Dysthymia, Adjustment Disorder, Major Mood Disorder, Bipolar, Melancholy

I'm feeling blah.  Vaguely disgrunted.  The technical term for this state is 'dysthymia'. I'm off. It's that Monday morning thing but it's Tuesday morning.
It's not an intrinsic thing. It's not autochthonous. It's not 'fixed'.
I haven't been continuously like this fo 2 weeks or more.  It's not like I have a major mood disorder. On the weekend with Laura, walking about Vancouver, playing tourist in my own city,  I felt really good. With a major mood disorder that wouldn't happen.  The depressed feeling would be more continuous.  I was enjoying something I'm interested in whereas with a major mood disorder I'd not enjoy things or people I usually do. I usually enjoy Laura and I certainly enjoyed her this weekend.
It's not that I have mood swings, either. Technically "mood swings" represent spontaneous shifts in mood independent of my environment. I felt good on the weekend because I was walking about town with a beautiful woman on a sunny day.
Today I feel blah and probably can come up with some pretty good reasons.   My concentration and memory were just fine on the weekend and they're fine today.  I was highly motivated on the weekend and I still am.  I certainly don't feel like there's no reason for living.  I wouldn't rather die. That's what one feels with  severe depression.
It wasn't melancholy either. If I had melancholia, Laura, Angelina Jolie, Nicole Kidman, Sophia Loren all couldn't put humpty dumpty together again.  Winning the lottery or getting a months vacation in Hawaii wouldn't lift melancholy.  Melancholy is the deepest depression and its independent of environment.  Severe major mood disorder doesn't get better with environmental rewards though with a mood disorder one can fake it a bit and smile. Not with melancholia. There's no faking it with melancholia.  Major Mood Disorder is fairly common.  I've only encountered a very few cases of melancholia.  The principle reason for so few of the latter is the success of modern psychiatry.  The cases of melancholia I saw had begun as major depressions but just got worse and worse without treatment until a couple of  people were mute and catatonic.
My minimalist blahs seem more related to the coming of winter, the routine, the stresses daily living and working in a city like Vancouver living, the same old - same old, aches and pains, aging, injured dog, self pity.
It's more an adjustment disorder sort of thing though not  even important enough or at the level to get that label.  Adjustment disorder is an exaggeration of a normal response to life stress.  One's reaction can be so negative and prolonged that an Adjustment Disorder can become a major mood disorder. But the standard adjustment disorder with depressed mood or mixed emotions can be related specifically to a significant event like loss of a job.  My blahs are too general for that.
Dysthymia is a lower grade  but more chronic thing. It can be permanent. Cognitive behaviour therapy says clearly we feel what we think. So negative thinking begets dysthymia.  Hemorrhoids do too.  Lots of things contribute to the dysthymia. Mostly it's self centeredness and bad coping habits. Personally, physiologically, I've not been getting to bed on time. So I've had a couple of days with an hour or so less sleep staying up later watching tv. That's all it takes when you're older to have a bad disposition.  A little more rest and I'll probably spring back.  
I've been isolated more this last couple of weeks. Misery loves company. Because my dog has been injured I've missed  church and meetings I'd other wise attend.  I'm in the midst of a slow process of change with a new office and staff.  Change, positive or negative, is experienced physiologically as stress.  I've had a lot of changes recently.
Where I might other wise have taken a course to "energize' me, I've just been 'taking care of business'. I'd forgotten how much stress is involved in a move. It was kind of negative stress too. Forced upon me by management.
There is  nothing like a positive new activity to perk up a dull life.  For years I took evening school classes till I had a Master of Divinity.  That really made the winter months fly by.   I might never use my M Div officially  but the learning was really exciting. Before that I'd done my Ship's Captain studies in Navigation and Offshore Sailing. I certainly used that learning.  Life is more an adventure when one is learning new skills.  The same held true when I took Spanish Classes and Hebrew.
The blahs are a bit like 'boredom' or 'ennui'. They're a bit self centered.
If I want to feel good, I must do good.  So I have to make changes. Maybe I'll go swimming tonight.  I always feel better after I exercise (never before).   I cleaned my place a few months back when I was feeling listless.  Nothing makes one feel better than scrubbing the house down.  I may have to put up the rack I got which will unclutter my kitchen. Anything that gets oneself out of oneself will take care of the blahs.  I'm not sure I'm feeling bad enough for such a drastic intervention as house cleaning but I know it would work.
I haven't been able to go for runs or long walks like I did with the dog since his injury so that's contributing.  Sloth and sedentary living are a major cause of all depressions.
With the sunshine lessening I probably should get the SAD Lite out.
It's also  Remembrance Day tomorrow. So this is an anniversary.  I 've felt sad every year at this time. As a child I was talk gratitude for  the soldiers for their service to Canada. As an adult I've been priviledged to help so many.  I've heard the most harrowing stories and never wanted to change places with guys who've been in the front line. Sure a good office job far from the front looked seductive as anything but nothing 'out beyond the wire'.   Without the Canadian Army, Navy, and Air Force we could all be like the Syrians or Afghanistanis.  My dad was RCAF .  I was honored to meet alot of military folk because of him.  Men who'd been in our army, navy, or air force in WWII. With Remembrance Day tomorrow I can't help but think of him.  I miss him too.  This alone could explain a day of the blahs. Grief. Grieving Dad.  Grieving all those soldiers who sacrificed their life for my freedom.

Journal, Sept. 1, 2015

I would like to wake up like my dog.  Gilbert is always bright eyed and bushy tailed. He wakes happy and excited. Licks my face.  Walks all over my chest, squirms and cuddles me. Then eventually brings me a yellow tennis ball because he knows that will be the first thing I want to do when I wake up.  Sometimes he just drops it into my face in case I want to chew on it before I throw it for him to fetch.
I wake up more grudgingly.  I had great dreams last night.  There's a world I often find myself in, in my dreams, this alternate reality. I return to it often. It's not the toilet where there's shit everywhere and no where to shit or stand. That's a bad dream. I didn't have that dream. No this other place is water, boats, people, dogs.  I'm often rounding a peninsula in a sailboat, anchoring in a sheltered cove.  It's sunny and blue sky and the sea is calm.  I'm walking with a dog near the shore. Lots of meetings with friends and family.  Sometimes there's old people and coffee tables. It's what I imagine heaven as.  I didn't really want to leave those dreams this morning.
If I showed up in someone else's office and described my feelings, they'd say I was 'dysthymic'.  Probably a little seasonal affective disorder, the technical explanation.  End of summer, beginning of fall.  I find my mood fluctuated with the sunshine. Then there's that Canadian thing of fall and winter where the summer is leaving and it's like losing a loved friend you don't see enough of.  This summer seemed to rush by.  I feel like I've hardly had a summer. So much work and stress and anxiety and burdens. They're not even mine but I've carried them.
Just yesterday, on the last day of August I said to a colleague, 'Freud took his holidays in August.  August used to be the slowest month.  Everyone cancelled. Peoples problems were less. There seemed to be more optimism.  What happened?"  He agreed. This August was different.  Troubling.  Less carefree.  The pace was steady at his office too.  No change in the density and traffic and flow.  None of the lulls.  That's what it was for me.  The emotional sound of nails scraping on a chalk board or frozen pane of glass just seemed continuous all year round.  My patients circumstances, often financially burdened, didn't change.  Even as they learned new ways of coping the stresses they were under increased.
We're aging too. Not only are the celebrities of our youth and adult hood dying but friends and mentors.  Grieving is a reason for feeling blue.
Taxes were a trial this year.  The office move was costly and unsettling.  An expanding company growing wealthy with increasing staff and marketting success displaces the lawyers and doctors working in their little office. The big guy has more clout. Our leases come up. They're not renewed.  One can't blame a big corporation wanting to collect from just one tenant rather than a dozen.  But moves are unsettling.  I'm aging and fear I'm seeing change as loss more than as opportunity.
Aging is all about loss and handling loss gracefully.
I didn't ride my motorcycle or take out my boat as much as other years.  The challenge and work of it all seemed unattractive. I chose to run on weekends instead, thankful for the repair of injuries and the returning athletic capability. It's hard though. Everything hurts.  I hurt when I walk to the washroom each morning. All the traumatic arthritis of distant crashes and near death remind me with the first stiff and painful steps of the morning.
When I talk with friends I feel more and more like I'm reviewing the conversations I loathed when my father and mother shared. I tell her I've got back pain tying my shoes. She says her vagina itches.
Only older people 'share' such intimacies freely.  Harry tells me about his hemorrhoids. We discuss infirmities.  All the medical words I learned as a young doctor my friends are now using to describe their own symptons.  I try to remain in denial.  Denial is my first and favourite go to place.
Aging and the thought of dying are contemporary discussions.  I am morally against physician assisted suicide but I know that suicide is never far from my mind.  Homicide isn't that far away either.  Thankfully the Darwin Awards allow me to laugh about all the stupid people. The older I get the more people seem stupid. And truthfully they are. Their inexperience and ignorance coupled with their arrogance is flagrantly thrust in your face. The worst are those with some power.
Daily someone tells me about grandstanding clerk or low level government worker cutting off the heads of others to make themselves look taller.
I find myself back biting, back stabbing.  I speak negatively about individuals and institutions and immediately regret it.  My long deceased aunt who was the executive assistant to the Canadian ambassador in Washington during WWII never said a negative thing against others. At her funeral it was what we all talked about. No one could remember this lovely Christian woman saying anything negative about anyone.  She used to say "if you don't have anything good to say about someone it's best you say nothing."  She was silent at times. We remember that.  But I love that she was so positive and refined.  I would be like her.
I have resentments. I have fears.  I find myself often with one foot in the past and one foot in the future, resenting something in the past or worrying about something in the future, shitting and pissing on my day because I can't get my head in the same room as my ass is.  I'm constantly bringing my mind back to the present.  The present is all I truly have and it's called a present because that's where God is.  Yet I'm a sinner. To sin means 'to miss the mark'.  It comes from the days of archery when the intention of the archer was to hit the bullseye but for a variety of reasons including his attitude he missed.  I'm trying to focus on God and the present and practice the presence of God but all too often I'm distracted by news I listen to with the misinformation and disinformation of the media.
I find myself wanting to enlighten everyone to the lies that I hear. The talk of the economy is put at a propaganda level of communication. There's 'techniques' of misinformation and disinformation that Hitler and later Stalin first ingeniously developped. Then the marketting companies advanced them so that every add campaign now incorporates these fallacies and cognitive distortions.  I listen to the source and hear the 'hustle' or the 'ad campaign' then later in the day hear otherwise intelligent folk parrotting the fashion of the month.  I'm momentarily crazed.  I feel like the human in the alien attack 'Invasion of the Body Snatchers."
But what does it matter?  Stupidity is being nurtured.  Collectively we're being herded.  Someone is pulling the strings. Or is it just as it is.
I struggle to avoid thinking or discussing matters that are 'above my pay grade'.  It would be so easy to be paranoid, knowing one is right, relishing the warm cuddly feeling of victimship and being paranoid.  Even Freud said 'sometimes the paranoids are write'.
But I'm a psychiatrist. I'm trained to 'tolerate the tension of opposites'.  Like the chess player I am I play either side with equal skill. I see the Glass Bead Game for what it is.  Just light and shade. I remember Leonard Cohen's song, There's a war between the rich and the poor, a war between the man and a woman.....there's a war between the odd and the even."
It's the dualism.  It's Martin Buber's I and Thou.  My questions and concerns are always a dialogue with God. We're forever playing hide and seek.  I'm facing death and life is just another state of discussion with death.  Everything is relationship.  I'm just trying to find the laughter and the love.  The "L" words.  Sex is a metaphor for our relationship with life.  Everythign is bipolar, waves and particles, everything in motion.  Finitude is an illusion but infinity and finite are just faces of a coin.
Unfortunately the more intelligent one is the more risk there is for depression. As a great older Christian psychiatrist told me , bitter people are a dime a dozen. "You don't want to be a bitter old man. That's common.'
My friend talks about the obese ladies, first gaining weight then wearing runners and expandable pants.  "They've let themselves go," she says.
Addictions are a way of living with one central fear of death and invalidity.  The existential questions are now poignant for me.  I read Kierkegaard, Camus, and Doystoyevski as a kid, appreciating the art and enjoying the story. Today I wonder if the hundred babies I delivered were good.  Or were half terrorists.  My friends children are drug addicts and drug dealers. I look back on a life of healing but wonder how many of those I healed went on to be criminals and murderers.  I took comfort in my indiscriminate love yet today I question the daily work of rescue and seeing every single person as a child of god and treating them as if they were a family member.  I prided myself in believing I was being a good person treating the devil and the saint equally.  I took an oath 'do no harm' and now with 'physician assisted suicide' being promoted by the Supreme Court of Canada, I'm looking back wondering if all those suicidal people I spent hours, days, weeks and years convincing that life was worth holding on to, well maybe I was wrong.  I could have worked less, made more money, had an easier life, just killing people.  I know the abortionists have a hell of a good life killing babies.  I still have nightmares about the dead baby I delivered. I still have nightmares about the boy who suicided on my watch. If I was a killer at worst I'd have to think about the ones who lived.
The abortionists haven't always got away with their killing. I heard the deformed courageous woman who didn't die when she was aborted.  She lived and told her story. "J'acuse" comes back to mind. The great French story of justice.
But my friend says there's no 'justice in the courts'. The courts are there solely to protect the rich and maintain the status quo. The reformer is the enemy of anyone who benefits from the status quo.  So the whole the beaurocratic system and all the outward appearances of the government system especially the courts are there to maintain the position of the rich and powerful.  They now have a term 'social justice' and it's even more disengenuous. Deconstructionism and constructionism.  Right is wrong. Black is white. I read between the lines and educated beyond my intelligence see what's really being said.  The government and courts are as 'fixed' as soccer and Vegas.
But of course it's all above my paygrade.
If I knew what I know today, would I do what I've done with my life.  Well, I wouldn't have married. I told my wife that her idea that marriage was for a couple and that marriage didn't need kids meant that marriages might as well be gay. I'd married for the sake of family and the women overnight said 'my body my own.'  My baby was killed aborted. I married and raised some women who were only little girls and we played at love and kept each other close covering each others back for a decade at a time. But the children were killed and I couldn't even save the life of my own child. The Supreme Court killed my baby as much as anyone.  The Prime Minister and Queen killed my baby.  And now as I age I'm growing more and more alone. Like millions of other men who daily must struggle to avoid being bitter.
Another man says his son stole all his money and left him to die. Her daughter is using the grand children to maintain her drug habit. Her children get her the money from social services she uses to maintain her addiction.  Obviously if one wants to be bitter, one can chose having children or not having children as the excuse for having a bad mood.
My bad mood is explained as much by anything but I wonder if life wouldn't have been better if I had devoted myself to learning killing instead of healing, Hundreds of my patients begged me let them die.  I struggled through depression after depression.  I helped women get through morning sickness and waddling days, and aches and pains then labour and delivery only to find that the courts and the beaurocrats are going to judge me in my senility on my 'popularity'.  I took over from a doctor who the patients still sing the praises of down here in the Down Town Eastside. He's famous today and I see that he maximized the methadone and opiates he could give, maximized the benzodiazepines he gave and didn't ever really address their addictions, didn't recommend abstinence but just gave them more and more drugs until they died or he left and said he was sorry he couldn't give them more illusion and pain relief.
I expect families will thank me for killing their relatives.  So many of my patients over the years have suffered caregiver burden. I have defended my patients over and over again from relatives who were wanting them dead or committed. I have fought to protect my patients assets and over and over again begged and cajoled to get them housing and treatment and hospitalization.  I now think if I'd just become a lawyer I could have written a law and told the physicians to kill the patients. I'm still struggling with a judge who condemned me for advocating for my patient and the doctors who supported him.  It doesn't matter that years latter my lawyers 'won' and the doctor's role as 'advocate' was upheld. I know this judge as a lawyer had a conflict of interest. All over the lawyers are looking to be in every aspect of our affairs insisting only they can represent everyone. So now we each of us daily need a lawyer who is a beurocratic body guard.  My rich colleagues have them on retainers and some go into the hospitals with their lawyer at their side.
I think of physician assisted suicide as I consider these profound changes in society and the devolution of Canada as I know it. I've read the horror stories of Holland's experience with legalized marijuana, their banning BC Bud, their 180 degree turn around after 20 years of that failed experiment. I've also read how their 'physician assisted suicide' started out kindly then became a variation on Hitler's gas chambers with widespread killing of the aging mentally ill because killing is always cheaper.  The addicts are given places to shoot up because their doctors don't believe in them as humans. They've given up hope. It's palliative care because we'd rather spend money on court rooms and elections and massive government waste and corruption than on authentic health care.
But what do I know. My opinion about what is right and wrong is just one man's views.  The whole of the democratic process suggests that each individual's opinion is equal to another.  So today more and more individuals on the planes I fly on think their opinion is as good as the pilots. M ore and more people comes into my office after a cursery look at internet and tell me what I'm supposed to do as a doctor. Everyone is an overnight expert with a google and it doesn't matter that the research says that all the computer health care programs have a 50 to 80% error range.  It's sexy.
A few of us old doctors at the back of the lecture hall listened to a couple of cute your female academic doctors give a presentation on 'Physician burn out".  They called their talk 'compassion fatigue'.  We joked, "when was the first time you diagnosed yourself as burnt out."
My first year after residency. When I left the university and was on my own in real medical practice.", one answer.
"I stopped counting after my 19th nervous breakdown", the other grey haired world reknowned clinician said.
I said, I've not had a drink or drug in 16 years so I don't know if I'm just being a 'dry drunk - "rest irritable and discontent' or I'm experiencing "burn out".
"Remember that survey a few years back where every doctor said they'd have more compassion if they got the annual $50,000 in back pay they thought they deserved but had been diverted to excessive administration whose role seemed sorely to interfere with medical and nursing care."
Yes I do.
I don't see anyone lining up to work with ex criminals, drug dealers, addicts and the dangerously insane but you notice how people who've never got their hands dirty are the quickest to be critics.
We began talking when the lecture was on, pulled our selves to gether and listened to the pollyanna stuff about getting exercise and getting enough sleep taking more time to keep up with the literature and all this 'sweet recommendations' we usually hear from the College, the day before or after they come up with some recommendation that multiplies every physicians workloads a hundred fold or the government refuses to pay for the increasing aging patient practice.  It's so easy to tell others to do the work.
"I've been hoping for war, " I said after that lecture ended and the three of us continued to talk.  "I ask God for forgiveness but it seems it's the only way that the 'dead weight' is winnowed out of the fat cat systems.  Germany has a better health care system and 1/20 the administration. "
The things breaks down into a poor me and shared expressions of self pity.
"I can 't afford to pay for me kids university and the alimony his mother demands."
And three old doctors all obviously suffering burn out have an ad hock  group therapy session and go off laughing in the end.
The rich and poor, the doers and the takers, the lovers and the haters have always been around.  12 step programs broke down the source of fear and resentment to 'financial insecurity, concerns about ambition, concerns about status, concerns about face and friends, and family."  Mental health is defined as the ability to love, work and play,.
There's infinite amount of work for doctors and never enough time in the day. Our love lives collectively suck and increasingly no one has the time or resources for play.  Doctors can't afford to buy a house in Vancouver on their income.  But then no one can, except those who inheritted or the criminals.
Bitch bitch bitch.
We have gratitude lists to change our attitudes.  I have to give my head a shake minute by minute. I thank God for the light and darkness, the happiness and sadness, sickness and health, the good and the bad. It's only in the contrast can I appreciate the good.  I am thankful for this life. It's had it's ups and downs. I know there are drugs to make everything bland.  The addicts I see are bubble boys and bubble girls. They are living their lives in illusions wrapped in the candy floss of their drug of choice, missing out on 99% of the spectrum of living. I remember when I drank wine, smoked a joint or smoked a cigarette.  Even these are their own valium type experiences.  Living life on life's terms is walking a high wire. It's 'raw".  It's the same with being intelligent. It would be so much easier to be stupid and believe in the 'group think' 1984 reality.
It's like the desire to take the other pills colour in the movie Matrix.  Just live in the Solyent Green world.
Time to get on with reality.  Ironically until they insist I kill people, they have made it law that I pimp for the abortionist, it's not enough that I say I don't do abortions, I required by law to make their killer richer. I expect the same will happen shortly when I say I'm too old to start killing patients for profit and they're say it's not enough for me to say I don't do it but that I must phone the killers and make appointments for my patients.  I wonder if I should go back through my lists of people I convinced not to kill themselves over the last three decades, speak to each of the hundred individually and encourage them to reconsider our decision.  I really think the lawyers in the supreme court should have taken lessons in boundaries and profession and stuck to 'lawyer assisted suicide' rather than telling physicians to kill their patients.  At least in Saudi Arabia they have a public executioner.  Given the way they've been botching up their killing in the court and jail side of the ugly business they probably want 'physician' assisted suicide because they know only physicians seem to know how to get things done. Which is why every restriction is place on us and the system hates and is terrified of us and other scientists.
