Counseling for Major Depression in Tulsa with Alina Morrow, LPC

Major Depression, Counseling Available in Broken Arrow for Tulsa Area Residents

By Alina Morrow, LPC-S, CAMS II, GC, CCTP

Disclaimer: The article below is for informational purposes only and should not be considered as direct advice, a personal diagnosis, or as an individual treatment plan. Always consult with a mental health professional or medical doctor if you have concerns.

Introduction and Overview

Major depression, also known as a unipolar depression, major depressive disorder, major depressive episode, or clinical depression, is a recurrent disorder characterized by a depressed mood and/or diminished interest or pleasure in nearly all activities with symptoms that lasts at least 2 weeks. In children and adolescents, major depression is characterized by an irritated mood rather than sadness.

Major depression affects 15 million Americans adults or 5 to 8 percent of the adult population. Major depression differs from the common down moods and temporary sadness common in life.

A major depressive episode is persistent and it’s symptoms interfere with the person’s everyday life routine, thoughts, behavior, mood, activity, and mental and physical health.

Major depression is 2x more common among women than men. Also, the disorder is 1.5 to 3x more common among first-degree biological relatives of those with the disorder than among the general population.

More than half of those that experience a major depressive episode will experience future depressive episodes at least once or twice per year. The number of major depressive episodes and the gravity of the symptoms increases when the depression is not treated when it occurs.

A person is suffering from major depression, (besides the depressed mood, diminished interest or pleasure in activities) he or she also experiences at least four of the following additional symptoms:

changes in appetite and weight, sleep, and psychomotor activity,
decreased energy,
feelings of worthlessness or guilt,
difficulty thinking, concentrating, and making decisions,
recurrent thoughts of death, suicide ideation, plans, or attempts.

The mood of a depressed person is described as sad (in some cases the sad feelings are denied), hopelessness, discouraged, or irritated (persistent anger, tendency to respond to events with angry outburst or blaming others, or an exaggerated frustration over minor matters). In some cases, the depressed mood can be read on the person’s facial expression or behavior. Some people complain of somatic discomforts such as body aches or pains rather than reporting sad feelings.

The loss of interest or pleasure, symptoms present in almost all depressed people, is described as a loss of interest in hobbies, a loss of enjoyment feelings in activities that were pleasurable in the past. The person withdrawals socially, neglects favorite activities, and even experiences a significant reduction of sexual desire.

Appetite change varies among depressed people. Some experience a reduced appetite, feeling like they have to force themselves to eat, while others experience an increased appetite and may crave specific foods (such as carbohydrates).

One of the most significant sleep disturbances associated with major depression is insomnia, that can vary between initial insomnia (difficulty falling asleep), middle insomnia (walking up during night while being unable to fall back to sleep), terminal insomnia (waking too early and being unable to fall back to sleep), and in some cases hypersomnia (oversleeping either during night, or during daytime).

Psychomotor changes vary betweens two phases: agitation, which includes the inability to sit still, pacing, hand wringing, or pulling or rubbing of the skin, clothing or other objects, slow body movements, increased pauses before answering, decreased speech volume, inflection, amount, variety of content, or muteness.

Decreased energy is experienced as tiredness and fatigue without substantial physical exertion. Also, the efficiency level and the daily tasks decrease either because the persons feels exhausted fast, or the time needed to accomplish a task takes more than usual.

The sense of worthlessness or guilt may include unrealistic negative evaluation of one’s worth, guilt or rumination over minor past failings. The person can misinterpret neutral events as proves of personal defects and has an exaggerated sense of responsibility over harmful events.

Depressed people may experience thoughts of death, suicide ideation, and even suicide attempts. The death thoughts range from beliefs that others would be better if they were dead, recurrent thoughts of committing suicide to planning how to actually do kill themselves.

Counseling & Treatment of Major Depression

Major depression, if diagnosed early, can be treated effectively. Around 80 to 90 percent of those who receive treatment can recover and return to their normal, productive life. The four treatment options available for depression are:

Psychotherapy/Counseling
Electroconvulsive Therapy (ECT)
Transcranial Magnetic Stimulation (TMS)
and Doctor Prescribed Medication

I. Psychotherapy/Counseling: Another effective approach in treating depression is psychotherapy. There are two forms of psychotherapy that have proven to be effective:

A. Cognitive-Behavioral Therapy (CBT): This is a type of therapy based on the Cognitive Model of Emotional Response, and considers that our thoughts and not the external situations, people or events, trigger the behavior and feelings.

The benefit of this perspective is that a person can change the way he or she thinks and further the way he or she feels and acts when the situations, other people or events do not change. A depressed person learns how to replace the negative thinking and unsatisfying behavior associated with depression with proactive and positive thinking, feeling and acting patterns.

