The pandemic, at least as far as the government is concerned, is officially over. Though the virus is still circulating, and many of us still wear masks or allow the COVID-19 to affect our decisions (for example, attending a packed event), many others have moved on, and the government programs that were initially designed to help provide resources and reduce society’s risks have all ended.
It has now been over three years. For many, life has moved on. Many people are going back to work, spending time with many friends, and taking fewer precautions than they did before. But while it’s easy to see how life has gone back to normal, a question remains: is it still affecting us, even now?
No Time to Cope – The Fast Pace of Life
Many of us lost people during the pandemic.
Many of us remember what it was like to live in fear.
Many of us developed habits, like drinking alcohol, that still continue to this day.
Many of us still worry that we or someone we love could be ill at any moment.
Many of us lost friendships, relationships, or trust in ways that haven’t come back.
The pandemic may be “over” on a government level. It may even be over as far as our own personal precautions (though not for everyone). But one way that it is not over is that we, both here in New York and as a country, have never really had an opportunity to grieve. We haven’t been given an opportunity to process trauma. We haven’t been able to recognize all that has been lost, from time with friends to our children’s education. We haven’t had many chances to examine how the stress has affected us.
Some of us have been able to move forward. But many others are still struggling with minor and major issues, including anxiety, depression, and grief, that we haven’t had an opportunity to process. We may be forced into a situation where we have to pretend like life is back to normal, but those 1, 2, and 3 years that were dramatically altered by the pandemic can still cause very real, longstanding issues even today.
Getting Help for Pandemic Stress
It’s okay to still be affected by the pandemic. It’s okay to have emotional and psychological issues that developed as a result of this lost, stressful time. Here in NYC, where the early part of the pandemic hit us all incredibly hard, it is understandable that we still have little things that may be affecting us as a result of those challenging times.
If you feel like you are still affected, let Flourish Psychology help. Our therapists understand your struggles, and we’re here to help you adjust and feel more closely aligned with your pre-pandemic self – or better. Contact us today to get started.
There is more than one type of depression, according to the diagnostic manual that therapists and psychologists in Brooklyn use to diagnose depression. As we review your symptoms and try to gain a better understanding of your struggles, we’re often looking at both subtle and clearer differences between these disorders in order to determine how to effectively treat them.
Major depressive disorder (MDD) is a more urgent, more powerful form of depression with symptoms considered to be severe. Persistent depressive disorder (PDD) is a “milder” but no less problematic form of depression. It was previously referred to as “Chronic Depression” or “Dysthymia.” These conditions have many similarities, and it is possible to cycle in between the conditions – showing symptoms of major depression at times, and persistent depression at others – but they are distinctive conditions.
Diagnostic Differences
Before we get into the symptomatic differences between the two conditions, let’s talk about the diagnostic ones. Persistent depressive disorder can only be diagnosed if the patient has struggled with it for over one to two years depending on the patient’s age. It is the term for a low level of chronic depression that is essentially constant throughout the day and night.
Though the symptoms are considered less severe compared to MDD, their long term presence puts patients at higher risk for self-harm the longer they struggle with it. Major depression, on the other hand, can be diagnosed in as little as two weeks and “episodes” are often severe in nature, which makes treating it more urgent.
Symptomatic Differences Between MDD and PDD
It’s easy to say “less severe than major depression” or “low level of depression.” But because depression is always a struggle, it important to identify what “less severe depression” means.
Both PDD and MDD will have feelings of helplessness, negative self-talk, loss of interest in pleasurable activities, and depressed mood. But what makes them different is the following:
Function – Patients with PDD are typically able to function in some form with most of their daily tasks. They may not be able to give activities their full energy, or enjoy those activities, or focus as easily as those without depression. But they can typically go to work, address some of their family’s needs, and take care of a pet. Their ability to function may be compromised, but they are capable of it. Patients with Major Depressive Disorder often find depression so debilitating, it dramatically interferes with their ability to function.
Intensity – Patients with persistent depression will describe a low mood and feeling “down.” They may show changes in appetite, sleep, energy, and concentration, but they are more capable of pushing through it with a bit of effort. Patients with major depressive disorder typically are *extremely* sad or down to the point of being overwhelmed by it. Engaging in daily tasks feels nearly impossible, and in some cases may not be possible. They feel impaired by their condition with more persistent thoughts of self-harm.
While someone with PDD may feel “low” and unhappy or passionless and tired throughout the day, a patient with MDD could, depending on the severity of their symptoms, be unable to even leave their bed. Despite MDD being more severe, however, it should be noted that chronic depression can both cycle into MDD at times, and also lead to significant life alterations that cause people to consider self-harm in the future, especially as they no longer experience joy for such a long period of time.
