Depression

Depression is a common mental health disorder characterized by persistent feelings of sadness, hopelessness, and a loss of interest or pleasure in previously enjoyable activities (anhedonia). It affects emotions, physical health, and daily functioning, often interfering with work, relationships, and overall quality of life.

Symptoms of depression can include:

Emotional symptoms: Prolonged sadness, feelings of guilt or worthlessness, irritability, crying spells, or suicidal ideation.

Physical symptoms: Fatigue, changes in appetite or weight, or sleep disturbance/irregularity.

Cognitive symptoms: Difficulty concentrating or indecision.

Psychotherapeutic approaches to depression may include:

  • Cognitive-behavioral therapy (CBT), is a widely used treatment that helps individuals identify and challenge negative thought patterns (often called cognitive distortions) and develop healthier coping mechanisms.

  • Eye-Movement Desensitization and Reprocessing (EMDR), which can help process and disempower past events associated with guilt, worthlessness, and low self esteem.

  • Internal Family Systems (IFS), which helps clients identify, understand, comfort, and unburden the parts of ourselves that carry the negative emotions associated with depression.

  • Acceptance and commitment therapy (ACT) or mindfulness-based interventions, which can also be effective by fostering present-moment awareness, emotional regulation, and values-based commitment to positive action.

Many people use prescription medications to manage symptoms of depression. Common options include selective serotonin reuptake inhibitors (SSRIs) like fluoxetine or sertraline, and serotonin-norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine. For individuals with more severe depression, other options like atypical antidepressants, tricyclic antidepressants, or monoamine oxidase inhibitors (MAOIs) may be considered. Any and all use of prescription medications to manage depression symptoms should be done under the careful guidance of a doctor.

Additionally, some people with depression have found success using electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), and Ketamine-Assisted Therapy to reduce symptoms.

Many people ask about “treatment-resistant depression.” Treatment-resistant depression is not defined in the DSM-5, and has some variability in how it is defined by different people and organizations, but is generally used in reference to depression that has not responded significantly to multiple courses of antidepressant treatment. In my clinical experience and understanding, I do not see treatment-resistant depression as a distinct diagnosis from depression, but rather a difference in magnitude and duration of symptoms and life-impairment. To a certain extent, all depression is treatment resistant, and I find the extra label does little to facilitate healing.

Lifestyle changes can significantly improve depressive symptoms. these may include:

  • Regular exercise

  • Healthy diet

  • Maintaining a consistent sleep schedule

  • Stress-management techniques like mindfulness or meditation

  • Time spent outside

  • Tech disengagement

  • Reduced alcohol or drug use

  • The care and company of a pet

  • Social support from friends, family, or support groups

Depression is highly treatable with psychotherapy, and many individuals see significant improvement with proper treatment. A tailored treatment approach are key to helping individuals regain a sense of well-being and normalcy. I work with many people from Oakland, the greater Bay Area, and beyond on reducing depressive symptoms in a way that is meaningful and long term.