CORONAVIRUS / COVID-19 UPDATE: VIRTUAL “TELEHEALTH” APPOINTMENTS ARE NOW OFFERED:
Joseph Contorer MFT and CounselingLA.com are here to offer support.
In response to the current Coronavirus Crisis, therapy sessions are being provided virtually. Various TeleHealth options include FaceTime, Skype and telephonic appointments. Effective approximately 3/17/20, several insurance companies, such as Anthem Blue Cross, have stated that they plan to cover the cost of member copayments on most plans for in-network mental health care for an initial 90-day period ending in mid-June, depending.
Thank you all and STAY SAFE!
Depression and Mood Disorders
Depression (mood disorders) sometimes creates a negative stigmatizing effect, yet it is a fairly common condition. I think of depression in general terms as a state of being blocked, stuck or subjugated. Depression pertains to the thoughts and concerns about what has happened; Anxiety is frequently associated and observed along with depression. Anxiety pertains to thoughts and concerns about what might happen next. Some people complain that they are depressed because of their anxiety and or that they are anxious because they are depressed.
Are you Depressed? Are you “Manic?” “Bi-PolAR”
Depression is a term and an actual clinical/psychiatric diagnosis, that describes a state of being that is more serious and pronounced than being sad or a little down or in a funk or having a bad day. There are several types of depression, which we now technically refer to as Mood Disorders. One of the more common diagnoses of mood disorders/depression is referred to as Major Depression and may be assessed to varying degrees of severity. More severe bouts of depression that typically include a general systemic loss of interest or happiness in many aspects of life, is known as “Major Depression.” A less severe, yet much more chronic, lower-level version of Major Depression that has been lingering for a long period of time is known as Dysthymic Disorder.
While there are various degrees, intensities and differing specific diagnoses, depression can be a very serious and debilitating disorder. Many people who are afflicted with depression and other related mood disorders will need professional help to treat their condition and they should have the help, understanding and treatment if they need it.
*Symptoms of Bi-Polar Disorder
(Consult a mental health professional, therapist or physician for technical consultation.)
MANIC EPISODE MAY LOOK LIKE THIS
People having a manic episode may
feel very “up,” “high,” or elated
DEPRESSIVE EPISODE MAY LOOK MORE LIKE THIS
People having a depressive episode may
feel very sad, down, empty, or hopeless
*From the National Institute of Mental Health
Symptoms and Causes of Depression
Major Depression symptoms may include all or some of the following, consistently present for a minimum of two weeks
Most all variations of depression include some degree of an aversion to normal predictable functioning/
(I.e. can’t get out of bed, or at least more difficulty engaging in a normal day/life of routine activities.)
Treatment for Mood Disorders THERAPY/TREATMENT FOR DEPRESSION AND MOOD DISORDERS
There are various therapy modalities and schools of thought to apply to a variety of problems/diagnoses, such as mood disorders (depression) or anxiety disorders. One of the more frequently utilized approaches is called Cognitive Behavioral Therapy (CBT.) This approach is found to often have a fairly rapid reduction of symptoms. The basic premise suggests that faulty or distorted thinking causes a disrupted mood. Through a set of applied “tools,” it is possible to re-program one’s thinking as well as the related behaviors/actions that compound together to form cognitive-behavioral therapy.
Most all of the self-reportedly "ground-breaking" self-help books that have been repeatedly recycled and re-branded and marketed over the last 40 years are all basically variations of Cognitive-Behavioral Therapy. The power is in the mind… You can change the way you feel.. Take control of your life etc.. Modifying your behavior, your thinking, your choices, your boundaries and on and on. Yes, it really is an effective rationale.
“You can change the way you feel by modifying the way you think.”
Cognitive Distortions Cognitive Behavioral Therapy will assess and address “Cognitive Distortions.”
The term “Cognitive Distortion,” is a more elaborate expression that describes a erroneous thought, group of thoughts, thinking or thought process that poses significant ramifications. Because these thoughts are “thinking errors,” the thought can be challenged and theoretically they can be corrected to a more accurate and healthy, constructive thought. The thoughts will influence the feelings, which will directly impact mood and or depression, anxiety, triggers to act out etc.
All or Nothing Thinking:
You see things in black or white categories. If your performance falls short of perfect, you see yourself as a total failure.
Disqualifying the Positive:
You reject positive experiences by insisting that they don’t count for some reason or other. In this way, you can maintain a negative belief that is contradicted by your everyday experiences.
Emotional Reasoning : “I feel it, so it must be true:”
You assume that your negative emotions necessarily reflect the way things really are.
Jumping to Conclusions/Mind-Reading/ “Fortune Teller Error:”
You make a negative interpretation, even though there are no explicit facts that convincingly support the conclusion.
Labeling and Mislabeling: Extreme form of overgeneralizing:
Involves describing an event with language that is highly “colored” and emotionally loaded (name calling, blaming accusing, etc). Rather than describe your thinking error, you attach a negative label to yourself, such as “I’m a Loser.” Conversely, when someone else’s behavior rubs you the wrong way, you attach a negative label to that person as well, rather than disapproving of their behavior.
