A depression may have been around for so long that it began in childhood or adolescence.The original triggers are lost in time. Or they can be identified. A depression may be set off by by the onset of a particular stressor, often one where there has been a personal loss or a blow to self-esteem. After a loss, feelings of emptiness, grief, and abandonment can follow. After a blow to self-esteem, harsh self-critism and feelings of failure can be experienced.
The onsets of many depressive episodes have significant psychological components, such as just described. However, they also may have genetic roots, and, if so, other family members may have been depressed. Also, biology may be the primary trigger; for example, some women experience premenstrual, peripartum (during pregnancy or after delivery), or postmenopausal depressions (DSM-5).
Depressive disorders are most frequently unipolar; that is, depression alone. However, there are Biploar Disorders in which there periods of depression and periods of markedly elevated mood that can take the forms of mania or, its lesser version, hypomania (DSM-5). For Bipolar Disorders and those depressions that are mainly triggered by biology, medication is the primary treatment with psychotherapy being a useful addition.
For more psychologically triggered depressions, medication by a physician may or may not be needed, depending on the degree of impact on day-to-day functioning as well as how badly the person feels. Especially in psychotherapy's early stages, medication and psychotherapy can be complementary. Medication may lighten the depression enough to make psychotherapy more effective. One reseacher at Oxford (Jacobson, 2013) has found that both psychotherapy and medication work to change negative emotions into more positive ones. Antidepressants seemed to make the shift toward positive processing well before an improvement in mood. Psychotherapy appeared to promote a corrective re-engagement with the outside world by translating the more positive processing into new cognitive and behavioral approaches to life. This researcher concluded that both treatment forms worked well in tandem.
Many in my field, including myself, share the opinion that psychotherapy is the primary treatment of choice for predominantly psychologically-based clinical depressions. Only psychotherapy can bring about fundamental changes in outlook, self-image, and behaviors as well as more self-awareness and self-agency. In the long run, these are the changes that increase resilience and decrease the vulnerability to depression. These are the changes that help reduce relapse rate. These are the changes that drive the therapeutic work.
Because depression is frequently accompanied by anxiety, it may be useful to go to the anxiety page. For more about pychotherapy, go to these pages- About Therapy, Individual Therapy, and Relationship Therapy.
If you are intested in talking to me about Depression Therapy, please use Contact Me to set up an initial appointment or call me at my office-317-872-4158.
Diagnostic criteria from Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition DSM - 5. (2013). Washington D.C.: American Psychiatric Association.
Jacobson, R. (1913).. A unified theory of depression. Scientific American Mind, 1, p. 14.