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What is clinical depression? It is not the unhappiness, grief and sadness that are normal feelings accompanying a temporary setback in one’s life or the ending of a significant relationship. These feelings in response to the normal life interruptions usually subside after a brief time. Major depression, or major depressive disorder, are quite different from the normal human experiences as are the other diagnostic categories of depressive disorders. These clinical disorders of depression are more long lasting and pervasive and interfere in a major way with one’s functioning and life satisfaction.


It is estimated that in the United States about 7% of the population or 16.2 million adults have had at least one major depressive episode in a given year. There is a life time prevalence of 21% of all Americans who experience clinical depression. In fact, clinical depression is the most common mental health condition after anxiety disorders. It is also not uncommon to see those with a depressive disorder also experiencing anxiety and vice versa.

Life time prevalence of major depressive disorder is between 10% and 25% for women and between 5% and 12% for men. Women and men experience depression differently. Men usually try to be seen as strong and unemotional.  They tend to hide their feelings or try to avoid depressed feelings by working too much, drinking too much, becoming overly involved in television or surfing the internet. Men also tend to focus on physical problems rather than emotional problems.


 In men, clinical depression tends to show up with symptoms of rage, irritability, difficulty focusing or making decisions, uncontrollable negative thoughts, hopeless feelings, feelings of frailty and suicidal thoughts or actions. Men are also more likely when depressed to engage in risky behaviors such as substance abuse, using non-prescribed drugs or irresponsible social behavior to avoid feelings of gloom and helplessness. They may also withdrawal and give up hobbies in which they once engaged.  

Women with clinical depression are more likely to acknowledge that they feel symptoms of clinical depression such as despair, not feeling like socializing, and having no energy for normal tasks of everyday life. They are also more likely to seek professional counseling. Factors that may contribute to the higher prevalence of depression in women may be that their role frequently results in their being more available for the emotional needs of others, are not expected to openly express anger and often assume greater responsibility for child care as well as the care of elderly parents, and at the same time be employed outside of the home. Furthermore, social norms allow women to express sadness and vulnerability. In general, women are often more socialized to talk about their feelings than men are. There are also hormonal changes that women experience that may increase their vulnerability for depression disorders, such as childbirth, premenstrual  syndrome, menopause and/or thyroid problems.


Clinical depression, which is classified under the Depressive Disorders, is characterized by deep despair, gloom, withdrawal from relationships and activities, sleep problems, negativity, passivity, difficulty expressing feelings and needs, and a sense of hopelessness about being able to reach goals or have a satisfying life and at times thoughts about committing suicide or making suicide attempts. Unsatisfying relationships are another characteristic stemming from difficulty communicating needs in a meaningful way as well as from deep seated feelings of hopelessness. Those experiencing a depressive disorder are often unresponsive to others and disengage from others as well as their family members and often feel conflicted between wanting to do things but feeling no energy to engage in activities. The withdrawal, passivity, difficulty expressing feelings and needs, as well as the deep despair which characterize clinical depression, interfere with the ability to form sustaining, positive relationships for those experiencing a depressive disorder.


In contrast to anxiety which is often characterized by hyperactivity, those with major depression often experience helplessness, deep despair, exhaustion, feeling overwhelmed, poor self-esteem, and joylessness. The helplessness characterizing major depression is an energy consuming, distracting, exhausting dread which is internalized. This internalized state results in a sense of powerlessness to change.


 Clinical depression may involve physical symptoms such as fatigue, insomnia or early waking, over or undereating; psychological symptoms such as the mentioned deep despair, withdrawal, internalized helplessness, and poor self-esteem and/or biochemical symptoms in which the interruption or reduction of chemical messengers in the brain called neurotransmitters such as serotonin, dopamine and norepinephrine may create chemical depression if the brain systems they regulate become dysregulated.


