On a most basic level, this involves being careful with the types of psychiatric medications that a mother uses while breastfeeding. Most medications on the market have not been tested and should not be presumed safe for infants.

There is also the issue of postpartum psychosis. Anyone suffering from depression has a small chance of experiencing a psychotic break, in which they lose control of their thoughts and actions. This is equally true during postpartum depression and should be very carefully monitored for.

Psychologists receive special training in psychological assessment and will be able to establish, within a reasonable degree of certainty, whether you may be at risk for this type of episode after childbirth. A psychologist or other licensed psychotherapist will also be able to assist you in managing that risk and making sure that both mother and child remain safe and well.

A second consideration for this delicate time in a mother's experience is the baby's early attachment experiences with her, which are critical for the baby's later emotional success. A therapist can help to coach a mother through these early experiences and help her to increase her bond with her new child. This will not only improve the child's experience, it will also help to aid the mother in overcoming her depression.

The third focus of therapy will need to be the meaning of childbirth and the meaning of the child. Postpartum depression, like most other types of depression, is usually caused by psychological conflict and ambivalence. As much as the symptoms of this depression may feel foreign or unprovoked, they are probably serving some purpose in your life. In order to overcome the depression, you will need to find a healthier way to accomplish these unconscious goals.

Psychotherapy is also very important for individuals experiencing mania and depression, because bipolar depression and bipolar mania often represent deep-seated beliefs about a person's self and world. Without changing these beliefs, it is unlikely that an individual suffering from bipolar will be able to comply with their medication regimen, because the medications will be taking away mental states that are deeply valued. Therapy can help bipolar individuals to understand the inner logic of their mood swings, and why they are attracted to express the extreme states of consciousness that they experience.

Psychotherapy for bipolar depression will usually be quite a bit different from other kinds of treatment for depression, because the therapist will have to take into account the difficulty that the patient is having balancing their mental states. In many cases a patient will look depressed, and so the therapist will help them to elevate their mood. The next thing you know, the client's mood is too elevated and they begin to behave irrationally!

This type of therapy is definitely a tightrope act. But, like any psychotherapy, it is a collaborative process. The therapist must walk the tightrope with the client only as long as it takes to help the client learn to walk it on their own. Ultimately the goal of therapy is always for the client to experience better control over his or her mental states. In the case of bipolar disorder treatment, part of this process is learning to select more nuanced mental states that express a better balance between positive and negative emotions.

In the case of bipolar depression, this often involves learning the value of the depressive state. In order to cure this type of depression, it must not be dismissed entirely but rather integrated with other mental states.

The most popular herbal treatment for depression is St. Johns Wort. It has been shown to be at least as effective as prescription antidepressants with only a small fraction of the side effects. The difficulty here is standardization, determining dosage, and potential for medical interactions. St Johns Wort is a very safe supplement to take, but there is still some risk, and a doctor should definitely be consulted.

Again, this is not something that should be relied on as a cure for depression. It is something that can improve your symptoms over time and help you to make the changes in your life and in your mind that you need to make in order to make permanent improvements. Psychotherapy can help you make these changes.

One of the big sticking points for people when they think about depression is the idea that depression is "caused by a chemical imbalance." This is a talking point that sounds good when the psychiatrist says it, because it makes it seem like somebody knows what is going on and it is something that we can correct. After all, you correct a chemical imbalance by adding in the missing chemical, right?

This is incorrect. The idea of chemical imbalance is based on the "biogenic amine theory" of mental illness, which states that mental illness is caused by a lack of certain neurochemicals (called biogenic amines.) This theory has been disproven. In fact, you can disprove it yourself by taking an antidepressant. The medication will increase the levels of its target neurotransmitter within a few hours, but you won't experience any positive effects for several weeks. Why is this? It is because there is something else happening in your neurons that we don't know about yet. In other words, even when antidepressants work, nobody really knows why.

In truth, there are plenty of different causes of depression, plenty of different treatments for depression, and even some treatment resistant depression. The most natural treatment for depression is to examine what is happening in your mind that is unhealthy and to change those thoughts and feelings into healthier ones. This is precisely the purpose of psychotherapy.

Treatment-resistant depression sometimes begins early on in life and continues from there. This used to be called depressive personality disorder, but this diagnosis was eliminated in the last update to the Diagnostic and Statistical Manual. Now there is dysthymia, which is long-term, low-grade depression, and major depressive disorder, chronic.

In reality, all of these diagnoses don't matter. What matters is the experience of the person going through these problems and what can be done to make things better for them. Often what is called "treatment-resistant depression" is simply not improving because the wrong treatments are being tried. I believe that everyone can get better, but that people are very complex organisms which need to be delicately examined and carefully understood in order to find the source of problems and their cures.

