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DEPRESSION
Depression is one of the most common psychological conditions in Western society. There are various contradictory statistics, as it is not always easy to diagnose depression accurately (see below). However, major depression seems to effect about 6% of the population, whilst as many as 20% experience some form of depression during their lives. Trends suggest that rates of depression are increasing and that they are highest amongst young adults. Women are twice as likely as men to experience clinical depression (men are twice as likely to become alcoholics or abuse drugs). Studies so far show no evidence of significant differences in the occurence of depression in different ethnic groups, whereas there is evidence of higher rates of occurence amongst working class people.
We all have periods in our lives when we feel deeply sad and might describe ourselves as depressed. This is often in response to life events, such as a death, relationship break up, redundancy etc. For most of us this is part of a natural grieving cycle and given time and the right support we work through these depressed feelings and return to a more 'normal' state of functioning. However, sometimes we get stuck in these low moods and need help to regain our balance. There is whole spectrum of feelings here, from feeling down to severe clinical depression.
According to the Diagnostic and Statistics Manual-IV, the clinical definition of a major depressive episode is - Five or more of the following symptoms present during a two week period (at least one of the symptoms is either depressed mood or loss of interest or pleasure):
depressed mood
loss of interest or pleasure
poor or increased appetite/weight loss or gain
insomnia or hypersomnia
psychomotor agitation or retardation
loss of energy/fatigue
feelings of worthlessness, guilt or self reproach
poor concentration/indecisiveness
thoughts of death or suicide attempts
When we feel deeply depressed we may have a whole range of symptoms in addition to the above, including, tearfulness, hopelessness, feelings of guilt, negative expectations, negative self concept, reduced libido, irregular menstrual cycle, constipation, etc. For some people depression may be a one off event in their lives, for others it may be a recurring theme.
In extreme cases people may develop psychotic depression. Here they become delusional and may have suicidal or murderous plans. They are also likely to neglect themselves. Such extreme cases need qualified medical care and are not covered in the information given on this site.
WHAT IS BIPOLAR?
Where depression occurs on its own it is called unipolar, where it appears with mania it is called bipolar. This condition used to be called manic-depressive. A manic episode is defined in DSM-IV as:
A period of persistently elevated, expansive or irritable mood, lasting at least one week, severe enough to disrupt work and social activities
At least three of the following symptoms:
increased activity or restlessness
rapid speech
inflated self-esteem or grandiosity (thinking you can do anything)
flights of ideas or subjective experience that thoughts are racing
distractibility
disinhibited behaviour (unrestrained buying sprees, sexual disinhibition)
decreased need for sleep
Mania represents about 10% of all depressions.
WHAT CAUSES DEPRESSION?
There is disagreement about what causes depression.
Sometimes depression is considered to be the symptom of an organic condition eg underactive thyroid, a viral illness followed by use of certain drugs (including alcohol). This is referred to as organically induced depression.
Some believe that depression is caused by a hormonal imbalance in the brain and that it can therefore be treated with drugs. Others believe that it is caused by emotional and psychological factors and that any inbalances in the brain are a symptom rather than the cause. At best drugs are therefore only treating a symptom and leaving the underlying cause untreated.
GENETICS
Some people believe that a tendency towards depression is inherited. There is some evidence that you have a greater risk of depression if someone in your close family has suffered from depression. However, this does not necessarily mean that there is a genetic factor at work, there may be other environmental factors at play. So far no gene for depression has been found and there is no definitive evidence of a genetic cause. There is also a theory that although our genes may carry the potential for a given disease, it is environmental factors that actually trigger the development of any such disease (see The Biology of Belief by Dr Bruce Lipton).
BIOLOGICAL MODELS
In the 1950's it was discovered that a particular drug which was known to deplete brain monoamine (nonadrenaline, dopamine etc), caused depression. It was therefore concluded that depression was caused by a lack of brain monoamine. This led to the idea that a lack of serotonin and noradrenaline in the brain caused depression and the development of drugs to help maintain the levels of these chemicals. However, not all depressed people respond to these antidepressant drugs and our current understanding of the brain suggest that there are more complex mechanisms at work.
