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Is There Something Wrong With Me? (Part 3 – Depression)

Disclaimer: This blog post is not intended as medical or psychological advice, but rather as personal opinion and educational information.

Blog Image by Liza Summer via Pexels

In part three of this series entitled “Is There Something Wrong With Me?”, I  explore the experience of depression and how to know when the developmentally normative emotion of sadness becomes pathological and requires clinical treatment. 

We all feel depressed at times. However, sometimes there is uncertainty whether what we are experiencing is normal, or if we need to seek professional help from a medical provider. My hope is through this series you will continue to gain a greater appreciation for the complex nature of our emotions, how thoughts and feelings influence our mental health, and a better understanding of when a normal emotion, like sadness, becomes something more serious, like major depressive disorder. And I hope it is encouraging to have a resource that shares credible information on mental health and wellness.

Quick Review:

  • In part one of this series, I defined the distinct roles of coaching and counseling in mental health and wellness. 
  • In part twoI explained how coaching and counseling approach anxiety differently, each serving a unique purpose in the spectrum of a client’s experience of anxiety. 
  • Today in part three, I explore how coaching and counseling address the same topic, depression, from different angles and how coaching is a proactive approach (education and preventative practices) while counseling is a responsive approach (responding to the diagnosis of depression with a specific treatment plan).

Coaching and Counseling: differing approaches to engaging with depression

  • In coaching, the focus is on the normal human experience of occasional sadness, grief, and depression that may be precipitated by a transient situation. The emotional, somatic, and cognitive impact may manifest as a temporary change of physical and mental functioning. Coaching is a proactive approach to depression that provides education about the way the brain functions, information on the neurotransmitter system’s influence on sadness, the role of neural pathways, explanation of proven neuroscience strategies to counteract negativity bias (which strongly influences depression), a safe space to talk about the temporary experience of sadness and grief, and explore preventative measures and healthy habits so a client can develop resilience to navigate short term experiences of sadness, grief, and depression from a position of strength. 
  • In counseling, the focus is on the pathological experience of depressive disorders that can be chronic, debilitating, and impact daily function including mood, cognition, memory, eating and sleeping. Counseling is a responsive approach to engaging with an individual who is deeply immersed in the experience of depression and cannot reverse course. Counselors center their attention on appropriately diagnosing the client’s specific depressive disorder, understanding how a client’s temperament, environment, and genetics contribute to the manifestation of the disorder, and creating a focused treatment plan** to reduce symptoms and increase functioning around the depressive disorder. For some clients, a referral to a psychiatrist may be required if medication is necessary to manage the brain chemicals that profoundly impact the symptoms of depression. **While there are a myriad of counseling theories (over 260 known approaches documented), one of the most effective at treating depression is cognitive-behavioral therapy. When considering a new counselor, be sure to ask them about their experience and success rate in working with clients with depression, what theory/approach they use in treatment, and why they use the approach with depression.

What is Depression?

A diagnosis of depression is not subjective (“you look depressed”) but rather assigned to a client by a counselor, psychologist, or psychiatrist based on observable symptoms over a specific time frame that corresponds to The Diagnostic and Statistical Manual of Mental Disorders IV (DSM-TR) used by clinicians. The DSM is published by the American Psychiatric Association and is considered the definitive handbook used by healthcare professionals as the authoritative guide to the diagnosis of mental, behavioral, and psychological disorders. 

Depression Briefly Defined

Depression: The DSM states that “the common feature of all depressive disorders is the presence of sad, empty, or irritable mood, accompanied by related changes that significantly affect the individual’s capacity to function such as loss of interest in activities previously enjoyed, and changes or difficult in cognition, memory, energy level, eating and sleeping. Careful consideration should be given to the delineation of normal sadness and grief from a major depressive disorder.” It’s normal to feel intense sadness about, or grieve, challenging life situations. However, depression is different in that it persists daily for two weeks, without reprieve, involves multiple symptoms in the diagnostic criteria beyond sadness alone and cannot be attributed to another medical condition, medication, substance, or a specific loss (bereavement, job loss, financial ruin, natural disaster, medical issue, or disability).

Depression is complex and cannot simply attributed to emotions like sadness or grief. An influential system of chemical neurotransmitters in the brain (serotonin, norepinephrine, dopamine, oxytocin, GABA, melatonin, endorphins and endocannabinoids), parts of the thinking brain (prefrontal cortex: dorsomedial, ventromedial, orbitofrontal, dorsolateral, ventrolateral) and the feeling brain (limbic system: hypothalamus, hippocampus, amygdala, and anterior cingulate) all impact the experience of depression. 

Types Depressive Disorders

There are a variety of depressive disorder. What differs among the various types of depressive disorders is duration, timing, and presumed etiology of the depression.