Medication is not the answer. Sometimes it can be helpful, for some patients, and for a certain period of time. But so can a sugar pill. Recent exposes have brought to light the fact that the anti-depressant medications on the market are no more effective than placebo when unpublished studies are taken into account. Since they have substantial side effects, their widespread use in psychiatry is highly questionable. Psychotherapy has a better potential for long-term success. If medications are being used, psychotherapy should at least be used as an adjunct.

And for patients whose symptoms do not respond to psychotherapy after a reasonable period of time, another psychotherapist should be consulted and/or another method of treatment should be used. There are those who will argue that a patient should stay the course with their therapist no matter what because the relationship between therapist and client is the most important thing. I strongly disagree. Results are everything. You shouldn't go to therapy to have a friend, you should go to therapy to solve your problems and make your life better. That's not to say that the treatment will always be pleasant; often it will feel terrible. So does chemotherapy. The results are everything.

This may be because "depression" is such a nebulous term. Like every psychological disorder, there are specific diagnostic criteria for depression. However, there has been some debate about the validity of these criteria, simply because th symptoms are so common, cover such a wide area, and are subsumed by so many other psychiatric conditions. So you could say that there are as many treatments for depression as there are types of depression.

Is this debate useful to the individual who is suffering from poor mood, troubled sleep, disturbed appetite and sexual functioning, low energy, decreased motivation, suicidal thoughts, etc? I would say that it is. I think that there is a basic trouble in the modern art of psychological diagnosis. Psychologists and psychiatrists have tried so hard to quantify and categorize mental illness, and mental illness has meanwhile stubbornly refused to fit into our categories.

At the time of this writing, the American Psychiatric Association is in the process of developing a new version of their Diagnostic And Statistical Manual of psycihatric disorders, which is used for clinical diagnosis and insurance reimbursement. This process has sparked fierce debate from all sides, because it is difficult to agree on what the functioning purpose of the diagnoses should be. Should it be to allow individual diagnoses to reflect the experience of the individual patient as accurately as possible? To enable treatment planning? To minimize hassle from managed care? There are many groups who would like their interests to be represented by the formulation of psychological diagnosis.

This is a long way of letting you know that treatment for depression can involve pretty much any psychological treatment modality, because when we say you "have depression" it doesn't really mean very much. It is not the same thing as when you go to a physician for a throat culture and they can tell you definitvely that you have been infected by a specific type of bacteria. There is no blood test for depression, no specific set of physiological correlates. In fact, if we look at what is happening in the body there could be said to be a number of different types of depression that have so far been inadequately distinguished from each other.

This is not to say that depression treatments don't work--they do. They simply need to be formulated based on your individual experience as someone who is suffering something we are tenatively calling depression. In other words, we know many effective ways to treat these problem, we just haven't figured out the most effective way to catalog them yet. And as we get that figured out, we will probably develop even more effective treatments.

Depression Treatment Centers

All of this sounds like it could bode well for the idea of a specialty depression treatment center. Some type of clinic that would have advanced knowledge of the types of depression, the way they present themselves clinically, and what can be done about them. I am not aware that this type of facility does or even could exist. Depression symptoms overlap with so many other psychological maladies that you could just as well say "feeling bad" as "depressed."

Depression, along with anxiety, represents probably the most common and indistinct set of psychological symptoms. People experience depression symptoms during grief (although you should not receive a diagnosis of depression during the 'normal' grieving period, which has arbitraily been set at six months.) People experience depression symptoms during drug detox, or when suffering from insomnia, or when feeling lonely. You can get depressed because of another mental health problem, or depression can bring about other problems. You can get depressed because of the troubles in your life, or you can create trouble in your life on account of being depressed. You see the diffficulty that comes along with a diagnosis of 'depression?' It represents so many basic human experiences.

The entire idea for modern antidepressant medications comes from the presumption that there are certain biological chemicals (neurotransmitters known as biogenic amines) that are missing in depressed people. This is what your psychiatrist means when he tells you that your depression is a brain disease caused by a lack of serotonin or norepinephrine. The problem with this idea is that it is incorrect, as has been disproven for quite some time. The medications based on this presumption seemed to work, though, and so they kept making them in spite of not knowing why they work. To this day many of the psychiatric medications that you will find are not based on any modern theory of neurochemistry.

For example, when you start taking a new antidepressant your psychiatrist will tell you not to expect any results for at least 4 to 6 weeks. However, immediately after you start taking that medication, literally within just a few hours, it will have already done what it was designed to do. It will have already increased your level of the target neurochemical. Now some of these drugs target serotonin, some target norepinephrine, some even target dopamine, but the fact is that within a few hours of taking that medication you will already have elevated levels of that target neurotransmitter. Nobody is exactly sure what's happening in the ensuing weeks after you begin taking medication that starts to alleviate the symptoms of your depression. But we suspect this is caused by another process in your body's adjustment to the medication.

All this is really fairly irrelevant, because we now know that the medications don't really work that well after all. Most of the reason why anyone thought they worked very well was because the pharmaceutical companies paid a very a lot of money to produce a very a lot of studies in order to find studies that have positive results. Any scientist can tell you that if you perform enough studies, sooner or later you'll get one with positive results. The odds are simply in your favor, the more studies you perform. The problem has been that only the studies with positive results were getting published. Now that the unpublished study results are starting to become available, we now understand that this has been the case all along.

