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    Michael E. Holtby, LCSW, BCD

Clinical Depression

Symptoms of Depression

Men & Depression

The Role of Psychotherapy

The Role of Medication

Other Resources on the Web

I have more clients who see me because they are depressed than for any other reason. Depression affects 17 million people a year, according to the National Institute of Mental Health. In a study published in the Archives of General Psychiatry of over 8,000 Americans between 1990 and 1992, they found 30% suffer from a mental disorder in any given year, and depression ranked the highest among the possibilities. In another study at Cornell University they found among Baby Boomers (ages 45-54 years) 31% of the men were clinically depressed. Unfortunately, it is estimated that two thirds of those individuals suffering from depression don't seek therapy. They blame themselves, or downplay their experience as just "sad" or "blue". It is particularly unfortunate because 85-90% can be helped with medication and psychotherapy.

The Symptoms of Depression:If you experience the following symptoms for a period of more than two weeks you are likely to be clinically depressed:

      Persistently sad, anxious or empty mood.

      Sense of hopelessness and discouragement.

      Loss of interest or pleasure in activities.


      Excessive crying.

      Sleep and eating disturbances.

      Decreased energy or fatigue.

      Thoughts of death or suicide.

      Difficulty with concentration, memory or decision making.

      Chronic aches and pains.

      Loss of interest in other people or withdrawal.

      Loss of sexual interest.

      Loss of motivation, enthusiasm and interest in life.

You don't have to have all these symptoms to qualify as clinically depressed. The more you have, however, the more severe is your condition.

For self-tests related to depression:

On-Line Depression Test

For a self-test on Self-Esteem

All about anxiety: The Calm Clinic

Grief & Bereavement Counseling

                                    Men & Depression:

"Many men transmute their depression into other pathologies. Some seek relief in alcohol or drugs - solutions that only compound the problem - while others express their unhappiness through reckless or violent behavior. Researchers sometines call these pathologies 'depressive equivalents,' noting that the lower rate of depression in men is almost perfectly balanced by higher rates of addiction and antisocial behavior.

Ok, men, Fine. Let's not call it depression. Let's call it a joyless life. But let's stop pretending that nothing is wrong. By official counts, women in this country become depressed at nearly twice the rate (12 percent each year) as men (7 percent). But scientists no longer trust these figures. What sets men and women apart, many believe, is not vulnerability to depression but the ability to acknowledge it. Manliness, no matter where you live is tied up with strength, independence, efficiency and self-control. Denying depression may help us feign those virtues but the cost of denial is huge. How huge? Men commit suicide at four times the rate of women"

    Quoted from Newsweek, June 16, 2003 - written by Michael C. Miller, MD

The Role of Psychotherapy

Most people suffering from depression feel those around them would get tired of their complaining. The fact is, the person most impatient with their condition is themselves. It can be very useful to talk with a trained therapist to sort out what are the contributing factors, and what needs to be done about it.

My approach to depression follows Kerman and Weissman's IPT model of Interpersonal Therapy. Here is their description of the process from The Harvard Mental Health Letter (April, 1988):


"The treatment has three phases: In the first three sessions, the therapist takes a psychiatric history, makes the diagnosis, and sets the framework for treatment. The need for medication is judged and the patient is educated about the symptoms and course of depression. The patient's present close relationships are reviewed, with special emphasis on recent changed associated with the onset of depression, such as the death of a family member, children leaving home, conflict in a marriage, or loss of a confidant. This review identifies the focus of treatment, which is one of four problem areas: grief, interpersonal role disputes, role transition, and interpersonal deficits. The strategy for the second stage depends on which of these is chosen.

In treating depression associated with grief, the therapist facilitates mourning by reviewing the details of the relationship and the events around the death. Then the patient is helped to find new activities and relationships to compensate for the loss. When there are role disputes -- conflicts with family members, friends, or coworkers -- the therapist and patient explore resolutions (including the possibility that an impasse has been reached or that the relationship must end.) When the central issue is a role transition, such as the beginning or end of a love affair or career, a move, promotion, retirement, or graduation, the patient is helped to acknowledge the positive and negative features of both old and new roles. Interpersonal deficit, the fourth problem area, is defined as difficulty initiating or sustaining personal relationships. It is often treated with practice in the social skills needed to establish or maintain specific relationships. In the third and final phase, patients are helped to recognize and consolidate therapeutic gains and develop ways to identify and counter recurrent depressive symptoms."

The effectiveness of IPT (Interpersonal Therapy) in the treatment of depression was compared with groups on a placebo, on an antidepressant medication only, or combined with IPT or with cognitive-behavioral therapy. The most effective treatment was a combination of IPT and an antidepressant medication in terms of long-term improvement. "

Clinical depression is an area in which I have personal experience. Fifteen years ago I was profoundly depressed. I haven't been since, but it involved an antidepressant medication, psychotherapy and some radical changes in my life. I never want to be in that place again, but my personal insights might be helpful to you.

The Role of Medication:

I am not a physician. I cannot prescribe medication. However, in many cases an antidepressant medication is very useful as a spring board to help you overcome what has become a chemical imbalance in your brain. For this reason I have three highly qualified psychiatrists with whom I work closely. They will see you for medication only, and I will see you for the psychotherapy. I can help you monitor the side effects, and be alert for contra-indications. For more information about specific psychotropic medications.

Many people don't wish to use medication. They fear a dependency upon it, or its potentially toxic effects. This is something we can explore as it relates to your individual case. An alternative, which is more subtle and takes somewhat longer is the use of Chinese Medicine and I can refer you to an appropriate practitioner.

"Life events may help push us into depression, but the condition itself has a biological basis, and targeting the physiological causes is often the surest way to alleviate it. Changing your biology through sheer grit is like running a marathon with a broken leg. It can be done, but not well. Medication may cause some uncomfortable side effects (upset stomach, sleep disturbances, delayed orgasm, headache), but it won't alter your personality. In fact, most people who respond to antidepressants feel more like themselves, not less."

    Quoted from Newsweek, June 16, 2003 - written by Michael C. Miller, MD

For more information go to these web sites:

An Extensive Site on Depression from the U.K.

"What Does Clinical Depression Feel Like?"

Anxiety and Other Related Problems

Mental Health General Information

Depression Resources List

A Patient's Guide to Depression

Depression - A Personal Web Site

Men and Depression

For HIV-AIDS and Depression see my Shrink Rap article:

"A Depression to Die For"



Last messed with February 23, 2016

Copyright(c) 2001 Michael E. Holtby, LCSW. All rights reserved.