We will first look at what research has shown to be the best type of depression counselling for overcoming depression permanently.
Many professionals advocate a combination of drug therapy and psychotherapy, but more and more studies show that medication is unnecessary if the sufferer receives the right sort of help.
As well as overcoming depression if you have it now, knowing exactly what depression is means you can recognize the onset of future episodes, if they occur. Gaining new skills, or being able to challenge depressive thinking and behavior at the onset, means you can be confident about leading a depression-free life. Good depression counselling will help you learn these skills.  More on that later.
Counselling or therapy that is effective in overcoming depression focuses on:

	What we do. (Behavioral therapy)
	How we think about things. (Cognitive therapy)
	How we relate to others. (Interpersonal therapy)
	How things are going to be better in the future. (Solution focused therapy)
	Getting our basic emotional needs met in the wider world
	Helping you find solutions to your immediate problems

Using a state of hypnosis and a combination of these above approaches has been shown to work best.   With hypnosis you are able to get into a more relaxed state and allow your subconscious mind the space and clarity to make the changes necessary.  This is a long term solution to depression equipping you with the necessary tools to lead a happy life.     
Overcoming depression is NOT focusing on why you are depressed, or what went wrong in the past. These types of therapy, far from overcoming depression, will tend to make it worse.
Here's a quick description of the therapies described above found to be effective in beating depression.

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The basic idea of behavioral theory is that everything amounts to behavior and inner processes are of little or no account. So if people feel miserable it is because of their behavior. Traditional behavioral therapists are less interested in the thoughts and emotions of their patients and more concerned with their behavior as can be observed.

Changing peoples' behavior can have dramatic results but it is now known that people's perceptions and thought processes are also vitally important when overcoming depression.

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Cognitive therapy works on the basic premise that all emotion comes from thoughts. For example: If you think about something scary, you will feel fear.

Basically, the idea behind cognitive therapy is that people learn to 'catch' their thoughts and challenge them so that they can feel differently.

Working on your thinking styles is absolutely essential if you suffer from depression. Any therapist or counselor who does not address this with you is going about it the wrong way!

Recent studies of how the brain works have shown that certain emotions occur before thoughts and it is possible to be afraid of something before we can think what it is. However cognitive therapy, if applied skillfully, has done very well in the research for lifting and preventing relapse of depression.

(The danger with cognitive therapy is that it becomes too complex for the patient to understand, so it must be applied with skill, and with consideration for the patient's way of learning.)

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This approach focuses on the way people relate with other people in their lives - how they communicate and express themselves. Whether a person is assertive, aggressive or timid or has 'social skills' is seen as key.

Extremely common in depression sufferers is the lack of satisfaction in various relationships: family, work, social. Depression can cause us to lose access to the skills and the desire to sustain these relationships successfully.

Whether it be feelings of wanting to be alone, not knowing what to say, or just feeling wretched and not wanting to be in company, a large percentage of depression sufferers exhibit what is crudely called "poor social skills" such as:

	Being less assertive
	Being less positive
	Showing negative facial expressions and poor eye contact
	Displaying less interaction in group situations
	Unwittingly carrying out 'off-putting' social behavior such as inappropriate questioning, too much or too little self-disclosure, or missing out small-talk.

Again this therapy can be seen as practical, sensible and very helpful for some people as communication skills are 'teachable'.

However like all the other approaches it's not the whole story.

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As it's name suggests, the emphasis here is on finding solutions to current problems and focusing on future wellness rather than past hurts. This is not to say that the past is ignored but the main emphasis is on teaching new skills and keeping therapy brief and focused.

It is an extremely hopeful and motivational form of therapy when applied skillfully.

Each therapy type contributes greatly to overcoming depression. Good depression counselling uses all these approaches in a skilful blend.  Let us look at the core elements of successful help for depression.

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No one type of depression medication has been shown to be significantly more effective than any other. Antidepressants are also very poor at preventing relapse, and more often than not require a long course of treatment.

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Effective therapy needs to incorporate everything that works in lifting depression. You may be able to help yourself effectively, although often it is useful to get the help of a professional.

Here we'll go through what you can do, as well as what you should look for in any therapy you choose to undergo.

