by Alan Brandis, Ph.D.

Depression is something that most people experience at some time in their life. It can be part of a normal, natural reaction to a loss, a major life change or a tragedy, in which case it is classified as a "Reactive Depression." As the grieving process proceeds, over the next few weeks or months the depressed feelings should fade and life should go on, with less and less time spent thinking about the loss and feeling sad about it. Although situation-specific counseling may be helpful in getting through such a period of depression, and while there may be a brief (days or weeks) period of grieving in which normal daily activities are suspended, most reactive depressions resolve themselves within 1 to 3 months and normal functioning returns.

In cases where the reactive depression does not resolve "naturally" and within a reasonable period of time, the depression is said to be "chronic" and becomes a cause for concern. Chronic depressed conditions are sometimes associated with certain chemical changes in the brain, specifically with low levels or low sensitivity to certain chemicals, called neurotransmitters, used to transmit nerve impulses. It is a "chicken and egg" problem as to whether the depressed feelings "cause" the chemical changes, or vice versa, and it really does not matter because once a person has chronic depression, the depressed feelings and the chemical changes can both be present.

Depression can also be present in the absence of a triggering event, in which case it is called an "Endogenous Depression" because it evolves from within the individual rather than from an external event. Both Reactive and Endogenous Depressions have been successfully treated with several types of interventions. A Psychologist or therapist can best help you determine which of the intervention approaches might benefit you the most.

Cognitive-Behavioral Therapy: This approach starts with the assumption that you are depressed because of the way you perceive and think about things, so it retrains you to think and react to events differently. It uses techniques such as thought-stopping, thought substitution, skill building such as assertiveness training, problem-solving and so on. This approach attacks the depression as a set of symptoms and treats the problem at the symptom level. For many people, it is effective and long-lasting. However, it requires concentration and discipline since it is a structured technique, and some depressed people are not able to follow through on the assignments or in the application of the techniques.

Dynamic Psychotherapy: This approach looks for the roots of depression in early childhood experiences such as emotional, verbal, physical or sexual abuse, or in the young child's interpretation and adoption of the parents' wishes, expectations and values. Through exploring and examining your perceptions of events and relationships from different stages of your life, the therapist helps you to understand how and why you came to perceive things the way you did, and to change your view of yourself and your life. This is what most people think of when they talk about being "in therapy."

Pharmacological Therapy: Medications for depression are abundant and offer the hope that taking a pill will "cure" the depression. Our experience has been that, for a significant number of depressed people, medication can relieve the most severe symptoms of depression, but it rarely does the whole job. Because many people we see have been depressed for a long time, and they have avoided close contact with others, there are a variety of skills (especially interpersonal skills) they may not have learned, and they often need help in sorting out what things mean in their relationships with people at work and in their families. We usually recommend that medication be used while one of the other interventions is also in progress.