The Lowdown on Depression Counseling and the Global Context

Depression is a relatively common medical illness which can affect most people at any time of their life. The causes of depression can be varied. What is now getting clearer is that >50% of major depression can be genetically linked. Another large part can be due to stressors during childhood or in the present. Whatever the cause, we also know that depression leads to alteration of certain hormones in your body.

    • Cortisol level
    • consistently elevated  level
    • consistently low Brain Volumes in severe untreated depression
    • Low on Imaging studies

How do people with depression feel? What do they describe it as?

Let’s look at a few ways people describe depression:

  • I have lost the ability to enjoy life
  • Nothing is enjoyable
  • I can’t imagine my future
  • Like being stuck in a Small box which I can’t get out of
  • I feel like I don’t matter at all
  • I feel like my mind is breaking
  • I feel shame and embarrasment
  • I have forgotten who I really am and can’t have fun anymore
  • I feel like I’m an actor playing me and am being forced to smile when I don’t feel like doing so
  • I feel miserable without any reason at all
  • I feel hopeless and that life has no meaning
  • I don’t know why I feel this way

These are just some of the ways people describe what they are feeling.. As you can see Hopelessness, Inability to experience enjoyment, feeling trapped and Sadness are just some of the symptoms


Let’s take a deeper look at Depression

Are there different types of depression?

Disruptive mood regulation disorder is characterized by severe recurrent temper outbursts manifested verbally and/or behaviorally that are grossly out of proportion in intensity to the provocation and that are accompanied by a persistently irritable or angry mood most of the day, nearly every day, in between the outbursts.
Major depressive disorder is characterized by episodes of depressed mood or diminished interest or pleasure that last at least 2 weeks and that are accompanied by characteristic associated symptoms e.g., changes in sleep, appetite or activity level; fatigue; difficulty concentrating; feelings of worthlessness or excessive guilt; suicidal ideation or behavior)
Persistent depressive disorder is characterized by depressed mood for most of the day, for more days than not, for at least 2 years.
Premenstrual dysphoric disorder is characterized by marked affective lability, irritability, anger, or increased interpersonal conflicts; marked depressed mood, feelings of hopelessness, or self-deprecating thoughts; or marked anxiety, tension, and/or feelings of being “keyed up” or on “edge” which develops in the final week before the onset of menses, starts to improve within a few days after the onset of menses, and becomes minimal or absent in the week post menses.
Substance/medication induced depressive disorder is due to direct physiological effects of a substance or medical condition. The depressive episodes are all due to direct physiological effects of a substance including medication.
Depressive disorder due to another medical condition is due to the presence of an etiological medical condition. The episodes are all due to the direct physiological effects of a medical condition
Atypical depression is characterized by oversleeping and over-eating. Their mood reactivity is different than typical features. For instance, mood brightens in response to positive events.
Depression with psychotic features occurs when a person has severe depression plus some form of psychosis, such as having disturbing false beliefs or a break with reality (delusions), or hearing or seeing upsetting things that others cannot hear or see (hallucinations).
Patients show recurrent episodes of major depression, without any mood elevation or mania
Patient show episodic swing in the mood from mania to depression. Bipolar disorder is characterized by cycling mood changes—from extreme highs (e.g., mania) to extreme lows (e.g., depression). They may experience complete despair,lethargy and suicidal feelings. Sometimes people have very severe symptoms where they cannot make sense of their world and do things that may seem odd or illogical.
Postpartum depression is much more serious than the “baby blues” that many women experience after giving birth, when hormonal and physical changes and the new responsibility of caring for a newborn can be overwhelming.
It is characterized by the onset of depression during the winter months, when there is less natural sunlight. The depression generally lifts during spring and summer. It can make an individual feel anxious and stressed and depressed. It may interfere with their moods and with their sleeping and eating patterns.
The most common depressive disorders include major depression (a discrete episode, clearly different from a person’s usual feeling and functioning), Persistent depressive disorder (a chronic, low-grade depression that can get better or worse over time) and Psychotic depression (the most severe, with delusions or hallucinations). Some people are vulnerable to depression in the winter (“seasonal affective disorder”), and some women report depression in the week or two prior to their menstrual period (“premenstrual dysphoric disorder”).

What are the risk factors for Depression?

What are the types of treatment for depression?

So there is no one size fits all approach for depression since it’s a complex issue.The broad types of treatment are as follows

Psychological/Talk therapy

Medical Treatments

Other Therapies

A. Psychological/ talk therapy treatments for depression

All of these help you in changing your thinking patterns. Here are the various types:

1.Cognitive behaviour therapy (CBT) & Rational Emotive Bevaviour Therapy (REBT) :

It is a structured psychological treatment which recognises that the way we think (cognition) and act (behaviour) affects the way we feel. CBT is one of the most effective treatments for depression and has been found to be useful for a wide range of ages, including children, adolescents, adults and older people. It works to change your thoughts and behaviour by teaching you to think rationally about common difficulties, helping you to shift negative or unhelpful thought patterns and reactions to a more realistic, positive and problem-solving approach.

2. Interpersonal therapy (IPT)

IPT is another structured form of therapy which focuses on the interpersonal relationship aspect in a situation. It takes into consideration the fact that a relationship has a huge impact on the emotional and mental well being of a person either in terms of being a cause of depression and also coming in the way of recovery from depression

3. Behaviour therapy

Some component of this is covered in CBT(point 1). The major difference is that this kind of therapy focuses on encouraging behaviour which is helpful, rewarding and reducing the avoidance which sets in when one has depression

4. Mindfulness-based cognitive therapy (MBCT)

This is a form of meditation where it helps you to focus on the present irrespective of whether it is positive or negative or pleasant\\unpleasant. This kind of meditation starts with tapping your physical sensations such as breathing, your chest moving in and out, the air through your nose and then moves on to your thoughts. This basically helps you to focus on the present, not let your mind wander off into negativity and identify early warning signs of depression so you can deal with them at an early stage.

B. Medication i.e Anti depressants:

So there is a lot of incorrect information floating around the web with respect to anti depressants but they can be used for moderate to severe depression. I say Moderate to severe, since only psychotherapy might not be adequate in these cases (especially those of Bipolar). They will require a two pronged approach of medication + therapy.


1.Maintaining a healthy lifestyle 2.Support groups & Forums 3.Relaxation techniques 4. Help from friends and family


This is a common fear. It’s important to know that it will pass. Depression can be successfully treated and that you will feel better in time and with the right treatment.


Of people diagnosed with major depressive disorder, who are treated and recover, at least half are likely to experience a recurrent episode sometime in their future. It may come soon after or not for many years. It may or may not be triggered by a life event. After several episodes of major depression, a psychiatrist may suggest long-term treatment.


If your symptoms are mild, do not impair your work or home life, or adversely affect your health, and you do not think about suicide or self-harm, you could wait a week or two before visiting a professional to see if the symptoms may improve on their own. But more serious symptoms need immediate attention.


Depression doesn’t spare the famous ones either. Have a look at this infographic to tell you who else suffered from depression