Today I feature some facts about a scourge of the modern world - DEPRESSION. I do hope it helps someone.
WHAT IS IT?
While we all feel sad, moody or low from time to time, some people experience these feelings intensely, for long periods of time (weeks, months or even years) and sometimes without any apparent reason. Depression is more than just a low mood – it's a serious illness that has an impact on both physical and mental health.
WHAT CAUSES IT?
While the exact cause of depression isn't known, a number of things can be associated with its development. Generally, depression does not result from a single event, but from a combination of recent events and other longer-term or personal factors.
Research suggests that continuing difficulties – long-term unemployment, living in an abusive or uncaring relationship, long-term isolation or loneliness, prolonged exposure to stress at work – are more likely to cause depression than recent life stresses. However, recent events (such as losing a job) or a combination of events can ‘trigger' depression in people who are already at risk because of past bad experiences or personal factors.
- Family history – Depression can run in families and some people will be at an increased genetic risk. However, this doesn't mean that a person will automatically experience depression if a parent or close relative has had the illness. Life circumstances and other personal factors are still likely to have an important influence.
- Personality – Some people may be more at risk of depression because of their personality, particularly if they have a tendency to worry a lot, have low self-esteem, are perfectionists, are sensitive to personal criticism, or are self-critical and negative.
- Serious medical illness – Having a medical illness can trigger depression in two ways. Serious illnesses can bring about depression directly, or can contribute to depression through associated stress and worry, especially if it involves long-term management of the illness and/or chronic pain.
- Drug and alcohol use – Drug and alcohol use can both lead to and result from depression. Many people with depression also have drug and alcohol problems. Over 500,000 Australians will experience depression and a substance use disorder at the same time, at some point in their lives.
CHANGES IN THE BRAIN
Changes in brain chemistry have been more commonly associated with severe depression rather than mild or moderate depression.
Everyone is different and it's often a combination of factors that can contribute to a person developing depression. It's important to note that you can't always identify the cause of depression or change difficult circumstances. The most important thing is to recognise the signs and symptoms and seek help.
TYPES OF DEPRESSION
There are different types of depressive disorders. Symptoms can range from relatively minor (but still disabling) through to very severe, so it is helpful to be aware of the range of disorders and their specific symptoms.
Major depression is sometimes called major depressive disorder, clinical depression, unipolar depression or simply depression. It involves low mood and/or loss of interest and pleasure in usual activities, as well as other symptoms such as those described here. The symptoms are experienced most days and last for at least two weeks. The symptoms interfere with all areas of a person's life, including work and social relationships. Depression can be described as mild, moderate or severe; melancholic or psychotic (see below).
This is the term used to describe a severe form of depression where many of the physical symptoms of depression are present. One of the major changes is that the person can be observed to move more slowly. The person is also more likely to have a depressed mood that is characterised by complete loss of pleasure in everything, or almost everything.
Sometimes people with a depressive disorder can lose touch with reality and experience psychosis. This can involve hallucinations (seeing or hearing things that are not there) or delusions (false beliefs that are not shared by others), such as believing they are bad or evil, or that they are being watched or followed. They can also be paranoid, feeling as though everyone is against them or that they are the cause of illness or bad events occurring around them.
Antenatal and postnatal depression
Women are at an increased risk of depression during pregnancy (known as the antenatal or prenatal period) and in the year following childbirth (known as the postnatal period). You may also come across the term 'perinatal', which describes the period covered by pregnancy and the first year after the baby's birth.
The causes of depression at this time can be complex and are often the result of a combination of factors. In the days immediately following birth, many women experience the 'baby blues' which is a common condition related to hormonal changes, affecting up to 80 per cent of women. The 'baby blues', or general stress adjusting to pregnancy and/or a new baby, are common experiences, but are different from depression. Depression is longer lasting and can affect not only the mother, but her relationship with her baby, the child's development, the mother's relationship with her partner and with other members of the family.
Almost 10 per cent of women will experience depression during pregnancy. This increases to 16 per cent in the first three months after having a baby.
Bipolar disorder used to be known as 'manic depression' because the person experiences periods of depression and periods of mania, with periods of normal mood in between.
Mania is like the opposite of depression and can vary in intensity – symptoms include feeling great, having lots of energy, having racing thoughts and little need for sleep, talking fast, having difficulty focusing on tasks, and feeling frustrated and irritable. This is not just a fleeting experience. Sometimes the person loses touch with reality and has episodes of psychosis. Experiencing psychosis involves hallucinations (seeing or hearing something that is not there) or having delusions (e.g. the person believing he or she has superpowers).
Bipolar disorder seems to be most closely linked to family history. Stress and conflict can trigger episodes for people with this condition and it's not uncommon for bipolar disorder to be misdiagnosed as depression, alcohol or drug abuse, Attention Deficit Hyperactivity Disorder (ADHD) or schizophrenia.
Diagnosis depends on the person having had an episode of mania and, unless observed, this can be hard to pick. It is not uncommon for people to go for years before receiving an accurate diagnosis of bipolar disorder. It can be helpful for the person to make it clear to the doctor or treating health professional that he or she is experiencing highs and lows. Bipolar disorder affects approximately 2 per cent of the population.
Cyclothymic disorder is often described as a milder form of bipolar disorder. The person experiences chronic fluctuating moods over at least two years, involving periods of hypomania (a mild to moderate level of mania) and periods of depressive symptoms, with very short periods (no more than two months) of normality between. The duration of the symptoms are shorter, less severe and not as regular, and therefore don't fit the criteria of bipolar disorder or major depression.
