Understanding what depression is, why we have depressive episodes, types of depression and treatment options.
What is depression?
Depression can be characterised by the following symptoms:
- Lowering of mood
- Reduction in energy
- Decrease in activity
- Lack of self esteem and confidence
- Sleep disturbances
- Loss of libido
- Limited capacity for enjoyment
- Poor concentration
- Lack of interest in pleasurable feelings
- Loss of appetite
- Weight loss/ gain
What are the different types of depression?
There are a number of depressive disorders:
Depressive episodes are diagnosed if an individual shows some of the above symptoms most days for two weeks. It can range from mild (two to three symptoms), moderate (four or more symptoms) to severe, where symptoms are marked and distressing. Recurring depressive disorder is diagnosed if someone has repeated episodes of depression.
Dysthymia is a condition similar to depression, where the symptoms are less severe but are seen for more than two years. A person would need to show at least two of the symptoms of depression for this period.
Antenatal/ Postnatal depression: Women are at an increased risk of depression during their pregnancy and in the year following childbirth. It is believed that this is caused by a mixture of factors, including the hormonal changes in the body straight after birth and adjustment to the changes in their lives.
Seasonal affective disorder (SAD) is a mood disorder which is linked to the seasons. It occurs mainly in the winter months, and appears linked to changes in natural light exposure. Depressive symptoms are most common, although there may be some mania as well.
Why do we get depressed?
From an evolutionary perspective, our depression is a reaction to the emotion of sadness, which has the function of helping us to manage with loss. In situations where we suffer a significant loss, sadness helps us to withdraw, recharge and assess our situation. When this sadness continues for a longer period of time it starts to effect our thinking and behaviour and can turn into depression.
There may be a number of reasons why we become depressed, especially in the modern world. The threat of loss can be high and persistent – not just of losing a loved one. It may be within the workplace or in relationships. If we feel a loss of control over some aspect of our lives, or ongoing stress means we don’t feel in control, this too could trigger a depressive cycle.
Our life experiences may also play a role in depression. Someone who has experienced trauma as a child, or had experiences where they were given the message that they were no good or worthless, may internalise these messages leading to unhelpful core beliefs.
However, some people can become depressed with no obvious trigger. This may be related to the link between depression and our brain chemistry. In particular, research has found that serotonin, the ‘feel good chemical’ which helps to regulate our moods, is lower. Norepinephrine, which plays a role in ‘fight or flight’, has been found to be lower in individuals with depression. However, this does not always lead to depression. Finally, there is some evidence that dopamine, the reward and reinforcement chemical, may be lower in people with depression.
Why do we stay depressed?
We can find ourselves falling into an unhelpful cycle, where our negative thinking leads to avoidance and reduction in activity. This then leads others to act in ways that reinforce our negative beliefs.
For example, if we think ‘others don’t like me, I can’t cope being around them’ we may avoid going to social situations. This in turn may make others think that we do not want to be invited, so they stop asking us to come. This then reinforces our beliefs that ‘others don’t like me’.
If you feel you are suffering from depression, please speak to your GP about support in your area. They are likely to complete a questionnaire with you, called the PHQ-9, which assesses your level of depression.
If someone has severe levels of depression, they are likely to be prescribed anti-depressants.
- Selective serotonin reuptake inhibitors (SSRI’s) which include Fluoxetine, Citalopram and Sertraline. These work to increase the level of the chemical serotonin in the brain.
- Other medications can include Venlafaxine or Duloxetine, which are Serotonin and Noradrenaline Re-uptake Inhibitors (SNRI’s).
- If people are unable to take these medications due to side effects, they may be prescribed a Noradrenaline and Specific Serotonergic Antidepressant (NASSA’s) such as Mirtazapine.
- Finally, if these medications do not appear to have an impact some people may be prescribed Tricyclic antidepressants (TCA’s) which include Amitriptyline and Clomipramine. However, these often have stronger side effects so are not routinely prescribed.
Some of the support for depression that is available includes:
Cognitive behavioural therapy (CBT). CBT is recommended for individuals who have moderate to severe depression. The focus is often on identifying and challenging specific negative thoughts that may perpetuate a depressive cycle. It can also involve behavioural techniques to increase activity and levels of dopamine in our body naturally.
You may be able to access support via your local Improving Access to Psychological Therapies (IAPT) service, which you can self-refer to. If you are interested in private therapy, either online or face to face contact me for further details.
Getting better from depression demands a lifelong commitment.
I’ve made that commitment for my life’s sake and for the sake of those who love me.Susan Polis Schultz
Depression lies. It tells you you’ve always felt this way, and you always will.
But you haven’t, and you won’tHalley Cornell
The shadows are as important as the light.Charlotte Brontë
Further Information on depression can be found from the following resources: