Neil Stegall

Neil Stegall, LCSW - Serving individuals, couples and families.
1001 S. Capital of Texas Hwy, Bldg L, Suite 100, Austin, TX 78746
(512) 773-6810

About Depression

We are all familiar with “down days,” “the blues,” and other expressions that describe brief experiences of sadness and pessimism. These emotional let downs are part of the fabric of human experience as we face disappointments in life and are usually brief in duration. We have become accustomed to saying we are “depressed” at such times. 

But these occasions should not be confused with clinical or major depression, a common and often intense mood disorder. 

Depression can be a profoundly painful and even disabling experience. Since an episode of depression can range from mild to severe, the experience will more or less deprive us of our sense of well-being, creativity, and resilience. We can feel just as if we have a physical illness: mentally dull, unable to enjoy life, low energy, disturbed appetite and sleep, and an understandable tendency to withdraw from our world. Physical aches and pains are common for some. Depression can spiral into deep despair in some cases, resulting in hopelessness and thoughts of dying, or even suicide. 

Depression is often found in families, suggesting a strong genetic basis. It is believed that a stressor, or multiple stressors, often arising from interpersonal relationships, can trigger the earliest episodes of depression. However, the resulting changes in the brain can lead to future episodes being triggered more easily by less readily identifiable stressors or changes in the individual. 

Individuals with recurrent depression unintentionally surrender their sense of hope in overcoming depression by identifying with the depression. They have the felt experience of being the depression. For them, this often signifies some weakness of character, something unchanging- because of this sense of identification. Depression ceases to be a painful but transient event, but a felt sense of self

Current treatments for depression are more commonly available and effective than at any time in the past: 

  • Cognitive behavioral therapy (CBT) to address patterns of thinking and behaving that may trigger or sustain depression

  •  Interpersonal therapy (IPT) brings focus to relations and roles that are relevant to the onset and continuation of the depressive episode

  • Mindfulness-based Cognitive Therapy (MBCT) for recurrent depression to minimize the recurrence and severity of depressive episodes through the practice of meditation used in stress reduction as well as explicit cognitive skills

  • Antidepressants such as the SSRIs influence serotonin function in the brain and seem to affect the efficient function of cells of the serotonin system as well

  • Dual action antidepressants, affecting both the serotonin and norepinephrine neurotransmitter systems, may be prescribed for some individuals, based on the evaluation of the psychiatrist

  • Other medications, as indicated, for persistent target symptoms such as lethargy or anxiety 

We know that the most robust, effective treatment strategies for depression involve the concurrent use of both antidepressant medication and targeted psychotherapy. Together they promote a restoration of biological function and psychological well-being. Individuals can have a renewed sense of energy, enjoyment, and balance and live their lives more fully. 

If you or someone you know is afflicted with major depression, please seek psychiatric evaluation and the support of an experienced psychotherapist. Major depression is a major cause of disability and misery- but something can be done to relieve depression

Important Notes

  • Sometimes depression is one wave of a cycle of a bipolar spectrum disorder, a class of mood disorders characterized by poorly regulated emotions, energies, and function. This possibility means that a careful psychiatric diagnosis and medical care plan with consistent follow up is required for all persons suspected of experiencing a major depressive episode. The incorrect treatment choice will be futile at best, and perhaps aggravate the intensity and severity of a cycling disorder.
  • Medical and psychotherapeutic treatment of depression is not meant merely to blunt or alleviate the predictable pain and distress of living arising from the escalating and punishing demands of modern life. Actual clinical depression requires the thoughtful consideration of how we create or respond to stresses of life that “go beyond the manufacturers intended use.” This assertion expresses the understanding that we must live our lives in a way that is true for our values and capacities as human beings, rather than conforming to the expectations and demands of an increasingly incoherent modern culture.

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