I have to get back to making gratitude lists. This is always a me and God, I and it or I and thou thing.  The complexity reduces to me and the other.  I'm obviously not in a loving carefree mood. If I surrendered and accepted God is in charge and all loving then I'd feel better.
It's all above my pay grade. As my friend says we're all 'slaves'.  Best to be grateful to be an 'inhouse nigger'.  He laughs at me calling me a 'wage slaves'.  He bought parking lots and made a lot of money.  The parking lot prices outside the hospitals and clinics are always the best source of revenue.
I lack some gene that makes him think like that.  Still I love his humor.  God has a real sense of humor. When you can get your head around that then finally you stop taking yourself so seriously. I have to remember that.

Therapies for Depression

Depression is a broad term to describe a psychiatric state of literally, unhappiness.  So called Clinical Depression refers to some such state that persists for at least a couple of weeks. It's associated with a depressed mood, most of day, most every day.  Sleep and motivation and cognitive function can all be affected.  There have been a wide variety of terms over the year to describe this state.  It's been called dysthymia, major affective disorder, mood disorder, major mood disorder, and at it's most extreme melancholia.  It's differentiated from the blahs by being a bit more severe and lasting a bit longer. It's differentiated from Grief or Bereavement, the natural state of loss when a loved one is lost, by lasting much longer.
At the turn of the century a study in Pennsylvania at a farm when Quakers kept people who came with mental illness treating them with tender loving care but not much else, the length of 'untreated major depression' was approximately 9 months.  Adjustment disorders, a reaction to a negative event in one's life such as the loss of a job or the break up of a dating realationship was considered to be about 6 months. The depth of suffering with an adjustment disorder could be as great as major mood disorder but if the disorder laster longer or was greater then the term major mood disorder or major affective disorder was used to describe the experience.  There have been some who wrongly defined adjustment disorders as 'minor' depressions but adjustment referred to the presence of an identifiable stressor. In Major Mood Disorder alone a person might have a stressor or not.
Indeed there is a tendency in the pharmacological industry associated psychiatric diagnosis to described disorders independent of the causation. Hence the 'antidepressants' medication is likened to 'fever' medication, like Aspirin and Acetomenophen.  People can have pain for a variety of reasons but aspirin or tylenol tend to treat the 'pain' regardless. There's this kind of non specific benefit noted with the antidepressant medications so that in association the term "major mood disorder' has by convention been likened to the condition a psychiatrist would use an antidepressant with.
That said depression and moods in general can be altered by a variety of factors in terms of the individual, their relationship or environment.  A large number of physical medica conditions give rise to depression. Often the first presentation of an underlying major medical physical illness is depression. Cancer, Diabetes, Heart Disease, Chronic low grade infections, Anemia, Metabolic Diseases, all commonly present with depression as the first sympton of the disorder.  For this reason people with persisting depression often benefit from seeing their family doctor who can readily rule out the major and more likely conditions that may present as depression.
Many of my patients have come to me after months of psychological treatments or counselling when they had an undiagnosed physical disease which was causing the person to have low mood, loss of energy and sleep problems and cognitive difficulties. The diagnosis of depression was correct. It's just that the cause and treatment had been wrong.  I saw one poor gentleman after a year of weekly psychotherapy and all manner of discussion of his sex life when he had an anemic condition. When the anemia was treated his mood improved and he no longer had need for psychological treatment and certainly was disheartened by the year of therapy, the $10,000 of dollars cost and the loss of work and relationship which had occurred. In several cases depression was the way my patients breast cancer presented. I did an appropriate medical screening history and found that they had other symptons of concern.  Hundreds of cases that have come to me for depression, even those who have seen family physicians before me have turned out to have a physical illness which when treated caused the patient to no longer need antidepressants or depression therapy.
The message there is 'screening'.  Give a boy a hammer and everything is a nail. That's the problem with counsellors.  They over diagnosis psychological depression and miss the other often common causes.
Psychosocial reasons for depression abound.  Often people become depressed by lack of exercise.  Scientific studies have shown that 1 half hour of aerobic exercise daily has the equivalent benefit on mood as taking prozac 10 mg daily has.
Often people who have eating disorders are depressed. Both obesity and anorexia are associated with depression.
