| What is Depression? |
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Depression is a word we hear often socially. Used in a more general, popular sense, it simply refers to someone feeling temporarily 'blue' or flat and generally 'down' in response to something that has caused a sadness response. Most people normally feel distressed by feeling like this, but gradually will return to feeling happier fairly rapidly. It is completely normal for people to feel sad sometimes.
Some people even deliberately seek out watching emotional movies to release feelings of sadness and feel better after they have done so. Expressing emotion is a biological as well as sometimes personally or socially necessary process.
Sad emotions can therefore be quite normal human nervous system reactions to disappointments over things that have let us down in comparison to expectations we had originally held about how things 'should' have been.
Relationship or job losses, friends disappointing us and other temporary upheavals can and do create temporary sad and upset states in our minds, emotions and bodies. Depending on our background and personality, these reactions may cause us to cry more frequently, feel angry or just feel flat and numb in response to adjusting to the changed circumstances confronting us. But in many cases, these normal changes in our mood states are simply emotion-releasing reactions to surrounding situations we are still processing mentally.
Generally the emotions involved can come and go over a few hours, or sometimes as long as a few days or even weeks at a time. During this time, our mental and emotional responses absorb the surrounding changes we have experienced, then they gradually return us back to our personally recognized, more usual, normal state of mood functioning.
It is actually more abnormal for a person to be happy and excited constantly, than it is for them to experience these relatively normal mild reactive ups and downs in mood, which help them learn about and to absorb changes occurring in the environment around them.
For some people, 'bouncing back' from a normal reactive 'down' mood does not happen as quickly or as completely as it ideally should.
There is a sizeable experiential difference between more 'normal' states of sadness and the more enduring, low, hopeless-feeling mood states often referred to as 'clinical depression'.
Where depression is clinically diagnosable, the mood 'low' the person experiences has become so entrenched, that it cannot voluntarily or easily be shifted by the person affected. It is important to obtain appropriate medical and psychological clinical support to help treat the serious mood disorder which occurs in these cases.
At the point depression is diagnosed, the state of mind ('cognitions') and emotional state ('mood') produced by the depressive disorder-related brain activities have usually begun to have noticeable, increasingly damaging impacts on various aspects of a person's daily life.
Some people are more familially and/or socially prone to depressive disorders. But they can potentially develop in anyone at any stage in life, if sufficiently adverse situations affect a vulnerable person's nervous system responses.
It is therefore important to realize that anyone facing atypical stress situations challenging their usual resilience can potentially experience at least one episode of depression.
It is estimated that about one in five people will experience some form of depressive disorder during their lifetime.
Another set of normal human reactions which can be more prolonged and difficult to process nonetheless, relate to mentally and emotionally challenging responses to particular life experiences.
Extreme sadness feeling reactions, often closely resembling clinical depression symptoms, can follow a selection of particularly stressful, self concept-changing personal experiences. These might include situations such as death and bereavement, job losses, financial distress, relationship breakdown and divorce, or experiences of life-threatening illness, or life-endangering accidents.
Life path-altering events such as these also can often trigger normal, sometimes quite prolonged periods of uncharacteristic fatigue, sadness and hopelessness. They may also involve extreme bursts of anger, mental tendencies toward blaming self or others for the situation unreasonably, situational denial of what has occurred, and feelings of loss in self esteem, or prior interpersonal confidence.
The normal, temporarily altered emotional and thought reactions described above are often referred to by clinicians as 'adjustment' responses, 'reactive depressive changes', or 'adjustment disorders'.
These emotionally reactive states are normally treated differently to clinical depression symptoms. It is less common that medication will be prescribed for such disorders as this can sometimes actually interfere with normal emotional processing of the adjustment response.
More routinely, those affected will be referred by their GP for professional counseling and/or interpersonal psychological therapies, which target locating and emotionally processing the source of grief as expediently as possible.
The person affected is assisted by an appropriately skilled therapist not to become 'stuck' in their adjustment reaction (thereby perhaps later becoming more at risk of developing further, more seriously entrenched depressive symptoms or disorders).
Depression was once socially dismissed as a thing some people invented to seek pity from others. Previous generations 'just got on with it' and 'soldiered on'. Those who let sad feelings "get the better of them" were previously viewed as 'weak', encouraging them to feel shame or embarrassment. This is still a prevalent attitude in some subcultures and social demographic areas and unfortunately prevents people from seeking the types of appropriate treatments outlined above, which could otherwise remit their symptoms far more effectively.
Such effective treatment is now widely available, inexpensive and evidence-based, that is, research-proven to work efficiently in helping people recover relatively rapidly from the debilitating impacts of depressive disorders.
