Chapter 8 – Overcoming Depression at Work and at Home

Building Personal Resilience: A Guide to Positive Living

Chapter 8 – Overcoming Depression at Work and at Home

Depression Therapy Ottawa

Psychologists use a variety of scientifically based psychotherapeutic approaches to help people recover from depression.

In this chapter

The purpose of this chapter is to provide a guide to the signs and symptoms of a major depressive disorder. You can use the information in this chapter to help identify signs of depression which you may be experiencing and to help you take charge of your illness and formulate the best treatment plan.


A case study is provided that illustrates depression related to ‘job burn-out’; and the causes of depression are outlined, as well as a symptom checklist. The diagnostic criteria of depression are outlined as are various treatment modalities and the differences among various treatment providers.

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About the Author

Gilmour Psychological Services® was incredibly fortunate to have Dr. Peter Judge join the group in 1992 until June 2023.

Defining Clinical Depression


The purpose of this chapter is to provide a guide to the signs and symptoms of a major depressive disorder. To keep things simple, manic-depressive, or bipolar illness is not included in the discussion. You can use the information in this chapter to help identify signs of depression which you may be experiencing and to help you take charge of your illness and formulate the best treatment plan.


All of us feel sad and low at times. Perhaps the stress of work is wearing us out, or a valued relationship has gone sour, or perhaps a loved one has passed on. These are normal events of life to which each of us reacts differently. We may want to seek the counsel of friends, family, or professionals to help us through these times. It is important to distinguish these normal and short-lived reactions of grief and sadness from major depressive disorder or clinical depression.


How do we know when we are clinically depressed? Although the actual diagnosis of a major depressive disorder must be made by a diagnosing mental health professional, such as a psychologist, psychiatrist, or family doctor, there are a number of symptoms characteristic of clinical depression. Although feelings of sadness are certainly a common feature of depression, clinical depression is often characterized by strong feelings of loss of control, hopelessness, high anxiety and sometimes thoughts of self harm.


It is important to remember that depression is not a weakness and it is not your fault. It is a treatable illness.

Case Vignette


To protect our clients' confidentiality, all case examples are fictitious.


Brian had worked long hours in the high-technology industry, sometimes six or seven days a week in order to meet the anticipated release date for the product he was working on. Initially, he saw this as a temporary situation for which he would make an extra effort over a period of about six months. He would put his family on hold temporarily, while he made his mark at work. Brian did make a good impression at work and was immediately given another urgent project to work on.


Two years seemed to go by very quickly when Brian suddenly felt that work did not hold the same interest for him as it used to. In fact, he felt dull and disconnected at work. He had been out of touch with the daily activities of his wife and children for so long that he felt distanced from his family and although he missed their warmth a great deal, he had forgotten, it seemed, how to get close to them again. His friends and fun activities had long since been replaced by work-related projects. He found it difficult to concentrate at work and felt his thinking was slow and muddled. He was sometimes embarrassed when he was unable to follow the train of events during meetings. Alone in his office, he sometimes felt tearful, his heart would pound and he found himself sweating and trembling.


Over the next few months, Brian tended to withdraw from his family even though part of him desperately felt the need to be close. He was no longer interested in sex with his wife and the tenderness and intimacy that he used to experience with her seemed absent. In fact, he found himself arguing with her over little things. Sometimes he would just leave the house in a fit of temper. He seemed to be always angry with the children; and then berated himself for being so intolerant. Although he never was a big breakfast eater, now he was no longer interested in dinner and had no appetite. He was alarmed to find that, over the last six months, he had lost 20 pounds.


At work, his usual high-level of productivity was noticeably lacking and associates began to comment on his flagging performance. During the day Brian felt preoccupied with awful thoughts that would race through his head and which he could not shake off. He felt that it took a great deal of effort to stay at work the whole day. One afternoon, alone in his office, Brian burst into tears unexpectedly and was frightened by the fact that he couldn't stop crying easily. He left work right away and arriving home that afternoon he longed for a release from his painful feelings and whirling thoughts. The next day, his wife made an appointment for him with their family doctor.

Causes of Depression


The causes of mood disorders can’t be traced to one unique factor. Instead, depression is likely the result of a combination of biological, genetic and psychosocial factors. In some people, depression occurs even when life is going well.