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1) Know about your condition - what you know about your depression has been shown to have an effect on how well you respond to treatment. 2) Cut down on rumination. Do whatever you can to decrease the amount of rumination you are doing. (Ruminating is 'chewing over' emotional issues in your mind without coming to any decision to act.) If possible, decide to put off difficult decisions for 1 or 2 weeks while you get your energy back. Ways to cut down rumination are to:   Stop yourself when you spot yourself doing 'all or nothing' thinking. Read novels when you have nothing to do, to occupy your mind. (Make them exciting novels, not romance or self help books!) Do exercise Work if you can Keep yourself occupied as much as possible in ways that stop you thinking too much!   3) Find ways to assess and monitor your depressive episodes - The way depression makes us adopt all or nothing thinking is a unique and crucial part of understanding depression. The way depression makes us generate seemingly hopeless outcomes to our situation can make it almost impossible to see a way out of it. Finding ways to gauge your depression can help to show the shades of gray that will ultimately defeat the black and white thinking on which depression thrives. This is often done in the form of a diary, where you grade how bad your days have been on a scale of 1 to 10, where 1 is the worst and 10 is the best. Then, after 2 weeks or so, you can look back and see how things have varied over that time. 4) Lower your emotional arousal levels calming down emotions such as anxiety and anger helps your brain function more subtly and decreases the amount of catastrophising you do. Along with getting proper rest, being able to relax is incredibly important. Relaxation therapies are effective in overcoming some of the other issues that can co-occur with depression. The effects of panic attacks, anxiety and anger etc can be lessened and overcome with the ability to relax properly and deeply. Physical disciplines such as Tai Chi, which occupy the mind whilst performing gentle, relaxing exercise can be useful, as can relaxation training such as guided imagery or self hypnosis. 5) Get exercise if you can. If you can increase the amount of physical exercise you get, it can be a great self help for depression. The results of the physical exertion will lift your depression temporarily at least, in addition to the other benefits of exercise. (As always, consult your medical practitioner before starting any strenuous exercise regime.) 6) Do What You Enjoy. Do what you used to enjoy doing, even if you don't particularly feel like it. Even complete small tasks within the home if you don't feel like meeting other people. Seemingly mundane tasks, if they have an end result, can result in a feeling of satisfaction, and actually increase your serotonin levels! 7) Maintain a regular sleep pattern. Do not lie in if you feel exhausted in the morning. All that happens is that you dream a large amount if you sleep through the morning, because your REM periods get longer the longer you have been asleep. Set a time to get up every morning, and get up. Try to spend 8-9 hours in bed, and get up regardless.   8) IMPORTANT! Check that you are meeting your basic emotional needs.

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The single, best proven approach for treating depression is a combination of cognitive, behavioral and interpersonal therapy while being brief, solution focused and strategic. If the therapy also includes the understanding of how dreaming figures in depression (which is not yet widely known), it will be even more effective. (You can always point your therapist towards this site. If they are good at what they do, they will be able to incorporate this into their approach quickly.)

Important note: Therapeutic approaches that increase rumination (going over past hurts and examining what was wrong with past relationships) worsen depression. This includes psychodynamic approaches, gestalt, hypno-analytical and person-centred counselling, plus many others. The evidence for this is now strong enough to stand up in court. (1)
What does this mean? Well, it's therapy that takes place over a short period of time, usually less (and often much less) than 20 sessions, with significant improvement within 6 sessions. It focuses on:

	the way you think about things
	what you do from day to day
	how you relate to other people
	how your current problems can be tackled to lessen the burden on you (practical problem solving)
	it is aimed at making you feel better, rather than changing your personality
	if you suffer post-traumatic symptoms, removing these quickly before other treatment

While the treatments outlined above do have different approaches there are some key similarities. These are the things you should look for in depression therapy, and your therapist or counselor.

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	The treatment has a developed rationale, and is treating key signs of depression.
	All treatments include some form of training: skills that the patient can learn.
	There is a chance to use and practice these skills, outside the therapy sessions.
	The treatments have time limits and goals.
	There is a follow up plan.
	Within the treatment, there is credit given to the patient for gaining these new skills, rather than the ability of the therapist.