Your first stop in accessing effective treatment should be to initially consult with your GP. lf you suspect clinical depression or even an adjustment issue is causing ongoing, difficult to lift symptoms such as those described above, your doctor will routinely assess and organize the most appropriate treatment path for you.
Exhausted, fatigued feelings are commonly reported by most depressed people. They can also feel very agitated and annoyed, listless or irritable for no apparent reason. These feelings can increase their tendency to think negatively and to project their negative feelings on to external causes and others.
Depressed people also often experience sleeping pattern changes. They may sleep too often, or find it is very challenging to get to sleep or, have difficulty remaining asleep.
Ongoing sleep difficulties can continue to cause distress and the intense tiredness this brings on can in turn increase fatigue and encourage further hopeless, trapped emotional feelings.
Those experiencing depressive disorders lose interest in things they usually enjoy doing. They experience difficulty with focusing on completing tasks they normally do daily. Depressed people also begin to feel they are achieving little in their lives and experience reduced pleasure in completing things they would usually do more productively..
Depression leads to people dreading or avoiding thinking about their futures and thinking with negative thought patterns about many aspects of their lives. These building patterns of negative thoughts, often referred to by clinicians as 'negative cognitions' hamper their capacity to recover and can lead to their further adoption of unhealthy behaviours and lifestyle choices. These emerging dysfunctional patterns in turn simply serve to worsen the depressive response cycle and result in a downward spiral into ever reducing levels of energy and hope.
Feeling trapped and hopeless about life is another common feeling expressed by depressed people. Desire to self harm and sometimes suicidal feelings may also grow out of this feeling of pointlessness about being alive. One of the key goals of therapy with people who are depressed is to shift this pattern of feeling and thinking into one of more clearly visualising and pursuing new hopes and future options.
Research has demonstrated that certain people have a higher genetic risk of developing depression, if placed in appropriately adverse stress situations which trigger their symptoms. Particular personality types also are at higher risk of depressive symptom development.
Stressful life events bring changes in surrounding circumstances which overwhelm a depressed person's usual coping strategies. As described, many people adjust well, particularly with appropriate support after trauma, stress, grief, loss or bereavement. Unfortunately, for complex reasons others do not.
Due to variously combined personal factors, some do not improve after adjustment challenges and their persisting low mood leads to a more 'locked in' state of depression. This in turn becomes an issue for further clinical treatment.
It is known that those who are prone to (either naturally or environmentally learned) higher responsive anxious or nervous arousal states are more likely to develop depressive disorders. Likewise, those who have obsessive or perfectionistic traits and very emotionally sensitive people, more easily hurt by criticism, are also at higher risk of development of clinical depression.
Emotionally-compromising changes to mood-maintaining parts of the brain can sometimes help encourage depressive mood states to develop and take hold. Biochemical changes conducive to encouraging development of depression can therefore be brought about by past or present excessive use of recreational drugs and/or alcohol.
They can also be caused by exposure to the effects of infections, organic illnesses, or by accidents to the brain. Previously healthy natural brain chemistry can become depressively symptomatic following such physiological slights to normal brain functioning.
Sometimes, purely physical conditions (for example, Hypothyroidism or Menopause), can cause continuing serious mood drops over a period of months or years. To rule out such causes first before commencing any other treatments, those experiencing ongoing low mood should certainly first visit their GP for a full physical check-up.
Once your GP has eliminated all other likely common biological causes of continuing feelings of fatigue, sadness or hopelessness, more psychological reasons for the episode may be suspected.
At that stage, your doctor is likely to preliminarily diagnose the abnormally prolonged low mood response as 'clinical' depression' or 'depressive disorder' or as a 'major depressive episode'.
A routine next step after diagnosis is usually a routine referral to a clinical psychologist, psychiatrist or other specialist for additional assessment and treatment collaboration.
The mental health specialist accepting the referral will then further examine and assess what has triggered and is maintaining the depressive episode, make further recommendations to the GP concerning treatment, and/or personally provide further therapeutic support.
Depending on the intensity of the episode being experienced and how long it has been a problem for the person concerned, a course of anti-depressant or other medication may sometimes also be prescribed. This strategy can greatly assist with shifting a clinically depressed person's symptoms more rapidly and thoroughly in certain people's cases.
Use of such medications, monitored closely by the prescribing doctor and coupled with referral for therapeutic interventions by a psychologist, is a treatment approach often termed as 'combined therapy'.
Patients with less serious symptoms and purely adjustment disorders may also be referred for purely psychological treatments if prescription of medication is not indicated.
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