The word depression means different things to different people. To some it is analogous to feeling sad, to others it is feeing despair, to others it means feeling hopeless, and to others it means being unmotivated or tired. Because of all these different meanings, when a client says to me he's depressed, I ask enough questions to find out exactly what he means.

From your point of view, you too should know what you mean when you say you're feeling depressed. The reason to know is so you can problem solve it. For example: When a client says she's depressed and means she's tired I can assist her problem solve this with questions that first examine her lifestyle. How much sleep per night is she getting? Does she sleep soundly? Are dreams or nightmares a factor?

To your medical doctor, naturopath, or therapist the word depression has a specific meaning. It is a condition that's been decided on or defined to be an illness. It therefore has specific characteristics and treatments. So if you're using the phrase "I feel depressed" with your therapist, doctor or naturopath  be prepared to answer questions and define exactly what it is you feel. You would be doing yourself a disservice to label 'not getting enough sleep' as depression. More importantly, you would be doing yourself harm by calling depression 'not getting enough sleep'.

Clinical Depression

The two major symptoms I look for is sadness and/or despair. Additionally I listen for one or all of the following:

• Loss of interest in or motivation for pleasurable activities.
• Preoccupation with failures and/or inadequacies.
• Difficulty concentrating and/or unable/unwilling to make decisions
• Fatigue and loss of energy (without a physical cause).
• Significant appetite change, or weight gain or loss (without physical cause).
• Sleeping excessively or not much ie.significant change in sleep pattern.
• Feeling agitated, worthless, hopeless.
• Recurring thoughts about death or suicide.

If you are experiencing these. You may be depressed under the clinical definition. There are several methods of dealing with depression.

Antidepressant Medications

You've probably heard of Paxil, Zoloft, Prozac, Celexa, Lexapro and Luvox. These are some of the more common medications prescribed by physicians for depression. They are targeted for your brain chemistry, and specifically for a chemical produced and used by the brain called serotonin. These drugs block the brain from absorbing serotonin, thereby keeping it available. Serotonin acts as a neurotransmitter, meaning it carries neuron information across the synaptic gaps between neurons. Because they keep serotonin available, these drugs are referred to as SSRIs - selective serotonin reuptake inhibitors. Another group of antidepressants is called serotonin and noradrenaline reuptake inhibitors or SNRIs. Like their name they attempt to reduce the brain's reuptake of both serotonin and another neurotransmitter - noradrenaline. This group includes Effexor, Cymbalta, and Serzone. Their are two other popularly prescribed antidepressants that I need to mention, Wellbutrin and Remeron. Their biochemical activity is different than the others mentioned but the idea is basically the same - keep neurotransmitter levels above normal. Another medication that has been used extensively in Europe for years and that has proven itself in research studies, is the herb St. John's Wort. In contrast to the other prescription drugs, St. John's Wort can be purchased over the counter. 

I have used Prozac, and I've used St. John's Wort. I have suggested to many clients that they seek a depression assessment by a medical doctor because I suspect they are depressed and therefore need to be on a prescription antidepressant. If they balk at this, I suggest St. John's Wort. It is milder than the others so not recommended for serious depression (suicidal for example). When I went on Prozac, I needed that level of intervention - and luckily, suffered no side-effects. That was fourteen years ago, and since then I have self prescribed St. John's Wort on two occasions for about 7 months each time. With any of these medications, it takes anywhere from a week to three weeks to feel different.

So the moral of the story here is, if you suspect you are moderately to seriously depressed, see your physician. If you are mildly to moderately depressed, see your naturopath.

Medication is Not Enough

In my opinion, and that of most therapists, a permanent cure for depression requires psychotherapy. Although all the pharmaceutical companies, and some physicians don't want to hear this, every good research study into treatment for depression has demonstrated that the "talking therapies" are equal to medication for positive outcomes. And in fact, the talking therapies are more effective cures over time, and vastly less expensive! "Talking therapies" have no side effects. In spite of my personal use of Prozac I personally would rather find, and have found, a drug free life style that prevents depression, than resign myself to using an antidepressant with its attendant risks.

My own therapy, my experience with clients, and my conversations with other clinicians has convinced me that psychotherapy is THE effective method of dealing with the illness.

From a Cognitive Behavioral Therapy (CBT) perspective, depression is quite responsive to treatment. Take a look at the Cognitive Model of Depression to understand how your thoughts and feelings are connected to create the depression; and how the feedback loop works.

The way I see depression from the TA point of view is similar to the CBT model: The coping strategies that have been reasonably successful for the Adapted Child ego state, are no longer appropriate or effective. The Critical Parent ego state uses this as an opportunity to attack/criticize  the Child, not just for behavior, but for every aspect of self. In response, the Child feels depressed. Only the intervention of the Adult ego state will protect the Child - if the Child decides the Adult has more potency than the Parent. For the Adult to gain Child trust requires therapy!

Here's the translation. If you are depressed, my approach would be to assist you in (1) getting some relief through medication if necessary (2) explore with you the specifics of why you want to change the way you feel with the goal of (3) supporting you in making a contract with yourself to look at issues, beliefs, thoughts, feelings that are no longer appropriate to who you want to be (4) coach you in talking to that depressed part of yourself - to begin a dialogue with it, listen to it, respond to it, nurture and take care of it as if it was a wounded kitten or puppy (5) examine beliefs about yourself as worthy of living, being happy, enjoying the goodies available in this life in order to disprove the Parent's harsh ideas. This is Parent Contamination of the Adult and progressively allows you to ignore critical  self discounting thoughts. The bonus here is that as you do this, you also become more accepting of others - spouses tend to like this.(6) devise strategies for putting more fun, relaxation, pleasure, and enjoyment into your life.

So if you think you might be depressed, there really are people and strategies that can help you; even if you feel that you are the hopeless exception.