Depression can change everything — how we think, what we do, and how we feel. It can even make us too pessimistic or downhearted to ask for help. But depression help is out there, with therapy right here in NYC.
Last updated: April 25, 2021
Symptoms of Depression
Depression can occur for many reasons and can range from mild to debilitating. Take depression seriously; it can be life threatening at times. Symptoms include:
- frequent feelings of sadness or hopelessness
- change in one’s weight or appetite
- thoughts of death or suicide
- low self-worth or excessive guilt
- trouble concentrating,
- lessening of enjoyment of things less that used to be fun
- having less energy — even small things seem like huge tasks
- slower physical movement or thinking than usual.
Major Depressive Disorder
Major Depressive Disorder (MDD) is a condition characterized by most or all of the above-listed symptoms. The symptoms need to last for at least two weeks in order for major depressive disorder to be the problem.
Persistent Depressive Disorder
Not everyone who suffers from depression has most or all of the symptoms described above. Some people will have one or two, but they will be impactful. Others have a few symptoms that last for years, even though they are not debilitating. People with these issues may have a condition called “persistent depressive disorder,” also known as dysthymia. Some of the more common symptoms of this condition include low mood, low self-worth, and low interest in enjoyable activities lasting for at least two years and sometimes for decades.
Other Mental Health and Medical Conditions
There are many conditions that can cause depression. These include hypothyroidism, post-traumatic stress disorder, obsessive-compulsive disorder, brain injuries, personality disorders, certain neurological conditions, and several others. For this reason alone, if you are suffering from depression it is important to be evaluated by a medical or mental health professional. The problem may be different than what you think, and treatment may be more helpful than you imagine.
What Causes Depression?
There is not solely one thing that causes depression. Some conditions have a clear cause. For example, genetic factors cause autism and viruses cause colds. The causes of depression are much more complex. Research shows that several factors make some people more vulnerable to depression than others. Relevant factors include genetics, childhood experiences, and the meaning we ascribe to life events or circumstances. Many people assume the life circumstances or events themselves cause depression, but it is far more likely that the way we think about those things causes us to cope well or to become depressed.
Consider the example of a breakup of a romantic relationship. Breakups can be painful — among the most emotionally painful experiences we have. If your tendency is to think about breakups as proof of your unworthiness as a romantic partner, you are likely to become depressed. On the other hand, if you are someone who tends to expect positive things in life, you might anticipate that you’ll be better off after a breakup.
One aspect of how we think that can lead to or worsen depression is the way we see ourselves. If we tend to think of ourselves as people who are hard to like, annoying, or burdensome to others, we will be more vulnerable to depression. Beliefs like these, when considered as a group, are called schemas. We all have schemas — schemas are not inherently unhealthy or problematic. However, when they end up embodying critical or negative views about ourselves, they can cause depression. One school of thought contends that when our schemas paint a picture of us as helpless, unlovable, or incompetent, we are particularly vulnerable to depression and anxiety.
Negative schemas are typically not something we’re born with, although that is difficult to prove scientifically. The current understanding is that schemas are shaped through a combination of inborn factors and learned experiences. These experiences can happen in childhood or adulthood. For example, if a college student starts to have a lot of success in school that she didn’t have before, she may start to see herself as smarter and more capable.
Is Depression Caused by a Chemical Imbalance?
At points in the 1980s and 1990s, it became popular to speak about depression as caused by a “chemical imbalance.” The reasons for this were that 1) scientists were learning more about the role of neurotransmitters (naturally occurring chemicals in the brain) in depression, and 2) it is destigmatizing. This understanding of depression was further supported by the success of Prozac in the early 1990s. Medications like can improve symptoms of depression by affecting neurotransmitter function in the brain.
However, depression is not usually as simple as the phrase “chemical imbalance” might suggest. Depression can be caused by unhealthy thinking patterns, by neurotransmitter dysfunction, other disorders, medical conditions, sociocultural issues, environmental issues, or any combination of the above.
Sometimes the cause of depression is quickly clear to a treating professional despite being a mystery to the depressed person. The cause? Another disorder. Read on to learn how this can happen.
