Major Depressive Disorder
Residential Treatment of Major Depressive Disorder at CooperRiis
Residential treatment of major depression at CooperRiis begins when the resident arrives at CooperRiis and is treated with compassion by our caring staff and other residents. Depression almost always means isolation. When residents arrive, they step back into a socialized life. We are very gentle and help to ease the resident into life at CooperRiis. We work with individual residents to find what is most helpful for them, rather than imposing a hard agenda on them. In this way, residents are empowered to be an essential part of their own recovery team.
Soon after settling in, residents meet with their team, which includes a therapist, a recovery coordinator, and our psychiatrist. All residents take part in a full evaluation in which they give a history of their lives, symptoms, and illness. We want to get to know residents and develop a full picture of what is troubling them – low mood, trouble with motivation, disruption in sleep, decrease in planning, changes in appetite, etc. – as well as what treatments they have had in the past, and what medications were most helpful.
All residents meet with our Integrative Psychiatry Director to discuss how medications can contribute to their recovery. It is important that we know about the resident’s treatment experiences, both negative and positive, so that we can best prescribe an antidepressant.
Medication, Therapy, and Other Treatment Modalities
Medication for Major Depression Disorder
The medications used to treat Major Depressive Disorder are called antidepressants, and there are several antidepressants available. We work with the resident to find the best dosage to reduce symptoms without incurring harmful side effects such as over sedation, sexual side effects, and mental fogginess. The goal is to minimize symptoms without sacrificing overall well-being.
Supplements, such as nutraceuticals, vitamins, minerals and plant extracts, are also used as a part of the treatment. In some instances, the dosage of an antidepressant can be reduced because the supplements have such a positive effect on symptoms.
Getting the right medication at the best dosage is a huge concern, but it is only part of the treatment plan at CooperRiis. We find that a combination of medication, psychotherapy, exercise, community involvement, and other interventions is most effective in treating the whole person.
Psychotherapy for Major Depression Disorder
For treatment of any challenge, CooperRiis takes a holistic approach. We don’t focus on the diagnosis, we focus on helping. What can you do? What does sound good to you? How can we best help you? Some of the therapy modalities we find useful for treating depression are:
- Group and Individual Therapy
- Groups specific to those diagnosed with depression (see below)
- Cognitive Behavioral Therapy (CBT) CBT is the root modality at CooperRiis. CBT focuses on solutions, encouraging patients to challenge distorted cognitions and change destructive patterns of behavior.
- Dialectical Behavior Therapy (DBT) Dialectical behavior therapy (DBT) provides clients with new skills to manage painful emotions and decrease conflict in relationships. DBT specifically focuses on providing therapeutic skills in four key areas: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.
- Emotion Regulation Therapy (ERT) involves understanding and labeling emotions, reducing emotional vulnerability, and decreasing emotional suffering
- Motivational Interviewing is a counseling method that helps people resolve ambivalent feelings and insecurities to find the internal motivation they need to change their behavior. During Motivational Interviewing, the therapist asks questions and uses reflective listening skills. The resident drives the session and the therapist is listening for cues to go deeper. It’s a wonderful technique to get to the root of things without an agenda.
- Acceptance and Commitment Therapy (ACT) is a form of mindfulness-based therapy that theorizes that greater well-being can be attained by overcoming negative thoughts and feelings. ACT looks at character traits and behaviors to assist in reducing avoidant coping styles. ACT also addresses commitment to making changes and sticking to goals.
- Compassionate communication (also called nonviolent communication) teaches how to clearly communicate feelings without blame or criticism, as well as empathetically receiving/listening to how someone else is without hearing blame or criticism. It helps individuals understand their own needs and recognize that others’ needs may be different.
Our group therapy sessions are about learning resilience by being in a group and learning to speak up. The groups are small and interactive and there is a lot of sharing and hearing other people’s stories, which encourages empathy and compassion. We find that this human experience can be incredibly helpful for those with depression. People begin to see that they are not broken, and that other people are having similar issues to their own. After being in group therapy for a while, residents begin to see themselves in a different light. Self-criticism begins to shift to the recognition that they are survivors and that they are not damaged. Not only do residents realize that they can emerge from depression, but that they can be a support for others as well.
