Depression therapy and counselling Edinburgh

Depression is a serious condition which is a form of mental health illness. It can be a long term clinical condition, or a short term reaction to a serious event such as a bereavement. It is usually treated with either or both psychological therapies and medication.

In different cultures depression, then known as melancholy, was recognised in ancient Greece, China and Egypt. Hippocrates (460-370 BC) referred to it and thought it was caused by excess “black bile”, or an imbalance.

If you are suffering from depression you should always consult your medical doctor. Even if you do not choose to take medication right away, it is important for them to be aware that you might need support for this condition at some point. If you are in crisis contact the Samaritans immediately and then seek treatment.

“I get the sweats and feel shaky”
“My breathing gets fast and I get chest tightness”
“I blush / flush and feel self conscious”
“I wish the ground would open up and swallow me”
“I can’t face seeing people”
“There’s no way I could go out”
“I feel so nervous I feel sick”
“I need a drink to talk to anyone, and sometimes then I get a bit nuts”
“It’s Hopeless, there is no way out of this!”
“I feel trapped, there’s no escape!”
“I can’t see a way out of this, there is no solution”
“Things will never change, I’m stuck”
“I do not see the point in carrying on”
“I  can’t see the point anymore”
“People would be better off without me”
“I feel down and depressed”
“if I was gone my partner would be better off with someone else”

Forms of depression including bipolar depression are usually either treated directly with cognitive behavioural therapy based psychological therapies or high intensity psychological interventions (as recommended by NICE), or it can be addressed by looking more holistically at the person using counselling, psychotherapy methods, mindfulness and other therapies chosen to meet the needs of the individual client. Other NICE recommended methods include behavioural therapy focusing on relationships, psycho-dynamic psychotherapy, couples behavioural therapy or counselling. http://www.nice.org.uk/guidance/CG90/chapter/1-Guidance#psychological-interventions

Generally therefore there are three options, but of course these can be combined into a course of treatment so it is not “either or”.

1. CBT based psychological therapies as recommended by NICE and the NHS, although this is often a rather “cold” and functional approach, and does not really look in any depth as to personal patterns and causation. NICE recommend 16-20 sessions.

2. Psychoanalysis, counselling and psychotherapy based work looking at the individual and working them them rather than “treating” the depression. In other words looking at the person, not the symptoms. Mindfulness, meditation, hypnotherapy and and other methods like life coaching can be useful too. NICE do recommend “short term” (16-20 sessions) psycho-dynamic therapy.

3. Cognitive Behavioural Analysis, a hybrid of Cognitive behavioural theory and psychoanalytic theory, which combines looking at function, and looking at why. It has a strong emphasis on relationships, experiences, personal understanding (perception / interpretation) and behaviour. It incorporates NICE recommended features of psycho-dynamic, cognitive behavioural and relationship behavioural therapy. Some studies have shown success rates of 85% combining forms of cognitive analysis with medication support from a GP [Keller, M. et al. A Comparison of Nefazodone, the Cognitive Behavioural-Analysis System of Psychotherapy, and Their Combination for the Treatment of Chronic Depression. New England Journal of Medicine Volume 342:1462-1470 May 18, 2000. ]

In reality the best approach is usually to combine elements of all three to help the individual, since no two clients are the same!!

Studies indicate that there is no clear “better” method comparing behavioural and other psychological therapies* Likewise there is little clear evidence to suggest “3^rd way” versions of CBT are better than original CBT methods (does not examine Cognitive Behavioural Analysis which is different and has good evidence of additional success) ^.
* http://www.cochrane.org/CD008696/DEPRESSN_behavioural-therapies-versus-other-psychological-therapies-for-depression ^ http://www.cochrane.org/CD008704/DEPRESSN_third-wave-cognitive-and-behavioural-therapies-versus-other-psychological-therapies-for-depression

Other useful approaches including relaxation techniques such as self hypnosis or hypnotherapy, which reduces symptomatology but not as much as linked up psychological therapy. http://www.cochrane.org/CD007142/DEPRESSN_relaxation-for-depression

It may be worth noting that studies do show that receiving short term psycho-dynamic therapy (such as psychoanalysis or cognitive behavioural analysis) does lead to greater improvement in patients compared with control groups for persons with common mental health issues. http://www.cochrane.org/CD004687/DEPRESSN_short-term-psychodynamic-psychotherapies-for-common-mental-disorders

Depression is often thought of in psychodynamic theory as a surface symptom, in other words how something deeper rooted “turns up”. Analytic work therefore looks to address the deeper causes, while mindfulness based or cognitive behavioural therapies might better manage the surface levels.

Depression is often thought of as an affect regulation difficulty. In other words developmental psychology has caused the person to be unable to manage triggers and stimulation and resolve their own depression. This is the link between the underlying developmental cause, and the surface presentation.

Various forms of depression are referred to at diagnosis by medical professionals. Generally:

• Clinical Depression / Major depressive Disorder
• Persistent Depressive Disorder (about 2 years mild but fairly constant)
• Post natal and antenatal depression
• Bipolar disorder
• Seasonal Affective Disorder (SAD)
• Variations of these (such as long term clinical depression, treatment resistant depression, and variations on pre and post natal)

Physical / neurological effects include:

•  Physical low energy, low sex drive and disrupted sleep
• Effects on the Hippocampus, effecting cortisol stress hormone production, memory handling, and knock on hormone levels. Serotonin production thought to be effected partly from here.
• Effects on Prefrontal cortex, ability to make decisions, regulate emotions, form memories, think “clearly”
• Effects on the Amygdala: the “fire alarm” or panic centre of the rear brain, effecting sexual drives, basic emotions, sleep patterns and anxiety levels. Links to cortisol, adrenaline and other levels.

