Treatment Resistant Depression

Have you tried different treatments for depression but are still struggling? Whether your depression is mild or severe, treatment-resistant depression often produces additional feelings of frustration and hopelessness. Understandably, there may be a temptation to give up on treatment all together, but it is important to explore all of your options if there is a chance of treatment helping you lead a meaningful, worthwhile, and satisfying life.

If this is your first time struggling with depression and you have had no prior treatment, the odds are that you can expect a complete recovery (American Psychiatric Association, 2000). However, without appropriate treatment, about 20-30% of individuals who experience a major depressive episode continue to have some degree of impaired functioning or distress months to years longer than would be expected. For some individuals, symptoms can persist even after having tried various types of medication or therapy. The Depression Treatment Program at Portland Psychotherapy is designed to help people who have tried other treatments without success.

Medical doctors use the term “treatment resistant” depression when two or more medications have failed to relieve depressive symptoms. Typically, the initial medical response to this situation is to continue rotating through medications and to address other possible medical causes of the symptoms (e.g., respiratory problems). It is also possible that you have tried alternative medical treatments (e.g., electroconvulsive therapy, vagus nerve stimulation, transcranial magnetic stimulation) without achieving the desired effects. Likewise, you may have had limited success with psychotherapy if you are struggling with treatment-resistant depression. Clearly, treatment-resistant depression calls for specialized, high quality attention and care.


  • Was your care evidence based? For all their good intentions, not all health care providers deliver evidence-based treatments. There is literally no reason to expect a treatment to work if there has not been high quality research showing it to be effective. All therapy delivered at Portland Psychotherapy is evidence based.
  • Was your care substandard? Not all treatments are created equally. Even if there is some evidence that a particular treatment works, there may be other treatments you haven’t tried that have been shown to work even better. Furthermore, no treatment is one-size-fits all. The Depression Treatment Program at Portland Psychotherapy will provide you with access to the highest quality individual and group psychotherapy for depression, with an emphasis on meeting your unique treatment needs as an individual.
  • Was your care thorough? It’s likely that the depression you are facing touches many aspects of your life, and addressing problems in one area may not automatically lead to improvements in other areas. For example, masking difficult emotions with medications does not necessarily lead to finding a sense of meaning and purpose in life. The Depression Treatment Program helps you explore and consider your full experience in helping you make choices and move forward.
  • Was your care coordinated? You may be working with different organizations and providers in managing your health, and poor communication between these resources can have a negative impact on outcomes. As a part of your services with the Depression Treatment Program, we will be sure to communicate with your other providers to create a coordinated team that will insure your best possible overall treatment.


How do I choose between treatment options?

Over the centuries, many people across different cultures have developed many diverse ways of dealing with life’s hardships. These include spiritual, artistic, meditative, medical, interpersonal, behavioral, educational, psychological, and community-based techniques. There is no single “right” technique, and there are many paths available for you to choose from. With so many options available, it can be difficult to wade through them all. In general, there are two main things to keep in mind when evaluating a particular treatment for depression: 1) What do you want out of therapy? and 2) Does the treatment do what it is supposed to do?

What Do You Want Out of Treatment?

When it comes to finding a treatment for depression, many people find themselves focused on trying to find something that will get rid of their unwanted feelings of sadness, worthlessness, emptiness, and loss. Indeed, many treatments (e.g., traditional Cognitive Therapy, antidepressant medications) are geared towards eliminating these symptoms of depression. Alternatively, rather than trying to get rid of depression, some therapies focus on finding meaning and improving your quality of life (e.g., Acceptance and Commitment Therapy). Although more meaningful living often reduces depression, the aim is about getting more satisfaction out of life rather than having fewer negative thoughts and feelings. By choosing a particular therapy you are choosing to make something important- what is important to you?

Does the Treatment Do What It is Supposed to Do?

After deciding upon what you want out of treatment, there is the question of whether a given therapy actually produces the outcomes that it is supposed to produce. Some therapies help almost no one (e.g., “quackery”), whereas other therapies tend to work well for many people. What works for some people might not work for others, so your own experience with trying a particular therapy will be the best way to find out what actually works for you. The downside to this “trial and error” approach is that you might have to try many therapies before landing on the one that works best for you, which can be costly and prolong your suffering. Fortunately, concerned researchers have spent decades systematically sorting through existing therapies and developing new techniques to learn the difference between what tends to work best for people and what tends to be a waste of time. Choosing an evidence-based therapy gives you the best chance of being effective and efficient in successfully overcoming your depression.

