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Depression

What is Depression?

Feelings of sadness, loss, and even misery are normal human emotions. These feelings may follow a disappointment, loss of a friend, loss of a job, or a number of other stressful or unpleasant life events. These feelings are common and are experienced by everyone.

Most of the time we recover quite quickly from our sadness, especially if we have other good things happening in our lives. Some people, however, continue to feel extremely miserable for long periods of time even though there may no longer be a good reason for feeling this way. Friends are unable to snap these people out of their depression and pleasant or lucky life events pass by unnoticed.

There are still other people who become extremely depressed for no obvious reason at all. At first they may just feel a bit down and find it difficult to get through the day. As their depression worsens they may lose their motivation to do anything at all until they reach the point where they have trouble even getting dressed in the morning.

Although there is a tendency to label all our unpleasant feelings as 'depression', there are clearly some people whose depression is much more severe than others. Severe depression that occurs for no obvious reason, or that continues for a long time despite the occurrence of pleasant life events and encouragement from friends, is called `major depression' or a 'depressive disorder'.

Signs of Depression:

• Feeling miserable. This misery is present for much of the day but may vary in its intensity. The misery lasts at least a week or two. The individual who is depressed usually looks sad and 'down' and may cry often.
• Loss of interest or pleasure in usual activities.
• Loss of appetite with excessive loss of weight (e.g., 2-3 kgs or more).
• Loss of interest in sex.
• Loss of energy, even when not physically active.
• Loss of sleep despite feeling exhausted. Sleep is typically restless and unsatisfying with early morning wakening (1-2 hours earlier than usual). Some people, however, may actually sleep a lot more than usual.
• Persistent worrying about unimportant things.
• Slowed or inefficient thinking with poor concentration, leading to difficulties sorting out problems or making plans or decisions.
• Recurring unpleasant thoughts, particularly about being guilty, being a bad and unworthy person, or wishing to die.
• Slowed activity and speech.
• Fearfulness. Fears about people, places, and things are extreme, often leading to withdrawal from a wide range of everyday activities and friends.
• Hearing voices when nobody is about that make unpleasant remarks about you.

Any of these features may serve as a warning signal of depression although many may also occur in disorders other than depression.

Treatment of Depression
Antidepressant medication

Deciding to take antidepressant medication is a big step for many people. These drugs will usually relieve depression in most people and may help to prevent relapse of the illness. However, unless episodes of depression occur very frequently, most people do not take antidepressant medication every day of their lives. They only take the medication when they are depressed and continue taking the medication for about six months to one year after recovery.

Many people choose to take antidepressant medication in conjunction with CBT, which is a very effective treatment regime.

Antidepressants do not relieve your depression straight away. These drugs take some time to have an effect on your mood. In the first few days the drugs are most likely to help with sleep and tend to have a calming effect, sometimes making people feel very tired and weak. However, after a week or two of taking the medication regularly this calming effect gives way to increasing alertness and energy. It may take up to eight weeks before the maximum benefits of antidepressant medication are noticed. Therefore, you should not expect to notice the benefits from this medicine too quickly.

There are a number of different types of antidepressant drugs. Ask your doctor for further information about these drugs and their side effects.

Cognitive Behaviour Therapy (CBT) Extensive research has shown that CBT is the most effective psychological treatment for depression. CBT involves the following:

• Increasing the frequency of activities, particularly pleasant activities. One of the characteristics of depression is that it takes away a person's drive, motivation, and energy. Depression tells people to withdraw from activities and from the people around them. CBT targets these symptoms by structuring the person's time in a manner which helps them to start fighting against the depressive urges to just stay in bed. This part of treatment is tailored to the individual's particular needs and levels of depression. It may mean starting with very small changes, such as sitting in the sun for half an hour a day, or eating a favorite meal. Gradually, the individual's motivation and sense of pleasure returns.
• Recognising and changing depressive thinking. Depressed people tend to think in a way which maintains the depression. It's like you're looking at the world through dark glasses. Depression can convince you that the situation is hopeless, that you'll never get better, that you are a worthless person. When people are depressed they tend to pay attention to the negative, and find it hard to remember or to notice positive things. CBT helps people to recognize that depressive thinking is not true, that it is skewed, and that all this type of thinking does is maintain the depression. CBT teaches people skills to change the thinking to a more realistic, hopeful thinking style.
• Lifestyle changes. CBT involves creating a lifestyle which will protect the person from a recurrence of the depression. This may involve getting more involved in social or community life, finding a meaningful hobby or pastime, or becoming more physically active.
• Relapse prevention. At the end stages of CBT, the person learns to identify the types of signs which may indicate that the depression may be returning These `early warning signs' tell the person that steps need to be taken to prevent a slide back into major depression. The therapist works with the person to come up with an action plan to be implemented if any of the warning signs occur.

The important thing to know is that there are effective treatments for depression, that you are not alone, that you do not have to suffer. Self Essentials psychologists and clinical psychologists are experts in this area.

If you are interested in learning more, or to make an appointment, call Self Essentials on (02) 9555 4810 or send an email to essentials@self.net.au