Patients with PDD also may experience what is sometimes called “Double Depression.” These are more severe forms of depression that resemble MDD that come at different times or after different triggers. These periods of “Double Depression” can increase the risk of self-harm considerably. But they may not qualify as MDD because they may not last the requisite two weeks or display all of the same symptoms.
How Does Recognizing These Two Different Conditions Affect Treatment
Therapy for depression – both MDD and PDD – can be very similar. Both benefit from many of the same therapeutic techniques, such as CBT. Both benefit from treatment from an experienced therapist. Both respond well to professional intervention. Many of the same techniques are used as well, such as cognitive restructuring and behavioral activation.
However, there are differences as well. First, duration and frequency of therapy may change. MDD may require more immediate and frequent meetings to help address the episode in the moment and reduce the risk of worsening symptoms. PDD may benefit from ongoing treatment that helps continue to address its symptoms over time.
In addition, In MDD, CBT often focuses on identifying and challenging negative automatic thoughts and cognitive distortions that contribute to the development and maintenance of depressive symptoms. The emphasis is on modifying maladaptive thinking patterns during acute episodes and targeting specific negative thoughts related to the current episode. In PDD, cognitive restructuring may also be utilized, but the focus is broader and may involve addressing deeply ingrained negative beliefs and schemas that contribute to the chronic nature of depressive symptoms.
Similarly, in MDD, CBT may include specific techniques to recognize early warning signs of relapse and develop coping strategies to prevent future depressive episodes. In PDD, since the condition is chronic, relapse prevention may involve ongoing monitoring and management of symptoms to minimize their impact and prevent exacerbations.
While the therapy techniques are similar, the way that they are approached is different.
You are who you surround yourself with. That’s a core belief that is passed down from parent to child – that you have to be with the “Right Crowd” in order to be happy and healthy, and that there is a “wrong crowd” that can make you negative or cause trouble.
The idea of a right or wrong crowd is, unfortunately, an often coded term used to denigrate a group of people that someone doesn’t find acceptable to their family. But the idea that you can surround yourself with people that hurt your mental health is absolutely backed by science.
Negative Friends Cause Negative Feelings
If you are someone that struggles with negative thinking, one of the first things to do is examine who you surround yourself with. That is because studies have shown that we are, in many ways, a product of our immediate environment. The people we choose to have close to us in our lives can affect our emotional reactions and our way of seeing the world in many ways:
Emotions Are Contagious – Studies have shown that people that find themselves in the presence of negative people are more likely to feel negatively. There are many studies that show that both positive and negative emotions are contagious, and so negative friends can influence our moods in a negative way.
Self-Perception Changes – Who we surround ourselves with also affects our self-perception – that is, it affect the way we see how we and our friends compare to others. If we are in a group of negative people, we might view others as more positive and accept the identity of negativity.
Poor Social Support – Negative people do not often offer the same level of social support as positive people. This can create an environment where a person doesn’t have the support they need to turn around negative thinking and address their own naturally occurring thoughts.
Reinforced Negative Thinking – Our friends are also responsible for reinforcing the validity of our thoughts. If we thinking negatively about someone or something, and our friends tell us that the negative thinking is valid, then we have the validation we need to continue to think negatively in the future.
Sometimes, the issue is simply relationship satisfaction. If you are with people that think and speak negatively, you may simply just not be very happy. That, in turn, creates an environment where you feel negative more often.
Addressing Mental Health Through Lifestyle Changes
If you have anxiety, depression, or another mental health condition, it is unlikely that “new friends” is going to make a big change. But if you’re looking to make your life better, identifying the behaviors of the people you surround yourself with and acknowledging the effect they may have on you can be a big help.
An important part of treating our mental health is understanding how our behaviors and experiences contribute to worse mental health symptoms.
For example, if you have a fear of spiders, and you purposefully avoid situations that might cause you to see spiders, your fear of spiders gets worse. This is the psychology of avoidance, which we mentioned in a past article. Or, if you have panic attacks, the way you breathe when you have panic disorder can actually trigger future panic attacks.
Our brains are complicated structures that work in equally complicated, often cyclical ways.
We also see this with depression, and one of the most common ways that this manifests is with the relationship between depression and sleep. Depression can cause sleeping issues and, to make matters worse, sleeping issues can cause depression. Understanding this relationship can help you make better decisions in order to help address your depression and also understand why you may feel the way you feel.
How Depression Causes Sleep Issues and Disturbances
Depression itself causes issues with sleep, both quality and frequency. Depression can cause both insomnia (inability to sleep) and hypersomnia (excessive sleep). Some of the scientific findings that relate to depression’s affect on sleep include:
Depression reduces REM sleep and affects how the body goes in and out of sleep stages.
Depression dysregulates melatonin, which his the hormone that regulates sleep/wake cycles.
Depression increases the likelihood of waking up in short bursts during sleep.
Depression reduces deep sleep time.
Depressed people tend to take longer to fall asleep at night.