Of the various types of psychotherapy that have been researched, one particular family of therapy, Cognitive Behavioral Therapy (CBT), has the largest body of research showing it to be consistently effective in treating depression. The Depression Treatment Program at Portland Psychotherapy is based in the CBT tradition, and specifically employs Acceptance and Commitment Therapy (ACT), Behavioral Activation (BA) , and Radically-Open Dialectical Behavior Therapy (RO-DBT) for the treatment of depression. You can learn more about the research behind these evidence-based therapies by clicking on the following links:

  • A summary review of various studies showing ACT to be as effective as the most effective treatments for a variety of disorders, including depression
  • A study showing ACT to be as effective as traditional Cognitive Therapy for the treatment of depression and anxiety
  • A study showing BA to be as effective as antidepressant medications and more effective than traditional Cognitive Therapy in treating severe depression
  • A study showing that BA and traditional Cognitive Therapy are more effective than antidepressant medications at preventing relapses of depression
  • A paper describing and comparing ACT, BA, and traditional Cognitive Therapy
  • A website dedicated to information about ACT and related topics


When choosing a therapy, it is also important to take into consideration your insurance, financial resources, time resources, and ability to travel to a clinic. The therapists at Portland Psychotherapy are able to accept a variety of forms of insurance, and we also have reduced fee services available for those in financial need. In addition to Portland Psychotherapy, there are several other low-fee clinics at various locations across the Portland area.

Online Self Help Programs for the Treatment of Depression:

Another approach to geographic or financial limitations is to consider whether online therapy might work for you. Below are some links to resources outside of Portland Psychotherapy regarding online depression treatment programs. The links are provided for access and informational purposes; we are not necessarily endorsing any products or services.

Beating the Blues (free online program)
The ANU Centre for Health Research e-hub (several free online programs)

Contact us:

If you or a loved one is struggling with depression or mood problems, we’re here to help. We are happy to help you figure out your treatment options and figure out the best path for you toward health and wholeness.

Feel free to give us a call at: 503-281-4852 x1

or send us a message using the confidential form below.

Behavioral Activation Treatment of Depression

Behavioral Activation (BA) is a core component of Cognitive Behavioral Therapy and is one of the most powerful and lasting treatments for depression. Whereas some treatments characterize depression as a medical illness, Behavioral Activation was born out of a psychological tradition that views depression as a set of learned behaviors – such as avoidance, withdrawal, and rumination – which can be “un-learned.” It offers hope that people with depression can learn new ways of living more rewarding lives.

The basic premise of Behavioral Activation is that increased engagement in meaningful activity will decrease depression. In contrast, the avoidance of unpleasant feelings and thoughts can backfire and lead to greater suffering. For example, a person may avoid the stress of the upcoming day by sleeping in late, but this strategy may leave the person with fewer chances for rewarding experiences; having fewer positive experiences can cause more unpleasant thoughts and feelings, leading to more avoidance, and ultimately more suffering. The solution to this depression feedback-loop is to learn how to become more active and engaged with meaningful activities (hence the name Behavioral Activation), even while feeling unhappy, anxious, unmotivated, or irritated.

Behavioral Activation is an evidence-based therapy, meaning research shows that it can help people. In one study (Dimidian et al., 2006), BA was shown to be as beneficial as anti-depressant medication in treating major depression – without the harmful physical side-effects. Further still, Behavioral Activation has been shown to be more effective than anti-depressant medications at preventing relapse of depression after treatment has ended (Dobson et al, 2008). In fact, research shows that it is primarily the behavioral component of Cognitive Behavioral Therapy that has accounted for its success (Jacobson et al, 1996). This point makes sense because, instead of directly trying to change the ways people think and feel, Behavioral Activation works “from the outside in” – the focus on changing behavior can lead to a better quality of life that then improves people’s inner experience – their thinking and emotions.

In conjunction with mindfulness practices and ACT, therapists at Portland Psychotherapy utilizes Behavioral Activation in individual and group therapy. Clients who participate in our program can learn how to stop the cycle of depression and prevent future depressive episodes. Our therapists help clients to work with rumination, to overcome avoidance and passivity, and to gain more flexible problem-solving skills. As a part of this work, we help clients achieve insight into the difficulties they experience by fostering greater self-awareness through mindfulness. We look closely at triggers of avoidance and help clients become less reactive and more deliberate in making effective choices. Most importantly, our therapists help coach clients to pursue activities they value. Our expertise in Behavioral Activation offers clients an opportunity to live more rewarding and meaningful lives.


People with dysthymia usually feel like they have little or no joy in their lives. Rather, things seem gloomy most of the time. If you have dysthymia, you may feel like you’ve been depressed your whole life. You may have a hard time enjoying things and having fun. You might tend to be withdrawn, worry frequently, or criticize yourself as being a failure. You may feel guilty, worthless, or have difficulties with sleep. In any given year, about 3% of people could be diagnosed with dysthymia.

