Depression

Posted on Updated on

Depression: easy access to information you can trust about common mental health problems, whether for yourself or to help family or friends understand

Depression is a formless sadness, an overwhelming or underlying dread that will not lift. It is often accompanied by fatigue that does not change regardless of how much sleep you get. Oftentimes, you can also have fitful sleep, with unusual dreams, early-morning waking. Interest in things you once found enjoyable drops dramatically, and you feel pretty worthless and uninteresting to other people so you might withdraw from contact with others.  To cap this off, you often either don’t eat, or eat more, and you find yourself asking what is the point.  You can also be more touchy than usual, and take offence more easily.  You may also resort to alcohol or other drugs to self-medicate.  It also typically very difficult to concentrate or make decisions.

There is also cultural stigma, in particular felt by men/young adolescent/adult males who feel they have little permission to feel, let alone express or process sadness or vulnerability.

Social media can also be a difficult place to communicate with others when feeling low in mood.

Causes of depression. This is complicated and is due to a range of biological, psychological and social factors. Dr Aaron Beck, the developer of Cogntive Behaviour Therapy (CBT) believes a person becomes depressed after their thoughts turn negative, and he has a developed a therapy which examines, and restructures thoughts as well activating behaviour (i.e. taking action) to feel better.

There is not much worse for a depressed person to hear that to “just get over it”, even when this is coming from “a good place”.

People who get depressed often have a family history of mood disorders &/or suicide. Other stressors (things which happen to people) can also lead to depression: for e.g. war, social upheaval, being a refugee, experiencing violence/aggression, emotional &/or sexual abuse, domestic violence, losing employment etc.,

It is believed to stem from both Nature and Nurture, and there is a strong genetic link to depression (giving a person a “vulnerability” to depression), and when an adverse event occurs – such as losing a family member, losing employment, (and those already described), this adverse event can “switch-on” a depressive response and illness.

Diagnosis of depression therefore looks at the range of biological, psychological and social factors relevant to the person. Things here include: family history, physical health, illnesses, way you think, your coping style, your emotional responses, and things in your life like trauma, abuse, poverty, bullying etc., that may be connected to the person’s depression.

Risk and protective factors for depression (Australian Institute of Health and Welfare)[1]

Risk factors Protective factors
Environmental and Social
Poverty | unemployment

Family discord (relationship break-up, conflict, poor parenting practices)

Parental mental illness

Child abuse (physical and sexual; neglect)

Exposure to adverse life events (bereavement, family separation, trauma, family illness)

Caring for someone with a chronic physical or mental disorder

Being in residential care (older adults)

Good interpersonal relationships (supportive relationship with at least one person/parent; perceived social support)

Family cohesion (positive parent-child relations)

Social connectedness

Academic/sporting achievements

Biological and psychological
Parental mental disorder and family history of depression

Being a female adolescent

High trait anxiety and pre-existing anxiety disorders, substance misuse, conduct disorder

Temperament – reacting negatively to stressors; personality trait of neuroticism

Negative thought patterns (pessimism, learned helplessness)

Avoidance coping style

Easy-going temperament

Optimistic thought patterns

Effective coping skills (social and problem-solving skills)

 

In any given year, approximately one million Australians experience a mood disorder, with it most commonly occurring in the age range: 24 to 44 years.  In particular, 4.1% of Australians annually are diagnosed with depression, and mood disorders are more common in women than men. 1 in 7 Australians will experience depression at some point in their life.

Many of the symptoms of depression – when considered in isolation – are a part of life; however, depression often presents with a cluster of symptoms and is defined as persistent low mood lasting more than two weeks with early morning waking, mood worse at a particular time of day, loos of pleasure in almost everything et.,:

  • Emotional
    • Pervasive sadness
    • Irritability
    • Low mood
    • Loss of enjoyment/pleasure
    • Being aggressive/angry
  • Thoughts (cognitive)
    • Worrying
    • Feeling worthless
    • Feeling hopeless
    • Thinking about death frequently
    • Guilt/self-blame
    • indecision
  • Physical
    • Can’t concentrate
    • Fatigue/low energy nearly every day
    • Significant change in weight/appetite (up or down)
    • Difficulty sleeping
    • More sensitive to pain
    • Agitation/being slowed down
  • Social
    • Withdrawing/deliberately isolating oneself

Diagnosing Depression looks at the context for what else is going in your life. Such as death of a family member (the experience of depression and bereavement can be very similar). Grief – however, – comes in waves, with positive memories of the person you have lost, whereas depression is more pervasive and is accompanied by feelings of worthlessness (which is not typically associated with people who are grieving).

The latest DSM (Diagnostic and Statistical Manual) has removed the bereavement exclusion.  In the previous version of the manual, this meant a person could not be diagnosed with major depression within two months of the death of a loved one.

Another cause of depression is a new medication (such as anti-hypertension medication, hepatitis medication or steroids are all acknowledge to in certain cases cause depressed mood) that you are taking for another physical condition, or depression caused by a recent illness. Thorough medical examination is therefore vital.

Australian research shows that people who have depression, miss on average 6 days of work per month because of their condition[2].

There are many different coping styles:

  • Some people may continue to go out and see friends, but they are regularly in tears when alone.
  • Some people may cut themselves off socially while otherwise coping fine.
  • Some people might feel angry and irritable with the world a lot of the time.
  • Some people may drink more than they usually do – in an effort to feel better and cope
  • [what is common to all is a sustained change in someone’s behaviour, or how they interact with friends and family]

Depression shows itself in having:

  • depressive thoughts and feelings
  • cognitive and physical problems (how you think, remember things, talk and write; concentration difficulties; memory problems; not feeling refreshed after sleep & or not having as much sleep – in particular, waking earlier and not being able to go back to sleep; lose weight/lose interest in food)

Depression is very treatable and treatment also involves looking at your lifestyle (eating better, stopping alcohol and exercising, including stress reduction exercises and meditation).  Talking therapy (such as CBT) is also very useful, and in severe cases, medication such as anti-depressants (to lift mood, help with sleep & energy levels & enable functioning) is also very useful, while monitoring with your GP for side-effects.

What is CBT? It is about getting to know how you think.  It is based on Beck’s observation that people with depression have streams of apparently spontaneous or automatic negative thoughts. CBT helps a person with depression identify these negative thoughts and work out how realistic they are – to assess them objectively – so that they feel better and can function better. People with depression will often “catastrophise” events in their life, and expect the worst (either in a situation or about how other people will think of them) – CBT helps people understand this thinking is not fact-based. People are given “homework” – like keeping a sleep diary, and a journal of their negative thoughts.

Source: Cross & Hanrahan (2016).

[1] Just because a person has experienced some of these risks, does not necessarily mean that a person will develop depression.

[2] Department of Health and Ageing.

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s