All the addictions are associated with depressions.  Alcohol is a 'depressive'.  Cocaine is a 'stimulant' but it quickly depletes the bodies stimulant neurotransmitters and causes a depression as a result.  Addictions are generally associated with a dramatic high followed by a low. Sex addicts get this and eventually the flogging of the dead horse phenomena in addiction leads to chronic depression and dysthymia.  Bipolar II in the diagnosis associated with addiction until proven otherwise.
Chronic anxiety states lead to depression. Indeed the Seligman 'learned helplessness' studies suggest that depression is a chronic anxiety state.  There's work with neuro implants that suggest that chronic anxiety may set up a derailed neurotransmitter pathway that requires a 'brain pacemaker' to disrupt and restore a person to having normal neurotransmitter release.
Electroshock therapy served to 'reset' this distrurbed neurotransmitter system.  Serotonin deficiency was disagnosed in the cerebral spinal fluid of suicidals and the general pharmacalogical explanation for depression was a low serotonin or noradrenaline state.  It's now recognised that there's more likely an imbalance between varying neuro pathways serving to maintain equilibrium.
All manner of therapies have therefore been scientifically shown to be beneficial in the treatment depression.  Prevalence studies of depression show as much as 30% of a population base may have some form of depression at any time.
Talking therapies - counselling - psychotherapy -have all been shown to be beneficall. The is much competition between the various 'schools' of thought and the 'latest' brand of therapy but one very interesting study some years ago showed that psychiatrists with 10 years of clinical therapy experience regardless of their theoretical basis had the same general benefit.
The 'convention' is to use a 'cognitive behavioural therapy' today, mostly because it's so easy to train a person in and therefore costs less. Psychodynamic therapies have equal if not greater success in the treatment of depressive disorders but require more training and are more difficult to learn than 'cognitive behavioural therapy'.
Generally speaking 'relationship therapies' have been good with most depressions.  Garden variety depressions were what we always gave the new residents as they tended to respond to any form of positive hopeful encounter.
Having branched out in to other areas of study I've seen that "pastoral counselling' has been effectively treating depression quietly for centuries because it combines cognitive behavioural therapies idea, with relationship therapy and even has the 'lending the ego' elements which were beneficial in psychoanalytic therapies.
The advantage of psychotherapies over doing nothing was the generally speaking it's been shown that therapy shortens the length of the dysfunction associated with depression and the risk of suicide.  Considering untreated depression can last 9 months, most counselling therapies result in a depressive episode getting better in 6 to 10 weeks.
Indeed prozac the antidepressant was considered a success because it was shown to have relatively equivalent benefit to 10 weeks of psychotherapy.  Combined psychotherapy and psychopharmacology, the person improved symptomatically but the potential for recurrence was also reduced.
Individual therapy is expensive as any labour intensive therapy is. Therefore there have been studies on group therapy especially with cognitive behaviour therapy which really lends itself to the class room. Indeed I  might argue that individual therapy of the CBT nature should only be considered when group therapy had failed.
Misery loves company. A significant success of the self help movement has been it's ability to counteract the tendency to isolation.
Spiritual people as evidenced by a measurable variable such as church attendance have less likelihood of depression and respond to treatment better with greater success.
Seligman at his Authentic Happiness site has been doing research on improving the various traits that counteract depression, two specifically being hope and reslience.
While a lot of people think that depression should be a reason to not be working, not working can actually make depression worse. Clearly a pilot who has depression may present a risk for his passengers but if he is sent home 'to rest' , the isolation might indeed make the depression worse. A very effective therapeutic strategy employed by the British Columbia worksafe program was to have depressed patients attend a daily coffee house thereby ensuring that they had the occupation benefits associated with group therapy and socialization.  People who isolate worsen their depression.
However depressives can run in 'packs'. Individually I've treated dozens of patients by encouraging them to reduce the contact with 'sick' people in their social network. It's the 'dosage' of the relationship that is sickening. One women became physically ill if she talked to her deeply mentally ill mother for more than a half hour a week. The mother was dependent and clinging and literallly what caloquially we'd call a soul sucker. In contrast one of my male patients had only to talk to his father for an hour and his father was constantly demeaning to him causing him to be literally suicidal.  Again by limitting the dose of the relationship to 15 minute contacts the man was able to get better. I routinely ask depressed patients to avoid the news in whatever form since it's commonly old and depressing.
