You may know how common depression is—6.7% of all Americans age 18 or older experience at least one major depressive episode each year, according to statistics compiled by the National Institute of Mental Health. It might even be expected in certain contexts, such as the loss of a job or a loved one. Other times, it creeps in mysteriously. As a therapist, I see many people who struggled for a long time before they finally sought help.
One of the first things I do when meeting for the first time with a person experiencing depression is try to figure out if their blues are an internal or external job. This can take a little time to unravel, as there are many layers that can lead to someone feeling depressed. It’s important when treating depression to try to change what we can control and learn coping skills that can help us with the rest.
So how do you know if your depression is a product of your environment—family, friends, job, housing or financial situation—or if it instead stems from unproductive or self-defeating thoughts, self-esteem or self-control issues, or possible biological reasons that may warrant a medical assessment?
When It’s an External Job
Perhaps this winter has been a difficult time in your life. The holidays are past, the weather is cold, and the days are short. The nation is apprehensive and divided about a new presidential term. Maybe you are worried about tax season, waiting anxiously on news from college applications, or feeling bad after excess food or drink at the end of the year.
Many people seek therapy after enduring a difficult situation. They have been caring for a sick family member, are going through a breakup, or have failed a class for the second time in a row. They need help for a depression which is mostly a result of a life situation that has happened to them. They feel like a weight has been put on them and can identify what it is.
Right now, many people are feeling the weight of conflict on a global scale. Some are worried about climate change, health care, humanitarian crises, or unemployment. “State of the world” depression, as I call it, is a common woe in 2017.
These cases call for action:
- Tools (to date again, for example, or to reconcile with a partner or roommate)
- Skills (to interview for a different job or take better care of themselves)
- Ideas (for how to ease overwhelm around finals at the end of a semester)
- Information (how to sleep better, study better, or manage time more efficiently)
Taking action on external depression is an important step toward feeling better and more empowered. Fortunately, therapy can help—especially solution-focused therapy, which is practical and tool-oriented.
When It’s an Internal Job
Have you had a time in your life when you just couldn’t seem to get enough sleep? When the things you always looked forward to didn’t interest you or when you had trouble feeling much of anything at all? People with these depression symptoms might say their lives are “better than most” and may feel guilty for feeling down. They may struggle with feeling ungrateful because, at the same time, they feel like something is “missing.” Life may feel like an endless treadmill of nice-but-nothing-great.
The No. 1 indicator to me of an internally driven depression is when people can’t tell me anything they’re excited about in their future.
The No. 1 indicator to me of an internally driven depression is when people can’t tell me anything they’re excited about in their future. When we lose the ability to look forward to the things that historically keep us satisfied, we’re in trouble. People with internally driven depression may have grown used to being on the sidelines, watching the energy of the world bustle around them. They may find it tiring to make decisions or to engage.
These cases call for structured treatment:
- Evaluation (by a medical doctor to determine there’s no medical cause, such as anemia, thyroid problems, or other issues that may cause fatigue or apathy)
- Cognitive therapy (thought charts and other structured homework done daily to encourage the person to engage less with their “sideline”-causing thoughts)
- A “good habits” checklist (making sure they are getting enough sleep, sunshine, healthy diet, exercise, contact with others, etc.—all the recommended depression treatments to give themselves the best chance of feeling better)
- Journal therapy (structured 5-minute writing sessions that allow a solution-focused therapist to look at the person’s thoughts)
Some things are out of my scope of practice (medical evaluations, for example), but since symptoms of depression overlap with some treatable medical conditions, if there is no identifiable external cause it’s always a good idea to see a doctor, too. Recently someone I work with in therapy felt too tired to socialize or exercise, which was creating problems at work as well as causing him to spiral personally. When he learned he was anemic and started following his doctor’s medical recommendations, his fatigue went away, which started positive momentum toward participating in his usual, satisfying life.
People with internally or externally driven depression can usually expect their symptoms to improve if they use structured, research-based treatment methods such as cognitive therapy. Depression tends to call for a lifestyle tune-up—and you don’t have to go it alone.
National Institute of Mental Health. (n.d.). Major Depression Among Adults. Retrieved from https://www.nimh.nih.gov/health/statistics/prevalence/major-depression-among-adults.shtml
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