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	understands what depression is and how to lift it - compare their understanding with that found on this website. You can do this over the phone or at 'first contact'
	endeavor to make you feel better after every session
	can help immediately with anxiety problems by teaching techniques to lower anxiety, or by deconditioning trauma to decrease flashbacks and general emotional arousal
	is prepared to give advice if needed or asked for. This may seem obvious, but some therapies deliberately avoid giving direction. This does not help when treating depression
	talks to you in terms you can understand and does not expect you to 'learn their language'
	does not drag you back to talking about the past once anything relevant has been said
	supports you in dealing with difficult emotions, but does not propose that 'getting in touch with your emotions' is necessary for improvement.
	if necessary, can help you develop your social skills so that your needs for affection, friendship, pleasure, intimacy, connection to the wider community etc. can be better fulfilled
	will help you to identify and draw on your own resources, which are often hidden from you by depression
	considers the effects of therapy or counselling on the people close to you
	knows how to teach you to relax deeply, as this is often a key part of treatment for depression and can result in quick relief from symptoms
	helps you think about your problems in a new and more empowering way, rather than just listening to you talk about them
	may ask you to do tasks between sessions
	will take as few sessions as possible, and will check with you regularly about how you think things are progressing
	will keep track of your progress and report to you regarding it regularly
	aims to increase your self confidence and independence
	is someone you can trust and get on with!

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MAJOR DEPRESSION is a huge problem and it is growing. By looking at the statistics we can clear up common misconceptions and make it easier to tackle major depression at its root.

Major depression is the No.1 psychological disorder in the western world.  It is growing in all age groups, in virtually every community, and the growth is seen most in the young, especially teens. At the rate of increase, it will be the 2nd most disabling condition in the world by 2020, behind heart disease.

The escalation in the problem, as well as the facts relating to recurring episodes of depression show that while the first line treatment of depression by antidepressants may sometimes control the symptoms, it usually does little to give sufferers depression-free lives.

More than ever, we need to look at alternatives to drugs that will equip us to deal effectively with the triggers that allow depression to take hold again and again. This is where drug treatments fail.

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First and foremost, clinical or major depression is growing at an incredible rate.

	People of all ages, backgrounds, lifestyles, and nationalities suffer from major depression, with a few exceptions.
	Up to 20% of people experience symptoms of depression.
	10 times more people suffer from major depression now than in 1945 (2)
	The average age of first onset of major depression is 25-29

A few key areas of society remain where major depression is not seen. Also, the huge increase in cases of major depression show that it can't be a disease.

Key Understanding   There is 10 times more major depression in people born after 1945 than in those born before. This clearly shows that the root cause of most depression is not a chemical imbalance.   Human genes do not change that fast.

Yet, it is estimated 35 to 40 million Americans living today will suffer from major depression at some time during their lives, with about half of this amount suffering from recurring depression symptoms.

This isn't due to more people telling their doctor. In fact, a major issue when considering the effect of major depression on society as a whole is the amount of misdiagnosis, or cases where major depression goes undiagnosed.

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If you have been feeling down, or out-of-sorts, your thoughts can easily turn to whether you are depressed or not. This first section will take you through the signs of depression and how depression is diagnosed.

However, whether you 'fit' the depression diagnosis or not is unimportant. If you are feeling so down that you need to do something about it, that is enough.

Usually, our clients report one or more of the following:

	Exhaustion on waking
	Disrupted sleep, sometimes through upsetting dreams
	Early morning waking and difficulty getting back to sleep
	Doing less of what they used to enjoy
	Difficulty concentrating during the day
	Improved energy as the day goes on
	Anxious worrying and intrusive upsetting thoughts
	Becoming emotional or upset for no particular reason
	Shortness of temper, or irritability

Not all people have all of these, and some have different signs, but if you are depressed, at least some of these will probably ring true with you.

The individual signs of depression - the way you feel - are what are used in diagnosing depression. So it's easy to see why there is so much confusion, seeing as the signs are generally common emotions and feelings.

There are also physical effects of depression, which we'll come to later.

Only a qualified doctor or health practitioner can formally diagnose you with clinical depression. However, how they reach this diagnosis gives an incredibly important insight into how to treat depression.

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Screening for depression is becoming more common, as we begin to realize how much is left undiagnosed. So let's look now at how clinical depression is normally diagnosed.

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According to the definitions of most medical, psychological and psychiatric bodies, there is a commonality in the diagnosis of depression. Most depression tests have a very similar framework.

