Depression is a mental disorder that is characterized by a lack of interest, low energy, irritability, lack of sleep, low mood, lack of self-esteem, and guilt. According to Marcus et al. (2012), depression is a leading cause of disability worldwide. Though depression affects people of all ages, depression symptoms often show at an early age, and they are recurring. There are three main types of depressive disorders: major depression, bipolar disorder, and persistent depressive disorder. Major depression lasts for about two weeks, and the patient may show five or more symptoms of depression. Persistent depressive disorder is often less severe than major depression, but it lasts for up to two years. Bipolar disorder is also referred to as maniac depression; it is characterized by severe mood swings . Interventions for depression include medication and psychological treatments.
Causes of depression
Traditionally, it was believed that depression is caused by chemical imbalance in the brain. But given that there are millions of chemicals that affect the brain's functioning, such an explanation is not satisfactory (Levinson, n.d). Also, the chemical imbalance in the brain results from other factors; many researchers regard these factors as the causes of depression (Levinson, n.d). The factors behind depressive disorders include genetics, trauma, substance abuse, brain structure, an individual's life circumstances, and other medical conditions. People who undergo traumatic life events during childhood are likely to be affected by depression later in life (Marcus et al., 2012). Trauma, when experienced at an early age, significantly affects the way the nervous system responds to fear, stress, and anxiety.
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Levinson (n.d.) estimates that genetics could have an influence of up to 50 percent in determining whether a person will be affected by depression. Two observations have confirmed that genetic factors cause depression: The fact that some families exhibit depression patterns and the observation of depression patterns in identical and non-identical twins. Since identical twins have similar genetic composition, it would be expected that if one twin is affected by depression, the other would also show risks of depression. The depression risk level would also be expected to be closer in identical twins than in non-identical twins. These theoretical expectations have been confirmed as true, proving that genetic factors cause depression (Levinson, n.d.).
Imaging examinations of depression patients show that the front part of the brain shows less activity when the person is depressed. The patients show higher levels of hypothalamic - pituitary -adrenal axis hyperactivity than normal people. That shows the role of brain structure in causing depression (Marcus et al., 2012). Individual life circumstances are also associated with depression. In particular, they are associated with reactive or situational depression. This is a type of adjustment disorder that follows traumatic life events. Situational depression often lasts for a short time, and it is characterized by stress. Common causes of situational depression include death of a friend or family member, job loss, marital problems, and illness. Some medical conditions increase the risk of depression. They include sleep disorders and attention-deficit hyperactivity disorder (ADHD). Adults with ADHD are more likely to develop depression and other mental disorders than the general population. For example, according to the Anxiety and Depression Association of America (n.d.), 50% of adults with ADHD develop anxiety disorder.
There is a bidirectional relationship between substance use and mental disorders. This means that mental disorder patients are likely to abuse drugs and substance, and drug and substance users are likely to develop mental disorders (National Alliance on Mental Illness, 2015) . Some substances, especially depressants, amplify guilt, sadness, and fatigue, thus increasing the risk of depression. Withdrawal from substance abuse also heightens the risk of depression (National Alliance on Mental Illness, 2015) . On the other side, depressed people are likely to use substances in attempts to escape from feeling s such as guilt and stress.
Managing depression
Though many depression patients never seek assistance, they are several treatment options for depression that have been proven to reduce the symptoms of depression. They include medication, psychotherapy, light therapy, and brain stimulation therapy (National Alliance on Mental Illness, 2015) . For a patient to be diagnosed with depression, they must have suffered a major depressive episode that lasted for more than 14 days (National Alliance on Mental Illness, 2015) . Different types of medication are used to treat depression. They include mood stabilizers such as lithium, antidepressants, and serotonin-norepinephrine reuptake inhibitors (SNRI). Psychotherapy involves counseling and coaching the patient to deal with their thoughts and feelings directly, rather than masking them or escaping from them. Light therapy involves the use of full-spectrum light to regulate the action of hormones associated with mental disorders (National Alliance on Mental Illness, 2015) . Brain stimulation therapies applied in the treatment of depression include repetitive Transcranial Magnetic Stimulation (rTMS) and Electroconvulsive Therapy (ECT).
Counseling Interventions for Depression
Counseling interventions for depression entails creating a relationship between the counselor and the patient with the aim of modifying the behavior and emotional state of the patient (National Alliance on Mental Illness, 2015) . Counseling interventions for depression include Cognitive Behavior Therapy (CBT), behavior therapy, interpersonal psychotherapy, and problem-solving therapy.
Cognitive behavior therapy is one of the most studied interventions for depression, and different literatures affirm that it is effective in managing the symptoms of depression. It is a type of talk therapy where the counselor spends several sessions with the patient; the counselor attempts to change the patient's behavior patterns, thinking, and esteem. CBT is short-time and goal-oriented; typically, it takes 12- 20 sessions (Renn & Arean, 2017). Aaron Beck is credited with inventing CBT. He discovered that there was a connection between thoughts and feelings, and people can overcome mental disorders by identifying the negative thoughts that cause them (Renn & Arean, 2017). CBT applies both behavioral and cognitive strategies in managing depressive disorders.