Magnification and “Catastrophizing:”
You exaggerate the importance of things, such as your mistakes or imperfections, while shrinking your desirable/positive qualities. You minimize someone else’s imperfections or errors, while emphasizing and maximizing their attributions/contributions.
You pick out a single negative detail and dwell on it exclusively so that your vision of all reality becomes darkened, like the drop of ink that discolors the entire beaker of water.
You see a single negative event as a never-ending pattern of defeat.
You see yourself as the cause of some negative external event, which in fact, you were not primarily responsible for. The distorted thinking will lead to a conclusion that the problem is your fault and your responsibility.
Should-Statements: “Could’ve, would’ve, should've, ought to, must….._________________”
You try to motivate yourself with “shoulds” and "shouldn'ts" as if you had to be punished before you could be expected to do anything. When you direct should statements towards others, you feel anger, frustration and resentment (can’t cause, change or control others.)
ADDITIONAL TREATMENT APPROACHES for depression, anxiety and many other mental health conditions may also include influences from several psychotherapy modalities such as Family Systems, Psychodynamic/Freudian therapy. Therapy will also consider historical issues, such as family of origin dynamics and what psychodramas are being potentially re-enacted in the present time. All clients will most undoubtedly experience a “Client-Centered” Therapy, where the client is offered helpful mirroring and empathy with or without specific homework/cognitive restructuring goals.
For more technical, clinical details on Depression and Mood Disorders symptoms please follow this link to: National Institute of Mental Health: Depression details from The National Institute of Mental Health
Treatment with Medication Prescribed by Medical Doctor or Psychiatrist/Psychopharmacologist
MEDICATIONS FOR DEPRESSION AND ANXIETY:
Since the advent of Selective Serotonin Reuptake Inhibitor (SSRI) medication, (I.e.: “Prozac,” (f Fluoxetine) became widely utilized for depression and anxiety disorders after it was approved in 1987) these seem to be the more preferred psychopharmacological options to treat depression and anxiety. There have also been several new drugs approved in the recent years for treatment of Bi-Polar Disorder, which was formerly most always treated with Lithium.
SSRI medication works by chemically blocking a mechanism that limits Serotonin levels; this chemical and this process has been found to be directly linked to alteration of mood, anxiety and or obsessional thinking. There are numerous other medications and classes of medications used to treat mood disorders and other mental health conditions as prescribed by your doctor or psychiatrist. There are numerous derivatives of Fluoxetine (Prozac,) that were approved since the late 1980’s in this class of drugs; patients respond differently to these variations.
MEDICATION AND “TALK THERAPY” COMBINATION
Some clients will be prescribed and or also elect to take anti-depressants, mood stabilizers, anti-anxiety or other similar related psychotropic medications. The need for medication therapy as part of the treatment plan is determined by a medical doctor, often times a psychiatrist and sometimes also involves the psychotherapist. Ultimately, the final decision to enter a course of treatment of psychotropic medications, such as Prozac/other SSRI drugs or Wellbutrin (Bupropion) or a mood stabilizing drug such as Lamictal or Lithium, rests with you, the client.
Some research suggests that medications have been found to greatly influence a positive outcome particularly when they are combined with psychotherapy (talk therapy.) Not every patient who takes anti-depressants is in therapy or has even necessarily had therapy in the past. Similarly, not every patient who is in therapy is concurrently also prescribed psychotropic medications. However, some estimates suggest that approximately 30-50% of therapy clients are either currently on antidepressants or have been on them in the past.
Medications and timelines
One conclusion suggests that being on medications can help with managing emotions in a constructive manner that allows the patient to better accomplish required therapy tasks and achievements via psychotherapy. Medications can help reduce the intensity of symptoms like depression, anxiety and mania, for example; thus the client may experience an increased ability to manage their depression/anxiety by using therapeutic techniques they experience in psychotherapy.
Some patients have been on medications and various medications for many years and will need to remain on them likely for the remainder of their lives. Other patients are prescribed medications for a more acute episode that is connected to an incident/time-period-case-specific issue and is likely more temporary situation. This may include a single episode of depression or anxiety that is typically connected to a specific event or present stressor, crisis trauma or death/loss etc.
This more temporary type of scenario implies that the patient may opt to discontinue the psychotropic medications in the semi-near future, perhaps as little as 6 months, but usually they are on it about 1 year. Most psychiatrists maintain the following philosophy about psychotropic meds like anti-depressants: If a patient has been prescribed psychotropic medications, like anti-depressants, and they have engaged in trial termination of usage (“titrating off”) but shortly thereafter, they determined that they were unable to stop taking meds because symptoms re-occurred or they felt too uncomfortable/unstable, this patient will likely opt to or need to be placed on medications permanently.
This is especially relevant if they have unsuccessfully tried to stop on several occasions. In these cases the implication is that there are perhaps more biological/organic based chemical conditions at play on top of or instead of a situational type of depression/anxiety. Also relative with longer-term/permanent psychotropic medication necessity, there is usually a family history of clinical and chemical depression, mood disorders or anxiety disorders, often times with a close family member currently under psychiatric care and prescribed medications as well.