We often use depression to describe feelings of sadness and grief that most of us experience at stages of our lives. It is also a clinical term used to describe forms of mental illness. Depression is a biological disorder that is made worse by life stress. It is a medical condition that affects your thoughts, feelings, behaviours and physical health as a result of alterations in body chemistry. It is a collection of signs and symptoms that persists over time which are not the normal reaction to life stresses.
What is not?
Depression is not the feelings of sadness or unhappiness that occur as a normal reaction to everyday stresses such as loss of a loved one or a relationship breakdown. This is a normal reaction to life events. Usually this is just a temporary low – we gradually pick up again and get back to normal. Depression is not a sign of weakness nor that someone has just given in. It’s not feeling blue or got out of the wrong side of the bed. The person is unable to just pull themselves out of it.
What causes depression?
There are many reasons why depression occurs. These can differ from person to person and are often a combination of psychological, biological and social factors. For some people biological (physical) reasons appear to be where depression develops. For other people psychological or social factors appear to be the trigger. Depression may follow on from stress and have an identifiable cause or may develop out of the blue without any apparent cause even when life appears to be going well.
Altered levels of neurotransmitters which communicate messages between nerve cells in the brain. Low levels of noradrenaline and serotonin are particularly associated with depression.
There is some correlation between physical illnesses and depression. Certain prescription medications may cause depression: Some drugs used to treat hypertension, some hormones, corticosteroids and several anti Parkinson drugs are all drugs that can cause depression.
As with other illnesses including diabetes and heart disease the tendency to develop depression runs in families.
Depression is associated with stress such as following personal tragedies or disasters. A combination of life events and losses can also contribute to a sense of inability to cope.
Developmental crisis and life events:
People are more prone to depression at specific life stages including adolescence, midlife and elderly and when experiencing a loss or during times of change.
People with certain personality characteristics are more prone to depression. Perfectionists and people who are very dependant on others are seen to be susceptible to depression under certain circumstances.
Depression can play a part in other psychiatric conditions including bipolar disorder (manic depression), schizophrenia, psychosis and anxiety disorder.
Alcohol and illegal drugs such as marijuana:
These substances are known to cause or increase the symptoms of depression.
What else could it be?
Depression plays a part in other illnesses and disorders including:
- Bipolar (manic depression)
- Some Physical Illnesses
- Anxiety disorders
- Side effects of some medications
- Panic disorders
- Obsessive compulsive disorder
- Substance abuse.
- Eating disorders
- Other psychiatric disorders.
Who gets depressed?
Research shows that one in every twenty people will become depressed. Anyone can get depressed but certain groups appear more vulnerable than others. Young adults (aged between 15 and 20) and people in their early 40’s appear to be the most at risk. Women appear twice as likely as men to suffer from depression. People with lower incomes and less education are more likely to become depressed. Certain factors affect vulnerability including early life experiences (child abuse or major losses in childhood etc) Personality style (highly self critical of have low self esteem). Sensitive personalities who often feel slighted or criticised when no negative intent is implied. Biological factors (including family members with depression), some physical illnesses and the strength or lack of social support systems.
Types of depression?
There are several types of depression. These can range from a short lived feelings of sadness that is related to a particular life event and will resolve without treatment to the major mental illness requiring immediate treatment.
- Reactive depression
- Post natal
- Bipolar or Manic Depression
- Prolonged bereavement
- Mixed anxiety and depression
- Typical and Atypical depression
- Hidden depression (can put on a brave face and deny any problems and hide the depression)
With so many types of depression it is important to distinguish the type of depression a person may have in order to determine treatment.
What are the symptoms?
Depression has characteristic symptoms that affects a person’s thoughts, feelings and everyday functioning and have persisted over time. Not everyone will experience all of the symptoms of depression or to the same degree.
- Sleep Disturbance – Either too little or too much without feeling refreshed or with profound fatigue.
- Lack of enjoyment in life is a typical symptom of depression however some people are able to maintain an ability to respond to pleasant experiences in a positive way.
- Appetite is affected by either lack of interest in food or overeating and often craving carbohydrates with the inevitable weight gain.
- Low energy or fatigue
- Low self esteem
- Feelings of hopelessness and despair
- Feelings of worthlessness
- Excessive guilt or self blame
- Suicidal thoughts
What treatment is available?
Evidence shows that different forms of depression respond better to one particular type of treatment than another. It is therefore important to determine the type of depression to determine treatment.
Treatment is usually in two steps. Firstly to relieve or remove the acute symptoms of depression and secondly maintenance treatment to prevent the recurrence of depression.
Most people with depression get their treatment as outpatients. However sometimes, where other medical conditions are present or when the person is suffering severe depression or are at great risk of suicide, hospital admission is necessary until the situation resolves.
It is always best to seek treatment early before the depression becomes severe.
The major types of treatment for depression include:
- Antidepressant medication package.
- Antidepressant medication combined with psychotherapy
- Electroconvulsive Therapy (ECT).
- Cognitive Behavioural Therapy.
- Interpersonal Therapy.
- Psychosocial Rehabilitation
- When treatments do not appear to work
It is important to allow time for treatments to work. Antidepressants can take several weeks to start making a difference. For some people antidepressant medication alone is not effective in relieving the symptoms of depression. For others it takes time to find the right medication that works for you and has the least side effects.
Without treatment, a major depression can last 6 to 12 months. In between episodes, most people feel better or are completely well.
Some people use this time to identify their support systems and attempt to help overcome depression by keeping busy, avoiding negative thinking, solving problems and reducing stress.