"In depression, sadness is not always the main symptom".

We talk about depression with psychotherapy expert Begoña Fernández Seco.

Mood disorders are known to have the ability to take many different forms. Among these, depression is one of the most frequent, and sometimes the difficulties in distinguishing it from normal sadness can keep many people who need professional help from going to therapy.

On this occasion we talk about depression with the psychologist Begoña Fernández Seco, a resident psychotherapist.a professional psychotherapist based in Madrid with more than 15 years of experience in this field.

Interview with Begoña Fernández: the complexity of depression.

Begoña Fernández Seco is a General Health Psychologist and Director of the Begoña Fernández Psychology Center, located in Madrid. In these lines she talks about her experience as a professional who has spent many years helping people with depression.

Is it very common for depression to arise without having its cause in a clear event, such as a separation, a layoff or the death of a family member?

Yes, it is quite common. In fact, it is frequent that the symptoms of depression appear some time after a precipitating event, and therefore, that the patient does not see the relationship that exists between his current symptoms and what is happening in his life at that moment, especially if the present circumstances are favorable.

In these cases, it will be necessary to inquire whether in the recent past, he has gone through some difficult situation or perhaps he has been accumulating several stressful episodes that have kept him in an attitude of struggle.

It is often taken for granted that people with depression are very sad. Are there cases in which the person with depression does not feel sad, but experiences other symptoms?

Sadness is one of the most frequent symptoms of depression, but it is not the only one, nor is it always the main one. Sometimes, it is put ahead of sadness, irritability, reluctance or lack of energy and motivation to do everyday things, guilt, feeling of failure, blockage, difficulty in making simple decisions. Sometimes, the person goes from one emotion to another in a relatively short period of time, and this can lead to feeling even more confused.

What is usually done in psychotherapy to help a person with major depression?

Major depression is a disorder in which the person has a negative view of himself, the world around him and also a pessimistic view of the future. This negative vision leads him/her to have automatic negative thoughts about him/herself and his/her circumstances and to distort reality and the way of interpreting what happens to him/her.

Psychotherapy teaches the person tools to realize and change the dysfunctional, exaggerated and negative way of interpreting what happens to him/her, looking for alternatives to his/her way of thinking about what happens to him/her. It also works with the behavioral part, to act in a way that brings him/her closer to achieving his/her goals.

On the emotional side, psychotherapy helps not to fight against negative emotions, and to learn to see the relationship between what we feel and what we think.

Is the process of improvement slow and how does it develop?

Depression is not a disorder that we can get rid of from one day to the next. The degree of hopelessness that the individual has will be key to the duration. That is why it is important to work with the feeling of hopelessness, because if we think that circumstances will improve in the future, this vision will help us to get out of depression sooner.

Another beneficial circumstance is to have a good social and family network, especially to avoid falling into self-absorption and self-attention to the symptoms that is so common in this mental disorder. Also rewarding activities, even if they are done with little desire, help the person not to fall into recurrent and looping negative thoughts.

In your experience as a psychologist, do you think that friends and family members of patients with depression tend to hold these people responsible for their own suffering?

It is less and less frequent to hear from relatives or friends phrases such as: "It's not that bad", "You have to do your part", "You have a lot of stories" or "You are just too weak". But until recently, when there was less information, it was a disease that people did not understand much in general.

What ideas about this psychological disorder do you think need to be more widely disseminated, so that people with depression feel more understood and have an easier time getting better?

To begin with, the phrases written in the previous section, since in most cases, it is the patients themselves who say all these statements to themselves, and not so much those around them.

Improvement does not depend on willpower, on "trying" to be better or "doing our part", but on learning to think and act in a way that is useful and adaptive. That it is realistic. And that the patient, who normally sees no way out, manages to contemplate varied and different ways of thinking and acting to get out of the loop in which they are stuck.