Biological


There are a number of medical ailments which can give rise to clinical depression. These include interacting medications; family history and genetics; chronic health problems; substance abuse; and thyroid and other endocrine dysfunctions. Low levels of thyroid hormone can produce symptoms of depression including slowed thinking and low mood. This condition is easily treated with a thyroid supplement and the depression resolves as a result. Neurological conditions can also result in symptoms of depression. Traumatic brain injury, stroke, Parkinson’s Disease, Multiple Sclerosis, brain tumours and other conditions can provoke a depression as these diseases affect different parts of the brain and disturb the balance of neurochemical action in the brain.


There is biological evidence that changes in the neurochemical balance of the brain are associated with depression, and this research has been used to develop antidepressant medications.



Genetic


Research indicates that genetic predisposition can be a significant factor in the development of depression. Of course, it is impossible for these studies to separate the effects of the subjects’ psychological and social environment as they grow up, from the effects of genetics. Nevertheless, family studies suggest that close relatives of patients with depression are two to ten times more likely to have had an episode of depression themselves. Adoption studies have lent support to the notion that there is a genetic basis for the inheritance of mood disorders and there is a 50% likelihood that one identical twin will have an episode of mood disorder if the other has had an episode.



Psychological


Life events and environmental stress also contribute to the development of mood disorder, and stressful life events most likely precede a first episode of depression. Common psychological problems that can precipitate a depression are chronic stress, relationship and marriage difficulties, lack of social contact, the unexpected death of a loved one and failures or other setbacks such as 'burnout' at work.

Prevalence of Depression


Depression is estimated to occur in about 5-10% of Americans. It is almost twice as likely to occur in women than men and while this may be due in part to the willingness of women to present themselves to physicians and the reluctance of men to do the same, it is also likely due to biological differences. The average age at which depression occurs is 40 years old and half of all patients have an onset between the ages of 20 and 50 years old. Major depressive disorder occurs most often among those who have no close interpersonal relationships, or are divorced or separated. Interestingly, the incidence of depression does not differ among different classes of people.

Symptoms of Depression


Depressive symptoms can be feelings, thoughts or physical signs. Sadness, hopelessness and despair are typical depressive feelings. These are often accompanied by harsh, self-critical thoughts. These feelings and thoughts often occur in the presence of physical symptoms such as changes in appetite (compulsive over or under-eating), accompanying weight changes and sleep disturbances.



How Will I Know if I'm Depressed?


Symptom Checklist:

  • Feeling low or sad
  • Difficulty sleeping
  • Disorganized
  • Feeling guilty
  • Feelings of hopelessness
  • Self-critical
  • Worthless
  • Preoccupation
  • Tense or agitated
  • Quiet and withdrawn
  • Compulsive eating
  • Easily tearful
  • Hoping to die
  • Body aches and pains
  • Feel alone
  • Feelings of loss
  • Fatigue or apathy
  • Fearful and anxious
  • Reduced appetite
  • Feeling hateful
  • Helplessness
  • Anger
  • Difficulty concentrating
  • Planning to kill self


As well, there are often physical symptoms of depression. Some people express their depression physically and suffer headaches, aches and pains, digestive problems and sexual problems.



Diagnosis


Major Depressive Disorder


When someone is depressed, they may have several of the symptoms listed below nearly every day, all day, that last at least two weeks.

  • Loss of interest in things you used to enjoy, including sex**.
  • Feeling sad, blue, or down in the dumps**.
  • Feeling slowed down or restless and unable to sit still.
  • Feeling worthless or guilty.
  • Changes in appetite or weight
  • Thoughts of death or suicide; or actual attempted suicide.
  • Problems concentrating, thinking, remembering, or making decisions.
  • Trouble sleeping or sleeping too much.
  • Loss of energy or feeling tired all the time.


Other symptoms include:

  • Headaches
  • Other aches and pains
  • Digestive problems
  • Sexual problems
  • Feeling pessimistic or hopeless
  • Being anxious or worried


If you have had five or more of the symptoms, including at least one of the first two symptoms marked with an asterisk (**) for at least two weeks, you may be experiencing a major depressive disorder.


Symptoms of depression may be mild, moderate or severe.