Mental Health Conditions That Can Cause Depression
A 2014 clinical research study suggests that approximately 10% of people with major depressive disorder have or have had agoraphobia in the past. For any of us to avoid depression, we need to engage in regular mood and health-maintaining activities. Agoraphobia strips people of the ability to be as active as they were and often prevents them from seeing friends, going to parties, concerts, or restaurants. It’s easy to see why this would leave someone vulnerable to depression.
Obsessive-compulsive disorder (OCD)
OCD is actually a quite varied condition that can cause depression in multiple ways. For example, many people with OCD spend significant amounts of time ruminating about the topic of their obsessions. This becomes unhealthy, unpleasant, and time-consuming for them. These effects of rumination can lead to depression.
Another way that OCD can cause depression involves compulsions. For example, if someone with OCD needs to touch something 16 times before leaving a room, this can lead to frustration and embarrassment. Over time these difficulties can lead to depression.
Post-traumatic stress disorder (PTSD)
Depression has long been associated with PTSD. Until 2013, PTSD was thought of as causing depression. However, with the introduction of the fifth edition of the DSM (the widely used text used by mental health professionals to diagnose mental disorders) in 2013, depression has since been understood to be a part of PTSD. Not everyone with PTSD experiences depression, but around half of those with PTSD are also depressed.
This close relationship between PTSD and depression means that everyone who has major depressive disorder should also be screened for PTSD. If you are currently dealing with depression, we encourage you to ask your mental health provider about this.
Postpartum hormonal changes
As described above, our bodies’ biochemical functioning can be an important contributor to depression. The hormonal changes that follow childbirth can cause significant depression for mothers. This type of depression can be serious. It is challenging because the mother is often facing new stressors and changes in her life precisely when the hormonal changes are having their greatest impact.
Another factor that makes postpartum depression dangerous is that it can be quite long-lasting, leading friends and family to assume that a mother should be “fine now” if enough time has gone by — but often that’s just not true. Uninformed attitudes like this from loved ones can worsen the depression.
Substance abuse and addiction
Depression can cause substance abuse. However, substance abuse can also lead to depression. Often this happens as someone begins to grasp how much their substance use has come to impact, or even define, their life. The process of realizing that your relationship with a substance has become one of dependence can, by itself, induce hopelessness and depression.
Additionally, substance abuse makes recovery from depression more difficult, leading to further frustration and worsened depressive symptoms.
Yes! Exercising, getting support from loved ones, and improving sleep hygiene are all good initial steps.
Research shows that effective treatments for depression include medications and psychotherapy. At present, only one natural supplement has been shown to sometimes be an effective tool against depression — St. John’s wort. However, its effects have been inconsistent in research trials. It is not a substitute for psychotherapy or medication.
It’s complicated. The functioning of neurotransmitters in the brain is different in people who are depressed than those who are not. However, it is not at all clear whether these neurochemical differences are caused by depression, are the cause of depression, or neither.
How to Help a Loved One with Depression
First, learn to see the warning signs. Changes to look for include:
- Decreased activity levels or enthusiasm
- Sleeping a lot (or sleeping poorly)
- Increased use of alcohol or drugs
- A pessimistic or bleak outlook that has worsened
- More frequent crying
- Change in appetite or weight
What You Can Do
If you are concerned that a loved one is suffering from depression, it can be helpful to express your concern to them. Describe the changes you’ve noticed — they may not have been aware of them. Be empathetic, and don’t try to convince them they’ve got no reason to be depressed. (Remember whatever reason they have is real for them.) Express a desire to help.
There is no guarantee that you will be able to get a loved one the help they might need. If they’re an adult, whether to get help or not is ultimately their choice. However, their knowing you are concerned can help a lot. It may facilitate their seeking out care if they know you’re in their corner.
One common mistake people make when trying to help a depressed friend or loved one is trying to convince them that they should be happy or to dismiss what they’re concerned about. It’s better to express your caring for them through attentive, patient listening. This communicates that you care, that you are not afraid of how they’re feeling, and that maybe you understand where they’re coming from.