Diagnosis of Clinical Depression

Diagnoses of clinical depression requires that the symptoms last for at least two weeks and are not caused by another medical condition, other psychological disorders or substance abuse. However, most people with a diagnosis of chemical depression have experienced the symptoms considerably longer than two weeks. The severity and persistence of the symptoms play a major role in the diagnosis of particular depressive disorders. It is the persistence of the symptoms that carries the most weight in diagnosing clinical depression given that the severity of the symptoms often fluctuates. When the symptoms of depression begin to interfere with the ability to handle the daily tasks of life and the ability to relate in a healthy way to others, a diagnosis of clinical depression can then be determined. To be diagnosed with clinical depression, and individual must have five depression symptoms every day, nearly all day for at least two weeks. One of the symptoms must be a depressed mood or a loss in interest or pleasure in almost all activities.


Diagnostic Categories of Clinical Depression

Currently the depressive disorders are divided between those characterized as unipolar depressive disorders and those characterized by symptoms of manic behavior or depression known as bipolar disorder in which the energy levels and activity level of the individual receive more emphasize than the quality of the mood as in the depressive disorder. Unlike the unipolar depressive disorder, bipolar disorder includes a diagnostic category in which both manic episodes and major depressive episodes occur; as well as a category where mania is the symptom and another category where depression is the main symptom but a depressive symptom that is reflected more in irritability and negativity than in despair as in unipolar depression. Manic behavior involves being overly talkative, racing thoughts, overspending, impulsivity and or risky behaviors.


Question Whose Affirmative Answers May Indicate A Depressive Disorder

  1. Have you felt empty and gloomy for a prolonged period of time?

  2. Have you lost interest in activities that once gave you pleasure?

  3. Is your energy low accompanied by considerable fatigue?

  4. Is it difficult to concentrate as well as to make decisions?

  5. Have you had unplanned weight gain or weight loss?

  6. Are you plagued by feelings of guilt, worthlessness, and/ or helplessness?

  7. Are you isolating yourself?

  8. Do you want to spent the day in bed?

  9. Have you tried to commit suicide or have had thoughts of wanting to be dead?

  10. Do your moods fluctuate between highs and lows?

  11. Are you drinking too much in order to dampen or hide your feelings?

  12. Do you compare yourself unfavorably to others?

If you answered yes to even one of these questions, you may benefit from a consultation with Beth Reimel Ph.D., LMSW. If you answered yes to several of these questions, it is in your best interest to seek counseling from Dr. Beth Reimel, PhD, LMSW.


Benefits of Counseling for a Depression Disorder from Beth Reimel, PhD, LMSW

My years of effective counseling with depressed clients will greatly increase the potential for a positive outcome from receiving counseling from Dr. Beth Reimel, PhD, LMSW. Initially I will want to rule out the possibility that a medical condition is contributing to your feelings of depression and if so, plan to work collaboratively with your physician. In addition, I will evaluate whether a referral for anti-depressive medication is in your best interest. Careful assessment is the first step in planning the treatment in which I will collaborate with you in terms of your goals.

I will provide an environment in which you feel able to explore feelings you have buried or felt unable to express that are keeping you trapped in depression. I will help you put your feelings in to words and to become more focused in describing your emotional needs. Looking at what you internalized as beliefs from your family of origin will help clarify how you feel about yourself and what you expect from yourself to consider yourself an okay person. By clarifying theses underling beliefs, you will gain freedom to keep what is helpful and discard what may be contributing to your depression.

Since it is not uncommon to people suffering from depression to bombard themselves with critical self-statements, I will engage you in challenging these statements and finding a more compassionate way of viewing yourself. Being able to forgive you for what has led you to a critical self-view, will free up energy for more enjoyment and goal attainment.

If you have failed to grieve a horrible loss in your life or felt hidden resentment about an injustice you’ve experienced, I will help you mourn that loss and untangle the resentful feelings that may be interfering with your ability to get your needs met in a constructive way.

Through providing my depressed clients a therapeutic experience resulting in greater self-understanding, self-compassion, adaptation of positive coping skills, understanding of influences leading to their clinical depression and the freedom to make decisions leading to a productive, satisfying life, I guide my depressed clients out of the grip of clinical depression.


Call Beth Reimel, PhD, LMSW at (616) 551-3884 or email her at today to begin your transformation. You deserve to feel optimistic and be able to live a purposeful, satisfying life.

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