  • Mild depression is when a person has some of the symptoms of depression and it takes extra effort to do the things they need to do.
  • Moderate depression is present when a person has many symptoms of depression that often keep them from doing the things they need to do.
  • Severe depression is present when a person has nearly all the symptoms of depression, and the depression almost always keeps them from doing their regular day-to-day activities. Some symptoms of depression may be mild but persistent, and these chronic symptoms of depression also need treatment.



What to Try First


In some cases, mild depressive symptoms can result from difficult decisions about your life that you may have avoided dealing with and put aside until later. In these situations, the first step is to identify the problem. Are you holding yourself back at work because of a misunderstanding or a belief which may not, in fact, actually be valid? Does the manner in which you relate to others, at home or at work, require a small adjustment to let you feel more comfortable with yourself and less constrained by what you feel others’ want from you? Some self-analysis and corrective action can go a long way to improving the way we feel about ourselves. In many cases however, this type of action alone is not sufficient and depressive symptoms persist.



What to Try Second


Visit your family doctor to rule out a medical cause of depression. This would be a good time to discuss your symptoms with your doctor and to formulate a plan of action. Your doctor may be able to suggest an appropriate referral to a mental health professional such as a psychologist or psychiatrist who can make a diagnosis and formulate a treatment plan.



When to Seek Professional Help


If you feel that you are having difficulty coping with your symptoms by yourself, then this is a good time to seek professional help. You can use professionals, not just for major problems, but as a sounding board for decisions that you want to make or to troubleshoot minor problems. Visiting a professional is particularly important if you have experienced a loss of control, or felt hopeless, or if you are struggling with suicidal thoughts.



Who are the Treating Professionals


Family doctors (M.D.)


Family doctors are not specialized in mental health disorders and not usually trained in psychotherapy. They are able to diagnose and treat depression. Medical doctors are members of the College of Physicians and Surgeons, which legally regulates the profession. They have an undergraduate degree, a 5-year medical degree and 1 or 2 years as a resident in family practice. Medical doctors are also authorized to admit their patients to hospital. They can prescribe medications such as antidepressants.



Psychiatrists (M.D.)


Psychiatrists are medical doctors who are experts in the pharmacological treatment of depression and other mental health disorders. Modern psychiatric training is oriented around a biological model of depression in which treatment by medication plays the primary role. Psychiatrists usually have heavy caseloads and long waiting lists. Psychiatrists rely on the clinical interview to provide them with the information they need to make a diagnosis. Psychiatrists receive the same education as a family doctor, but instead of spending 2 years as a resident in family practice, they spend 4 years as a resident in the psychiatric unit of a hospital.



Psychologists (Ph.D. or Psy.D.)


Psychologists are mental health professionals who have received their doctorate degree (Ph.D. or Psy.D. 4 to 6 years after an undergraduate degree) before taking a one year supervised, post-doctoral internship to meet the certification requirements of their regulatory body. Psychologists are trained as research scientists as well as clinicians and bring an understanding of the scientific method to their professional duties. Psychologists study human behaviour and are trained in a variety of psychotherapeutic and assessment techniques. As well, they are permitted by law to diagnose mental health disorders and to use psychological assessment tools to help make diagnoses. Psychologists do not prescribe medication. Extended health plans cover a portion of psychological assessment and treatment. Psychologists often work in close consultation with referring physicians and use this connection to facilitate admissions to hospital, if necessary.



Social Workers (M.SW)


Social workers hold a Master’s degree in social work, an applied discipline which is not research oriented. They often work in community health centres and school boards. They are trained to provide a supportive role and they may not have extensive training in a systematic form of psychotherapy. However, they are often experienced at crisis intervention. Typically, their scope of practice does not include diagnosis.

Treatment of Depression


Depression can be treated with antidepressant medications, psychotherapy or both. Treatment is often most successful when antidepressant medication and psychotherapy are used in conjunction with each other.



Medications


Medications work by altering the balance of specific neurochemicals in the brain. All of the antidepressants mentioned below take about three weeks to reach maximum effectiveness. For this reason it is important to take the medication regularly, even if there are few immediate changes in symptoms. Taking an antidepressant medication increases the chances of depression resolving within one month by 50%. It is important to continue taking the medication even after you begin to feel better. This strengthens the likelihood that the treatment will be successful and helps guard against a relapse.



