NYC marriage counseling, couples counseling therapist Irina Firstein, LCSW CBS Interview Psychotherapist New York


What is Depression?

There is a difference between depression and occasional sadness or feeling “blue”. Anyone who has experience depression knows the difference. Depression is a feeling of extreme sadness, helplessness and hopelessness. Depression is also characterized by self blame. Physical characteristics of depression are sleep disturbance, lack of appetite or overeating, lack of energy, diminished libido, inability to concentrate on tasks, isolation, withdrawal from friends and family, diminished activity. Depression is characterized by negative thoughts and in some cases thoughts and plans of suicide.

Causes of Depression

There are several causes of depression: family genetics, chemical imbalance (as in bipolar illness), psychological (low self-esteem, disappointment, rejection, loss, perceived failure, loss, relationship stress and others), activation of old or current trauma, chronic or serious pain or illness and medications taken for these illnesses (certain heart medications, chemo therapy, etc). When evaluating a person for depression it is important to understand whether it is genetic / biological or caused by circumstances. Sometimes circumstances that lead to depression are outside of person’s control and sometimes are a result of poor choices.

Treatment for Depression

Depression can be successfully treated with use of anti-depressant medications in conjunction with psychotherapy or psychotherapy alone. I work with a number of psycho pharmacologists and when appropriate make referrals for medication evaluation. There is overwhelming evidence that therapy is effective for treating depression and relieving symptoms. Therapy can often prevent a mild or situational depression from becoming more severe as well as prevent future depressions. In sessions with depressed clients we identify causes and deal with behavioral, interpersonal and situational contributors. I work with my clients to pinpoint the issues that contribute to their depression and we explore different aspects of these issues. We talk about options, choices, identify negative thoughts, develop coping skills and self care practices, insights that lead to changes. Depending on the history of the patient, I often will use EMDR once there is some stabilization of the depression as depression sometimes is caused by a trigger or triggers from past traumatic experiences. When appropriate, we discuss the possibility of medication management and I make a referral to a psychiatrist.

When to seek treatment:

  • Persistent, extreme sadness
  • Hopelessness and Helplessness
  • Feeling fatigue, disinterest in any normal life activities
  • Withdrawal from family and friends
  • Inability to focus or concentrate
  • Self blame and self hate
  • Difficulties with sleep
  • Sudden and significant weight loss / gain
  • Negative thoughts and / or thoughts of suicide

Interested in learning more? Read our Articles on Depression here:

If you feel depressed and think you need help, please contact me at: 212 953-1388 (phone) or (email)

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