In May 2013, the American Psychological Association published a new edition of The Diagnostic and Statistical Manual of Mental Disorders (DSM), the standardized text and clinical reference used by psychologists and therapists across North America to diagnose their clients. The manual includes the names, features, symptoms, and demographical information on all the recognized mental illnesses, including addictions.
Despite the newer version of the DSM, little change was made to the clinical criteria for diagnosing depression in adults. Major Depressive Disorder is considered to be a medical illness that includes symptoms of persistent sadness, loss of interest in daily activities, occupational and educational impairment, along with eventual emotional and physical problems.
According to the DSM, to be diagnosed with depression, an adult must exhibit:
-a depressed mood for most of the day, nearly every day
-decreased interest or pleasure in most activities
-a change in sleep pattern – insomnia / hypersomnia
-fatigue or loss of energy
At times symptoms of anxiety (such as irritability, paranoia, irrational worry, preoccupation with irrational concerns, a fear that something awful will happen, and paranoia) can also appear along with depression, such as the case with Greg. Other symptoms of depression include:
-Loss of motivation
-Appetite disturbance – weight loss/gain
Some, if not all of these symptoms can lead to drinking. The dissatisfaction with one’s life, the inability to feel anything, the lack of connection with oneself and others might stimulate the desire to drink. In fact, it might drive an entire addiction.
It might be obvious that in order to create a life of sobriety, in order to finally get clean, the psychological disorder of depression needs to heal. Addiction typically has underlying issues that need to be treated. One can make the choice to get sober, create a network of support, and even create a new life. However, if those underlying issues are not addressed, and in this case, those that led to depression, there might be risk of relapse.
Major Depressive Disorder usually requires long-term treatment, including psychotherapy and medication. Treatment that is considered to be evidence based for depression includes the use of medication such as selective serotonin re-uptake inhibitors, also known as SSRI’s. This form of medication increases the levels of serotonin, which can ease depressive symptoms and they have fewer and milder symptoms than other anti-depressants. In addition to medication is the use of psychotherapy, particularly Cognitive Behavioral Therapy (CBT). CBT identifies negative and distorted thinking patterns. This successful form of therapy emphasizes the link between thoughts, feelings, and behavior, and more importantly, it attempts to identify the way that certain thoughts contribute to the unique problems of an adolescent’s life. Interpersonal Therapy used with medication is also seen as evidenced based and has shown a faster rate of response than medication used with CBT. Interpersonal Therapy is a form of therapy that invites teens to regain control of their mood and functioning by exploring in more detail the nature of his or her relationships. IPT is based upon the ideas that regardless of genetics, depression develops within the context of relationships.
However, when someone does not respond to these evidenced based treatments, depression can become chronic. As treatment continues to be ineffective, this can worsen symptoms and undermine any hope that a recovery addict has. There are some factors that seem to consistently contribute to chronic depression and treatment resistance, such as the severity of the depression, co-occurring disorders, addiction, history of abuse, family depression, and a distressing work environment.
If it turns out that that you or someone you know is diagnosed with depression, keep in mind that with the right support and your continued presence in his or her life, depression is treatable. But, by all means, don’t ignore these symptoms. Treatment begins by being assessed by a mental health professional.
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