Tricyclic Antidepressants


These effective antidepressant medications have been available for the past forty years. There is a great deal of research available on the effectiveness of this medication. Tricyclics are often used when a sedating effect is required for symptoms of sleep disturbance resulting from depression. However, these medications can be toxic in overdose and have adverse side effects.



MAOIs


These antidepressants are called monoamine oxidase inhibitors (MAOI). They have significantly harmful interactions with certain foods and can cause changes in blood pressure and so are more difficult to prescribe and monitor. They are not usually the first choice of prescribing physicians, but tend to be used when other medications have not proven to be effective.



SSRI


These antidepressants are perhaps the most popular antidepressant medications used today. Examples include Paxil, Zoloft and Prozac. These antidepressants are significantly safer than the older medications described above and have fewer side effects.

Management of Depression


Managing depression increases your sense of control and puts you on the right track towards a return to good health. This is the time to try to become more aware of your feelings, to open yourself to the idea of treatment, and to make a commitment to follow through. It is important to examine your lifestyle and make a plan that will facilitate your treatment. The plan should include elements of structure to help provide a framework for taking care of yourself. Examples of this type of structure are getting up and going to bed at regular times and making sure you get proper nutrition and exercise.


There is a tendency in depression to become isolated and withdrawn from others and it is important to try and minimize these tendencies. Ask friends for their support, understanding and patience during your depression. It can be helpful to talk to your friends about your feelings and treatment and to spend time with them in social activities. Some people find it very difficult to be with others during this time. If you feel this way, do what you need to lift your mood and make yourself feel better. Many people find that family members are very supportive and helpful, but if you find yourself alone and unable to be with others, tell your therapist.


Try to maintain a positive attitude. Although this is easier said than done, it is useful to try and be aware of any negative thoughts that might occur. Remind yourself that depression is a temporary emotional state. Live one day at a time without worrying too much about events from the past or things that may happen in the future.

What to Expect When You Meet with the Therapist


Treatment of depression usually has three components. The first is to make an assessment. This can take between one to three sessions and will consist of an interview with the therapist as well as possibly a psychological questionnaire if the therapist is a psychologist. During the interview the therapist will ask questions about your history. He or she will want to know about your family origin, your schooling and work history, as well as your attitude and feelings about them. The therapist will also want to know about your medical history, to be sure that medical causes for depression have been ruled out.


After the assessment portion of therapy, you and your therapist will work together regularly, usually for about 1 hour per week until you are feeling better. It is important that you plan regular sessions, and not just when you feel a particular need. This is because therapy is a systematic process of discovery and you don’t have to be in acute turmoil to benefit from it.


Be prepared to spend some time in therapy. There is no instant cure for depression and now is the time to give yourself the gift of time to truly work through issues that are standing in the way of feeling normal and healthy again. After you are feeling better you should continue therapy for a period of time. Some clients like to lengthen the time between visits, but it is important to continue therapy on a regular basis even when you are feeling better, to prevent relapse and to maximize the effectiveness of the treatment.




Crisis Intervention


The therapist may postpone the assessment component of treatment if you are in an acute crisis and need immediate intervention. In this case, therapy will focus on the immediate issues of concern and provide emotional support for your well-being that will help ease your state of mind and facilitate positive action. The therapist can work in conjunction with your family or others to help ensure a continuity of support. As well the therapist will work closely with your family doctor regarding medications and the need for hospital admission if there is a serious likelihood of suicide. If you are admitted, the hospital will take over your treatment until you are discharged; then your therapy can resume.




How to Access Professional Help


People usually present themselves to their family physician first, as they already have a relationship with their doctor. Psychologists can certainly be contacted directly, but it is often useful to have a referral from your family doctor, or a friend. In either case, the physician will conduct or be asked to conduct an assessment to rule out physical causes of depression.


Although some family doctors restrict their practice to psychotherapy and have received intensive training in psychotherapy, this is not often the case. The biological model of mental illness is an important element in psychiatric training and psychiatrists are well positioned to choose among a variety of antidepressant medications to fit the patient’s particular needs and situation. Psychologists are able to provide psychotherapeutic intervention but not medications.


If you are a student there are psychologists and social workers available in the school boards and universities to whom you can turn in times of need.


As well, there are community health centres which staff doctors, psychologists and social workers. These services are usually made available at no charge to the community.


Finally, hospitals are available in times of crisis and psychiatrists and psychologists will be available to determine if an admission is appropriate.

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