Reavell, Hopkinson, Clarkesmith, and Lane (2018) conducted a study to evaluate the effectiveness of cognitive behavior therapy in managing the symptoms of depression. The study was conducted among Cardiovascular Disease (CVD) patients. CVD disease patients have a higher risk of developing depressive disorders than the general population (Reavell et al., 2018). The researchers used medical databases such as MEDLINE and CENTRAL to find randomized control trials. They then observed the differences between the patients who underwent CBT and the controls. The CVD patients who received cognitive behavioral therapy registered lower depression scores than the controls. The difference in depression scores was significant. The patients who underwent CBT also recorded greater positive changes in the mental quality of life than the controls. Reavell et al. (2018) concluded that cognitive behavior therapy is effective in the management of depression and anxiety. Pinquart, Duberstein, and Lyness (2007); and Gould, Coulson, and Howard (2012) studies also concluded that cognitive behavior therapy is effective in the treatment of depression.
Cognitive behavior therapy is structured and goal oriented. Typically, it involves four steps. In the first step, the counselor helps the depressed person identify the factors causing depression. After identifying the factors behind the depression, the therapist encourages the patient to share their thoughts about the causative problems. The third step entails identifying the negative thinking patterns behind the mental problem. In the final step, the counselor helps the patients to modify the negative/inaccurate thinking patterns.
Problem-solving therapy is based on the presumption that low self-efficacy, negative emotions, and lack of effective problem-solving skills increase the risk of depression. It is a competency-based counseling intervention that aims to develop problem-solving skills in the patient. Some people regard problem-solving therapy as a variant of cognitive-behavioral therapy. The main difference is that cognitive behavior therapy focuses on maladaptive cognitions while problem-solving therapy focuses on ineffective problem-solving skills (Renn & Arean, 2017). Like CBT, problem-solving therapy is a short-time intervention; it typically takes between 7 and 14 sessions ( Zhang, Park, Sullivan, & Jing, 2018). The steps involved in problem-solving therapy are identifying specific problems, setting achievable goals for each session, coming up with different methods of achieving the set goals, evaluating the different solutions and choosing the best one, creating a solution-implementation plan, and weighing the effectiveness of the chosen solution.
Researchers have conducted various studies to measure the effectiveness of problem-solving therapy in managing depression. Recently, Zhang et al. (2018) did a systematic review and meta-analysis of problem-solving therapy clinical trials in primary care. A meta-analysis is a type of statistical study that combines the findings of different researches. Zhang et al. (2018) evaluated 11 studies with a total of 2022 participants. The primary care patients who received problem-solving therapy registered statistically significant overall effects in depression and anxiety outcomes. Zhang et al. (2018) concluded that problem-solving therapy is effective in the management of depression for primary care patients. These findings support those of similar studies done before. Arean et al. (2010) and Khirkham, Choi, and Seitz (2016) concluded that problem-solving therapy is effective in the management of late-life depression.
Interpersonal psychotherapy focuses on the interpersonal causes of depression. It is based on the premise that a person’s relationship with others is plays a key role in psychological health. Like problem-solving therapy and cognitive behavior therapy, interpersonal psychotherapy is a limited-time intervention; it takes about 20 sessions. The counselor works with the patient and people close to them to identify the main problems that the patient is exhibiting in their interactions (Weissman & Markowitz, 2002). They may identify many problems, but interpersonal psychotherapy is more effective when the counselor deals with one or two main problems (Weissman & Markowitz, 2002). The main steps in interpersonal psychotherapy are psychoeducation and identifying the underlying interpersonal issues, the intermediate phase, and the termination phase. In the intermediate phase, the counselor focuses on a few interpersonal issues. The final phase entails reviewing the success of the intervention.
Cuijpers, Donker, Weissman, Ravitz, and Cristea (2016) conducted a meta-analysis of interpersonal psychotherapy clinical studies to determine the effectiveness of the intervention in treating different stages of depression. Cuijpers et al. (2016) evaluated 90 studies with more than 11,000 participants. The study found that when a patient with sub-threshold depression receives interpersonal therapy, the intervention prevents the onset of major depression. Cuijpers et al. (2016) concluded that interpersonal intervention is effective it the treatment of acute depression, preventing new depressive disorders, and preventing relapse.
In summary, depression is one of the most common mental disorders. Symptoms of depression include irritability, low mood, guilt, lack of sleep, and low self-esteem. The three main types of depressive disorders are bipolar disorder, major depression, and persistent depressive disorder. Depression is caused by a combination of factors; the factors range from genetics to drugs and substance abuse. Interventions for depression include medication, counseling, and brain stimulation therapies. Examples of counseling interventions that empirical researches have proven as effective are cognitive behavior therapy, interpersonal psychotherapy, and problem-solving therapy. These interventions are more effective when combined, rather than used separately
References
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