If you believe you may be suffering with the symptoms of dysthymia and would like to discuss treatment options with one of our therapists, please call us at 503-281-4852.

Major depression is a serious problem for individuals and for society. According to a recent report published by the World Health Organization, major depression is the number one cause of death and disability in industrialized nations. This means that depression causes more problems for society than heart disease or diabetes or HIV or any other single health problem you can think of.

Selling the idea of a “chemical imbalance”

Over the last decade or so, television and print commercials stating that depression is caused by a “chemical imbalance” have become commonplace. It seems that you cannot watch TV anymore without seeing a commercial advertising that some psychological problem is due to a “chemical imbalance.” Unfortunately, this depiction of depression is greatly oversimplified and leaves out many important factors in understanding this problem. While describing depression as due to a chemical imbalance may be useful in helping a drug company sell more of its products (prescriptions for antidepressant drugs increased 148% between 1990 and 1998), this notion can also lead to negative effects among those struggling with depression. Many others have written about this misconception and advertising technique (for a few examples see here and here). The main problem with this idea is that it is disempowering to the individual dealing with the problem, as it can lead to a person believing that there is nothing they can do to deal with their depression beyond taking a pill.

At this point, some readers may be thinking that I am blaming people with depression for being in the predicament they are in, but I am not. The answer is far more interesting than that. Read on to find out more.

Two problems with the idea of a chemical imbalance as the cause of depression

A number of studies have shown that people with depression often have unusual levels of a variety of neurotransmitters in certain parts of the brain. Based on these findings, some people (e.g., drug companies) have concluded that lower levels of particular chemicals in the brain “cause” depression. This conclusion is based on an error in logic. Correlation does not mean causation. It also ignores the heaps of research showing that depression is associated with people’s behavior, with their thinking patterns, and with their history. Depression is at least as correlated with these things as it is with brain chemicals. In terms of brain chemicals, the only conclusive thing we can say is that depression is associated with lower levels of certain chemicals in the brain, not that depression is “caused by” by the levels of those chemicals.

The idea that depression is solely a “chemical imbalance” also does not account for the fact that several forms of psychotherapy have been shown in multiple studies to be just as effective as (and better at preventing relapse than) antidepressant medication. These findings are evaluated in more detail below.

How could psychotherapy be just as effective as medications?

We behave the way we do because our brain reacts in certain ways to our environment. Any new information or changes in our behavior or habits are stored in our brains. In fact, whenever we learn a new way of thinking or behaving, our brain changes to reflect this new behavior. For example, when someone learns to do mathematics problems better, a region of their brain has changed its structure to reflect this new learning. Both the cellular structure of individual neurons has changed as have the levels of neurotransmitters (for some research that shows that exercise, for example, changes the brain’s structure, look at this link).

Events in our lives can teach us to be depressed, and in turn our brain changes in a way that is consistent with acting depressed. As a result of experiences in life, we end up with a brain which reacts in certain depressed ways. Just like our brain changes when we learn to live in a depressed manner, we can also learn live a non-depressed life and our brain will change to reflect that. Consistent with this idea is research which has shown that similar changes are found in peoples’ brains when they recover from depression, regardless of whether this occurred as a result of psychotherapy or medication. In simpler terms, if you change your behavior, regardless of how this occurs, your brain will change. Similarly if your brain changes, your behavior changes.

Thus there may be multiple ways of recovering from depression, including both medication and psychotherapy. In fact, several studies have shown that some forms of psychotherapy (e.g., CBT, mindfulness based cognitive therapy, and interpersonal therapy) can decrease the rates of relapse to depression even after therapy is stopped. This doesn’t happen with medication. With medication, relapse prevention only lasts as long as the medication is taken. Thus, in order to prevent future episodes of depression, a person may need to stay on medication indefinitely.

How does psychotherapy help depression?

Science has not been completely clear on this point yet. But neither do we know why antidepressants help with depression. We just know that they do. Anyone who tells you they absolutely know how psychotherapy helps alleviate depression is trying to sell you something.