These are all findings that implicate depression as a cause for possible sleep related problems.
How Sleep Issues Can Contribute to Depression
So, we know that depression can cause sleep issues. But where challenges arise is that science has shown that sleep issues can cause depression. Examples of these findings include:
Sleep deprivation studies have shown that even one night of poor sleep can cause depression-related symptoms, or exacerbate symptoms in those that already have depression.
Sleep disturbances cause abnormalities in regions of the brain that are linked to mood regulation and negative bias, increasing the frequency of negative thinking.
Sleep quality issues can alter the portions of the brain that are responsible for good decision making and stress coping.
Numerous studies have linked poor sleep, chronic insomnia, and a host of sleep issues with the development and maintenance of depression, although exactly how they are linked is not always clear. Nevertheless, it is clear that sleep issues can both cause depression and increase depression related symptoms.
Breaking the Poor Sleep/Depression Cycle
Sleep is not the only cause of depression, nor is depression the only cause of poor sleep. But the cyclical nature of the two – where poor sleep leads to depression and depression leads to poor sleep – is still very important for those with depression to recognize and understand, as they can help explain symptoms and experiences, and also help improve decision making about when to rest.
This is one of many examples of the ways that our mental health is more complicated than many of us believe. It is also why, by treating depression, we can improve our sleep quality which may also improve or depression. If you feel like you’ve been down or sad, reach out to a therapist and start receiving the support you need to improve your mental health.
The Diagnostic and Statistical Manual, known as the DSM (in this case, the DSM-V), is a manual that psychologists and therapists are meant to use to guide patient care. It provides therapists and patients with a diagnosis – for example, “Generalized Anxiety Disorder,” that, once identified, helps guide treatment.
But there are issues with the idea of using diagnoses at all.
For one, every person is different. While many conditions present in very similar ways, there are situations where two people experience similar symptoms, but one qualifies for a diagnosis and the other does not, or may qualify for something else. Treatments are also very individual based, and may need to change based on how the person responds to questions.
There are also issues with patients that adopt their diagnosis as an identity. Some clients actually feel their symptoms get worse when someone tells them that they have a specific condition. There are many, many reasons that diagnoses can actually be problematic.
Today, we’re going to talk about another one.
Does a Diagnosis Even Matter?
Most people are familiar with depression. Depression is one of the most common and most challenging mental health conditions. Living with depression can be extremely difficult, and the sooner you seek treatment, the better the outcome will be. There are different forms of depression, such as chronic depression and major depressive disorder, and each one has its own diagnostic criteria.
But what many people do not know is that, to qualify for a diagnosis of chronic depression, a patient has to exhibit clinical symptoms for at least 2 years. This means that, if you’ve only experienced depression for 1.5 years – even if you have all the same symptoms – you do not qualify for a diagnosis.
There are many valid reasons for this, and maybe we can discuss them in a different article. But there are also drawbacks. If a client has all the symptoms of chronic depression, but hasn’t yet hit the criteria, a therapist may still determine that they would benefit from a treatment that targets chronic depression. The diagnosis may not matter.
Similarly, therapy and counseling are designed to make your life better and address areas of concern. They do not require a diagnosis to be helpful, nor are they only designed to treat the diagnostic conditions. Imagine if you have other issues:
Worried About the Future of Your Career in an AI Obsessed World?
Stressed About Parenting?
Feeling Sad About Losing a Pet?
If you are relying on a diagnosis, you may not qualify for a treatment, as these are not necessarily mental health disorders. But these are still issues that affect your quality of life, and therapy is also capable of addressing these very same issues. That is why many people see their therapists for years. It is not just about getting a diagnosis, but, rather, trying to make sure that your overall quality of life is better.
We see this with disordered eating as well. “Orthorexia” is a term that describes an obsession with healthy eating that can actually make a person unhealthy or preoccupied in a way that affects their quality of life. Most eating disorder therapists, including our team here at Flourish Psychology, recognize and understand that it is a very real condition. But it is not currently included in the DSM-V, and would thus not qualify as a condition that can be diagnosed according to that manual.
Treatment Regardless of a Diagnosis
One of the reasons that we’ve chosen to be a cash-only private practice is because we do not believe that diagnoses should be required to seek treatment. Insurance companies frequently require a diagnosis, and may refuse payment if no diagnosis is given or stop treatment if the psychologists believe the patient is no longer struggling. They also require that anything that is diagnosed be reported, and become a part of a person’s permanent medical record.
Diagnoses are extremely helpful. We study them extensively in graduate school, and we learn how to treat them. They are also limiting and cause problems for both patients and practitioners. If you feel like you might benefit from a therapist, it is always beneficial to seek help. Do not worry about if you have a diagnosis. Instead, embrace the idea that you can have someone on your team to help you improve your overall quality of life.
Location: 300 Cadman Plaza West Floor 12 - Brooklyn, NY 11201
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