Counseling for Depression: The 11 Commandments-From Barrington, Algonquin and Dundee, IL

Depressive disorders come in different forms, just as is the case with other illnesses such as diabetes, cancer or heart disease. This article briefly describes three of the most common types of depressive disorders.

However, within these types there are also variations in the symptoms, their severity and duration. Major depression causes symptoms i.e. excessive fatigue, relentless pessimism, hopelessness etc. that interfere with your ability to work, study, sleep, eat, and enjoy activities that were once pleasurable.

This type of depression can be disabling and may occur once but more commonly occurs several times in a lifetime. A less severe type of depression, dysthymia, generates longer-term, chronic symptoms that do not disable, but prevent you from functioning optimally or feeling enthusiastic when you should.

Many also experience major depressive episodes sometime in their lives. Another form of depression is bipolar disorder.

This serious and often devastating disorder is characterized by mood changes that cycle in and out or on and off- severe highs (mania) and lows (depression). Occasionally, the mood switches are dramatic and rapid, but usually they are slower and gradual.

When in the depressed cycle, one can have any or all of the symptoms of depression. When in the manic cycle,however, you may be overactive, over-talkative and manifest too much energy.

Mania often affects your thinking, judgment, and social behavior in ways that cause serious problems, anger and embarrassment. For example, once in a manic phase you may feel elated and full of grand schemes that might range from unwise business decisions to romantic or promiscuous sprees.

Left untreated, this disorder can literally ruin your life and even cause a deterioration into psychosis. Medical treatments typically used, depending on the condition type and severity, include anti-depressant medications, anti-psychotics, psychotherapy and mood stabilizers.

The best psychotherapeutic treatment is cognitive-behavioral therapy which treats how your thinking processes affect your mood and behavior.

Unfortunately, sometimes patients inappropriately drop-out of medication therapy, rather than follow-through because of side effects which could have been ameliorated had they stayed in treatment.

Wonder if you are getting the correct treatment for your depression? The following recommendations are based on a review of the scientific literature regarding the use of psychotherapy, counseling and medication in treating depression.

Take heed:

1. The treatment of first choice for your depression should be cognitive behavioral or interpersonal psychotherapy. This is because of their superior long-term outcomes; they also pose fewer medical risks than using drugs or combined treatments. However, you should consider medications, combined treatment, or other types of psychotherapy if you do not respond appropriately.

2. You should not undergo insight-oriented psychotherapy by itself because studies suggest that it may produce poorer outcomes.

3. It is important that psychotherapy or counseling be included in your treatment program when anti-depressants are prescribed; you are at a higher risk for relapse if you use medication by itself.
Generally, the best results are achieved by the combined use of cognitive-behavioral therapy and medication.

4. Everything else being equal, when starting medication, a single medication administered with psychotherapy should be used.

5. Everything else being equal, when using an anti-depressant, you should use the lowest, safest therapeutic dose for the shortest possible duration. This minimizes the risk that you may experience any possible side effects, cardio-toxicity, potential suicidality or even drop-out of treatment prematurely.

6. If you are hospitalized, antidepressants should be only very cautiously prescribed, especially if you have cardiac vulnerabilities, because of the risk of sudden death.

7. If you have been suicidal, you should take antidepressants only if there is a vigilant monitoring plan in place to prevent over-dose.

8. Everything else being equal, you should be very reluctant to have ant-depressants prescribed for your children because there is no compelling evidence that they are effective for them and little is known about the health risks they pose for this population.

9. Caution should be used in prescribing antidepressants to elderly people because of possible hypotensive and side effect risks.

10. You should avoid taking regular minor tranquilizers alone for your depression because they have resulted in worse outcomes than no treatment at all.

11. It is crucial to hire the right professional for the right task. Clinical psychologists receive most of their training in psychology, counseling and psychotherapy.

Psychiatrists receive most of their training in medicine. Choose a psychologist for counseling and therapy; go to a psychiatrist for medication.