The social aspects of depression get ignored sometimes, because our American cult of "rugged individualism" tells us that people should be able to handle their emotions without outside help. This approach may appear to work for a few special individuals like Gandhi or Mother Teresa, but in everyday life, the simple truth is that people need other people to help them feel good. While it’s true that too much dependency (or co-dependency) can end up sabotaging the very thing we need – emotional intimacy – it‘s healthy and normal to want support and validation from others. As many people know from experience, feeling depressed for a while is a common reaction to the loss of a relationship, or a hurtful experience within one. Long-term depression often has something to do with deeper hurts that may have occurred in significant relationships early in life.

Therapy is a place to explore and come to terms with these past hurts. It’s also a place where a relationship can have a healing effect on depression. The client gets to experience validation and support without having to worry about the therapist’s emotional needs. She also gets to experience mixed or negative feelings, and talk about them, without losing or destroying that validating, supportive relationship. What makes this possible is that the client and therapist make a commitment to building a relationship that’s strong enough for whatever conflicts or difficult feelings come up. The client commits by investing time, money, and a willingness to be truthful. The therapist commits by being reliable, by never crossing the boundary between a therapeutic relationship and a social one, and by bringing her focused, thoughtful attention to whatever emotions the client needs to express.

 To help my clients recover from depression, I listen carefully to each person’s individual experience and try to address whatever behavioral, physical, mental, spiritual, and social / relational issues are involved. 

​WHAT YOU CAN DO IF YOU'RE DEPRESSED

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• ​Get physical exercise
  
• Drink plenty of water
  
• Eat nutritious foods
  
• Ask your doctor about anti-depressants
• Go outdoors
  
• Spend time in nature
  
• Meditate or pray
  
• Talk to friends
  
• Make something creative
  
• Journal
  
• Talk back to negative thoughts
  
• Notice small successes
  
• Assert yourself
  
• Breathe
  
• Use affirmations
  
• See a therapist
  
• Remember what’s helped before

​Depression affects everyone differently. It can be a chronic condition or a reaction to a bad situation. Some signs of depression are

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• apathy
  
• overeating or loss of appetite
  
• insomnia or oversleeping
• irritability
  
• social isolation
  
• fatigue
  
• thoughts about suicide or death
  
• feeling worthless or guilty
  
• trouble concentrating or making decisions
  
• medical problems
  
• feeling down or sad
  

​Depression

​This list of symptoms, though, can’t fully represent what it’s like to feel depressed, any more than a Muni Map represents what it’s like to travel along a San Francisco street. From a holistic point of view, depression affects, and is affected by, all areas of a person’s well-being: behavioral, mental, spiritual, physical, and social.

Behaviorally, depression can affect the ability to get out of bed in the morning or perform the most basic acts of self-care. It can even lead to suicide. For a lot of people, though, its effects aren’t so obvious. It may only cause a subtle downshift in the ability to meet the demands of their work or social life. As a therapist who works a lot with this latter, "high-functioning" group, I know that the emotional pain is very real in spite of outward appearances.

Mentally, depression amounts to negative thinking, sustained over a period of time. Negative emotions are inevitable. On their own, they last from a few seconds to a few minutes. Thoughts, however, are ultimately in our control and, with practice, can be changed. A negative emotion is like a hitchhiker; it needs a negative thought to do the driving so it can take you for a long, unpleasant ride. Catastrophizing, a term that refers to treating small setbacks like major failures, is one example of the kinds of thought patterns, usually not even conscious, that carry depression along. Identifying and practicing ways to replace these patterns, known as "thought fallacies," is what happens in cognitive therapy.

On a spiritual level, depression may feel like a lack of purpose, meaning, or joy. It makes it hard to connect with the feelings of wholeness, love, pleasure, or creativity that make life seem worth living. Contact with nature, spiritual practices such as meditation, creative work, and reflection on some form of benign power beyond the self, have all been known to lift people out of this kind of despair.

The role of physical, or biochemical factors in depression was debated a lot before anti-depressant medications became as effective as they are today. What research shows is that talk therapy and medication work better together than either one by itself. As a therapist, I’m neither for nor against anti-depressants. I encourage physical habits that are known for helping people feel better, such as exercise. Anyone who’s ever gotten an endorphin rush from a brisk walk, understands this body-mind connection. When my clients want to consider medication, I let them know that 1) it often takes some time to find the specific drug, dosage, or combination of medicines that works best for each individual, and 2) a psychiatrist, as a specialist in this area, is probably better equipped to guide them through that process than a general physician. The same principle applies to herbal treatments: it takes time, and it’s best to work with a qualified practitioner. With or without medication, it’s important to know that depression can be caused, at least in part, by brain chemistry. It doesn’t represent a moral, personal, or psychological failure. This is hard for some people to believe at first, especially if they’ve been put down as "lazy" or "unmotivated" in the past, or if the depression itself is creating feelings of failure and self-blame.