Different kinds of depression, different causes
People who get depressed have often been exposed to situations that have led them to feelings of helplessness — despair, feeling like there's no way out, feeling trapped, fearful — and beliefs that they are helpless to escape painful circumstances and feelings.
Some people have a genetic predisposition toward one or another kind of depression. The predisposition is visible in brain imaging like qEEG and fMRI. In people with recurrent, serious depressive episodes, the left frontal region tends to be under-activated. That region of our brain is an "engine" of optimistic approach behavior, positive motivation — it is what activates when we identify and "look forward" to reaching a goal.
Some people worry and ruminate more; others feel more anxious, aroused body sensations. Vigilance, hesitancy, holding back because of possible danger are functions of part of the right brain frontal/temporal region. If this region is more activated than the left brain optimism engine, we will not "go for it." This right brain defense/alarm/danger signaling system can be hypersensitized by trauma.
Assessment
We discuss your personal and family history, sleep patterns, and diet. We discuss events or situations that may have led to your developing beliefs that you can't control important outcomes — and later we help you change that learning. With many people learning to create small accomplishments, praising instead of criticizing themselves, and generally altering "black and white" thinking and creating helpful patterns of thought will improve the mood. Many have written extensively on these ideas, e.g. Aaron Beck, Martin Seligman, David Burns and more. Their books are great resources and much cognitive behavior therapy is based on their work.
With very persistent depression that has not cleared up despite previous treatment attempts, a quantitative EEG study may provide useful information. The research of Richard Davidson at University of Wisconsin, Madison over the last 30 years points to very distinct EEG patterns in people with recurring depression. Even between major depressive episodes, the left frontal/temporal region of the brain is less activated than usual. This left front corner of our brains functions as an "engine of optimistic approach" and positive mood. These patterns of less than normal activation on the left or excessive activation on the right brain predispose you to depression and are in part inherited. This lack of activation on the left relative to the right is also why medications often don't work as well as one might hope. You can't make a medicine go to just the left frontal region of the brain. Not coincidentally, the left frontal region is where TMS treatment is usually administered. TMS can excite a region of brain, potentially lifting a serious depression. The effects, however, tend not to be permanent, so even if a patient has success with TMS, we encourage approaches that produce new, permanent learning: cognitive behavior therapy and possibly neurotherapy.
Treatment
Predispositions do not mean anything is inevitable. What it means is that some people have more need of powerful, learned skills than others. If you're predisposed to high blood pressure, you have more than the average need to learn to relax, even in work and social situations. The predisposition toward depression means you can benefit from learning how to activate that optimism circuit — that part of your brain that identifies a meaningful, enjoyable accomplishment, makes a plan to go get it, and then goes for it. Part of what is needed is the habit of creating attainable goals instead of frustrating yourself with goals that are too out of reach. Every time you notice that you've made an accomplishment, and acknowledge and praise yourself for it (instead of telling yourself it wasn't enough, "too little too late"), you activate that left frontal system. If you start doing that a lot, you start getting that system more activated — and you start preventing depression.
When we find QEEG evidence that patterns in the EEG predispose you to depression, we will suggest training (neurotherapy) to change these patterns. Neurotherapy happens when we couple neurofeedback aimed at undesirable brain patterns with cognitive behavior therapy.
Medications can be very helpful to some people, but we don't see them as long-term solutions. Many people we see want to reduce or eliminate their need for medications. That needs to be done in close consultation with the person prescribing the medicine. Many medications will have very unpleasant side effects if you stop them suddenly and you should never discontinue medications without talking about your wishes with the prescriber. That said, we see training and practiced skill in problem solving, optimism, assertiveness, anxiety management, social connection, good nutrition, and solid sleep, possibly coupled with neurotherapy, as the long-range answers to most people's depressed moods.