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Depression: A Complex, Common Condition

More than 15 million people in the US have some degree of depression. Yet many either don’t recognize that they have depression or don’t realize how treatable it is. What’s more, their loved ones don’t necessarily know how to help or what to say.

As a licensed clinical social worker at MarinHealth Medical Center, Kristin Wolcott Farese works with clinically depressed people every day. Here, she shares her knowledge regarding the causes, symptoms, and treatment of depression. She also touches upon some of the latest research into a condition that impacts quality of life for far too many Americans.
Depression: A Complex, Common Condition
Kristin Wolcott Farese, LCSW
Kristin Wolcott Farese, LCSW is a Licensed Clinical Social Worker at MarinHealth Medical Center.

Bill Klaproth (Host): According to the NIH, major depression is one of the most common mental disorders in the United States. Left untreated, depression can lead to serious health complications including putting your life at risk. Here to talk with us about depression is Kristin Wolcott Farese, a licensed clinical social worker at Marin General Hospital. Kristin thank you for your time. First off, what causes depression in people?

Kristin Wolcott Farese (Guest): Well that’s a very big question. You know depression is a very complex disease and there is no one answer to that. Brain chemistry and sometimes brain structure are always components of depression. Genetic inheritance can make some people more susceptible to mood disorders like depression our temperament can really influence our stress response which can in turn influence emotional resilience in the face of stress. Habits of thinking are often looked at when people are struggling with depression. The way that we think about ourselves and things that happen to us can really contribute to and reflect core beliefs about ourselves and make people more susceptible to depression. Chronic stress or trauma, we have talked about this in a previous podcast about the nervous system getting stuck in overdrive when people face trauma or chronic stress, and this is a very common experience with people who are depressed. Overactivation of the nervous system usually occurs when the stressors that people are experiencing exceed the resources somebody has at the time to cope and so the nervous system can get stuck in this state of activation and it can look like panic or anxiety or debility, hypervigilance or more symptoms of collapse like withdrawal, isolation, anhedonia which refers to just a loss of pleasure in things that generally provide pleasure to people, lethargy. Seasons or limited exposure to daylight can induce depressive symptoms in some people. And then finally medical problems and medications always need to be ruled out as a source of any mood disturbance.

Bill: So, when you said this is a big question, you really meant it so, very complex and a lot of factors can contribute to depression. So, how do we identify this in someone then? What are the common signs or symptoms?

Kristin: A lot of people equate depression with sadness and that is certainly usually a component of depression; but sadness doesn’t really encapsulate depression completely. it’s really more about being stuck with - with limited to no ability to feel any intense emotion. And so, when we are looking at depression, we are looking at significant changes in mood, behavior, thinking, and physical symptoms that get in the way of functioning. So, mood changes are like sadness, irritability, sense of emptiness, the effect of somebody who is depressed is usually very restricted or blunted. In other words, they are not showing a wide range of emotion. Behavior can include social isolation, or withdrawal, agitation, or a retardation in psychomotor, tearfulness, you know difficulty getting out of bed, active suicidal behaviors like planning a suicide, passive suicidal behaviors like engaging in activities that could result in harm or death or not really caring if one stays alive or wakes up in the morning, self-harm and substance abuse or also behavioral signs of depression.

Bill: So, look for those changes in moods or changes in attitude or even lifestyle if someone is having trouble getting out of bed or   doesn’t want to get out of bed. Wants to stay in their room and things like that so if we recognize these symptoms in a friend or loved one; what should we do?

Kristin: I think it’s important to let your loved one know what you are observing. and let them know that – just encourage them to seek help in the form of a psychotherapist who may in turn also refer to a psychiatrist for evaluation and since suicidal thinking can sometimes be a symptom of depression; it’s always important to ask your friend or loved one if they are having any thoughts of harming or killing themselves. You know a lot of people don’t know what to say to somebody who is depressed and there’s a well-known researcher named Brene’ Brown who is all over the internet now, who talks a lot about empathy versus sympathy and so one of the suggestions is that it’s important to just learn how to be with somebody, even saying I don’t know what to say right now, I’m just so glad you told me rather than needing to – feeling like you need to provide advice or the perfect response.

Bill: Well, that makes a lot of sense. Now you mentioned therapy in there. Can you share other forms of treatment?

Kristin: Sure, well you know that generally for people who are stuck struggling with a clinical depression; the treatment of choice is a combination of medications and psychotherapy oftentimes it’s really important for people to go on some medication just to provide that floor so that they can build some skills and work on managing their emotions differently.

Bill: And when it comes to other treatment options; are there natural ways people can put into practice to manage this on their own? I’m thinking you know mindfulness and meditation. Are there ways that can help?

Kristin: Yes, absolutely. People who are suffering from depression often have the inclination to withdraw or isolate and the opposite is really what’s needed. And so, finding connections informally you know with friends and family or more formally with therapy, recovery groups the theme is connection. The group modality for treatment either formal or informal is really a central component of treating depression.

Bill: So, what is the long-term outlook for this? I feel like my opinion that we are starting to pay more attention to mental health. It’s part of the conversation now. We are not just trying to shove it in the corner and forget about it. It’s out there. We know about this, we know it’s a problem we need to take care of it. Do you see us trending towards really recognizing this and accepting it and treating it like it should be?

Kristin: I do you know depression, anxiety, other mental illnesses are really becoming more and more part of the public discourse. And I just see a lot of opportunities for new really important things to come out of that. It’s no longer shoved in the corner, really and I personally see a lot of hope in the renaissance of the group modality for treatment. The opportunities for connection to share experience are extremely therapeutic and then I think as you mentioned earlier, just the impact. There is a lot of research now going on, on the impact of mindfulness and self-compassion, gratitude practices, the impact of that can have on regulating emotions in the brain. So, neuroscience is really the cutting edge of understanding the causes and most effective treatments for depression. And then one more thing that I’m noticing is the just increasing use of body in treatments, so really teaching people how to settle their nervous system you know that’s becoming more mainstream in treatment for a variety of the disorders.

Bill: Well that’s good to know Kristin. Thank you for sharing that with us and last question for somebody listening to this, obviously, they are listening because either they are depressed, or they may be listening because they fear this in a loved one possibly. What’s your best advice for that person listening right now?

Kristin: Well, first just to know that you are not alone. I read a statistic recently, it’s over 15 million people in the US are affected by depression. You know many people don’t recognize depression for what it is or maybe they have lived with it for a long time and they might not be aware that depression is a disease that’s very treatable. Depression is not a weakness. it doesn’t reflect a flaw. It’s something that reflects some chemical shift in the brain that can be treated. And then just also normalizing how – how much courage it really takes to treat depression in part, because it really does tend to often implicate others or require one to make changes and so that it is scary to rock the boat , but it is essential. It’s really something that once people can learn to approach this and get the help that they need; people really do find a lot of freedom and movement on the other side.

Bill: Kristin, great thoughts and always remember, you are not alone. Thank you again for your time. For more information visit, that’s I also want to let you know Kristin and I did a podcast on Identifying Suicide Risk. The Best Ways to Help a Loved One. I just want to pass that along. You can find that on the Marin General podcast page at, that’s This is the Healing Podcast brought to you by Marin General Hospital. I’m Bill Klaproth. Thanks for listening.