Types of depressive disorders are listed below:

  1. Major depressive disorder indicates an individual has felt sad, low, hopeless, or worthless most days for at least two weeks while also exhibiting at least five of nine other symptoms concurrently (such as sleep problems, loss of interest in activities, or change in appetite, etc). Specific variations which are listed below in point number eight.
  2. Disruptive mood dysregulation disorder is a diagnosis for children under the age of 10 in which they exhibit symptoms of severe, recurrent temper outbursts manifested verbally and/or behaviorally and accompanied by labile mood swings (laughing, crying, irritability, temper, exaggerated changes in mood) between outbursts. As children mature into adolescents and adulthood, many develop unipolar depressive disorders or anxiety disorders.
  3. Persistent depressive disorder is mild or moderate depressive moods disturbance that lasts for at least two years in adults and one year in children. The symptoms are less severe than major depressive disorder. 
  4. Premenstrual dysphoric disorder is a combination of premenstrual syndrome symptoms in the week before the onset of menses, along with five additional symptoms during menses (severe mood symptoms such as extreme irritability, anxiety, or depression, etc). These symptoms improve within a few days after the onset of menses and are minimal or absent in the post-menses time frame.
  5. Substance/medication-induced depressive disorder is a depressive state that occurs as a side effect exhibited during the use prescription medication, exposure to other substances, or withdrawal from a medication or substance.
  6. Depressive disorder due to medical conditions can create changes in your body that cause depression like symptoms. Examples include hypothyroidism, heart disease, Parkinson’s disease, and cancer. If you’re able to treat the underlying condition, the depression usually improves as well.
  7. Unspecified depressive disorder is a diagnosis given when symptoms characteristic of depression disorder are present and cause impairment but do not meet the full criteria for any of the specific diagnosis by lack of intensity, frequency, or duration compared to the standard diagnosis.
  8. Specific depressive disorders are found within the major depressive disorder category include:
  • Seasonal affective disorder is a form of major depressive disorder that typically arises during the fall and winter, goes away during the spring and summer, and is linked to exposure to sunlight.
  • Prenatal depression is depression that happens during pregnancy. The DSM refers to these as “major depressive disorder (MDD) with peripartum onset.”
  • Postpartum depression is depression that develops within four weeks of delivering a baby. The DSM refers to these as “major depressive disorder (MDD) with peripartum onset.”
  • Atypical depression, also known as major depressive disorder with atypical features, vary slightly from “typical” depression. The main difference is a temporary mood improvement in response to positive events (mood reactivity). 
  • Other specifiers that may be used in diagnosis include “with anxious distress; with mixed features; with melancholic features; with psychotic features; and with catatonia”.

NOTE: While Bipolar Disorder is a diagnosis that exhibits both depressive and manic episodes, it is considered its own classification in the Diagnostic and Statistical Manual of Mental Disorders and does not fall under the depressive disorders.

Summary

Sadness is a normal emotion that can make a person temporarily feel low, empty, and hopeless emotionally while also exhibiting changes in daily functioning somatically and cognitively. There are many tools and wellness practices that individuals with a normal experience of sadness and grief can use to cope with sadness and prevent a downward spiral towards depression. Many can be learned in coaching sessions and customized to a person’s unique situation.

For those individuals whose experience of sadness and grief is persists daily without reprieve for more than two weeks and impacts their daily functioning, or coexists along with episodes of mania, therapy may be the right next step. In counseling an individual will receive a diagnosis and focused treatment to improve their experience with depression. If this resonates with you, and you are uncertain where to start, speak with your primary care physician who can recommend a reputable counselor, psychologist, or psychiatrist depending on the uniqueness of your situation and severity of your symptoms.

Final Thoughts

A book I recommend on the topic of depression is Upward Spiral by Dr. Alex Korb. He uses neuroscience to explain the complexity of depression, and what habits can be developed to reverse mild depression in an extraordinarily clear and insightful way. It was written by a psychologist who struggled personally with depression. The book offers a thoughtful approach to explaining the downward spiral of depression as well as eight practices that create an upward spiral towards better mental health. Though it is a deeper dive into the structure of the brain and neuroscience of depression, it is still very readable to anyone who has not studied psychology. Please note this book is not intended for an individual who is struggling with major depression and needs counseling and/or medication to reverse the course of a major depressive disorder. 

Additionally, I recommend Breath as Prayer by Jennifer Tucker as a helpful resource for last week’s topic of worry/anxiety and this week’s topic sadness/depression. Jennifer writes “Breath prayers combine two powerful tools that can help calm: the science of deep breathing, and prayers of meditation on God’s Word.” I love this book, read an entry almost daily, and have given it away as a gift at least a dozen times. Each of the 80+ breath prayers are organized by one of 12 themes, so it is easy to locate a breath prayer to provide comfort in almost any situation.

(NOTE: I only recommend books I have actually read, and I do not include affiliate links. Why? Affiliate links give an influencer, blogger, or creator a financial payback for recommending an item, which I believe creates bias. If I personally recommend a book to you, my trusted blog readers and clients, it’s because I think the book is valuable and not because I will be financially rewarded for recommending the item.) 

In part 4 of this series, I will answer questions you may have on the topic of mental health. Additionally,  I will also provide some insight and encouragement around establishing intentional practices in the pursuit of mental health and wellness.

I’M GRATEFUL YOU TOOK THE TIME TO READ THIS POST. DID YOU FIND IT HELPFUL? IF SO,I WOULD BE HONORED IF YOU SHARED IT WITH A FRIEND.
Bethany Grace

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Disclaimer: This blog post is not intended as medical or psychological advice, but rather as personal opinion and educational information. Though Well Soul Studio, LLC was founded by a clinician with a master’s degree in counseling, the scope of this practice is limited to certified embodied coaching, somatic therapy, and enneagram discovery. If it is determined a client’s needs would better be served by a licensed mental health professional such as a counselor, psychologist, or psychiatrist, Well Soul Studio, LLC will always make that recommendation. A client’s mental health and well-being are always a priority at Well Soul Studio, LLC. 

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