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On Depression

Feelings of despair, including grief, powerlessness, guilt, and shame, can make sense in our shifting global landscape. We can focus on each step to cope and heal.

OVERVIEW: WHAT IS DEPRESSION?

Nearly 300 million people worldwide struggle with depression. Depression—known in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as Major Depressive Disorder—can be different for each person, and isn’t always easily noticeable to others. The way it is defined in the DSM-5 includes the following symptoms, of which clinicians typically look to identify 5 to meet criteria for the diagnosis: 

  1. Depressed mood most of the day, nearly every day.
  2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.
  3. Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.
  4. A slowing down of thought and a reduction of physical movement (observable by others, not merely subjective feelings of restlessness or being slowed down).
  5. Fatigue or loss of energy nearly every day.
  6. Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
  7. Diminished ability to think or concentrate, or indecisiveness, nearly every day.
  8. Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

It's also not to say that anytime someone feels depressed that they are automatically diagnosable. Feelings of despair, including grief, powerlessness, guilt, and shame, can make sense in our shifting global landscape. Cultural, genetic, environmental, and lifestyle factors may alter our perceived safety and security, and contribute to someone developing depressive symptoms.  

NEXT STEPS: MANAGING DEPRESSION

Regardless of whether your experience of depression fits DSM-5 criteria, there are options for navigating your symptoms and beginning to heal. Therapists designed a guidebook for navigating depression and its symptoms. The book includes five skills from evidence-based therapies for depression that help you identify the direction you want to move in, stop waiting to feel motivated, recognize flaws and growth in yourself, and ask for support within your relationships.

These treatments each stress a slightly different focus for intervention. Cognitive Behavioral Therapy (CBT) focuses on the impact of thoughts on emotions and behavior, and targets changing thoughts in order to improve symptoms. Meanwhile, Behavioral Activation and Acceptance and Commitment Therapy (ACT) focus on changing behavior as the precursor to improving mood. The skill from Dialectical Behavior Therapy (DBT) focuses on improving relationships and support networks, while Growth Mindset focuses on one’s approach to tasks and recognizing the inherent ability to change.

These differences in treatment focus may be overwhelming and confusing to navigate, especially if you’re trying to decide what you’re supposed to do. The good news is that each of these comes from evidence-based treatments for depression, so it’s not that one intervention is better than another, but rather that there are many options for you to try. You don’t have to stick to something that doesn’t resonate with you or make sense just because it’s what you’re “supposed to do.” Rather, you can pursue one line of intervention, give it some time (typically a few weeks of committed effort), and see how it is impacting you, if at all.

Depression comes hand-in-hand with hopelessness. When that gets applied to treatment, it often sounds like “there are no options for me” or “I can’t do it right.” The pure fact that we were able to include five evidence-based therapies (out of even more!) and we only had the space to cover one skill from each indicates that there are actually a lot of options for treating depression, and suggests that there will be interventions to resonate with you and make an impact. While your depression may look different from someone else’s, know this: you’re not alone in this experience, and things will get better.

These concepts stress the loop between thoughts, feelings, and behaviors. How will you use CBT, ACT, and DBT to help lift your depression? This post might provide additional guidance. We can focus on each step on the path to change—places in which we feel stuck and free—all toward an end result. We can get comfortable with our definition of the end result changing, too. Learn more about CBT's role in challenging thought patterns here.

This article is not therapy or a replacement for therapy with a licensed professional. It is designed to provide information in regard to the subject matter covered. It is not engaged in rendering psychological, financial, legal, or other professional services. If expert assistance or counseling is needed, seek the services of a competent professional.

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