The symptoms of dysthymia are similar to those of major depression but are less severe. However, in the case of dysthymia, symptoms last longer. A person has to have this milder depression for more than two years to be diagnosed with dysthymia.
Seasonal Affective Disorder (SAD)
SAD is a mood disorder that has a seasonal pattern. The cause of the disorder is unclear; however it is thought to be related to the variation in light exposure in different seasons. It's characterised by mood disturbances (either periods of depression or mania) that begin and end in a particular season. Depression which starts in winter and subsides when the season ends is the most common. It's usually diagnosed after the person has had the same symptoms during winter for a couple of years. People with Seasonal Affective Disorder depression are more likely to experience lack of energy, sleep too much, overeat, gain weight and crave for carbohydrates. SAD is very rare in Australia and more likely to be found in countries with shorter days and longer periods of darkness, such as in the cold climate areas of the Northern Hemisphere.
Remember, depression is treatable and effective treatments are available. The earlier you seek help, the better.
SIGNS AND SYMPTOMS
Depression affects how people feel about themselves. They may lose interest in work, hobbies and doing things they normally enjoy. They may lack energy, have difficulty sleeping or sleep more than usual. Some people feel irritable and some find it hard to concentrate. Depression makes life more difficult to manage from day to day.
A person may be depressed if, for more than two weeks, he or she has felt sad, down or miserable most of the time or has lost interest or pleasure in usual activities, and has also experienced several of the signs and symptoms across at least three of the categories below.
It’s important to note that everyone experiences some of these symptoms from time to time and it may not necessarily mean a person is depressed. Equally, not every person who is experiencing depression will have all of these symptoms.
- not going out anymore
- not getting things done at work/school
- withdrawing from close family and friends
- relying on alcohol and sedatives
- not doing usual enjoyable activities
- unable to concentrate
- lacking in confidence
- 'I’m a failure.'
- 'It’s my fault.'
- 'Nothing good ever happens to me.'
- 'I’m worthless.'
- 'Life’s not worth living.'
- 'People would be better off without me.'
- tired all the time
- sick and run down
- headaches and muscle pains
- churning gut
- sleep problems
- loss or change of appetite
- significant weight loss or gain
If you think that you, or someone you know, may have depression, there is a quick, easy and confidential checklist you can complete to give you more insight. The checklist will not provide a diagnosis – for that you need to see a health professional.
The encouraging news is that there is a range of treatments, health professionals and services available to help with depression, and there are many things that people with depression can do to help themselves.
There is no one proven way that people recover from depression. However, there is a range of effective treatments and health professionals who can help people on the road to recovery.
There are also many things that people with depression can do for themselves to help them recover and stay well. The important thing is finding the right treatment and the right health professional for the individual's needs.
Psychological treatments (also known as talking therapies) help people with depression to change negative patterns of thinking and improve their coping skills so they are better equipped to deal with life's stresses and conflicts. Psychological therapies may not only help a person to recover, but can also help to prevent the depression from reoccurring.
There are several types of psychological treatments shown to be effective in the treatment of depression:
Cognitive behaviour therapy (CBT)
CBT is a structured psychological treatment which recognises that a person's way of thinking (cognition) and acting (behaviour) affects the way they feel. CBT is one of the most effective treatments for depression, and has been found to be useful for a wide range of people, including children, adolescents, adults and older people.
In CBT, a person works with a professional (therapist) to identify the patterns of thought and behaviour that are either making them more likely to become depressed, or stopping them from improving once they become depressed.
CBT has an emphasis on changing thoughts and behaviour by teaching people to think rationally about common difficulties, helping them to shift their negative or unhelpful thought patterns and reactions to a more realistic, positive and problem-solving approach.
CBT is also well-suited to being delivered electronically (often called e-therapies).
Interpersonal therapy (IPT)
IPT is a structured psychological therapy that focuses on problems in personal relationships and the skills required to deal with these problems. IPT is based on the idea that relationship problems can have a significant impact on a person experiencing depression, and can even contribute to the cause.
IPT is thought to work by helping people to recognise patterns in their relationships that make them more vulnerable to depression. Identifying these patterns means they can focus on improving relationships, coping with grief and finding new ways to get along with others.
Behaviour therapy is a major component of cognitive behaviour therapy (CBT), but behaviour therapy focuses exclusively on increasing a person's level of activity and pleasure in their life. Unlike CBT, it does not focus on changing the person's beliefs and attitudes. Instead it focuses on encouraging people to undertake activities that are rewarding, pleasant or give a sense of satisfaction, in an effort to reverse the patterns of avoidance, withdrawal and inactivity that make depression worse.
Mindfulness based cognitive therapy (MBCT)
MBCT is generally delivered in groups and involves learning a type of meditation called 'mindfulness meditation'. This meditation teaches people to focus on the very present moment, just noticing whatever they are experiencing, be it pleasant or unpleasant, without trying to change it. At first, this approach is used to focus on physical sensations (like breathing), but later it is used to focus on feelings and thoughts.
MBCT helps people to stop their mind wandering off into thoughts about the future or the past, or trying to avoid unpleasant thoughts and feelings. This is thought to be helpful in preventing depression from returning because it allows people to notice feelings of sadness and negative thinking patterns early on, before they have become fixed. It therefore helps the person to deal with these early warning signs better.
To find out about other psychological treatment approaches and the level of evidence behind them, download A guide to what works for depression.