Depression is a disorder that is evidenced by excessive sadness, loss of interest in enjoyable things, and low motivation. It is normal to experience feelings of sadness and despair in response to adverse life events. Such events could include loss, major life changes, stress, or disappointment. In most cases, the sad feelings resolve as you come to terms with the changes in your life. In situations such as bereavement, these feelings may persist for months and return at significant times, such as birthdays and anniversaries related to the lost loved one. Provided you have times when you can enjoy things, however, this sadness is not a sign of depression.
Depression is common. One in three people will experience a major depressive episode at some stage in their lives. While most cases of depression are mild, about one person in ten will have a moderate or severe episode.
What Are The Signs Of Depression? The features of depression include:
A. Psychological Symptoms:
i. Feeling miserable. This misery is present for much of the day but may vary in its intensity. The misery lasts for weeks.
ii. Loss of interest or pleasure in usual activities.
iii. Slowed or inefficient thinking with poor concentration, leading to difficulties sorting out problems or making plans or decisions.
iv. Recurring unpleasant thoughts, particularly about being guilty, being a bad and unworthy person.
v. Thoughts that you would be better off dead or of harming yourself in some way.
B. Physical Symptoms:
i. Loss of appetite with excessive loss of weight.
ii. Loss of interest in sex.
iii. Loss of energy, even when not physically active.
iv. Loss of sleep despite feeling exhausted. Sleep is typically restless and unsatisfying with early morning wakening (one to two hours earlier than usual). Some people, however, may actually sleep a lot more than usual.
v. Slowed activity and speech.
vi. Any of these features may serve as warning signs of depression. You need to exhibit at least five of these symptoms to be suffering with a depressive disorder.
What Causes Depression?
No one knows exactly what causes depression. It is clear that genetic factors are important in many cases of depression. Depression seems to run in families (as do other mood disorders), and about 30% of the predisposition for depression is due to genetic influences.
Stressful life events play a part in the onset or relapse of depression. Ongoing conflicts with others can take their toll on our well-being, as can other social and environmental stressors such as financial difficulties, retirement, unemployment, childbirth, loneliness, or loss of someone or something important. In vulnerable people, these unpleasant life events may be enough to cause or worsen a depressive illness. A persons personality characteristics are an important factor. When people are depressed, they usually have a very negative view of themselves and the world. They do not appreciate good things, and bad things seem overwhelming. Some people have a tendency to view things this way even when they are not depressed. In other words, they may have a depressive personality style.
Another possible cause of depression that should not be overlooked is physical illness or medications. Glandular fever, influenza, hepatitis, thyroid hormones, anaemia, diabetes, birth control pills, alcohol and other substances of abuse, or other medications such as those for heart or blood pressure conditions, may all cause symptoms of depression.
HOW TO DEAL WITH DEPRESSION
There are a range of ways to deal with depression, and often they are best used in conjunction with each other. The primary medical options are Cognitive Behavioural Therapy (CBT), antidepressant medication, and in some severe cases, Electroconvulsive Therapy (ECT). Education and coping strategies are also important when learning to manage your depression.
A. Cognitive Behavioural Therapy (CBT)
CBT is an excellent treatment for depression, alone or in conjunction with medication. CBT involves learning: i. to control the negative thoughts that lead to loss of interest and feelings of worthlessness; ii. to combat the emotions of sadness and hopelessness, and; iii. Loss of energy, even when not physically active. iv. to counteract the behaviours related to poor concentration and thoughts of death
Techniques for problem solving are also taught whether the problem is a consequence or cause of the depression. CBT is very effective and 80% of people with mild, moderate or severe depression improve.
CBT will often be recommended when:
i. The depression is mild, moderate, or severe.
ii. The person has had a prior positive response to CBT.
iii. A competent, trained clinician who has expertise in CBT is available, or the person is prepared to use internet CBT.
iv. There is a medical contraindication to taking medications.
v. The depressed person prefers CBT or iCBT.
B. Behavioural Strategies:
A key feature of depression is inactivity. People find that they are doing less and then feel even worse because they are doing less. Behavioural strategies for depression aim to identify and change aspects of behaviour that may worsen depression. People are encouraged to act against the depression by increasing activities, even though this is the last thing that they feel like doing. Relevant behavioural strategies include activity scheduling, social skills training, structured problem solving, and goal planning. One of the advantages of this form of treatment for depression is that once acquired, these new behavioural styles can be applied throughout life, minimising relapse or recurrence of depression.
C. Cognitive Strategies:
People who are depressed will usually show a style of thinking that focuses on negative views of the world. They often think of themselves as worthless and of the world as being a bad or unfair place, and they are without hope that their lives will improve in the future. When something bad happens, they blame themselves, but when good things happen, they tell themselves they are just lucky. Furthermore, people with depression are less likely to recognize and appreciate positive events when they happen; rather, they tend to be more tuned into the bad things in their lives and brood over those events.
The aim of a cognitive approach is to help people identify and correct their distorted and negatively biased thoughts. This approach identifies and challenges underlying assumptions and beliefs. With encouragement to reframe the way they think about life, people are able to recover from failures more effectively and to recognise and take credit for the good things in their lives. People learn that they have some control over what happens to them. As with behavioural strategies, having these skills reduces relapse and recurrence of depression.
For some people, antidepressant medication will be the first line of treatment for the elimination of severely depressed mood. It would be unadvisable to manage very severe depression without a trial of medication. For mild to moderate depression, antidepressant medications are not often recommended as a first line treatment. Different antidepressant medications work in different ways. You may need to trial more than one type to find the medication that works best for you. Make sure to keep in close contact with your prescribing physician during the early stages of taking medication, as the side effects can often be difficult to deal with.