So the bottom line is that there should really be very little trust for modern psychiatry in spite of its claims to evidence-based practice. Granted, there are certain medications that do seem to be effective. For example, medications for bipolar disorder. However, in my opinion, these medications are not any more effective than appropriate psychotherapeutic interventions and by appropriate I mean therapeutic interventions which specifically target the symptoms and causes of those symptoms of whichever psychiatric or psychological disorder you're talking about.

So in the case of depression treatment, we can say that we should not be trying to treat the depression. As I have mentioned in the previous article, we should instead be trying to treat the patient, to understand why it is that they are malfunctioning, why it is that they are not properly adapted to the present situation, and what meanings their maladaptation holds for them.

I actually believe in the idea that there are chemical differences in a depressed brain vs. a nondepressed brain, but I don't think that there is any specific nondepressed chemical profile. I think it is specific to the individual and I think that the chemicals that the brain is using are based on the needs of that individual and their specific internal and external environments. So in order to truly enact change at the chemical level. We must find the correct psychotherapy, which will enable the individual to naturally adapt to their circumstances. That is in fact the entire purpose of psychotherapy, whether it be treatment for depression, bipolar disorder, schizophrenia, or any other diagnosable disorder.

In future articles I will discuss specific types and subtypes of depression, possible ways to classify them, as well as the diagnostic criteria for depression and the types of available treatments for depression.

Many people like to talk about their theories of depression, saying that depression is anger turned inward, or that depression is a biochemical disorder, a shortage of neurotransmitters, or a way of coping with hopeless situations. It seems like everyone has a pet theory of depression, but my opinion is that treatments for depression have to match the symptoms of depression. Because depression itself is too broad a category to simply assign one treatment for or to even say it's just one disorder. Diagnostically you can break it down into specifiers and similar disorders such as dysthymia. There used to even be a depressive personality disorder but this disorder is no longer acknowledged in the current diagnostic manual.

In fact I would say that the entire diagnostic model of current psychiatry and psychology is largely a failure because it tells us much less about the treatments that we should be giving patients than any other medical diagnostic model. In fact, the treatment is the only important thing that we really need to be paying attention to. How is it that we can make the patient feel better and function better in society?

And so it is with a diagnosis of depression, because if you say a patient is depressed, there are really only a couple of things that you can assume. There are wide range of symptoms. Sometimes conflicting symptoms, which can indicate depression can also indicate other things.

For example, there is little difference between a classical case of clinical depression and perfectly ordinary grief. Grieving is differentiated only by the length of time over which it is expressed, and also by the circumstances under which it is expressed. So you would not attempt to treat depression following the loss of a loved one if it were less than six months, because you would call it grief even though it looked identical.

However, clinically, this doesn't make a lot of difference. The important thing with depression is always going to be to help the patient to come to terms with whatever it is that they're having difficulty coming to terms with. And so the important thing when seeking treatments for depression is to seek treatments for the individual character structure and individual symptoms of the patient before you, rather than trying to find a treatment for some generic category that someone has decided to call depression.

Because depression doesn't really exist. None of the disorders listed in the diagnostic and statistical manual of psychiatric disorders actually exists. Those individuals who would claim that depression is a medical disorder brought about by an imbalance of neurotransmitters are speaking gibberish. I will believe that depression is caused by an improper level of neurotransmitter as soon as you can tell me what a proper level of neurotransmitter is. There is no such measure. We can do studies to see the differences in chemical makeup in the brains or the bloodstreams of depressed people vs. people who are not depressed, but all that gives us is a correlation between a certain chemical level and a certain expression of the individual. It does not tell us that the treatment for depression is a correction of this neurotransmitter imbalance. It does not tell us that the neurotransmitter levels are incorrect. For all we know the body could be trying to naturally adjust for some other factors that we haven't thought of yet. In fact, that's probably the more likely case.

So when we consider depression treatment, we should not simply look at the symptoms, or the blood levels of neurotransmitters, or the circumstances of an individual's life. Rather we should look at all of these factors and try to draw a complete picture of where they're at to the extent that we are able as psychologists. From there, we can help the individual to explore these factors in a way that naturally facilitates them changing their thoughts and feelings. There are plenty of excellent approaches to doing this, but do not necessarily assume that depression as an entity exists. These include cognitive interventions, psychodynamic interventions, psychoanalytic interventions, humanistic interventions, and a number of more specialized approaches.

In this blog I will be exploring a number of these approaches in greater depth. I will also go into detail about the various specifiers and diagnostic criteria for depression, as well as the psychodynamic considerations in working with depressed patients. We will therefore be able to develop a better sense of what are appropriate treatments for depression and how the clinician can go about treating depression in the individual rather than in the abstract.