Margaret Wehrenberg - The 10 Best-Ever Depression Management Techniques: Understanding How Your Brain Makes You Depressed and What You Can Do to Change It

If I could start a list of all the people who helped me with this book, I would have to start with my clients over the years of doing therapy. Their hard work, their honesty, and their openness have contributed to my education as a therapist. I thank them, one and all, for working with me.

I want to thank people who talked me through parts of the writing of this book, especially Dr. Shannon M. Burns and Drs. Syed and Fatima Ali.

My editors also deserve appreciation. Andrea Costella was a guide through the concept and development of each stage of this process. Her wisdom and patience make it easy to hear her feedback. And she is always right!

A very special thank you! to Casey Ruble, my copyeditor. She seems to have a sixth sense about how to hear what I am saying and make it come out right. Her ideas about organization and her reflections on the content were invaluable in shaping this material.

And as always, I thank the crowd of my family for the support and encouragement they always give: Marge Polzin (and Dad in absentia), Pat & Myron Schumacher, Mark & Jeanne Polzin, Mary Polzin, Jerry & Sue Lohr, Tom & Linda Polzin, Janet Crowder, Bill & Su Polzin, and Katy & Dick Deitte. I must also mention Wes Proffer, my brand-new grandson Max, and all my wonderful nieces, nephews, and their little ones who bring me so much comfort and joy. You are my lifelines. Thanks.

Although depression is a common mental-health complaint and a leading cause of disability over the course of a lifetime, it is hard to understand what causes it and how to treat it. That is not surprising when you look at how many varied symptoms constitute this one category of mental illness. Listing the symptoms a depressed person might have, the Diagnostic and Statistical Manual, Fourth Edition, Text Revision ( DSM-IV-TR ; American Psychiatric Association, 2000) includes, among others, such diverse symptoms as:

• Loss of interest or pleasure in things that might have otherwise been interesting
• Loss of concentration (low mental energy)
• Vegetative symptoms such as loss of appetite, trouble sleeping, or loss of libido
• Negative mood (feelings of hopelessness and helplessness)
• Rumination
• Suicidal ideation

In addition, therapists diagnose the course of the disorder from mild to severe, recurrent or single-episode, with or without psychosisthe options are many. And these symptoms do not include the effects of bipolar disorder, which is a form of depression that includes cycling between depressed and manic moods.

Depression also affects a large number of people, exacting a great cost in disability and suffering throughout the lifespan. Information from the National Institute of Mental Health (NIMH; 2008) about the numbers of people affected includes:

• About 20.9 million American adults (9.5% of the population) suffer from some sort of depression.
• Major depressive disorder is a recurring and chronic illness, frequently returning for two or more episodes, with episodes that often last 2 years or more.
• Major depressive disorder is the leading cause of disability in the U.S. for people ages 15 to 44.
• Depression is currently the fourth-most disabling illness worldwide, and according to the World Health Organization, it will be the second leading cause of disability by the year 2020.
• About 10% of men and up to 25% of women will experience depression in their lifetime.
• Dysthymic disorder (a type of low-grade depression that is more like persistent negative mood) affects approximately 1.5% of the U.S. population age 18 and older in a given year. This figure translates to about 3.3 million American adults.

The cost of the disorder is nothing short of phenomenal: an estimated $83 billion in the U.S. in the year 2000, including $26 billion in treatment costs and $57 billion in losses such as absenteeism, reduced productivity at work, and the value of lifetime earnings lost due to suicide-related deaths. According to the NIMH, people with depression fare even more poorly at work, socially, and with their families than do people with a variety of general medical conditions (NIMH, 2006, para. 2).

Yet depression is often regarded as something of a generic mental-health disorder in that most clinicians, regardless of their specialties, are expected to know how to treat it. With such a variety of symptoms and causes, therapists face a Herculean challenge in knowing which methods to try and where to start to help their clients manage depression. The goal of this book is to offer insight into how the inner workings of the brain contribute to depression, and, in doing so, shed light on how to more effectively control its symptoms. By presenting what I believe are the 10 best depression-fighting techniques, I demonstrate how to manage the physical, cognitive, and behavioral ramifications of depression, as well as change the brain to think in a healthy way.

TYPES OF DEPRESSION AND DEPRESSION SYMPTOMS

The possible reasons that a person may become depressed are varied. Scientific studies on the neurobiology of depression increasingly recognize that depressive disorders represent a family of related but distinct conditions (Shelton, 2007, p. 1). Depression may occur due to genetic vulnerability to the disorder or as the outcome of abuse or neglect in childhood that has disrupted brain function and altered the individuals ability to handle lifes challenges. It may be the outcome of trauma or even long-term, nontraumatic chronic stress. Each of these causes of depression affects the appearance, severity, and course of the illness as well as the treatment choice for recovery.

Working in the therapy office, I have noted distinctive differences between clients complaining of depression, based on the underlying history of the illness.

• When depression developed subsequent to a serious loss, especially early life adversity, clients show an intensity of symptoms, especially plunging into despair and hopelessness.
• Depression that emerged subsequent to a period of chronic stress requires changing the stressor in order to improve the depression. I often see these clients suffering exhaustion and isolating themselves to try to replenish themselves.