Neuro plasticity studies at Oxford Centre of Mindfulness (part of Oxford University) show how anxiety and stress levels are different in depressed and anxious patients, in particular in comparison with those using mindfulness.

Psychotherapy and Counselling for Depression, Edinburgh

Some forms of psychotherapy such as CBT or cognitive behavioural therapy seek to assist in self management of conditions such as depression, and NICE recommend CBT based psychological therapies for a wide range of psychological conditions and mental health conditions.

Both the causes of depression, and the experience of depression can be distressing in their own right, and even if you prefer medication as an overall treatment, having counselling can assist you in coming to terms with the condition, managing it’s effects and talking through and resolving historical effects and issues.

If medication is not your preference, then psychotherapy and counselling are useful in understanding the complexities of the individual’s condition and moving forward positively.

According to Goldberg et al (2019) MBCT is effective in addressing depression. According to Khoury et al (2015) MBSR is effective in a range of clinical conditions including depression. Wintera et al (2022) found Body Psychotherapy helpful with depression. Alladin et al (2020) found Cognitive Behavioural Hypnotherapy effective in depression. Markowitz, J.C et al (2022) found psychotherapy benefited depression.

Goldberg, S. B., Tucker, R. P., Greene, P. A., Davidson, R. J., Kearney, D. J., & Simpson, T. L. (2019). Mindfulness-based cognitive therapy for the treatment of current depressive symptoms: A meta-analysis. Cognitive Behaviour Therapy, 48(6), 445–462. https://doi.org/10.1080/16506073.2018.1556330

Khoury, B., Sharma, M., Rush, S. E., & Fournier, C. (2015). Mindfulness-based stress reduction for healthy individuals: A meta-analysis. Journal of Psychosomatic Research, 78(6), 519–528.

David Wintera , Clelia Malighettib , Sabrina Cipollettab,⁎ , Sajjad Ahmedc , Benjamin Bensonc , Frank Röhrichtd (2022) “Construing and body dissatisfaction in chronic depression: A study of body psychotherapy”  

Alladin, A., & Alibhai, A. (2007). Cognitive Hypnotherapy for Depression: An Empirical Investigation. International Journal of Clinical and Experimental Hypnosis, 55(2), 147–166. https://doi.org/10.1080/00207140601177897

Markowitz, J.C et al (2022). ‘The Neglected Role of Psychotherapy for Treatment – Resistant Depression. The American Journal of Psychiatry, 179 (2), 90-93.https://doi.org/10.1176/appi.ajp.2021.21050535

Psychoanalysis for depression, Edinburgh

Psychoanalysis does not treat the condition, in this case depression, but views the depression as an outcome of issues within the individual, such as a history of rejection, detachment, disassociation,  or other relationship or developmental related issues. Thus the overall person is helped.

It can be advisable to use other psychological therapies such as CBT or counselling to stabilize the condition first, or indeed medication. But generally once this is complete, psychoanalysis can often give far deeper insight into causation, and this is designed to give choice and control back to the individual. One way of looking at this is understanding the old narrative, and then designing and writing a new one.

Support for depression in Edinburgh

Stuart runs a psychoanalysis clinic in Edinburgh.  CBT, clinical hypnotherapy, counselling, psychotherapy and eastern psychology (including mindfulness) are available where appropriate.

Who provides assistance in Edinburgh

Stuart trained in Analysis, clinical hypnotherapy and stress counselling from 1993 to 1996, and since graduating with a Diploma from ASM/IHP (externally NVQ accredited and assessed diploma course and CNHC accreditation route via SSM) and an NVQ Level 4 externally accredited award, he has completed CPD training in a range of counselling and psychotherapies. His approach is psychoanalytic at core, but also integrative, using eastern and western psychology methods. He is a CNHC registered hypnotherapist (UK regulator for complementary therapies set up with UK Government funding and support and an AR scheme). He is also registered on the Federation of Holistic Therapists AR Scheme. Accredited registers are maintained by the Professional Standards Authority for healthcare practitioners not subject to statutory regulation. He is also a Fellow of the National Council of Psychotherapists, a full member of the National Association for Counsellors Hypnotherapists and Psychotherapists. Both of these are CNHC accreditation and verification routes in their own rights. He holds a BSc (Hons) IIT specialising in human resources and modelling, a BA (Hons) Open in psychology and Social Studies based topics, a BA(Hons) in Philosophy and Psychology, and a MSc Psychology. He also completed accreditation with the NACHP in counselling, psychotherapy and hypnotherapy. Certified Depression & Mood Disorder Treatment Professional (CDMDTP)

 Keywords: Depression, persistent depressive disorder, mental health, depressed, feeling down, clinical depression, counselling, psychoanalysis, psychotherapy, CBT, hypnotherapy, Edinburgh, Glasgow, Falkirk, Dublin, long term depression, clinical depression, depressed feelings, anxious depression, psychotherapist, CBASP, cognitive behavioural analysis, mindfulness.

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