Seven Domains of a Whole, Healthy Person
- Physical wellness
- Emotional and psychological health
- Intellectual creativity and learning
- Social and community connectedness
- Purpose, productivity, and fulfillment
- Empowerment and independence
Because every person is different, some domains will receive more emphasis than others during treatment, but all are attended to. An exciting addition to CooperRiis is our Spiritual Director. This staff member provides more opportunities for residents to go to their chosen house of worship, celebrate holidays, participate in mindfulness exercises, yoga, and other spiritual pursuits. For people dealing with anxiety symptoms, relaxation and mindfulness, as well as yoga, can be helpful.
What is Major Depressive Disorder?
Sadness is a part of life. Occasional feelings of melancholy, listlessness, or ‘the blues’ are just a few of the many feelings we experience as healthy individuals in response to our world. Clinical depression, however, is different, and is considered a serious mental health condition. A Major Depressive episode is defined by an incessant feeling of intense sadness and lack of interest in formerly enjoyable activities that goes on for an extended period. Major Depressive Disorder (MDD) impacts both mood and behavior. People with Major Depressive Disorder often have trouble performing and participating in everyday activities and sometimes feel as if life isn’t worth living.
Major Depression is surprisingly common. The Journal of the American Medical Association states that the lifetime incidence of depression in the United States is more than 20-26% for women and 8-12% for men.
The median age for the onset of clinical depression is 32 (U.S. Census Bureau Population Estimates by Demographic Characteristics, 2005).
Types of Depressive Disorder
Seasonal Affective Disorder (SAD) – depression directly caused by the time of the year. It occurs most often in the winter months when sunlight is not as readily available, typically going away in the spring and summer.
Persistent Depressive Disorder – depression that lasts for two years or longer.
Psychotic Depression – depression accompanied by psychotic symptoms such as hallucinations, delusions, and paranoia
Postpartum Depression – depression that develops in the weeks or months after childbirth.
Premenstrual Dysphoric Disorder (PMDD) – depression experienced by women prior to the start of each period. Other symptoms can include fatigue, anxiety, mood swings, change in appetite, change in sleep patterns, difficulty concentrating, irritability, and feeling overwhelmed.
‘Situational’ Depression – usually a short-term, stress-related type of depression that develops in response to a traumatic event. Common events that can trigger situational depression include the death of a loved one, divorce, and illness. Situational depression is also called ‘stress response syndrome’.
Signs and Symptoms of Depression
To be diagnosed with major depression, you must be suffering from five or more of the following symptoms for two weeks or longer, and at least one of the symptoms must be loss of interest in activities or a depressed mood. Symptoms may vary depending on what kind of depression has been diagnosed.
- Feelings of sadness and/or irritability
- Loss of interest in once enjoyable activities
- Significant change in weight (loss or gain)
- Changes in sleep patterns – trouble falling asleep, insomnia, or the need to sleep more than usual
- Feeling and appearing restless and agitated or slowed down
- Fatigue or loss of energy
- Feelings of worthlessness and guilt
- Inability to focus/difficulty in thinking
- Thoughts of death or about suicide
(Adapted from DSMV)
Other symptoms that are commonly seen in depression but not part of the diagnostic criteria include negative thinking with an inability to see positive solutions, irritability/lashing out at loved ones, social isolation, and difficulty making decisions.
About the Author
Michael Groat, MSc, PhD is President and CEO of CooperRiis residential treatment program located in Asheville and Mill Spring, North Carolina. Michael earned his Ph.D. in Counseling Psychology from SUNY-Albany. Prior to joining CooperRiis, he was associate professor of psychiatry and behavioral sciences at the Baylor College of Medicine, Houston, TX, where he also served as director of the division of adult services at the Menninger Clinic.
Michael is also a former candidate in adult psychoanalysis at the Center for Psychoanalytic Studies, Houston, and completed a 4-year fellowship in psychodynamic psychotherapy at the Austen Riggs Center. He has published on suicide prevention, applications of attachment research, and uses of clinical outcomes, and has lectured nationally and internationally on the same. Michael has long-standing interest in suicide prevention, therapeutic communities, organizational and systemic interventions, personality assessment, and intensive psychotherapy.