I FEEL SO SAD AND DEPRESSED

Feeling blue every now and then due to life circumstances is normal and being human. We have emotions and they change from happy to joyous to sad and blue based on our immediate circumstances. If you feel unhappy, it will likely go away in a day or two. Depression is different.

What is depression?

The defining features of depression are: 1. A loss of pleasure. Events, situations, and activities are no longer rewarding (pleasurable). 2. A significantly low (depressed) mood. Each of these features has occurred most every day for at least two weeks. There are other important dimensions of depression too, that can be described as cognitive (thinking), physiological, or action-related (what you do).

Negative thinking. Individuals who are depressed tend to have frequent negative or pessimistic thoughts about the past, present, or future. Self-oriented negative thoughts tend to be about personal failure, responsibility, or self-reproach (guilt, regret). Such thoughts are also related to thoughts of being helpless and the person’s situation as being hopeless. Thoughts of suicide may crop up. Negative thinking functions to make emotional distress worse or motivate a person or escape or avoid situations where effort and action is required. Situations where difficulties occurred are likely to cause negative thinking when that situation is encountered again or recalled. For example, at a dinner party you notice that nearly everyone has a partner with them but you. That situation can cause thoughts of failure or regret. Dinner parties are likely to be avoided in the future.

Physiological responses. Depression results in changes in bodily functions—physiology. We see this when a person complains of feeling sluggish and lethargic (slow moving). Likewise, there may be changes in sleep patterns resulting in difficulty falling asleep, staying asleep and early morning awakening. A similar pattern is observed with eating and appetite—consuming too much or too little food.

Action (behavior). As the name implies, depression affects behavior through a decrease in the frequency and duration of healthy activity. A person with depression will spend more time engaging in unhealthy being sedentary (sitting, sleeping) behavior. Similarly, there is an increase in avoidance (withdrawal) of people, places, and situations. The avoidance behavior occurs for several reasons. Getting out of bed requires more effort when a person is depressed. It is easier to simply lie in bed even though doing so makes the depression worse. In the past when a person attended school or church services, for example, unpleasant events or thoughts occurred there. Going back to those situations is painful. It is easier on the short term to avoid those situations, stay home go back to bed, even though doing so is unhealthy.

What causes depression?

Brain chemistry plays a significant role in depression. Neurotransmitters are naturally occurring brain chemicals. When neurotransmitters change in function, this impacts mood stability. Research suggests that reduced dopamine levels contribute to depression. Dopamine is a type of neurotransmitter that plays a role in the "reward" center of the brain and body functions such as mood, motivation, attention, and memory to name a few.

Genetics contribute to depression. If someone has a family history 0f depression, they are more predisposed to being depressed themselves. According to Stanford Medicine, if an individual has a parent or sibling with depression, they are 2 to 3 times more at risk to develop depression compared to the average person.

Loss of rewarding activities and punishment produces depression.1 We all have experienced loss of rewarding activities. Consider your childhood when your parents made the decision to relocate to a different state. This change resulted in a loss of friends and activities that made up your life. For adults, loss of rewarding events, activities, and situations comes in many forms. Many older adults look forward to retirement only to find themselves feeling depressed after ending their job! They have lost the structure of Monday-Friday work week, friends and social interactions in the workplace and the job itself.

Punishment refers to very unpleasant (aversive) events following one’s actions and that cause the behavior to decrease. A child who speaks up in the classroom may be laughed at by their peers and ridiculed for being the “teacher’s pet.” Consequently, the child speaks less in class and feels sad and uncomfortable in the classroom. They may even start to avoid going to school and perform poorly on exams and homework. A spouse who makes dinner for her partner, suffers a barrage of ridicule and complaints because the food is cold, delivered late, and tastes like “dog food.” The actions of the partner to the food preparation make the spouse feel punished. Doing so decreases the partner’s mood and the likelihood that they will prepare food for their partner. Learned helplessness is a term that has been used to describe situations where actions are punished regardless of what the action is and there is no way to escape the harsh consequences. The person learns that nothing they do will change the situation. Depression ensues. Domestic violence is an example where learned helplessness is observed.

Coping skills is a third factor that influences the extent to which the loss of rewarding activities or punishment results in depression. Individuals with better coping skills will be more resilient in the face of adversity (loss of reward, punishment).

1In this context I am referring to major depressive disorder also known as “clinical depression.”

Treatment

Evidence-based treatment for major depressive disorders includes three types of cognitive behavior therapy (CBT). Cognitive therapy is a well-established, scientifically-based intervention that focuses on guiding patients to challenge and replace distorted thinking and learning new skills to cope with life’s challenges. An important component of cognitive therapy is behavioral activation. Cognitive therapy is as effective as medication for depression.

Behavioral activation treatment for depression (BAT-D), is an evidence-based treatment. BAT-D is designed to systematically increase participation in values-guided rewarding activities. Engaging in rewarding activities improves mood and increases positive, healthy thinking. BAT-D has been shown to be very effective for severe depression and is equal to or better than cognitive therapy or medication.

Antidepressant medication may be a necessary treatment for major depressive disorder in some cases. Many patients, however, want to avoid use or discontinue medication. Working with a therapist or counselor who can provide evidence-based cognitive behavior therapies will enable that patient to meet their goal of managing life situations free of medication.

For more information about CBT or to seek help for depression and other life challenges contact Clinical Counseling Associates of Kansas City.

Written by:

Duane A. Lundervold, PhD, BCBA-D, LPC