Some things to remember when taking antidepressant medication are:
i. Take the medication daily.
ii. Dont stop the medication without contacting the health professional who prescribed it.
iii. Side effects lessen as your body adjusts. If the side effects dont diminish, or are unreasonable, contact your health professional.
iv. Dont stop the medication when you feel better, or your depression may return.
Electroconvulsive therapy (ECT)
ECT is an effective form of treatment for depression, especially if:
i. there are medical contraindications to medication. ii. there is a need for a rapid improvement because of suicidal intent or refusal to eat; iii. the person has experienced treatment failure following CBT, several medications, or combined medication and CBT treatment trials; iv. the person has had a previous positive response to ECT; v. somatic symptoms are prominent; vi. psychotic symptoms are present;
ECT involves the application of a brief electric current to carefully selected sites on the scalp. These electric currents, which are administered by a psychiatrist and anaesthetist, produce a minor seizure in the brain. Prior to the procedure, the person is given a short-acting general anaesthetic and a muscle relaxant to reduce awareness of the procedure and to prevent a physical seizure.
Although many people are fearful of ECT, this technique is arguably the safest and most effective medical treatment for severe depression although there can be some memory related side effects. ECT is more rapid in its effect than antidepressant drugs, and CBT and antidepressants remain useful adjuncts to treatment since they can help prevent relapse after ECT is completed.
Education for people with depression is extremely valuable. Education provides a knowledge base that potentially gives the person greater control over his or her disorder. Greater control in turn may lead to reduced feelings of helplessness and an increased sense of well-being. Providing education for families or carers is also very important to help increase the support and assistance they provide to the person. The most essential pieces of information for a person with a major depressive episode are that depression is a common disorder and that effective treatments are available. It is important to remember:
i. Depression is an illness, not a sign of weakness or a character defect.
ii. Recovery is the rule, not the exception.
iii. Treatment is effective, and there are many treatment options available. There is a suitable treatment for most people.
iv. The goal of treatment is to get completely well and stay well.
v. The rate of recurrence is quite high: half the people who have had one episode of depression will have a recurrence, and the rate increases with the number of previous episodes.
vi. The person and his or her family can be taught to recognise and act upon early warning signs of depression.By seeking early treatment, the severity of the episode may be greatly reduced.
COPING WITH THE SYMPTOMS OF DEPRESSION
The symptoms of depression can be addressed to help you feel better. Here are some ways to deal with these symptoms.
A. BEHAVIOURAL STRATEGIES:
i. Set goals for daily activity. Plan full days of useful activity by making a list of the activities you are going to engage in at different times during the day. Try to stick to this plan as closely as possible.
ii. What activities do you enjoy? Try to increase the amount of time you spend on these enjoyable activities.
iii. Avoid comparing the way you are behaving or feeling now while you are depressed with the way you used to behave or feel before becoming depressed.
iv. Reward yourself for your efforts. Ask others around you to encourage and praise you for each small step you take. Recovering from depression is a bit like learning to walk again after breaking your leg.
v. If a task seems too difficult, do not despair. Break the task down into even easier steps and start again more slowly.
B. LOSS OF APPETITE
Eat small portions of food that you particularly like. Take your time and do not feel under pressure to finish if you are eating with others. Drink plenty of fluids.
C. SLEEP DISTURBANCE
i. Get up at the same time every morning.
ii. Avoid sleeping during the day.
iii. Reduce tea and coffee intake if excessive (no more than two or three cups per day and none after about 4:00 p.m.).
iv. Do not lie awake for more than about thirty minutesget up and find a relaxing activity.
v. Try relaxation exercises.
D. WORRYING OR INEFFICIENT THINKING
Put your worry to a useful purpose. Rather than endlessly pinpointing your problems, pick out one or two that seem really important and make a decision to resolve them. You may like to ask a friend to help you.
Go through the following steps:
1. Say exactly what the problem (or goal) is.
2. List five or six possible solutions to the problem. Write down any ideas that occur to you, not merely the good ideas.
3. Evaluate the good and bad points of each idea in turn.
4. Choose the solution that best fits your needs.
5. Plan exactly the steps you will take to put the solution into action.
6. Review your efforts after attempting to carry out the plan. Praise all efforts. If unsuccessful, start again.
With assistance, the right treatment, and a solid understanding of the disorder, you can overcome depression.
E. LOSS OF INTEREST IN SEX
Seek nonsexual activities with your partner that you still enjoy. Explain to your partner that your loss of interest and affection is a symptom of your depression, not a rejection of him or her, and that these symptoms will be temporary.
F. MISERABLE FEELINGS, UNPLEASANT THOUGHTS
These negative thoughts and feelings tend to focus your attention on things you do not like about yourself or your life situation. These thoughts also tend to make your problems seem worse than they really are. As well as concentrating on your negative features and experiences, when you are depressed, you tend to underestimate your positive characteristics and your ability to solve problems. A number of strategies may help you achieve a more balanced view of things:
i. Make a list of your three best featuresperhaps with the help of a friend or relative. Carry the list with you and read it to yourself whenever you find yourself focusing on negative thoughts.
ii. Keep a daily record of all the small pleasant things that happen and discuss these events with your friends when you see them.
iii. Recall pleasant occasions in the past and plan pleasant occasions for the future (this may best be done in conversation with a friend).
iv. Consider alternative explanations for unpleasant events or thoughts. Although your initial explanation may be that you are at fault, rethink these conclusions and write down all other possible explanations for these events or thoughts.
v. Keep yourself busy doing useful activities. Avoid sitting or lying about doing nothing.