Symptoms of Depression
Depression symptoms can look very different for New Yorkers or anyone working hard to get ahead, who doesn’t have time for a sick day. Sadness and apathy are often associated with depression. And those are clearly common symptoms. But many people with depression in NYC may just push through those.
There are many other symptoms that may be easier to conceal, or may not even register as depression for the person suffering. Many “successful” people in NYC may not show their sadness or hopelessness to the world. Or they may not even realize that other changes, some of which are physiological, are in fact depression symptoms, e.g., changes in sex drive, appetite, or sleep.
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Normally we think of depression as something that slows us down. But, high energy emotions like anxiety and anger can also be indicative of a depression diagnosis.
When we think of a depressed person, we typically imagine someone lying in bed all day, not eating, and totally apathetic. That can certainly be one presentation. But someone who can’t sleep, is anxious, asking for more responsibilities at work, or overeating and gaining weight can also mean depression is the problem.
Depression is incredibly common in New York City. Depression causes more disability in NYC than anything else. More than 500,000 New Yorkers are estimated to have a diagnosis of depression at any one time. A survey given to New York college students indicated that nearly 20% of them met criteria for depression. Clearly residents of NYC are at risk.
Do You Have Depression?
Depression is a condition that affects feelings, thoughts, and behaviors. Symptoms vary but can include:
- depressed mood, fatigue,
- inability to concentrate,
- heavy arms and legs,
- feelings of worthlessness,
- trouble getting out of bed,
- anhedonia (nothing is fun or pleasurable),
- changes in appetite, sex drive, or weight.
Harmful Effects of Depression
As if depression wasn’t enough of a problem on its own, it also appears to cause other health problems. There are likely many reasons depression causes other diseases, for example, it increases cortisol which raises blood sugar. Depression also increases inflammatory markers like cytokines.
Depression is also associated with decreases in physical activity and social support, two protective factors. Together with other mechanisms depression may increase the chances of stroke, heart attacks, diabetes, osteoporosis, and cancer. In fact, prolonged depression may double the likelihood of stroke for those over the age of 50.
So depression’s role in mortality is a serious one outside the risk of suicide. Even though we know that most depressive episodes will end within 12 months even if they are not treated, given the suffering and the physical health risks, getting effective professional help early is highly recommended.
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Treatment for Depression
Depression treatment is definitely warranted as soon as possible, since the longer it lasts the more complications can occur, that is, increased health risks, loss of relationships, poor work performance, etc. Here are some approaches to the treatment of depression.
Self-help can be considered, but I highly recommend seeking a proper diagnosis from a psychologist, psychiatrist, social worker, or mental health counselor first.
There is scientific evidence that some self-help treatment can work, for example, certain (but not all) self-help books and physical exercise. But there are also many examples of people trying things on their own without success or even making things worse by receiving bad advice from unproven methods presented in books.
Mindfulness for Depression
While there is scientific evidence that mindfulness based treatments can reduce depressive symptoms, for some people (those who have had a number of depressive episodes) there is evidence it can make the depression worse. So it is a good idea to be under the care of a professional.
Natural Remedies for Depression
Depression symptoms have been reduced by some natural remedies. While more research is needed, speaking to your physician about the safety of these natural remedies could be a way to find natural relief.
While some of the nutrients listed in the natural remedies section can be taken as supplements, adopting a particular diet can also improve depressive symptoms. There have been a number of studies supporting the Mediterranean Diet as one which can reduce depressive symptoms. This diet emphasizes fish, fruit, vegetables, whole grains, legumes, nuts, and olive oil.
Some metanalyses have concluded that antidepressants are not much more effective than placebo. It appears that antidepressants may not be much more effective if someone has mild or moderate depressive symptoms, but there may be differences if the depressive symptoms are severe.
So consulting with a psychopharmacologist is a very prudent thing to do if you have a depression diagnosis. You can at least ask about the severity of your symptoms, the rationale for an antidepressant given the severity, and the potential side effects.
I frequently provide psychotherapy for depressed clients. And if their symptoms do not show quick improvement, are severe, and/or have been long standing (years), I will refer them to a few psychopharmacologists I trust.
CBT and Interpersonal Psychotherapy
Therapy for depression can be very effective.
In fact, cognitive behavior therapy (CBT), specifically Cognitive Therapy has been shown to be as effective as antidepressants without the side effects. In some studies, people receiving cognitive therapy were also less likely to relapse months down the road than those taking medications for depression.
The gold standard in psychotherapy for treating depression is cognitive therapy. It has been studied the most. With that said, Interpersonal Psychotherapy (IPT) has also been shown to be effective for depression treatment.
If you need treatment for depression, CBT or IPT are two very good choices. There are very few if any negative side effects, and the outcome data from many scientific studies support the idea that the vast majority of depressed people will improve with psychotherapy. They do take time and effort (doing homework and discussing emotions and thoughts with someone)—at least significantly more than swallowing a pill daily. So those are realistic matters to weigh.
Of course, there are also many studies that show CBT combined with antidepressants work well. So utilizing one treatment doesn’t have to prevent you from getting help from the other.
How CBT Therapy can help Depression
Cognitive Behavior Therapy (CBT) specifically works by helping identify how thinking, emotions, and behaviors interact to maintain depression. A good CBT therapist can then help the client learn new ways of thinking, relating to thoughts, and various emotional and behavioral exercises to change thoughts, feelings, and behaviors into more adaptive ways of responding.
