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How I Work With Depression

Depression is usually only talked about when it is very severe. In a major depressive episode, it is possible to lose all interest in others, food, fun, activity, or life itself. The simplest activities of daily living may seem overwhelming and the source of great anxiety. Hopelessness becomes palpable. The standard treatment today for this is safety monitoring, antidepressant medication, behavior activation (doing things through will power when the pleasurable impulse is lacking), and supportive psychotherapy. Depression can be considered more broadly, however.

Low level depression is a way of life for very many people. Psychology has a word for it, dysthymia. At this level, life may have some satisfactions, and we are able to meet our economic and role responsibilities as we understand them. Still, the machinery and fundamentals of depression are just underneath the surface. Deeper depressions do break through from time to time, and at best life seems a chase of contentment that is always out of reach. One can think of major depression as being decompensated and dysthymia as being compensated.

It may seem that the work of therapy is done when a person becomes compensated again. Life is again ‘normal’. This is often where clients will stop coming to therapy, and this is certainly a legitimate choice. Feeling better however is also a good foundation for doing deeper work that will break through the ceiling into joyful living. Major depression tends to recur, and perhaps the best (but by no means easiest) relapse prevention is eliminating low level depression as a way of life.

Depression is very different from sadness. Joy is very different from feeling okay or neutral. Getting away from low-level depression doesn’t entail uninterrupted good-feelings, but does entail much more feeling and liveliness. Those who have made the change would never go back. To me, this is some of the most important work of therapy.