Diagnosing Depression continued...
Your doctor may ask:
- If you have had a history of drug abuse or prior depression.
- If you are currently taking medication.
- If you’ve experienced symptoms of mania or hypomania, which if present, suggests bipolar disorder. Bipolar disorder is a condition in which people experience periods of mania and depression.
- If your depression has seasonality. This means that depression symptoms occur almost exclusively during certain times of the year. If so, you may have Seasonal Affective Disorder (SAD), a type of depression that occurs at certain times of the year -- typically in the winter -- and has been linked to reduced sunlight exposure in the colder seasons.
- If the onset of depression symptoms coincides with a medical illness like heart disease or cancer, or emotional triggers like a divorce or death of a loved one.
At the end of the session, the psychiatrist will provide a diagnosis. “Depending on symptom severity and the specific subtype of depression, I make a recommendation to the patient as to what the appropriate treatment approach should be,” says Angelos Halaris, MD, professor of Psychiatry and medical director of the department of psychiatry at Loyola University Medical Center.
Deciding on a Treatment
Finding the right treatment is not like choosing wallpaper. You’re not looking for what works best for your personality, but rather depending on the recommendation of your doctor who can customize your treatment depending on the severity, type, and triggers of your depression.
For some, lifestyle changes like exercise and relaxation may be all that’s recommended. Others may benefit from talk therapy. Still more may require lifestyle changes in combination with therapy and/or medication.
Here’s a breakdown of various types of psychotherapy:
Cognitive Behavior Therapy (CBT)
Once you’re feeling a little better or begin practicing lifestyle strategies like exercise or relaxation or start medication, your doctor may recommend cognitive behavior therapy (CBT). It’s not appropriate for everyone, but often people have long-established patterns of thinking that are dysfunctional and nonproductive. “As long as those patterns persist, they can interfere with your ability to get better,” says Halaris. Let’s say your mom criticizes you, and you feel bad about it. Your automatic response to her criticism is that you’re no good. Therapy helps you understand your feelings about the criticism, and let go of the automatic response by replacing it with a positive one like ‘I have an excellent career.’ Therapy usually lasts once weekly for three to four months.
Interpersonal therapy (IPT) is based on the idea that improving your communication skills and patterns, as well as the way you relate to others, can help your depression. Your therapist will focus on issues concerning your relationships such as disputes with friends or family, divorce, or work conflicts, and find better ways to help you deal with them. IPT analyzes how you interact with people and if your interactions cause problems, how to correct them, and how to change those behaviors. Your therapist may help you explore the triggers that influence your depression such as grief, loss, or transition. Therapy usually takes place weekly for two to four months. A maintenance phase is often recommended with monthly follow-up visits.
Psychodynamic therapy focuses on gaining insight about how your emotions affect your behaviors. Therapists and patients work very closely to find problematic patterns and help you understand and correct them. This type of therapy may be used along with CBT or IPT. Research published by the American Psychological Association found this therapy grows more powerful after treatment ends, meaning patients later discover even more meaning from their past therapy once it’s ended. These therapies can last several months to many years.