Depression: the most common mental health issue

Adults with depression may have low self-esteem. They may display poor concentration, low motivation, and withdraw from social or recreational activities. They may respond intensely to criticism or feedback. Changes in appetite, weight, and sleep issues may occur. Depressed adults may display a decline in grades, and experience boredom and lethargy.

In terms of seeking treatment, adults who struggle with identity issues may be reluctant to identify themselves as someone who has a depressive disorder. Issues with authority and concerns about confidentiality may make seeking out help problematic. I am sensitive to these issues and make sure to validate and normalize my client’s experience. I also tailor my interventions to adapt to specific factors connected to the type of depression my client’s may exhibit. Anger, perfectionism, avoidance, and divorce are just some traits and stressors that can exacerbate depression.

Anger and Depression
Adults who have depression may present with typical symptoms such as a depressed mood and withdrawn behavior. Males who are depressed may display more anger rather than sadness. Males who feel pressure to live up to perceived gender norms may be less likely to show vulnerability. Their anger towards others may be a way to prop up their self-esteem and negative feelings about themselves. Unfortunately, their anger can serve to alienate them further. Therapy can provide a safe place to verbalize feelings and connect with deeper emotions. This can help my clients feel more connected and identify and modify cognitions contributing to their distress.

How I can help
I teach clients how to identify negative emotional states and understand the connection between thoughts and feelings. Through the therapy process they learn how to modify dysfunctional thoughts that lead to anger. They develop alternative perspectives that are more balanced and adaptive. I help my clients see underlying self-esteem issues that contribute to anger and depression. They learn how to observe difficult emotions without becoming flooded or acting on them and communicate more effectively. I strive to create a safe place where clients can increase self-understanding about who they are and what is important to them. This understanding often leads to more self-confidence and a stronger sense of self.

Perfectionism & Depression
In adolescence one of the major development tasks is developing one’s identity and independence. As teenagers experiment with discovering who they are they may place more emphasis and passion towards focusing on specific domains such as academics, athletics and peer relationships. They may develop lofty goals and ambitions as they pursue their goals. There striving and dreams of excellence is not always problematic. However, for some falling short of meeting their goals can lead them to become extremely self- punishing and punitive toward themselves. They may perceive failure or setbacks as intolerable. This can lead to depression, anxiety and irritability. Some people feel they will not live up to expectations and may avoid tasks all together, at times these expectations may be unrealistic.

How I can help
Having high personal goals and expectations is not unhealthy and can lead to success. However, problems arise if people react punitively if they fail to meet goals. Being extremely critical of oneself if goals are not met can lead to depression and anxiety. Harsh self-appraisals after not meeting goals can also decrease emotional resilience and lead to avoidance behaviors. To manage this type of perfectionism, I work with clients on skills to help develop compassion towards themselves. I utilize mindfulness and acceptance skills to help them learn to be able to define themselves in a holistic fashion rather than just by outcomes. I help them to confront issues rather than avoid them by helping them break down fears and tasks into manageable components.

Often people who have high expectations of themselves also have high expectations of others, which can leave them feeling disappointed and frustrated. I help my clients develop more realistic expectations regarding others. They learn how to see other perspectives, which can increase empathy and mitigate negative mood states.

Peer Relationships and Depression:
As teenagers transition into adolescence there is a shift away from caretakers to peers and friends as a source of social influence. For example, support, validation and encouragement, become roles that friends take on more significantly. Adolescent’s relationships with peers can greatly impact their self-esteem and mood. Teenagers who struggle with peer relationships may isolate and avoid others expecting rejection. This can further increase isolation and depression. Alternatively, a strong desire to fit in may lead teenagers to be over accommodating to their friend’s demands at the expense of their own interests. They may believe that if they don’t not accommodate, their friends will reject or abandon them. This can create resentment and hostility. The over accommodating teenager may feel that relationships are not reciprocal and that they are being taken advantage of.

How I Can Help
I employ CBT skills to help manage feelings or fears pertaining to rejection. Often my clients may view their relationships in a bias and negative fashion leading to distress. They may have inflated perceptions that others view them more poorly than is actually the case. Distress can be minimized by helping to perceive relationships more accurately. Mindfulness skills are used to help detach from others judgments or perceived judgments which can mitigate depression and anxiety. Helping identify negative patterns when selecting friends and helping to create boundaries can help establish stronger self-esteem. I explore with my clietns how their interpersonal style may impact relationships and get in the way of forming positive connections. I work with them on strategies for developing their interpersonal and communication style to improve relationships.

Divorce and Depression
Divorce can be an extremely painful process. There are different stages people experience as they go through the process. Initially, it may be hard to accept, leaving them feeling shocked and emotionally numb. They may also become withdrawn and minimize the separation. As times goes on they may blame themselves for the separation and believe if they just did better, were more easy going or more lovable the relationship would not have dissolved. Missing the family unit and adjusting to the stress of the dissolution of the marriage may lead people to feel unsafe and anxious. They may develop trust issues regarding relationships in the future.

How I can Help
I help my clients verbalize anger or depression regarding the divorce. Expressing feelings such a betrayal and disappointment can allow them to gain more clarity, insight and be less prone to internalizing negative feelings and blaming themselves. Giving them a place to process feelings can also help prevent rebellious or acting out behaviors. Mindfulness skills can be extremely helpful in navigating feelings of abandonment and rejection they may feel from one or both of their parents. Consulting with family members on setting proper boundaries and communication strategies can also be helpful.

Depression Treatment for Older Adolescents
College can be an extremely exciting time providing the opportunity for intellectual and emotional growth. However, personal freedom, self-exploration and challenging academics although invigorating, can be stressful. Being away from home, facing new demands and thinking about the future can be daunting and contribute to anxiety, depression or self-doubt. The symptoms may derive from the existential struggles that college students often face regarding who they are intellectually, emotionally, and sexually. Am I smart enough? Am I good enough? What is my purpose? are common questions college students ponder. Starting and leaving college are both significant life style shifts and may be particularly difficult for students. Fortunately, therapy can help.

How I can help
Psychodynamic therapy is a deeper dive into motivation and can create expanded awareness allowing college students to understand and resolve issues pertaining to identity, relationships and choices about meaningful careers. During the process of psychodynamic therapy college students can have the space to explore possibilities and find their authentic voice. CBT and Mindfulness skills can also help college students cope with depression, anxiety or volatile emotional states. Learning how to regulate emotions with mindfulness skills can also help with academic performance and time management.

Carolyn Ehrlich LCSW, CGP, Counseling Tribeca, specializes in Relationship Counseling NYC. In Couples Therapy Tribeca I help increase your self awareness and help you gain more insight into your inner life. We’ll work together so you can get more out of every day and meet any challenge life throws at you.