specific type of therapy used by your therapist.

 

Summary

If you are concerned about experiencing a mood of sadness, I strongly suggest that you consult a mental health professional to obtain a qualified assessment of the degree of seriousness of your mood disturbance and a recommendation of whether informal self help approaches would be appropriate or whether you need professional treatment for a clinical level of depression.  One of the most important factors determining if your treatment will be successful is the quality of the relationship that develops between you and the therapist.  Another important factor, perhaps even more important, is the degree to which you get actively involved in the retreatment program.  A skilled and competent therapist assists you in developing and maintaining both of these factors.

 

Comments

[mrs srini]

respected dr scott,

I have been undergoing bouts of sadness in my life currently for the past 3 months. This has happened after a very nasty incident with my father in law who verbally
abused me for a mistake i didnt commit.

Sometimes i divert my mind from the thoughts
but it has been taking a toll on me very much.I need help as I have young son of 6months age. Please advise me.

thanks