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 x1. Evidence-based treatment of dysthymia gives you the best chance that treatment will be successful and minimize the risk of relapse.

Is Depression Just a Chemical Imbalance?

What is depression?

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 few decades, 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 about 400% from the mid 1990s to the mid-200s), 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, 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

The idea that depression is due to a chemical imbalance has been thoroughly debunked by modern science. It’s widely acknowledged to be a marketing ploy or perhaps more generously, a “figure of speech.” It’s definitely not scientifically accurate.

Research has consistently failed to show a correlation between levels neurotransmitters in the brain and depression. There are no blood tests that can correlate neurotransmitters with depression levels. There are millions of chemical reactions occurring in the brain at any given time and there is no way to tell if those are related to derpession.

The origin of the idea was not based on research about levels of neurotransmitters in the brain, but instead on early research showing that anti-depressants affect seratonin (among other neurotransmitters). The logic was that if antidepressants increase seratonin levels, that therefore depression must be due to low seratonin levels. But this is a logical fallacy. Making this conclusion is simlar to saying that pain is caused by a lack of asprin in the brain. Just because asprin reduces pain doesn’t mean that pain is caused by an “asprin imbalance.”

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).

This idea also applies to depression. 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 how to live a non-depressed life and our brain will change to reflect that. Consistent with this idea is research showing that similar changes are found in peoples’ brains when they recover from depression, whether this is the 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. And other research shows that once on antidepressants, it can often be hard to get off due to antidepressant discontinuation symptoms.

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 both help people some of the time. 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 in accounting for much of how psychotherapy works. 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 that 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 much of the therapy that we  do at Portland Psychotherapy. 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. This is, of course, an oversimplification, but it’s an important part of recovery from depression.

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 your depression would have improved 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 or may not want to have to take an antidepressants for the rest of their life. 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 Portland Psychotherapy, we use evidence based practices in treating depression, which includes cognitive behavioral approaches and emotion-focused therapy.

Depression Treatment


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. We also provide referrals to our in-house medication provider if needed as part of a complete treatment experience.

In our depression treatment program, 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.

Some of the specific evidence-based treatment for depression we offer are:

If you would like to talk to someone for an initial consultation, you can call our confidential phone line at 503-281-4852 x1 or leave us a message using the secure contact form below:

Seasonal Affective Disorder & the Winter Blues


When the season moves into winter, the days grow shorter, and the skies turn gray, do you find that your mood darkens as well? If so, you’re not alone. Approximately 10% of Americans experience a lower mood during the winter months, and this rate is as high as 20-30% of people in more Northern latitudes such as Oregon. For many people, the “winter blues” can develop into something more serious. In a given year, approximately 5% of Americans develop what’s called ‘Seasonal Affective Disorder (SAD),’ with this rate increasing in more Northern latitudes, such as Oregon. For example, around 1% of people living in Florida experience SAD, whereas around 9% of people living in Alaska experience SAD. Dark indoor work environments may also contribute to SAD.

What is Seasonal Affective Disorder?

SAD is a form of depression that begins and ends during a specific season each year. Here, we discuss the most common type of SAD, which occurs during the fall/winter, and is caused by the decrease in natural light during these seasons. It usually subsides by the spring or summer. Symptoms of SAD include increased need for sleep, daytime fatigue, irritability, decreased activity, decreased concentration and ability to think clearly, decreased sex drive, and increased appetite, particularly for sweets and starchy carbohydrates.

How can I learn more about SAD?

You can find out more information about SAD online at our Portland Depression Treatment program website: In addition, Norman E. Rosenthal, MD, the person who first described SAD in a study published in 1984, has information and resources about SAD on his website: If you’re looking for a book devoted to SAD, we recommend Dr. Rosenthal’s book, Winter Blues: Everything You Need to Know to Beat Seasonal Affective Disorder.

What can I do about SAD?

We all can’t move to the Southwest during the winter months, but there are many simple changes you can make to lessen the impact of SAD. The most tried and true treatment that we know of for SAD is “Light Therapy.” Since Light Therapy is one of the most well-researched and cost-effective treatment options, and has minimal adverse side effects, we’ll discuss it in the most detail below. At the end, we’ll also discuss other treatment options that can be helpful and important to consider, especially if Light Therapy doesn’t seem to be doing the trick.

What’s light therapy?