Almost without exception, clinical depression will be diagnosed if a certain number of feelings, that are signs of depression, are present over a certain period of time

Below is the 'official' guide for diagnosing clinical depression:

A person can be diagnosed as suffering from clinical depression if:

1. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

• depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood.
• markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)
• significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains.
• insomnia or hypersomnia nearly every day
• psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
• fatigue or loss of energy nearly every day
• feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)
• diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)
• recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

2. The symptoms do not meet criteria for a Mixed Episode.
3. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
4. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).

The symptoms are not better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.

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OK, so that's what the doctors use. But if we look at E, it raises some interesting questions.

It says that clinical depression can be diagnosed if the symptoms cannot be attributed to bereavement. So, since grieving is a natural response, we can see that depression is simply an out-of-place natural response.

And of course it is. If it were not, we would have to take drugs to create it.

So what about the incredibly popular idea that depression is due to some unnatural chemical imbalance in the brain? That this 'imbalance' is the source and root cause of depression?

It's possible, but it just doesn't make sense for the majority of cases. And when we look at the increase in depression over the last 50 years or so, we will see that our brain chemistry just can't change that quickly.

Key Understanding   Most depression is not due to a chemical imbalance, or genetic factors. Low serotonin levels are a result, not a cause, of depression. Despite the prevailing ideas for the last few decades, this is now known to be a fact.   This misunderstanding is also the reason why drugs for depression miss the point, and treat the symptoms instead of the causes.

Understanding this is one of the keys to understanding depression itself.

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If you are depressed at the moment some of the following symptoms may sound familiar:

	You feel miserable and sad.
	You feel exhausted a lot of the time with no energy.
	You feel as if even the smallest tasks are sometimes impossible.
	You seldom enjoy the things that you used to enjoy-you may be off sex or food or may 'comfort eat' to excess.
	You feel very anxious sometimes.
	You don't want to see people or are scared to be left alone. Social activity may feel hard or impossible.
	You find it difficult to think clearly.
	You feel like a failure and/or feel guilty a lot of the time.
	You feel a burden to others.
	You sometimes feel that life isn't worth living.
	You can see no future. There is a loss of hope. You feel all you've ever done is make mistakes and that's all that you ever will do.
	You feel irritable or angry more than usual.
	You feel you have no confidence.
	You spend a lot of time thinking about what has gone wrong, what will go wrong or what is wrong about yourself as a person. You may also feel guilty sometimes about being critical of others (or even thinking critically about them).
	You feel that life is unfair.
	You have difficulty sleeping or wake up very early in the morning and can't sleep again. You seem to dream all night long and sometimes have disturbing dreams.
	You feel that life has/is 'passing you by.'
	You may have physical aches and pains which appear to have no physical cause, such as back pain.

It's this wealth of depression symptoms, and the broad scope that confuses many people as to what depression actually is. Explanations rarely cover all the symptoms, and everybody's experience is different.

The idea that depression can simply be treated as a chemical imbalance is rapidly losing ground.

Therefore, the first incredibly important stage of getting help for depression is to understand what depression is.

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If you are, or have been depressed, you may have noticed that you ruminate, or worry a lot during those periods. Typically, these ruminations are emotionally-arousing. That is, you have a thought and you feel unpleasant after it - anxious, angry or helpless.

The trouble with this sort of emotional arousal is that it doesn't do anything. The thought creates the emotional reaction (usually anxiety or anger) and that is it.

What this does is leave an uncompleted 'loop' in the brain's limbic (emotional) system.

Normally, the emotion would be 'played through' by action being taken. For example: You think "That's a tiger in the bushes", feel anxious, then run away. The cycle has been completed. Or, someone annoys you, you shout at them, and the cycle is completed.

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When these emotionally arousing introspections remain incomplete at the onset of sleep then the brain needs to 'do something' with the emotional 'loops' that have been started.

What it does is create scenarios that allow those loops to complete. We call them dreams. The dream acts out, in metaphor, a situation that will allow the emotional loop to be completed and therefore 'flushed' from the brain. In other words, an imaginary experience whose pattern resembles the 'real life' one enough to create the same emotional reaction.

Normally, this does its job, and everything stays in balance.

