Depression

 

What is depression?

Depression is an illness that makes you feel sad and miserable over a long period of time. It is a physical illness on a molecular level: the balance of different chemicals in the brain is disrupted, causing symptoms expressed through the mind (thinking), and the emotions (feeling).

People who are depressed have difficulty coping with everyday life and may even feel suicidal. Depression is associated with a wide range of symptoms and can be treated.

Depression is categorised into different types: reactive, endogenous, manic, and psychotic being the major divisions. These categories are less important than recognising the illness and getting help.

Depression is an illness which can affect anyone at any age; being depressed does not mean madness or insanity.

What causes it?

The changes in brain chemistry which cause depression can occur 'out of the blue', but more commonly are triggered by stressful or traumatic life events. Examples of these events fall broadly into three areas, which affect most people: money, employment, relationships (including bereavement).

Other illnesses may bring on depression. A special type of depression, Seasonal Affective Disorder (SAD), is caused by low levels of exposure to sunlight during wintertime.

 

Who gets it?

Anyone can get depressed at any time in their lives. Some people seem to be more prone to it than others, either because of previous life events, previous depression, or because they're just made that way (genetic predisposition). 5% of the population suffer depression at any one time. Women are twice as likely as men to get it, particularly after childbirth (as many as 85% of women have some type of mental illness just after childbirth, and around the menopause).

A number of famous, talented and highly successful people have suffered from depression, including Winston Churchill, who called it his "Black Dog" (even in the nursery, his nanny noticed his episodic grim moods of hopelessness, and likened it to a "Black dog on his back"). Contemporaries include John Cleese, Spike Milligan, and the late Kenny Everett.

 

What are the symptoms?

These are cognitive (to do with the thinking mind), and emotional. The commonest ones are:

  • persistently low mood and tearfulness, (often without any obvious trigger)
  • loss of sex drive
  • overwhelming fatigue by day, but inability to go off to sleep at night, often with frequent waking and finally waking unusually early
  • increased or decreased appetite and weight
  • feeling sluggish and slowed up yet often having a sense of agitation and restlessness
  • sense of unreality and detachment from life
  • low self-esteem, with an irrational cloud of guilt hanging over one's head the whole time, perpetuating the feelings of worthlessness
  • lack of drive, motivation, and loss of interest in usual pleasures with an inability to enjoy anything much at all
  • forgetfulness and poor concentration
  • bursts of anger and impatience
  • unexplained and niggling physical aches and pains and the fear that they may represent something serious
  • feeling that life is not worth living, even to the point of wishing self harm or oblivion by suicide.
 

What can help?

1 - Recognising that there is a problem

This is a major hurdle, especially for men, who are often trained through gender stereotyping to keep a "stiff upper lip" and tend to bottle up negative emotions. The same applies to a lesser extent to women.

Shame, guilt and low self-esteem can result from the mistaken belief that to express pain is a sign of character weakness, but these feelings are in fact symptoms of the illness.

The effect of burying the anguish of depression is very destructive and fuels the illness, leading the sufferer down a vicious spiral.

2 - Getting help

Non-drug therapy

Formal help through talking (as opposed to a chat with a friend or relative, which is very valuable but has limits to its usefulness) takes two forms:

Cognitive Behaviour Therapy (CBT)

Is becoming increasingly recognised as a valuable tool in treating depression. It is essentially a way of changing low mood and the consequent behaviour by modifying the underlying negative thoughts. It is very much a way of treating the cause rather than just dealing with symptoms.

Psychotherapy

Aims to deal with unresolved conflicts arising from negative past experiences which are at the roots of a particular person's illness. It requires considerable commitment and time for both therapist and client.

Tablets

Drug therapy most definitely has a useful place in treatment. It acts to restore the imbalances of brain chemicals which arise in depression. This in itself can make the sufferer feel sufficiently well to be able to start to deal with the root causes of the illness.

It can be difficult to think at all in a depressive illness, and the great value of drug treatment is that it can help the sufferer function again as a human being, with clear thought and balanced emotions.

Antidepressants are not:

  • addictive or habit-forming
  • "tranquillisers"
  • a cop-out

There are four main classes of antidepressants: Tricyclics (and Tetracyclics), SSRI's (Selective Serotonin Reuptake Inhibitors), MAOI's (Monoamine Oxidase Inhibitors), and Lithium. Each has its own value and place, and its own set of side-effects. Discuss these in full with your own doctor so you know what to expect when you start a particular choice of treatment.

Hospitals

Treatment in hospital is by the methods above, with the added benefit of rest from the trials of everyday life through being in a place of safety with nursing care, and the option of ECT (Electroconvulsive Therapy) which is very successful in severe depression which is resistant to the other methods.

3 - Helping yourself

  • Relaxation tapes, yoga, transcendental meditation and aromatherapy are some techniques which can unwind tension and reduce stress.
  • Physical exercise stimulates the brain positively, and promotes physical relaxation and a sense of well-being.
  • Adjust the pace of life to make goals realistically achievable and increase the sense of control over destiny.
  • Eat a well-balanced, healthy diet.
  • Avoid mood-altering substances: tobacco, alcohol, cannabis and stronger drugs actually feed depression and the short-term high acts as a diversion from the important issues.
  • Join a self-help group (see below).

4 - Complementary therapies

Other forms of therapy exist which can be used in addition to those described above although it is best to discuss these with the GP to make sure they are appropriate for the patient and their particular circumstances. For instance many people find art or music therapy helpful in expressing their deep feelings sometimes more easily than by talking. Aromatherapy and relaxation can also help, especially with the anxiety symptoms which many people with depression suffer from. Homeopathic medicines can help some sufferers as can hypnotherapy but again these avenues are best discussed first with the individual's GP.

 

Care for the carers

If you are caring for a depressed loved one, then you too are facing particular strains. Get support. You will need time, energy and a strong ego. Talking to a mental health professional can be invaluable. You will need to set reasonable boundaries for your own involvement, avoid guilt feelings, and hold on to the strands of your own life.

Remain hopeful: the overall recovery rate for all depressives who receive full treatment is now around 95%.

 

Where can I get further information?

Apart from contacting your own GP, the following organisations may be of help:

Depression Alliance
212 Spitfire Studios
63-71 Collier Street
London
N1 9BE
Telephone: 0845 123 2320
Website: www.depressionalliance.org

Seasonal Affective Disorder (SAD) Association (UK)
PO Box 989
Steyning
West Sussex
BN44 3HG
Website: www.sada.org.uk

The Association for Postnatal Illness
145 Dawes Road
Fulham
London
SW6 7EB
Telephone: 020 7386 0868
Email: info@apni.org
Website: www.apni.org

The British Association for Counselling
BACP House
15 St. John's Business Park
Lutterworth
Leicestershire
LE17 4HB
Telephone (Reception/General Enquiries): 01455 883 300
Email: bacp@bacp.co.uk
Website: www.bacp.co.uk

MIND (National Association for Mental Health)
15-19, Broadway,
Stratford
London
E15 4BQ
Telephone: 0208 519 2122
Mind Info Line: 08457 660163
Email: contact@mind.org.uk
Website: www.mind.org.uk

Depression UK
C/O Self help Nottingham
32-36 Pelham Street
Nottingham
NG1 2EG
Email: info@depressionuk.org