Light therapy involves using devices specifically made to treat SAD can provide daily doses of artificial light. These devices can be purchased without a doctor’s prescription, and you can find them over the Internet. They are sometimes available at Costco, but unfortunately Costco also sells some devices that are poorly made and aren’t likely to work. So, be careful about what device you buy. Costs range from $120 to $300. Be sure to buy one made to target SAD, and manufactured by a reputable company. In addition to the standard white light boxes, manufacturers are beginning to make blue light devices. Although there is some promising research supporting the use of blue light boxes, for now, broad-spectrum white light boxes are probably the better choice because there is larger evidence base for their use. They are also just as cheap or even cheaper than the blue light devices that have been tested.

How do I use a light therapy device?

Most people have a good response by sitting in front of a light box for 20 to 90 minutes a day. One session in the early morning, ideally before the sun comes up, is enough for many people, although some people find they need to also sit in front of the box again in the afternoon or early evening. All you need to do is sit in front of the light at the proper distance and engage in regular activities, such as eating breakfast, working, talking on the phone, or reading. You don’t need to stare into the light, though you should be facing the device. Most people begin to notice improvements within a week of regular use.

Steps to implement light therapy:

  1. Obtain a reliable light box (see below for recommendations)
  2. Set up the box in a convenient location at home or work
  3. Sit in front of the box for enough time and at the right distance for your device (usually 20-90 minutes/day)
  4. Try to sit in front of the box in the early morning (usually 6-7am, or so)
  5. Monitor whether your current plan is working. If not, consider adding an afternoon/evening session and/or increasing your time spent in front of the device
  6. Sit at the proper distance and at the right height, so that at least some of the light comes into your eyes from above
  7. Repeat each day through the season of risk
  8. To prevent SAD in following years, start light therapy in the early autumn before you experience any symptoms

Another option is dawn simulation. Dawn simulators work like a soundless alarm clock. Programmed to begin 30 minutes to an hour before you wake up, dawn simulators time lights to gradually come on before you wake up, mimicking a sunrise. The added benefit of a dawn simulator is that the treatment is over when you wake up and begin your day. While dawn simulators have been shown to be helpful, the evidence for their effectiveness is not as strong as it is for light boxes and therefore it works for fewer people. Many people use both a dawn simulator to make it easier to get up in the morning and a light box.

Is light therapy safe?

For the most part, light therapy appears to be safe. Side effects, if present, tend to be minimal and may include headaches, eye strain, and mild nausea—and even these tend disappear after a few days of use. Although well researched, people with eye problems are usually not included in studies, so problems cannot be completely ruled out. While side effects are generally minimal, it’s always good to talk to a professional before starting light therapy, but especially if you have an eye condition that makes your eyes vulnerable to light damage, you have a condition that makes your skin especially sensitive to light, or if you take medications that increase your sensitivity to sunlight, such as certain antibiotics, anti-inflammatories, or the herbal supplement St. John’s Wort.

Where can I learn more about light therapy?

An educational video that I made about SAD:

The Mayo Clinic has a page about how use light therapy:

Recommended light therapy devices

Below are some devices that I’ve tested and should work if used properly:

  • ** White light therapy — this is the kind of device that is used in research and has the best support for being effective. If you can afford it, it’s the one that I would recommend. Prices have really dropped a lot lately, so it’s becoming more affordable.
  • Smaller white light therapy deviceIf you can’t afford the one above, a smaller white light therapy device emits enough light, but only if it’s six inches from your eyes. You’ll have to be very careful to position it above your eyes and make sure it’s close enough (about six inches away). This makes it very difficult to use in a practical fashion, so I’d highly recommend spending the extra money for the one above.
  • Blue light therapy — has some research support, but not as much data. It’s more expensive to buy and may not be quite as effective.
  • Dawn simulators — very easy to use for those who have a hard time getting out of bed. However, they are probably not as effective for everyone. This can be a good place to start, but if it doesn’t work, you’d want to move onto a regular light therapy device.

Other Treatments for SAD

While light therapy is the most proven treatment for SAD, there is also evidence that cognitive behavioral therapy (like that delivered at the Depression Treatment Program at Portland Psychotherapy) can be helpful. Some research even suggests that these options are just as effective as light therapy. While some antidepressant have also been shown to help with SAD, they tend to come with more severe side effects than those associated with light or behavioral therapies, and therefore should be considered second line treatments. However, if light therapy or other treatments do not work, then it may be worth trying an antidepressant. Although research shows a link between vitamin D deficiency and depression, it isn’t yet clear whether taking vitamin D supplements improves SAD symptoms. However, for anyone with depression symptoms, it’s a good idea to get a medical workup, including laboratory tests, to see if your Vitamin D levels are excessively low.

All in all, if light therapy is not for you, or doesn’t work for you; you may want to consider one, or a combination of, these other options.

NOTE: This information page is educational in nature. If you’re experiencing severe depression or having suicidal thoughts, we urge you to seek professional services.

Major Depression


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:

Bipolar Disorder


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.