Depressive Disorders

Dr. Cohen has treated depressive disorders for thirty years and founded the Anxiety and Depression Treatment Clinic in 1987. He was one of the first doctors in San Diego to employ modern methods of psychotherapy and medication treatment for depressive patients.

Depression is a common, yet serious condition that interferes with normal functioning. It causes emotional pain for the depressed person and for those who care about her or him. A depressive disorder is more serious than the occasional blues or sadness that most people experience. Depressive disorders usually require treatment.

When treated properly, depressive disorders are very treatable. Yet, people with depressive disorders often have difficulty obtaining proper treatment. Many doctors do not recognize the signs of depressive disorders and ignore patients' complaints or minimize their importance. Other doctors prescribe tranquilizers or antidepressants without really knowing how or when to use these drugs effectively. The result is side effects that cause many people to quit treatment prematurely. Some therapists take depressed patients on long journeys through their past, while not addressing the depression-provoking issues at hand. Dr. Cohen's use of psychotherapy with or without medication has been proven over many years. His rate of success with depressive disorders is high.

Types of Depression
Depression is often characterized by low mood, anxiety, restlessness, hopelessness, guilt, sleep problems, low energy, changes in appetite, reduced self-esteem, impaired concentration and memory, reduced interest in activities, feelings of failure, aches or pains. The degree that people with depressive disorders experience these and other symptoms can vary greatly from person to person. Depressive disorders are seen more commonly in women than in men.

There are several types of depressive disorders. The most common are major depressive disorder, dysthymic disorder, agitated depression, and adjustment disorder with depression.

  1. Major Depressive Disorder (MDD), also called "major depression," is characterized by a seriously depressed mood and an inability for the person to work, sleep, study, eat, or to enjoy pleasurable activities. MDD is often disabling. Most people with MDD have recurrent episodes throughout their lives. Treatment is usually highly effective for MDD.
  2. Dysthymic Disorder (DD), also called dysthymia, is an ongoing depressive disorder characterized by long periods (two years or longer) of depression of a mild or moderate severity. Many people with DD experience it as an ongoing, nagging problem they have had most of their life. The symptoms of DD are less severe than those of a major depressive disorder. People with DD are not disabled, but the condition can interfere with normal functioning or experiencing pleasure or joy.
  3. Agitated Depression is a variant of a major depressive disorder in which the anxiety symptoms are prominent. A person with this disorder is often visibly agitated, upset, or anxious, and unable to sleep. Less obvious is the major depressive disorder underlying the anxiety symptoms. Treatment is usually effective if it addresses the anxiety and depressive symptoms.
  4. Adjustment Disorder with Depression indicates a depressive reaction in a person with no previous history of depression. The depression is usually triggered by a loss, such as death of a loved one, major health issues, or loss of a job. Some adjustment disorders with depression reflect a person's inability to adjust to a life change such as the onset of middle age or old age. Although every living person deals with loss and life changes, some people get stuck, and the result may be depression (or anxiety or physical illness). Adjustment Disorders with Depression are highly treatable.
  5. Seasonal Affective Disorder (SAD) is a depressive disorder occurring during October through March, when there is less natural sunlight. The depression generally lifts during spring and summer, but it may not lift entirely. This suggests an underlying dysthymic disorder. Some cases of SAD improve with light therapy, but many do not. Psychotherapy and medication treatment are often effective.
  6. Bipolar Disorder (BD) is also known as manic-depressive illness. BD is less common than major depression or dysthymic disorder. The term "bipolar" refers to the cycling moods from extreme highs (mania) to extreme lows (depression). The treatment of bipolar disorder is often different from other depressive disorders.
  7. Postpartum Depression is the term for a major depressive episode in a new mother within one month of giving birth. Postpartum Depression is treatable, but some cases may be complicated by impaired or delusional thinking. Postpartum Depression requires immediate psychiatric care to diagnose the severity of the depression and to initiate treatment.

Dr. Cohen's Broad Experience in Treating Depressive Disorders
Dr. Cohen's treatment of depressive disorders involves psychotherapy or medications or both. Psychotherapy initially focuses on identifying the patient's depressive feelings and their origins. Is there a personal history of depression, a family history? What events or changes may have been involved? Subsequent sessions may focus on personal relationships, work situations, volunteer activities or hobbies. Psychotherapy addresses each individual's strengths, sense of worth, communication skills, and life goals.

Medication can be very useful in reducing depression and secondary symptoms such as anxiety or insomnia. Many people with depressive disorders are sensitive to medications, especially the SSRI and tricyclic antidepressants, which have high rates of side effects. This is why Dr. Cohen uses safer methods when prescribing these medications. Many people respond well to low antidepressant doses. Dr. Cohen also is uniquely knowledgeable about natural, non-drug therapies for anxiety disorders.

Related Articles:

Annals of Pharmacotherapy. Antidepressants: An avoidable and solvable controversy. 2004;38:1743.

View all of Dr. Cohen's medical articles, consumer publications, and presentations.




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