Music therapy has been shown to be a treatment for depression. It's especially beneificall if people are themselves participating in making the music.
Given the wide range of successful treatments available it's usually beneficial to consider the efficiency and cost effectiveness of a therapy.
Magnetic therapies have been shown to be very effective for therapy and equivalent in some patients as medication therapy however right now the cost is higher than electroconvulsive therapies.
Hypno therapy is an effective therapy for depression as is neurotherapy.
Often the therapy that is used is the one most available in the community.  It's also is affected by what experience the therapists have. In eastern Canada it's common that there are a psychotherapeutically trained psychiatrist with extensive experience in a variety of non pharmacological treatments as well as pharmacalogical treatments and physical treatments. In western canada it's most common that the psychiatrists are only trained in psychopharmacology or if trained in other forms of therapy these are supported by the community financially or professionally.
Massage therapy is very attractive to patients. I once asked my heroin addicts if they had the choice of going to detox or massage therapy which would they choose.  They'd naturally choose massage therapy.  Unfortunately there's no evidence that massage therapy is an effective treatment for heroin addiction.  Abstinence is and detox is not nearly as pleasant as doing heroin and getting a government funded massage.
No one ever questions what individuals do to treat their own depressions. This is in fact the 'right' to 'pursuit of happiness'.  I personally find riding my Harley Davidson Electraglide an antidepressant but it's most unfortunate I can't convince an insurance body to pay for my motorcycle. Similiarly i personly think that if I were depressed I'd benefit from a year of high paid tropical therapy on a beach. I suspect I could devise a scientific study to show that this did work but the cost would be prohibitive for any insurance company.
Much of the failure in treatment of depression has been due to the failure of patients to follow medical regimens, such simple suggestions as don't drink alcohol or exercise a half hour a day, or get out of bed.
Dance therapy is an effective therapy for depression.  I used dance and psychodrama to effectively treat depressed patients. There's just no support in the very conservative medical system for me to do these therapies. I'd need a larger office or space where I could do dance. I have a group therapy that helps depression but even to have a group therapy in my office I have to pay the higher overhead costs for the office that can hold 10 people at a time.  Further the medical service plan discourages me from having group therapy because it's more time and effort for my staff to arrange and bill and yet there's no commiserate increase in the therapy cost.
So there's lots of therapies and lots work. The choice of therapy and indeed the choices available are numerous. People don't need to be depressed. Talk about it and get help.
When I started in psychiatry I commonly talked with patients and rather quickly they got better. Often just listening to people who had otherwise well established lives served to result in their mood improving.  Later I would see more complex problems with less and less resources and more and more demands on my services.  As a result I tended to use medications more often. Commonly I have the pleasure and benefit of working with a psychologist or occupational therapist who does the lions share of talk therapy.  I'm a consultant and diagnostician and the the psychopharmacologist in these arrangements.  The psychologists and counsellors and occupation therapists can't prescribe medications and aren't aware of the whole medical and neurological aspects of depression which can be an important part.  A number of the psychologists I work with a specifically trained in a subset of patients and their experience and training makes them especially good with this group of patients. My experience and training is really broad based with some subspecialty areas so it's refreshing to work with psychologists who are subspecialists themselves. Increasingly family physicians are working psychologically with patients so that makes things easier all round.
I still come across alot of depressed negative people in my daily walk in life.  It's like the number of addicts who actually access treatment. Very few. So commonly I'm treating an addict in the office but there are a dozen or so more who deny they have addiction and attribute their regular social and occupational problems to the 'other guy'.  Similiarly depressive people often are the last to seek help which is unfortunate too.
When I consider psychiatric illness I often think it was akin to physical illness in the 30's. All manner of people had physical illness like heart disease or treatable infections or cancers but they never sought help for them. As a result the morbidity and mortality rate only one or two generations ago was so much higher.  Today people have much more 'quantity' of life in general but the 'quality 'is still an issue.
Ironically alot of people think that they'd be happy if they were rich but wealth is not a cure for depression and not a guarantee against it.  I used to think if I lived on a tropical island I d not see depression becuase I'd associated it more with the dreary winter months but when I worked on a tropical island I saw just as much depression.  I have been thankful for the wide range of therapies that I've learned, the excellent psychopharmacologies and elegant psychotherapies.