PSYCHOLOGICAL MODELS
This isn't one theory, but a whole range of theories. They all share the underlying idea that depression has an emotional or psychological, rather than a biological cause. Some view depression as linked to actual or perceived loss, others that it relates to unrealistic expectations of themselves which they can never live up to. For many depression is linked to formative experiences in early childhood, although it may be triggered by a more recent event. So, for instance why does one person who is made redundant develop depression, whilst another uses the opportunity to start their own business and looks back on it as the best thing that could have happened? One individual is more adaptable to life events and holds a more secure self image. Their identity is not threatened by the loss of their job. (These ideas are expanded further in the section on treatment below).
COGNITIVE MODELS
These theories are related to some psychological models. They view the way a person thinks (their cognitive functioning) as related to how they deal with life events. To put it crudely persistent negative thinking leads to depression. The individual gets stuck in negative thoughts that are not corrected by life events and ends up viewing the world through a negative filter. These negative thought processes may well have started in childhood, due to an inappropriate or dysfunctional family environment.
In some cases it does appear that depressed people are 'over reacting' to situations, but for many others their 'negative' reaction seems wholly appropriate.
BEHAVIOURAL MODELS
A behavioural model seems depression as a function of insufficient reinforcers, ie a lack of positive reward. Either the individual's behaviour is not appropriate to encourage positive responses from others, or those others with whom the individual mixes fail to provide appropriate rewards.
SOCIAL MODELS
This looks at the link between multiple negative life events and depression. It does seem that those suffering from depression report more negative life events than those not suffering from depression. The life events most likely to be linked to depression are 'Exit' events, such as relationship break-up. However, not everyone who experiences these life events develop depression, so they seem to be contributing factors, rather than the whole picture.
Social models also look at other factors such as racism and unemployment. Studies show no definite link to racism, but unemployment is a definite risk factor for men.
SPIRITUAL MODELS
Again there are many different spiritual approaches to depression. One view is to see depression as a spiritual crisis in which the lack of meaning and hopelessness is related to a lack of spiritual meaning. It could therefore be seen as an unresolved existential crisis. Another view is to see depression as a very low energy state. In this model we are viewed as beings of light temporarily occupying physical bodies. In order to interact with the physcial world we have had to lower our energy levels (lower vibrational frequency) in order to interact with matter. Those suffering from depression have lowered their energy too far and need to raise their energy levels again.
You can read more about the latest thinking on the causes of depression in my book The Depresssion Trap.
DIAGNOSIS (in the UK)
If you want a definite diagnosis of depression then your best option is to see a psychiatrist. They have been trained in the diagnosis of psychological conditions. Most GPs have very little training in this area and although many will tell you that you have depression if you describe some of the classic symptoms, they may not really be qualified to give this diagnosis. Before starting to take drugs which can be addictive and have side effects you may want to consider getting a second opinion from someone who specialises in this area. Although you may well be referred to a counsellor or psychotherapist to help you recover from depression, they are not usually qualified to diagnose the condition. For many of them a diagnosis is not important, as their approach is to work with the individual as a whole person, rather than to think in terms of disease.
Please note that this information relates to the UK and the situation may well be different in other countries.
TREATMENT
In order to decide on a treatment we need to have some understanding of the cause. From the brief look at causes above you will see that this is not a simple matter. There are many different approaches to treatment as there are many different models to help us understand it. Your GP is most likely to offer you antidepressants and counselling. However, in many areas there is only limited counselling available on the NHS. I have collected together some of the treatments available and hope that you find this information useful.
DRUGS
There are a number of different antidepressant drugs that you might be prescribed. You can find out more information about these on the Depression Alliance website (see below).
