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No Change Is Normal Mood (e.g., Depression)

Question:

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p>I have been looking over depression information basically since high school. The part that always confuses me is when it says a sign of depression is when the symptoms last for 2 weeks or longer and represents a change in the person’s normal mood behavior. My issue is this I can not identify with what is deemed a “normal” mood. I have always for as long as i remember had feelings which can be found in the symptoms of major depression. If you ask those around me i always look “angry, upset, sad, unhappy and even depressed” and truth be told they say those things as its like no skin off my teeth and I reply to them with a very aggravated “and so what this is just me leave me alone” I don’t guess this is really a question anymore huh? Well could there be something else as a cause of this issue? I have been hospitalized for mild depression, I have been in therapy for depression. Taking Zoloft and Prozac and what have you which never worked. I no longer take therapy or meds. Although I know the issue is not gone and would like to pursue therapy options again I just want to receive the proper care and proper therapies.

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  • Dr. Dombeck responds to questions about psychotherapy and mental health problems, from the perspective of his training in clinical psychology.
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Answer:

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p>The DSM diagnostic criteria for Major Depression do specify that a range of behaviors is present for a two week period that represent a “change from previous functioning”. This is because, in the classical case, a major depressive disorder occurs in a person who is otherwise functioning normally and is not depressed. In this case, the episode of serious depression represents a departure from standard functioning. The patient was well, and then developed the depression. When the depression clears up, the patient will be well again.

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p>While there are many cases of depression that occur in this on/off manner, there are also many cases of depression that are recurring and/or chronic in nature. Major Depressive Disorder (MDD) can be specified as a “single episode”, for instance, or as “recurring”. Once you’ve had a single MDD episode, you are at heightened risk for more. The nature of how exactly this increased vulnerability occurs is not very well understood presently, but it is nevertheless there. When MDD is recurrent, the intervals between depressive episodes can be free and clear of mood problems, or there can be lingering depression in several forms. A common form is something called Dysthymia, which is a chronic low level depression that is constantly in the background more days than not over a period of years. When MDD occurs in the context of Dysthymic Disorder, you have a condition known informally as “Double Depression”. MDD and Dysthymia can be very difficult to disentangle, and indeed, it is not entirely clear where one diagnosis ends and the other picks up. Again, classical Major Depression has a clearly defined onset and offset, where as Dysthymia is more of a constant chronic background to a person’s life.

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p>I’m sorry to hear that Medication treatment has not proven helpful to you. I have found that many times, patients will complain that medication has not been helpful, but when you ask family members they will say that it has been helpful. Typically what occurs is that some of the more physical depression symptoms clear up first (the sleeping and appetite and slowness problems) while the thinking problems don’t move too much. Patients don’t notice that the changes are happening so much, I think, because they are more attuned to the mental aspects rather than the physical aspects, while family members do notice the physical changes. At any rate, if you say it didn’t help, I’ll have to take your word for it.

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p>My recommendation for someone who is depressed and wants to try non-medical therapy is always simple and straightforward. The best understood and best working psychotherapy for depression is cognitive behavioral therapy or CBT. CBT teaches you how to pay attention to the thoughts that are in many cases a powerful causative force driving your depression’s progress. In the therapy, you learn how to pay attention to these frequently hidden thoughts, and to do reality testing on them. When you look at them clearly, they tend to not make much sense – to be exaggerated, etc. When you can de-exaggerate the depressive thoughts, you can change them and by doing so – change your mood. Learning to do this can be an incredibly empowering process. CBT is pretty widely available these days so ask around for a therapist who works in this modality and you’re likely to find someone local.

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