Well done – you’ve taken an important first step.
If you’re here, you’ve probably realised that injunctions to “cheer up”, “snap out of it” or “think positive” just don’t work. This is because depression isn’t simply a state of mind over which you have automatic control. It is rather a whole body disease, with identifiable physical symptoms.
What Happens When You’re Depressed?
Increasingly being identified as being in part due to an imbalance of brain chemicals and possibly because of an irregularity in the functioning of the parasympathetic branch of the autonomic nervous system, depression can cause a variety of symptoms in addition to the overwhelmingly sad and negative feelings normally associated with the condition. These include;
- extreme fatigue
- decreased motor (muscle) coordination
- changes in sleep pattern
- changes in appetite and weight
- a loss of motivation and interest in things which were previously pleasurable
- memory loss
There is also a mounting body of evidence to suggest that depressed individuals have higher incidence of occurrence of life threatening conditions such as cancer, diabetes and heart disease than their non-depressed counterparts.
Depression – A Mind & Body Illness
In an effort to increase their understanding of the illness, I often illustrate the parallels between it and an condition like Type 2 diabetes when talking to clients for the first time.
Like Type 2 diabetes, depression is an illness with manifest physiological symptoms, whose cause is generally part physical, part environmental. Like diabetes, unless controlled, the chance that it will trigger additional physiological problems is significant. Finally, like diabetes, successful management of depression may involve pharmacological intervention, but relies just as heavily on attitudinal and behavioural changes on the client’s part.
If you suspect that you, or someone you know is experiencing depression, your first point of call should be your doctor. You can of course book an appointment with a counsellor or psychotherapist, but if s/he assesses you to be suffering from a depression which would benefit from anti-depressant medication, s/he will refer you back to your doctor in order to ensure that talking therapy has the best possible chance of being successful.
Whether your first visit is to the doctor or therapist, you are likely to be asked to undergo diagnostic assessment to determine the extent of your depression. This will involve you being asked a number of questions which you will need to score. A typical set questions might include something similar to the following:
In the last 7 days, have you:
- Felt talking to other people was overwhelming?
- Felt able to cope when things go wrong?
- Felt abnormally tired, anxious, tense or nervous?
- Been unhappy?
- Been disturbed by unwanted memories or images?
- Had someone available to offer support?
- Thought about death or suicide, or made plans of this nature?
- Had moments of panic or terror?
- Experienced difficulty with sleep?
- Felt despairing or hopelessness when thinking about the future?
Whoever gives this test will want to ensure that your low feelings are not related to a recent traumatic event, such as a death or loss, since to experience a mild, short-term depressive episode is an entirely expected response to such situations. If however, you have no such history, or such feelings persist more than two months after the event first occurred, it is possible that your doctor may diagnose a clinical depression.
So You Have Depression – How Do You Treat It?
There has for some years now been a body of evidence to support the proposition that in depression, recovery rates are increased and re-occurrence is reduced most significantly when sufferers experience a care plan which is comprised of a mix of treatment options. The most common are anti-depressant therapy, psychotherapy and exercise.
Many people when told they are suffering from depression are alarmed at the thought of being prescribed anti-depressant medication. This is in part because there is a confusion about what this medication actually is.
Medication prescribed for clinical depression today is usually in the class of drugs known as SSRI anti-depressants, that is Selective Serotonin Reuptake Inhibitors. Serotonin is a neurotransmitter chemical secreted into the spaces between the brain cells and which is responsible for helping us achieve a sense of calmness and relaxedness. In depression, serotonin production may be lowered, or it may not be utilized most effectively in the brain. SSRI’s inhibit the process whereby serotonin is absorbed back into the brain cells, leaving more of it between the brain cells for a sense of well-being. They have been demonstrated to be highly effective in treating depressive illness, especially when combined with psychotherapy and/or exercise.
Common SSRIs include Seroxat Fluoxetine, Cipramil and Cipralopram. They are to be distinguished from the major tranquillisers and anti-psychotic drugs associated with more pervasive mental illness.
A number of options for treating depression exist within psychotherapy or counselling, including CBT, art therapy and psychodynamic therapy. If SSRIs are able to put more brain chemical bac where it belongs, so that you are able to think rationally, psychotherapy is able to provide the tools you need to recognise your negative feelings, thought patterns and beliefs, the circumstances which are prone to trigger those thoughts and feelings, how manage those thoughts feelings and how to reduce or eradicate the triggers. In short, psychotherapy provides the means to give yourself the best chance of making decisions which will allow you to function well in your world.
There is an increasing body to evidence which suggests that regular aerobic exercise can help alleviate the effects of mild to moderate depression. Exercise has a multi-layered effect on depression; it causes an increase in the release of endorphins and enkephalins which have an influence on mood and well-being, it may provides a social outlet; it provides a distraction from negative thougts and finally, it can engender a sense of empowerment as goals and target are realised. The results are so conclusive that exercise programs are now routinely prescribed to supplement or as an alternative to drug or talking therapies.
The Way Forward
If you’re depressed, it’s no doubt very difficult for you to believe that you’re ever going to feel better – that swallowing a pill a day, talking to a stranger or going to the gym twice a week will make any difference.
But it will.
I have lost count of the number of people I’ve seen with depression who have believed that their negative feelings were inescapable, only to discover after a few weeks of combined therapies that their perspective had entirely changed – get your thinking back on track with the right treatment and the world really does look very different.