What is Depression?

by Dave Piltz

Even though depression can manifest in many ways and in several disorders, the symptoms of depression are common and include the following: 1) mood (sadness, feeling alone and empty, despair), 2) lack of pleasure (loss of interest, low motivation, apathy, withdrawal), 3) self-esteem (low, indecisiveness, suicide thoughts), and 4) emotional (extreme sensitivity, irritability, low threshold of frustration, enormous guilt) (Preston, & Johnson, 2014).

Underlying causes

A variety of medical issues can cause depression such as but not limited to Alzheimer’s Disease, Asthma, Chronic Pain, Thyroid issues, Lyme Disease, Multiple Sclerosis, Rheumatoid arthritis, and Lupus. In addition a variety of medications can cause depression (Preston, & Johnson, 2014). There is also evidence that lack of neurotransmitters (norepinephrine, serotonin, and dopamine) cause depression. Finally there are environmental factors that are attributed to depression such as marital status, lack of social support, stress, and substance abuse (Patterson, et al, 2010).


There is a host of options for medical treatment for depression and are classified based on their mode of action. There are seven modes of action for depression medications and are: 1) norepinephrine-serotonin reuptake inhibitor, 2) selective serotonin reuptake inhibitor, 3) selective norepinephrine reuptake inhibitor, 4) serotonin antagonist reuptake inhibitor, 5) alpha, antagonist + noradrenergic/specific serotonergic, 6) dopamine-norepinephrine reuptake inhibitor, and 7) monamine oxidase inhibitor. Each of these affects a certain neurotransmitter pathway (Patterson, et al, 2010). Typically the first line of defense is determined by the clinical situation. If the situation is dealing with anxiety, irritability, suicide, aggression SSRIs are given first whereas if the issues are apathy and  low energy/motivation dopamine or noradrenergic reuptake inhibitors are used first.


The therapeutic environment is best served by working with the client in dealing with their specific emotions and environmental factors. Any type of systemic family therapy would be beneficial coupled with family and psychoeducation. In addition non-systemic therapy such as cognitive behavior, dialectical, or mindfulness is also valuable.

Alternative treatments

One should consider meditation, yoga, and or massage to help to relax and calm the person. Exercise and proper nutrition is also important in allowing the body to be well balanced so that new behaviors can become habits more effectively.  In addition acupuncture, acupressure, Reiki or other energy modalities should be considered to help relax and potentially let go of emotional content that is not helpful.


American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Gehart, D., & Tuttle, A., (2003) Theory-based treatment planning for marriage and family therapists. Belmont, CA: Cengage Learning.

Gehart, D., (2014). Mastering competencies in family therapy a practical approach to theories and clinical case documentation. Belmont, CA:  Cengage Learning.

Patterson, J. E., & Albala, A.A., & McCahill, M.E., & Edwards, T.M. (2010). The therapist’s guide to psychopharmacology: Working with patients, families, and physicians to optimize care. New York: Guilford Press.

Preston, J., & Johnson, J. (2014). Clinical psychopharmacology made ridiculously simple. 8th Miami, FL: MedMaster.

Smith, P., (2008). A concise guide to better health and longevity what you must know about vitamins, minerals, herbs & more choosing the nutrients that are right for you. Garden City Park, NY: Square One Publishers.