Treatment for Depression

Depression is a monster. It feels like it will never go away. As a clinician, the number one most dangerous part of depression is the element of hopelessness. The key however is that depression will not last forever! Depression has the effect of placing gray colored glasses over your eyes that are tricky to remove. You may pull them off for a day, week, or month, but they have a way of returning. 

We have many interventions (CBT, EMDR, DBT, TMS, Ketamine, medications, etc.). Within these interventions are what I call “micro-interventions” - how do we actually practice these? What are the steps that we take?

On an interventional level, Cognitive Behavioral Therapy (CBT) is the gold standard first line treatment for depression. Often though, there is residual depression, or it may not work 100% (oftentimes I see it as a huge help but not always a permanent cure). For any lingering depression or CBT-resistant depression, my next favorite is to go to EMDR for Depression. This targets deep inner core beliefs, similar to CBT, but using full-scope body, emotional, memory, and logical processing with the goal of engaging the two hemispheres of the brain and four main areas that regulate emotion. EMDR is most effective when paired with TMS, which helps “wake up” parts of the brain that “go to sleep” during depression. TMS also appears to help individuals in EMDR connect more with memories and emotions that we are trying to activate. TMS and EMDR are generally covered by insurance in the treatment for depression, which helps alleviate the financial burden. Medications for depression can be helpful, but can oftentimes facilitate the spiral of hopelessness when they do not work (which is very common). 

A few of my favorite micro-interventions within CBT and DBT:

Purposefully seeing the positive. We walk, we eat, we sleep. Do we stop to smell the roses? Actually no! That is a purposeful activity that can help alleviate depressive symptoms. I often give my clients the activity to stop on a walk, notice the vibrant green in the leaves of a tree, notice the flickering in the wind, notice the strains of lighter green within the leaf, feel the crispness that it carries, see the shine, etc. You must do this for a minimum of 15-seconds for your brain to program and convert short-term memory to long-term memory. Seeing the beauty and intentionally focusing on it for enough time to input more positive programming to your long-term memory essentially tricks your brain into having a more positive outlook and more positive material overall. Another great example - drinking your favorite beverage. Instead of gulping it down, take 15-seconds to purposefully engage with the positive of it (spend time smelling, noticing the pleasant warmth or cool from the cup on your hand, noticing the flavor on different parts of your tongue, etc.). Draw it out for a minimum of 15-seconds!

Benefit finding. Taking the negative events and experiences that have occurred and shaping them into a positive, somehow, however you can (even if it takes being really creative)! What did you learn? How did you grow? As my mother used to say, “every lesson costs.” Education is not free. Leaving my precious earrings at the hotel taught me to check more thoroughly and made me realize how much I value gold jewelry and the sentiment they carried. Does that make it easy? No! Can it help reframe the event to make it not quite as awful? Maybe. Even if it doesn’t feel like it, our neurons are being programmed to see the positive which is the opposite of the natural reaction. This creates a chain reaction cascade of events to help other events be seen in a more positive light, even when you’re not trying. Practice is key!

Talk back. Talk back to negative or demeaning thoughts! That little voice in yourself that tells you that you aren’t good enough, tell it no! “I am good enough!” If you don’t believe it, keep trying. If you still don’t believe it, scale it down and start with something smaller. Instead of “I am good enough,” use something that you can believe more - perhaps “I am good enough for some people.” Talk back to that demeaning voice with this until you believe it (or at least partially believe it). The goal is to override this negative voice naturally, which will occur with enough practice. 

Use mantras. “I am doing the best that I can” is a favorite of mine (credit to my mentor Jen Vachet, LMFT). You may not believe it initially, but given the circumstances of your upbringing and environment - you are doing the best you can! We all are doing the best we can with the resources that we have. Life is hard. We are not perfect. We cannot expect perfection from ourselves. Another favorite, “You’ve got this!” Maybe you really feel like you don’t have this! The point is to put a voice inside your head, believable or not, telling you that you do so that you have personal encouragement guiding you! If it helps, give the voice to a mentor, friend, or family member. 

Veronica Calkins