The good news is that many depressed people begin to experience their depressive symptoms lifting after a few weeks of CBT. To be clear, it does not work for everyone, but it is by far one of your best bets if you or a loved one have depression. It is critical though that you receive psychotherapy from someone well trained in CBT, not someone who simply says they do CBT.
How to find good depression therapy in NYC?
As with most services, I am a big fan of a referral from someone I trust, a family member, friend, or other professional, like my internist. If that person says she or he had a great experience and that the therapist was really able to help, that is a good starting point.
I do recommend at least one other step though before researching the therapist that was recommended. If you are comfortable, I would ask what changed that indicated you went from being depressed to no longer being depressed and what took place in therapy that was responsible for that. These two questions are crucial for determining whether the referral is a good one.
Many people will end up really liking the process of therapy, even when it is not effective. It is important to know that with depressive episodes, for many people, the passage of time can alleviate some symptoms (as stated earlier, this is not a reason to seek treatment early, effective treatment reduces the duration, and can prevent complications). So we want to have some idea that there were specific techniques used that could have been responsible.
Good therapy also helps the depressed client understand (not just be an unknowing, passive recipient) what causes and maintains symptoms, and what tools can be used to prevent and reduce depression in the future.
So my goal is for successful treatment to not only eliminate depression currently, but to also help clients become more confident that the new habits they have learned and the new tools they have can help them in the future.
If you don’t have anyone who can provide a referral, calling a local university with a psychology department or a research hospital with a psychiatry department could be a good place to start. Even using Google to search for faculty members there who may have a practice could be useful. And likely Google can provide you with an infinite number of other practitioners as well.
Once you have some names, calling the therapist with specific questions is a good idea. You want to ask things like, “What kind of therapy do you use for depression?” “Why do use that form of therapy as opposed to others?” You are looking for the person to explain that the form of therapy used has the most scientific support. Then you want to ask, “How were you trained in that form of therapy?” “How long were you supervised in that form of therapy?”
While I think these are very fair questions to ask, I don’t believe expecting the person to spend more than 10-15 minutes by phone is necessarily fair. After all, she or he has other calls and clients to see. But, responding to those questions, can be done quickly, confidently, and very openly. If the therapist is defensive or comes across in any way that doesn’t make you feel comfortable, then those questions have provided you with very important information—this therapist is likely not for you. (See How do I find a Therapist for more specific questions to ask).
How much does it cost to have depression therapy in NYC?
Depression therapy in New York City can cost anywhere from $100 to $400 per session. If you have insurance, you may be able to see someone in-network with a much lower co-payment, e.g., $10 to $20.
If you prefer to see someone who did a better job of answering your questions about effective therapy and that therapist is not in-network, you may be entitled to out-of-network reimbursement, which can be substantial, e.g., up to 80% of the cost. But you want to check on that before you start.
The last thing anyone suffering with depression needs is to find out they can no longer afford to see the therapist that was helping. Another option is to go to a university clinic, which frequently provides sliding scale services based on income.
University centers typically have graduate students providing therapy under the supervision of faculty members. While these therapists are not as experienced, there is scientific evidence that they can be effective as long as they are providing scientifically supported therapy.
In fact, I would recommend seeing a graduate student providing scientifically supported therapy supervised by a faculty member over someone with decades of experience who provides therapy that is not supported by science.
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Steps to take to get depression therapy in NYC
Step 1. As mentioned before, collect a list of a few names from a trusted person or a credible institution like a university or research hospital.
Step 2. Ask questions. Ask the therapist questions to get a sense of his or her competence in the area, scientific knowledge, and openness to discussing these things in a non-defensive manner.
Step 3. Schedule an appointment. After deciding which one did the best job at making you comfortable by answering your questions, schedule an appointment. I do think it is important though to give therapy with any single clinician 3-4 sessions. Of course, if something occurs that is really off-putting, 5 minutes is enough to terminate therapy. But it can take a few sessions to properly assess and understand you, establish rapport, and begin to provide you with effective tools.
Step 4. Save time. You may want to ask if there is any paper work you can complete in advance of coming in to session.
Step 5. Understand the financial policies and commitments. You want to know the costs, if your insurance will help, and what the office’s cancellation policy is if you don’t make your appointment. There are no right or wrong cancellation policies (because you can choose not to start therapy if it is objectionable), but not being aware of one is certainly a problem.
Step 6. Insurance questions. Unless the financial responsibility of the entire amount isn’t cumbersome to you, it is a good idea to be clear with your insurance carrier what your plan will cover. That includes understanding if you have a deductible and if there are any maximum payments for the year, or any other factors that could make it more expensive than you think.
Step 7. Ongoing assessment and advocacy. Questioning the therapist before entering therapy is an important way to determine if she or he is the right choice for you. Likewise, continuing with therapy requires a similar approach. Continually assessing how much therapy is helping is a really good idea. That doesn’t mean it makes sense to expect magical “Aha” moments and breakthroughs every week. Rather it is important that you are finding value and that when you and the therapist discuss your progress and future goals you are on the same page.
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Cognitive Behavior Therapy in NYC
If at any point I can be of help, please feel free to contact me at my New York City CBT practice or at New York Behavioral Health where I am the clinical director. A member of our team or I would be happy to work with you or answer any of your questions about depression, Cognitive Behavior Therapy (CBT), other mental health issues, or any scientifically supported treatment for mental or behavioral health issues.