Finding Help for Depression
The first step in getting treatment for depression is getting an evaluation with a mental health professional. This is necessary for several reasons. For one, depression can be caused by many factors, including other mental health problems. For example, post-traumatic stress disorder, obsessive-compulsive disorder, body dysmorphic disorder and many others can cause depressive symptoms. To determine what treatment should entail, get a professional consultation.
Cognitive-Behavioral Therapy (CBT) for Depression
Cognitive-behavioral therapy (CBT) for depression can involve efforts to increase certain behaviors that improve mood and decrease behaviors that worsen mood. CBT may also focus on the relationship between one’s thoughts and behaviors. Some people experience low mood that is at least partially fueled by specific thought patterns – for example, negative thoughts about one’s competence or self-worth. None of us has total control over which thoughts come into our minds. However, we can exert some control over what we tell ourselves. CBT can help change this mental dialogue in ways that improve mood.
Cognitive-behavioral therapy is different from traditional counseling in that you are typically given specific exercises to do between sessions. These exercises are what help you change your mental and behavioral habits and improve your mood. For example, one commonly used exercise in CBT is called a “thought record.” Using a thought record helps people to better understand how their interpretation of events affects their mood. It can then be used to help alter unhelpful patterns of thinking, providing a lasting natural tool against depression.
You might also be asked to make changes to your schedule. Changing what you do during the day or in specific situations can be surprisingly helpful in overcoming depression. However, it’s often challenging to determine which changes are important to make without some help. CBT for depression helps you identify helpful changes to make, and to overcome obstacles to making those changes.
Behavioral Activation for Depression
Research has shown behavioral activation, a version of CBT, to be effective in the treatment of depressive disorders. This approach is partially based on the fact that clinically depressed people have often ceased to do specific things that used to bolster their mood. They may not be aware of this change, but by re-engaging with those activities and behaviors, mood often improves. Working with a CBT therapist can help people determine if and how such behavior change might be helpful in their efforts to address depression.
Medication can be an important part of the treatment for depression but is not always necessary. The most commonly prescribed antidepressant medications are known as selective serotonin reuptake inhibitors, or SSRIs. SSRIs have been shown to be helpful, primarily for people with moderate to severe depression. They do have side effects for some people. Consult with your mental healthcare provider about whether medication might be helpful for you.
Steps to Take Without Therapy or Medication
If you’re interested in trying to improve depression on your own, some of the smartest strategies can be seen on our ABC PLEASE skills page. These skills are simple and straightforward to use. They’re often cheap or free, too! Cognitive-behavioral therapy for depression will often use some of the approaches described there, but you don’t need to be in therapy to try them.
Does mindfulness help with depression?
Mindfulness can be thought of as a type of awareness we all have, to some extent, that comes from calmly and nonjudgmentally focusing on what we’re doing. (Read more on our main mindfulness page.) Mindfulness can be an effective part of recovery from many difficulties, including anxiety, substance abuse, emotion regulation problems, and angry outbursts. However, practicing mindfulness alone is typically not a sufficient approach to resolving major depressive disroder for most people.
Some therapies, such as mindfulness-based cognitive therapy, combine CBT with mindfulness practice. This combination has been shown to be effective, particularly in preventing relapse among those who’ve recovered from depression. Mindfulness helps us create a healthier relationship with our thoughts; this is likely to be at least somewhat helpful for everyone. However, without changing other aspects of one’s life, mindfulness can often fall short of helping one achieve full recovery from depression.
If You’re Worried About Suicide
If you have reason to believe someone is at significant risk to try to end their lives, contact a suicide hotline. Try the National Suicide Prevention Hotline at 800-273-8255. For those in New York, consider NYC Well. It’s a free, confidential service from the NYC Department of Health, and it’s and available around the clock. They offer texting and internet chat service in addition to phone. Their number is 888-NYC-WELL (888-692-9355).
How to Find Help for Depression
Please contact us for help in your efforts to find therapy for depression here in New York City. Our CBT therapists are doctoral-level psychologists. We also have student therapists who offer reduced-fee services. Our offices are in midtown Manhattan, but we offer teletherapy services to people elsewhere in New York State, New Jersey, and Florida. If you’re looking for therapy for depression in another part of the country or world, please contact us — we are happy to help!