Effective
depression
counselling
in Nanaimo

healing sorrow and despair

What is depression?

Depression isn't simply about feeling down. Everyone has ups and downs, but that alone isn't what we're talking about with depression, even if the "down" times last a while or feels really strong. True clinical depression is a disorder and it affects how people think, feel, and behave.

Symptoms can include (but aren't limited to):

fatigue
feelings of hopelessness
dark thoughts
restlessness
physical pain
anger
suicidal thoughts, images, or impulses
loss of interest in things that used to hold interest
changes in appetite
increases in emotionality

Depression is actually an umbrella term that encompasses a number of subtypes of depression diagnoses.

These include:

Major Depressive Disorder (also known as clinical depression)
Persistent Depression Disorder (also known as Dysthymia)
Seasonal Affective Disorder
Postpartum Depression
Situational Depression
Psychotic Depression
Bipolar Disorder
Premenstrual Dysphoric Disorder
Atypical Depression, and
Disruptive Mood Dysregulation Disorder

Some forms of depression are believed to be caused by difficult life events, while others are more likely to arise due to changes within the brain. Whatever the origin, however, psychotherapeutic treatment typically focuses on identifying and changing thought patterns and behaviours, and on learning and implementing improved coping skills.

Before getting further into treatment considerations, let's discuss three of the most common kinds of depression in some more detail.

Note, this research is being presented for your information and is not intended as a substitute for professional evaluation, diagnosis, or treatment.

Major Depression (Clinical Depression)

People with this form of depression experience a persistent feeling of sadness or lack of interest. In order to meet the diagnostic criteria for this kind of depression, you'd need to have 5 or more of the following symptoms, more days than not, for at least two weeks:

Loss of interest in your activities
Feelings of guilt or worthlessness
Negative ways of thinking with the inability to see the positive
Feelings of restlessness or agitation
Inability to focus
Lashing out at loved ones
Irritability
Social isolation (pulling away from loved ones/usual social connections)
Increase in sleeping
Feelings of lethargy/exhaustion
Suicidal thoughts
Weight gain or weight loss

Some people are more prone to Major Depression Disorder than others. Many people who are affected by it tend to have bouts of this form of depressions that comes and goes throughout their lifespans.

Dysthymia (Persistent Depressive Disorder)

This form of depression is a lower-grade but longer-term form of depression. It can last years and can get in the way of daily life and relationships. People with this form of depression are often perceived by others as being gloomy or pessimistic (think Eeyore from Winnie the Pooh). One of the defining characteristics of dysthymia is that individuals consistently report difficulty feeling happiness, even in situations that would typically be considered joyous.

In order to fit the criteria for dysthymia, a person must exhibit symptoms of depression for two years or more.

Dysthymia is frequently referred to as a form of "high-functioning" depression. These individuals tend to look fine to those around them, but they themselves feel robotic, going through the motions. Dysthymia is usually not as severe in terms of mood dysregulation/severity as in the case of Major Depression, but it is wears on people significantly due to its pervasive, long-term nature.

Seasonal Affective Disorder (SAD)

This type of depression is related to changes of season. While it is possible for SAD to occur in the spring or summer (less than 10% of the time), it usually happens in the fall and winter months. Many affected individuals will notice the onset at about the same time every year.

The usual depressive symptoms of hopelessness, loss of interest/pleasure, and fatigue often start out mild but get more serious over time. Common winter-onset symptoms also frequently include:

Cravings for carbohydrates (sugars, breads, pastas)
Heaviness in legs and arms
Uncharacteristic and frequent oversleeping
Problems in relationships

While the most common explanations most people hear are specifically related to Vitamin D, in actual fact there still isn't clear agreement amongst researchers on the causes of Seasonal Affective Disorder. Hypotheses that have been implicated by valid research include the effects of sunlight, body clock (circadian rhythm) disruptions, seratonin insufficiency, and too much melatonin.

Treatment: Depression Counselling

Your depression counsellor will likely start out by getting some history so that he/she can get an understanding of what kind of depression you have, how long you've had it, how severe it is, and how you are functioning with it. This is the assessment phase of counselling, and it will inform the counsellor on next steps.

Most forms of talk therapy for depression involve identifying the interactive role of emotion, thought/perception, and behaviour. This interactive model is commonly referred to as Cognitive-Behaviour Therapy, but is frequently a part of other modalities as well.

An example:

Joe is depressed. It's been going on for some time now and he decides it's time to do something about it. First he goes to see his family doctor. His doctor provides him with a prescription for an antidepressant medication but also recommends that Joe talk to a depression counsellor.

Joe's symptoms include feelings of despair and hopelessness, a decrease in energy, and a loss of excitement for things he used to enjoy. In his first session, the therapist gets some history, then asks Joe questions about the kinds of thoughts he has and how the correspond to behaviour choices and emotions. Joe notices that when he is feeling low in mood, he doesn't like himself very much, and then thinks other people probably don't like him either. As a result, he isolates himself. Even when friends he really likes invite him to do things he might enjoy, he says no, stays home, and watches five episodes of a show on Netflix. After that, he notices how empty his life is becoming and he feels even more depressed. Wishing to get away from those dark thoughts, he cracks a beer, watches another show, has yet another beer, then goes to bed way too late. He wakes up the next morning, feels even more tired and even more depressed.

Over time, he starts to see that he has all sorts of these little patterns involving thoughts, feelings, and behaviours. He learns that they seem to maintain or even worsen the depression. And he learns that he can change them to more positive, constructive patterns. Within just a few weeks, he notices his depressive symptoms begin to lift.

It's not always that straight forward, of course, and we certainly have more than one tool at our disposal. That said, Cognitive-Behavioural Therapy is powerful, effective, and the research-based protocol of first choice for the psychotherapeutic treatment of depression.

Do I need to go on medication?

It depends, but the choice is ultimately yours.

Many individuals prefer to see if their symptoms will improve with talk therapy before taking anti-depressant medication, while others feel the suffering is simply too much to bear. We will work with you wherever you're at with that. Do note that there are often side effects from antidepressants (which, depending on the medication, may include dry mouth, sleep problems, reduced libido, feelings of disconnection, etc). Most people feel these symptoms are relatively mild.

As said, the decision is ultimately yours, but we may encourage medication in cases where our clients are considering suicide or in the rare circumstances that the depression is so deep that talk therapy alone is not proving effective.

As psychotherapists, we do not prescribe medication. We will, however, consult on medication queries with your doctor upon your request.

Take action NOW!

Depression counselling has been conclusively proven to help! Don't suffer unnecessarily when there is so much we can do to lighten your load, restore hope, and return you to your regular self.

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Research Sources:

Disclaimer: No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

Our clinical director: Ron Depner MC, RCC

Ron's career began working with children, adolescents and their families in hospital and treatment centre settings. Following a Bachelor of Arts with a major in Psychology, he pursued a Master of Counselling. Ron is a Registered Clinical Counsellor (RCC) with the BC Association of Clinical Counsellors. He holds multiple advanced certifications and awards in areas of couples and individual counselling. Ron oversees the clinical aspects of service delivery for The Therapy Place.

Effective depression counselling in Nanaimo