COUNSELLING
Cognitive Behavioural Therapy is the type of counselling most often offered by the NHS for the treatment of depression. There are studies that point to its effectiveness as being at least as good if not better than drugs. Other talking therapies have not been studied to the same extent, however a recent study on the effectiveness of various types of counselling showed that the relationship between the therapist and client is more important than the type of counselling employed. Different people find different approaches helpful and it may be worth taking some time to work out what is best for you.
To find out more about some of the approaches to counselling click on the links below:
Some hypnotherapists claim to have a lot of success with depression. I am not aware of any clinical studies on the effectiveness of hypnotherapy at this time. You can find out more about hypnothrepay here .
ST JOHN'S WORT
St John's Wort is a plant that has been used in herbal medicine for thousands of years. It has a reputation for helping with depression and a series of recent double-blind, placebo-controlled studies indicate that it is as effective as prescription antidepressants but has far fewer side effects. It should not be taken if you are already taking antidepressants (if you are taking any prescription drugs its best to check for interactions before taking St John's wort). Find out more here.
EXERCISE
Exercise is now seen as a promising treatment for mild to medium depression. It's not yet clear why this is the case. It may be the exercise itself which has an impact on the body's chemistry, it may also be the camaraderie associated with prescribed exercise. Read more here.. Yoga is also thought to be good for depression, especially the breathing exercises.
DIET
Many people believe that diet can play an important part in combating depression. Three separate clinical studies in Britain, Israel, and the U.S. indicate that an increased intake of omega-3 fatty acids had "a substantial impact" on depression and bi-polar disorder. Read more here. Deficiencies in certain vitamins, espiecally the B complex, are also thought to be linked to depression.
It is also best to avoid certain food and drink when suffering from depression, especialy alcohol, caffeine and sugary foods. Some people have even found that their depression was linked to food intolerances, so having an allergy test can be helpful in some cases.
MEDITATION
Recent research indicates that meditation has a effect on mood. However, this research was based on experienced meditators, so the results might be different for beginners. Cognitive Behavioural Therapy recommends the use of mindfulness meditation in helping to combat depression and there has been some evidence to show that this is effective. I have also come across a number of anecdotal cases where individuals have found meditation helpful in recovering from depression.
Meditation can be helpful for those suffering from depression, but there is also a danger that in some cases it can heighten feelings of helplessness, despair etc. For this reason it may be less suitable for those with severe depression. However, there is some evidence that meditation can help those with severe depression too if they are under the constant guidance of an experienced teacher. This suggests that it is not meditation itself that is potentially harmful, but rather the misapplication of it by inexperienced students.
I cover meditation in more detail in my book, plus you can find out more here.
COMPLEMENTARY THERAPIES
A number of complementary therapies are reported to have helped some people suffering from depression. I cover these in more detail my book and you can find some general information about each therapy by clicking on the links below
We all have experiance of how music can effect our mood. Some claim that it can actually help with depression. Read more here.
SELF HELP
There are a number of things that you can try to help with your depression whilst undergoing treatment. It can help to feel that you are doing something, that you have some control over your recovery. The following suggestions are covered in more detail my book.
Laughter has been said to be the best medicine and there have been a number of studies linking a well developed sense of humour with recovery from stress, depression and suicidal thoughts. So why not try watching funny films, reading funny books, collecting jokes you enjoy, etc.
Pet Therapy. For many people pets can be a lifeline, connecting them to the world and providing unconditional companionship and acceptance.
Aromatherpy. Certain oils are said to help with depression. These can be released in an oil evaporator or applied in a base massage oil.
Positive Input. Be careful what influences you allow into your mind. Avoid negative inputs such as The News, depressing TV programmes, films and books and people who bring you down. Surround yourself with positive influences instead.
Sunlight and Colour. Some people find that a lack of sunlight makes their depression worse. If you always feel worse in the winter then you might want to try a full spectrum lamp. Colour can also have an impact on our mood, so surround yourself with colours that lift your mood.