B. Interpersonal Therapy (IPT): This is a short term therapy that has proven to be effective in treating depression by focusing in improving dysfunctional personal relationships and adopting a new, more functional life role. Even if depression can be triggered by exterior events, it usually involves an interpersonal component which affects relationships and roles in these relationships.

Interpersonal therapy focuses in identifying those interpersonal events such as conflicts, interpersonal role transitions, prolong grief, that cause and maintain the depression.

II. Electroconvulsive Therapy (ECT) is a treatment option used only in severe cases of depression when the other two options (medication and psychotherapy) do not work and the patient experiences symptoms such as psychosis (a severe mental disorder in which contact with reality is lost or highly is distorted) or thoughts of suicide.

This treatment approach uses an electric shock to cause a seizure (a short period of irregular brain activity) which releases a lot of brain chemicals (neurotransmitters that help deliver messages from one brain cell to another). This therapy is administered by a psychiatrist in a hospital setting up to three times per week, but usually no more than 12 session are needed. Before the treatment, the patient receives an IV line that allows medication to go straight into the blood. The patient also receives general anesthesia and muscle relaxers.

During the treatment, the patient’s blood pressure and breathing are closely monitored. A 1 to 2 second electric shock is applied to the heart which causes the brain seizure. Medication is also given to prevent the body from moving during the shock. The patient will wake up within 5 to 10 minutes after the treatment.

The most common side effects of the electroconvulsive therapy include:

blood pressure or heart rhythm changes during treatment,
temporary short-term memory loss (in few cases, longer-lasting problems with memory),
confusion,
nausea,
muscle aches and
headache after treatment.

III. Transcranial Magnetic Stimulation (TMS) is a noninvasive therapy that uses weak electric currents to excite neurons by changing the brain’s magnetic fields. The patient receives the electric current through an electromagnetic coil placed on his or her scalp which creates a magnetic pulse. The magnetic pulse causes small electric currents in the brain which stimulates neurons involved in mood regulation. This treatment is not FDA approved and is used only in clinical trials.

Frequently Asked Questions

Q. How much does it cost per session?
A. My price is $150 for a 50-minute session.

Q. Who can come to counseling?
A. Anyone who wants guidance to improve their quality of life.

Q. What are the office hours?
A. Monday thru Friday from 10 am to 4 pm.

Q. How soon can you see us/me?
A. I can usually schedule you the week that you call.

Q. What do I need to do to make an appointment?
A. You can call, text or email me with the day and time you prefer, and we can go from there. PLEASE NOTE: A debit or credit card is required to reserve an appointment. The card has to be provided at the time you schedule your first appointment.

Q. What office policies do I need to be aware of prior to making an appointment?
A. All the clients that schedule appointments with me will be informed about the Making/Cancelling or Rescheduling Appointments Policy. This policy is included in the first appointment forms and is discussed with every client at the beginning of our work together. This policy states that each client will receive a text reminder 2 days (48 hours) prior to their scheduled appointment. The client is required to respond back by confirming, cancelling or rescheduling the appointment the lastet by 8pm the day I send the reminder. If the client fails to respond back, it will be assumed they cancelled the appointment without further notice and they become financially responsible for the booked appointment. Please know that at 8pm the appointment becomes available to other clients, and it is no longer yours.

Q. What is the role of the Making/Cancelling and Rescheduling Appointments Policy?
A. This policy helps me provide equal access to services to all clients (existent or new clients). Each time a client makes an appointment the allocated time is dedicated just to them; therefore, no one else has access to that appointment. This allows me to keep my schedule organized and coordinate the care of each client I have, as well as allocating the rest of the scheduling hours to others that are in need of services. When a client does not respond to my reminder, they directly affect several people. My schedule is affected, and other clients are prevented from having access to appointments. Please understand that mental health services also involve emergency or highly critical situations where clients need to receive services as soon as possible. If you (the client) do not respond to let me know the status of your appointment, I am not able to coordinate the care for other clients and attend to their needs. Clients that need services but cannot be scheduled are put on a waiting list. This is the reason I ask a confirmation by 8pm the day I send the reminder. After 8pm, the clients on the waiting list are contacted and the available appointments are offered to them. Usually the time span between the moment I send the appointment reminder and the latest time I accept confirmations or cancellation is usually 10 to 12 hours. I send the reminders in the first part of the morning (between 8 and 10 am). By not responding to my reminder in that time frame, you (the client) keep an appointment blocked and others will not have access to services. Therefore, you (the client) become financially responsible for making an appointment and not taking responsibility for it or disregarding the needs of others. Please understand that I cannot discriminate against clients. Since this is a policy all the clients abide by when they start counseling with me, I cannot differentiate between clients and make exceptions.