Nevertheless, in this author’s eyes, one theory appears particularly promising. This is what is called the behavioral theory of depression, first proposed by Ferster in 1973. This theory holds that depression is the result of a lack of rewarding activities in a person’s life, whether this is due to lack of opportunity (e.g., being trapped alone in a cave) or due to other reasons (e.g., a person withdraws from friends as a result of “not wanting to bring them down”). According to this theory it is the lack of engagement in activities that are truly meaningful and valued that results in depressed feelings. In depression, a person then typically reacts to these depressed feelings by further withdrawal or disengagement with life, which results in exacerbating the depressed feelings.

According to this theory, the problem here is not actually the depressed feelings or thoughts, but rather a person’s reaction to these depressed feelings or thoughts which perpetuates the lack of rewarding activities and keeps the person depressed. Thus techniques which help the depressed person become reengaged in the world are the route to recovery. This is the basic theory behind the type of therapy that we use at the Portland Mood Disorders Clinic. We help people to overcome the obstacles to engagement in valued activities in their life and to not just feel better but also to live better, with more vitality and meaning.

If you need help with depression…

If you think you may be suffering from depression, don’t hesitate to find someone who can help. Studies show that while depression can sometimes go away on its own, often it does not and requires treatment. Other studies show that even if depression were to improve without professional help, it usually improves more quickly with treatment, either psychotherapy or medication or even a placebo. Some people choose to see their primary care doctor for medication. If medication helps, that’s great. Some people find that medication doesn’t help or doesn’t help enough. They may find that side effects are too high of a price to pay. For many people, psychotherapy is a good alternative to medication. Psychotherapy can often be helpful even if medications aren’t.

Some people try psychotherapy first. Some forms of psychotherapy have more evidence for depression than others. Particularly well proven are cognitive-behavioral therapies, interpersonal psychotherapy, and emotion-focused therapies. I’d recommend starting with someone who practices one of these approaches. If they are not helpful, look for other approaches. At the Portland Mood Disorders Clinic, we use evidence based practices in treating depression, which includes cognitive behavioral approaches and emotion-focused therapy.

Depression is highly treatable. In consultation with you, we will design the most effective treatment plan for your specific situation. Our approach is active and focused on your values and specific needs.

At the Portland Mood Disorders Clinic, we specialize in using evidence-based therapy and counseling methods for mood disorders. This means that the work we do is informed by science and is based on what has been shown to be effective in research studies.

Nearly 6.3 million Americans are on antidepressant medications, a rate that has more than doubled in just the past ten years (Olfson, 2002). Many people wonder why they might want to go to psychotherapy for their depression symptoms when medication is such a common treatment. That is a very legitimate question, and one that should be explored with all the facts. While medication is helpful for some forms of depressive disorders, it is often not the only or even best treatment for depressive symptoms. Numerous scientific studies, including those conducted by the National Institutes of Health, have shown that several forms of psychotherapy are at least as effective in reducing symptoms of depression as are medications. In addition, some studies have shown that psychotherapy is more effective at preventing relapse of subsequent depressive episodes than medications. Furthermore, for those who do respond well to antidepressant medication, studies have shown that the addition of psychotherapy to pharmacological treatment (i.e. medication) often results in even greater benefit. Psychotherapy can help make sustaining changes in your life so that you aren’t just able to get out of bed in the morning, but you have created a life that is worth getting out of bed for.

If you would like to talk to someone for an initial consultation, you can call our confidential phone line at 503-281-4852 or leave us a message using the secure contact form below:

If you have lived in the Northwest for any period of time, you know that all this beautiful green nature around us comes at a price – rain. The dark, dreary days of winter here in Portland can often seem to stretch on for months. For some people, the lack of sunlight simply means another day indoors, but for others if can have a profound effect on their mood and their quality of life.

Seasonal Affective Disorder (SAD) is when a person experiences increased depression that correspond to the seasons, most frequently with the onset of depressive symptoms occurring during the late fall or early winter months and subsiding in the spring or summer.

