Situational depression occurs when there is a triggering event which is distressing and creating a downward spiral. This can be a loss of a loved one, illness, rejection, abandonment, blow to one’s self esteem, a sense of failure in an important endeavor or trigger from past traumatic experience or event. All of us react to such events with deep sadness, but sometimes, it turns into feelings of depression which are associated with hopelessness, feelings of aloneness, lack of energy, sometimes guilt and shame.

Sometimes the depth of these feelings indicates a possible biological component as well. Situational depression can be treated and resolved with psychotherapy alone. Insight oriented therapy combined with a good therapeutic relationship can be enough. EMDR can also be very helpful as most causes of a situational depression have origins in past traumatic events. If the depression does not respond to therapeutic interventions, it may be a good idea to have a consultation from an experienced psychopharmacologist.

When a patient comes in with a depression that is more or less chronic with various degrees of severity and with no apparent trigger or precipitating event, there may be a biological cause. While psychotherapy is helpful, in these cases it is useful to consult a psychopharmacologist to explore options for antidepressant medication. A good psychiatrist is usually able to figure out the right medication which will alleviate the distressing feelings and lift the depression.

The post Different Types of Depression first appeared on Irina Firstein, LCSW.

Sadness is a normal and healthy human emotion, in response to variety of experiences. It often is connected to disappointment which is mild to moderate, feeling hurt by someone or something, feelings of occasional loneliness, work related stress or mishap of some kind or another. It is an opposite of feeling “happy” or joyful. This is usually a feeling that passes relatively soon, it can be days or hours and the person will return to a “normal” emotional state. Usually when one is sad there is no disturbance in sleep or appetite, no issues with functioning at the workplace or school or generally in any major area of life. Feelings of sadness usually resolve spontaneously.

Depression on the other hand is a more profound state. It is deeper than sadness, or is a sadness that does not lift over time. In fact, it usually gets worse. It is also, unless, biologically driven, connected to disappointment, failure, rejection, sense of aloneness, low self esteem and generally a profound sense of loss. Depression is characterized by low energy, lack of desire for anything, inability to experience any pleasure, social withdrawal, disruption in sleep and eating, a general sense of hopelessness and futility. It is a much deeper, darker and more profound state. Whereas a sad person can sometimes be cheered up, a depressed person, generally can not get out of their state and attention and intervention by loved ones do not help or if they do, it is not lasting. Depression can last a long time, and, over time can get worse and needs professional attention.

There is usually no treatment needed for sadness, it is part of natural ebb and flow of human emotions, and is as normal as joy. In case of depression, usually psychotherapy and often times medication as well, are in order. This combination is usually sufficient to resolve depression over time.

The post Am I Sad or Depressed? first appeared on Irina Firstein, LCSW.

Grieving a loss of a parent is normal. However, when it is extremely prolonged with not much significant ease, this can become what we call, complicated grief.  In a way what this means is that this is not only pain of a loss of a loved one, but, that there are complications in the relationship with a deceased parent that have not been worked through or resolved and it is difficult to move through the stages of grief and loss which leads to a “stuckness” of  unresolved feelings – most often guilt, anger and sometimes, shame. Sometimes, complicated grief reaction occurs when there is not sufficient separation that usually is a part of an adult relationship with a parent or if the death took place under sudden or tragic circumstances with no preparation for facing the loss.

In dealing with a loss of a parent, usually, emotional support from friends and family as well as time, can eventually provide some relief. As time passes and other things occur, there is a natural sense that “life goes on”, so to speak.

However if the loss, heartbreak and grief start turning into a feeling of depression, it may mean that the reaction to the death is “complicated” grief and it is time to seek professional help. With a help of an experienced therapist, it is important to identify the “unresolved” issues or any other elements of the relationship with a parent or other self  related feelings and issues that are in the way of integrating this major event into one’s life and continuing to experience life in its fullest capacity.

The post Depression After The Death of a Parent first appeared on Irina Firstein, LCSW.

Its a  kind of Post – Holiday Blues, I don’t want to call it depression, but for many its a slump. For many of us the social calendar is empty and the work one is full. The credit card bills will soon be arriving, reminding you of all the money you spent on gifts, etc.

You can try to change this “blah” perspective to a positive and productive one. Its time to think about doing all things you have been putting off because you are not preoccupied with all the year end stuff, such as gifts, travel, family obligations.

If you worry about feeling lonely and isolated during this time, have a dinner party, make plans to see people. Many of your friends, family and colleagues feel the way you do. reach out to friends and family and organize stuff, everyone will appreciate this, go see films, plays and concerts you had no time to indulge yourself with during December. Many, knowing about this slump actually plan trips in January and February.

You know you have been here before and it passes. As the months go forward and you weather the cold weather and snow storms, you know spring is coming and with it rebirth and new inspirations and good feelings.

Hang in there!

The post How to Deal with Post-Holiday Blues first appeared on Irina Firstein, LCSW.

I would like to present some reasons for holiday blues as well as some ideas on how to cope or minimized stress and depression  during  holidays.

Holidays are stressful for many reasons: there are demands such as parties, shopping, entertaining, endless gifts, not to mention pressure to be happy. Many of us have unrealistic expectations of ourselves and others, some are not able to be with our family or friends for financial or other reasons, there is financial stress that comes from over-commercialization and feelings of duty and expectations. Many suffer from a mild depression in winter anyway due to limited light (seasonal affective disorder). Finally, for some of us, holidays are sad because of a recent loss due to death or a breakup. Even past losses become more intense during the holiday season as we think of being with those who are no longer here during this time. Holidays are a time when feelings of loneliness if they are there, become more intense. Loneliness and loss are often at the root of all sadness and depression.

Here are some tips to help deal with holiday stress and depression:

– Don’t deny your feelings, feel them and acknowledge them. If you are going through a loss, or if there are reasons to feel sad, its OK. No one can force themselves to feel happy if they are not. Don’t put more pressure on yourself then you already feel.

– If you can, reach out. Think of everyone you may be able to connect with, go on a spiritual retreat or volunteer your time to help those who are in a much worse situation, this puts things in perspective quickly and makes you feel good that you were able to make someone else’s life better.

– Remember, holidays don’t have to be perfect every year. Every holiday season is different and its not helpful to compare. Life changes, families change, try not to hold on to past, but embrace what is now. If you are married or in a serious relationship, you may have to compromise this year and suck it up, go to your partner’s family and miss seeing yours. May be your best friend is not around this holiday, accept life as it is, do the best you can. If you are a couple with older married children, they may not be with you this holiday season, find a way to accept this and celebrate with those who ARE  around. Try to enjoy who you have around you, rather then dwell on who can not be with you now. This too may change next year.

– Many of us have financial stress during holiday time. Stick to a realistic budget. Don’t compare yourself with what others can spend.

– It’s a good idea to plan ahead in terms of shopping and entertaining. Last minute scrambling creates a lot of stress and takes whatever joy there is out of holiday season.

– Don’t abandon good self care habits like exercise, healthy eating, don’t use holidays as a reason to drink excessively,  get plenty of sleep. Say NO when its too much! Emotionally healthy living is a balance between caring for self and caring for others.

– Make sure you get some old sure proven activities in that make you feel good, whatever they may be. It can be as simple as watching a favorite movie, listening to music or curling up on a couch with a good book.

– Finally, if the sadness, blues or depression persist way after the holidays are over, may be its a good idea to seek professional help. This may be a full blown depression and it needs to be dealt with.

Let me know if you have other good tips or ideas so I can share them.

The post Why Holiday Blues and How To Beat It. first appeared on Irina Firstein, LCSW.