Dr. Val FarmerDr.Val
Rural Mental Health & Family Relationships

Help Is Available For Depression

April 15, 1996

Do our moods come and go without any control on our part? Thank heaven that is not true. We can do something to manage our moods and stress and even our susceptibility to depression.

Lynn Rehm, a psychologist at the University of Houston, emphasizes that depression is treatable. There are effective drug treatments and counseling techniques to deal with depression that are inexpensive and don't take forever.

He believes depression is caused when the connection between a person's behavior and their long term goals is broken. A depressed person sees the pathways to their goal either blocked by daunting circumstances or they have lost confidence in their ability to deal with the challenges presented by circumstances.

Watch for distortions in thinking. Without a belief or hope that they can accomplish long term goals, several thinking traps create or maintain a depressed mood.

A depressed person:

  • pays selective attention to negative events and consequences in their life. Depression undermines their accuracy for predicting future positive events and overemphasizes the negative.
  • pays attention to immediate consequences instead of their long term goal.
  • resists changing their perfectionistic standards and goals. They are not flexible enough to either redefine their long term goals or consider alternative pathways to their goals. They believe their future efforts will be futile. Feelings of anger and hostility may accompany the depressed mood when there is a feeling of lack of control.
  • takes excessive blame and responsibility for negative life events. They place the cause of failure or anticipated failure primarily on personal deficiencies. They are self-critical, unsatisfied and unaccepting of themselves. A depressed person also fails to take credit for the positive things that they are doing.
  • engages in self-punishment and negative self-talk.
  • gives insufficient self-rewards, especially rewarding small steps on pathways toward long term goals.

There are ways to help. Rehm's treatment consists of some structured teaching units that address the faulty thinking of a depressed person.

People are helped to clarify and think through their long term goals. They coach them on how to increase positive events on a day to day basis. They show them how to pay attention to positive events, take pleasure and satisfaction in their long term efforts, be careful about assigning blame for negative events and how to take credit for positive events. They also are encouraged to take small steps toward long term goals and reward themselves for their successes.

Looking out for Bi-polar disorder. Psychologist Stephen Josephson of Cornell University Medical Center

feels there is a need for careful diagnosis between depression and bi-polar depression. Bi-polar depression is a biologic form of depression where a person alternates between depressed mood and an excited or euphoric mood. In their manic state, they often go without sleep, have racing thoughts, pressured speech, become argumentative and engage in impulsive behaviors such as spending sprees, excessive drinking, gambling or sexually acting out. In extreme forms, their ideas may become grandiose and irrational.

This form of depression runs in families and has a strong genetic component. Medication can easily control it though certain kinds of antidepressants might trigger a hypomanic episode - hence the need for careful diagnosis.

Both Rehm and Josephson see value in psychotherapy for bi-polar disorder - besides taking medication. Rehm sees bi-polar episodes as being triggered by stressful events. Coping skills that help them better handle stress and their moods will make them less susceptible to recurrent depression or manic episodes. They also need to be taught how to monitor their moods and activities and to regulate themselves accordingly.

Josephson feels it is important for bi-polar patients to understand the connection between their reduced amount of sleep and how it triggers manic behavior. Leading a balanced life with exercise, work and play will lead to regulated sleep and fewer interpersonal conflicts. They can be trained in anger management so they can monitor their own internal cues. People are also coached on how to respond positively to others who might also provide helpful insight into their pumped-up moods. They need to learn how to get back to their regular routine.

Medication compliance is essential. Weight loss may trigger increased activity levels. Josephson also feels the moods of bi-polar patients are sensitive to light and dark in much the same way as Seasonal Affective Disorder. (Certain people get depression from long-term winter darkness.)

I'm writing this column at the request of a North Dakota family who lost a college age son to suicide. Afterwards they learned he had bi-polar disorder. Knowing some signs might have helped them understand and intervene more strongly in his life. They hope this column offers insight that will help prevent another family from going through the same tragedy.