Symptoms of Seasonal Affective Disorder

The following are the most common symptoms of SAD, though individual patterns vary. Symptoms may include:

• increased sleep and daytime drowsiness
• irritability
• fatigue, or low energy level
• decreased sex drive
• diminished concentration
• difficulty thinking clearly
• increased appetite, especially for sweets and carbohydrates causing weight gain

Treatments

Fortunately, relocating to Florida is not the only answer. Oregon has been a leader in the research on Seasonal Affective Disorder and there is strong empirical support for the effectiveness of making environmental and behavioral changes including the use of a light box, dawn simulators, and other behavioral interventions. If the symptoms of Seasonal Affective Disorder are taking a toll on your life, the therapists at the Portland Mood Disorders Clinic can work with you to make the winter months less dreary and daunting. Call us at 503-281-4852 to set up a consultation to see if we can help.

Classes to help deal with Seasonal Affective Disorder and the Winter Blues

Every fall and winter we host some classes about how to cope with the long and dark winter in Portland. To see if we are currently offering classes, you can look here.

Online resources

Center for Environmental Therapeutics has some great background information about SAD and the most effective treatment – light therapy. The website also has some a really good self assessments to help you determine whether you have SAD. If you want someone to help you implement a light therapy plan or are having problems sticking with a plan you have made for yourself, we are experienced in helping people get going and can help you to implement light therapy in the winter months.

A good dealer of light therapy devices is Philips Electronics, where you can get light boxes and dawn simulators.

Videos about dealing with the winter blues and SAD

We have some videos on youtube about dealing with the winter blues and Seasonal Affective Disorder.

INFORMATION SHEET:

To download a brief informational brochure about Seasonal Affective Disorder, click here.

You can also read a more technical oveview of research on light therapy treatments.

What is Depression?

Major depression is a serious problem for individuals and for society. People dealing with depression experience a low mood or lack of interest in pleasurable activities, and also may experience sleeplessness or oversleeping, lack of appetite or overeating, feelings of worthlessness or guilt, fatigue, feeling slowed down, and suicidal ideation. Depression is a very common problem, with studies finding that approximately 8% of people in the U.S. could be diagnosed with depression in any given year (most never seek treatment so are not diagnosed). According to a recent report published by the World Health Organization, major depression is the number 1 cause of death and disability in industrialized nations. This means that depression causes more problems for society than heart disease or diabetes or HIV or any other single health problem you can think of. Studies show that while depression can sometimes go away on its own, often it does not and requires treatment. Other studies show that even if depression were to improve without professional help, it usually improves more quickly with treatment, either psychotherapy or medication or even a placebo.

Symptoms of major depression can include feelings of sadness, worthlessness, fatigue, changes in appetite, loss of motivation or pleasure in life, sleep difficulties, difficulties with attention and concentration, and thoughts of suicide. For some, these periods come on fairly suddenly and strongly and tend to last for a few weeks to a few months. For others, the feelings of sadness, hopelessness, low self esteem, and general dissatisfaction with life are more pervasive and longstanding; it may be difficult to remember a time when you did feel satisfied with life.

If you are experiencing the symptoms of depression and would like to discuss treatment options with one of our therapists,

call us at 503-281-4852

or contact us through the secure, confidential form below:

In recent years there has been increased attention in the popular media to bipolar disorder. You can hardly turn on the TV or look through a magazine without seeing a drug advertisement to treat bipolar disorder. While this increased awareness has been very useful in many ways, there is also a lot of misinformation out there.

There are actually several different diagnoses that are included in the bipolar disorders category, including Bipolar Disorder I, Bipolar Disorder II, and Cyclothymia. What each of these disorders has is a common experience of intense mood swings that significantly interfere with life. These mood swings can range in intensity and duration. They may include prolonged periods of intense depression as well as extended periods of mania or hypomania where a person may feel unusually energetic, or revved up, a decreased need for sleep, changes in appetite, racing thoughts, and/or impulsive behavior that may have destructive consequences.

Moods swings are a very normal part of life for most of us; some days we feel “up” and some days we feel “down.” At times these feelings can seem like they come out of the blue. This vacillation is simply what demotions do, they are frequently changing. However, if you are concerned that you may have more extreme mood swings that last for a prolonged period of time and which are having a negative impact on your life, it may be useful to talk with a professional about your concerns. The Portland Mood Disorders Clinic works with people who experience a range of difficulties relating to mood, including the distressing mood swings that are associated with the bipolar disorders. Please give us a call at 503-281-4852 if you would like to schedule an appointment to talk with one of our therapists about your concerns.