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  • Michael Milgraum

This article, written by Dr. Milgraum, was published in Kol Habira on February 14th, 2019

Major depression is one of the most common mental disorders in the United States. In 2016, it was estimated that 16.2 million adults and 3.1 million adolescents in the U.S. had experienced at least one major depressive episode that year.

This condition impacts physical, cognitive, emotional, and behavioral functioning. Its symptoms can include chronic sadness, lack of motivation, lack of enjoyment, fatigue, low self-esteem, elevated guilt, poor concentration, difficulty sleeping, sleeping excessively, weight gain or loss, and increased thinking about death and dying.

Depression is complex and can have many different presentations. Sometimes, physical discomfort will predominate, and the person with depression may even deny feeling sad. Some people experience depression primarily as an ache inside, often in their chest area. Others say they just feel numb.

There are many causes of major depression. Genetics is certainly a factor, but early life experiences, trauma, health problems, and beliefs about oneself can all play an important role. Treatments for depression include psychotherapy and medication. Effective psychotherapy for this condition can take many forms. Cognitive behavioral therapy (CBT) focuses on the thinking habits and behavioral choices that worsen or improve the condition. Psychodynamic therapy gives attention to how early experiences formed one’s self image and expectations about others. Insights gleaned in therapy help the patient develop improved responses to current challenges.

Parents of a child with major depression often find the situation highly frustrating and distressing. If the child is an adolescent, the depression frequently can take the form of extreme withdrawal from the world (excessive sleeping, spending most of the time in his/her room, avoiding relationships with family and friends). If this withdrawal is also accompanied by refusal to attend school, serious conflicts between parent and child can ensue. Given the impulsivity of many adolescents, parents may also become concerned about whether their child will try to harm him- or herself.

If parents suspect that their child is depressed, they should have him or her evaluated by a professional as soon as possible. Generally, the longer the condition goes untreated, the more difficult it is to reverse. Medication can help calm the emotional suffering, but I strongly recommend that it be used in conjunction with psychotherapy, to help the patient develop improved mental and behavioral responses to situations. The medication may improve mood, but without therapy, the underlying coping deficits will continue to undermine the child’s functioning and interfere with finding their way toward a happy and enthusiastic life.

It is particularly important for therapists to help adolescents become aware of the interaction between their mood and their choices. As mentioned above, people with depression often withdraw from activities hey used to enjoy. The decreased activity gives the adolescent more time to dwell on their worries and perceived deficits. In addition, the lack of activity leads to decreased interest and motivation, which then intensifies the depression. Thus, a vicious cycle of depression, inactivity, and depression is established.

Behavioral therapists can help the adolescent break this cycle using a technique called Behavioral Activation. In this technique, the patient makes a log of all activities done during the day and the emotional effects of those choices. Over time, the patient will see that choosing to be more active (e.g., going for a 30-minute walk or talking on the phone with a friend) results in much better mood, as compared with less active pursuits (e.g., lying in bed and surfing YouTube). The therapist helps the patient to make a plan for each day and to gradually develop a routine that stimulates them positively and makes them want to seek more positive experiences.

Whatever therapeutic technique is used, the most important thing is that the therapist communicates unconditional positive regard for the client. Individuals who are depressed are usually very self-rejecting. Care, acceptance, and commitment offered by a therapist, parents, and friends can help the person remember that he or she is important, valued, and worth the effort needed to rebuild wellness.

© 2019 by Michael Milgraum

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