Key Understanding   Dreams and Depression   When unfulfilled emotional arousal remains in the brain's limbic system at sleep onset, the brain creates scenarios that allow those loops to complete. We call them dreams. The dream acts out, in metaphor, a situation that will allow the emotional loop to be completed and therefore 'flushed' from the brain. In other words, an imaginary experience whose pattern resembles the 'real life' one closely enough to create the same emotional reaction.   For example, during the day you worry about what someone has said to you, thinking that they were perhaps criticising or making fun of you. That night you have an anxiety dream where someone stabs at you with daggers and you try to run away. The dream allows your system to complete the loop started by the emotional arousal.

However, because you do so much more ruminating, or introspecting, when depressed, the brain has to increase the amount of dreaming you do. And before long you are:

1. Spending too much time in dream sleep (Rapid Eye Movement - REM) and missing out on physically-rejuvenating Slow Wave Sleep.
   
2. Depleting your hormonal system with extended night-time emotional arousal.
   
3. Exhausting your 'orientation response' - a crucial brain activity that allows you to change your focus of attention and so motivate yourself. It is also a key part of concentration.
    

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If you are continuously having the same problems or ruminating in the same way then you may experience recurring dreams (the same dream over and over). This usually continues until the situation changes or you begin to deal with it in a less negatively arousing way.

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Dreams exaggerate the feelings they represent from waking life, so even if you have just had a fleeting moment of anger at someone during the day, the dream that flushes this out may involve you becoming furious.

As an aside, dreams usually just 'borrow' imagery from your surroundings.
So, for example, images from a recent T.V program may be used by the dream when representing something from real life. So the fact that you kill your brother in a dream, for example, doesn't necessarily mean you have any problems with your brother at all!

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Depressive thinking styles will tend to cause more negative emotional arousal, and therefore more dreaming. This extra dreaming is to try to 'clear the brain' for the next day, but because our negative arousals are excessive when depressed, our natural rhythms find it hard to cope with this "over-dreaming"

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Basically because dreaming is hard work.

Dreaming itself is not a restful activity. Dreaming is called 'paradoxical sleep' because brain wave patterns are similar to those of the brain when completely awake.

Dreaming is a state of arousal.

As far as much of your brain is concerned, your dream is real. So adrenaline and other stress hormones in your system will be active in the body.

This is a double edged sword, because over-dreaming, as well as using up these hormones and energy, is actually making it harder for the body to make more. As you try to flush out the incomplete emotions, you spend more time in REM sleep, and therefore less time in deep sleep, when your body should be recuperating in preparation for producing these hormones for the next day.

So if you are over-dreaming you're not resting but flooding your system with adrenaline and other stress hormones. If most of your sleep consists of dreams -  your body and mind will begin to feel very tired during the day. Depressed people often report that the worst time of day is first thing in the morning.

Sometimes a depressed person may start waking up early in the morning and not be able to get back to sleep. This may be a way of the body trying to cut down on over-dreaming in order to try and lift depression.

This depletion is also why depressed people often feel at their worst first thing in the morning.

As the day progresses, their hormones replenish themselves and their energy levels increase, and they are better able to motivate themselves.

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(Note: Levels of the stress hormone cortisol are much higher in depressed people.)

And because we can clearly see that what maintains the clinical symptoms of depression is emotionally arousing introspection, or rumination, we know exactly how to deal with it. Cut down the amount of emotional arousal.

To beat depression for good, we have to break the cycle in as many places as possible, and stop it from re-forming.

As depression progresses, we get locked into a trance-like state - as we become emotionally aroused with negative emotions, our brain treats this arousal as a traditional 'threat' and reverts more to ' All or Nothing thinking' reducing our possible outcomes even further.

	The more emotionally-arousing, negative thinking we do, the more we dream.
	As the excessive dreaming causes more REM sleep, meaning less deep sleep, we become exhausted.
	The more exhausted we are the more we are likely to interpret reality in depressing ways.
	The cycle continues by finally affecting our immune systems, and periods of repair and re-growth we undergo in deep sleep, affecting our health, which can only add to depression.

Only when we understand the connection between emotional arousal, dreaming and exhaustion does the true essence of depression become clear.

From this understanding we can clearly understand the physical effects of depression, why they happen and how to prevent them...

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