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Depression has many faces. Personal experience is dominated by feelings of sadness, dejection, burn-out, hopelessness and an inner void. Cognitively, thoughts tend to center around concepts of a lack of meaning and purpose in life, doubts about self-worth and past goals, and an uncertain, bleak and dismal future. Persistent ruminations about such topics do not lead to any productive conclusions, but rather to agitated and subdued mood states, impairment of memory and concentration as well as impaired sleep. During the day, lack of energy, loss of interest in leisure or social activities add to a sense of helplessness. Appetite is often reduced (in some cases, though, enhanced), which further compounds the feelings of feebleness - social withdrawal ensues. In severe cases, the negative thinking leads to suicidal ideation, which is sometimes a precursor for suicide attempts.
There are many possible causes for depression. Psychosocial stressors, such as permanent high pressure on the job or the responsibilities of being a single parent, the loss of a loved one, role transitions, or cognitive factors such as perfectionism or an overly high achievement motivation can all play a part in giving rise to or maintaining a depressive episode. Severe cases of depression are often predisposed by other psychological problems, such as traumatic experiences, drug abuse, or eating disorders and are usually accompanied by an unstable self-image and inadequate feelings of self-worth. Since several somatic factors (e.g. hormone levels) can also impinge on mood states, a medical work-up is advisable to get a complete overall picture.
Following a thorough diagnostic evaluation, a personalised theoretical model is developed to take account of all relevant predisposing, causative, and maintaining factors of the depressive episode. Based on this model, treatment options are discussed and areas targeted where therapeutic interventions are needed to effect short-term relief and achieve long-term stabilisation.