Depression

Depression is probably one of the most common problems that people come and see me for. The symptoms of depression can range from feeling a little low to being so debilitating that you cannot function on a day to day basis. If someone is so depressed that they cannot function, anti-depressants will help. However, anti-depressants will not address the deep-seated reasons why you are depressed. When you come off the anti-depressants, the symptoms will often recur if not immediately, then at some time in the future.

If someone is severely depressed, I would always suggest that they seek medical support with anti-depressants, if that is what their doctor suggests. However, another way to work with Depression, is through psychotherapy. I would suggest psychotherapy rather than counselling for depression as depression is usually very deep-seated and long-term. Psychotherapy for depression takes a long time to work but it is effective and permanent.

What is depression?

The word depressed is a common everyday word. People might say Im depressed when in fact they mean Im fed up because Ive had a row, or failed an exam, or lost my job, etc. These ups and downs of life are common and normal. Most people recover quite quickly. With true depression, you have a low mood and other symptoms each day for at least two weeks. Symptoms can also become severe enough to interfere with normal day-to-day activities.

Who gets depression?

About 2 in 3 adults have depression at some time in their life. Sometimes it is mild or lasts just a few weeks. However, an episode of depression serious enough to require treatment occurs in about 1 in 4 women and 1 in 10 men at some point in their lives. Some people have two or more episodes of depression at various times in their life.

What are the symptoms of depression?

Many people know when they are depressed. However, some people do not realise when they are depressed. They may know that they are not right and are not functioning well, but dont know why. Some people think that they have a physical illness for example, if they lose weight.

There is a set of symptoms that are associated with depression and help to clarify the diagnosis (which are set out in DSM IV-TR). These are:

Core (key) symptoms:
Persistent sadness or low mood. This may be with or without weepiness.
Marked loss of interest or pleasure in activities, even for activities that you normally enjoy.
Other common symptoms:
Disturbed sleep compared with your usual pattern. This may be difficulty in getting off to sleep, or waking early and being unable to get back to sleep. Sometimes it is sleeping too much.
Change in appetite. This is often a poor appetite and weight loss. Sometimes the reverse happens with comfort eating and weight gain.
Fatigue (tiredness) or loss of energy.
Agitation or slowing of movements.
Poor concentration or indecisiveness. For example, you may find it difficult to read, work, etc. Even simple tasks can seem difficult.
Feelings of worthlessness, or excessive or inappropriate guilt.
Recurrent thoughts of death. This is not usually a fear of death, more a preoccupation with death and dying. For some people despairing thoughts such as lifes not worth living or I dont care if I dont wake up are common. Sometimes these thoughts progress into thoughts and even plans for suicide.
An episode of depression is usually diagnosed if:

You have at least five out of the above nine symptoms, with at least one of these a core symptom; and
Symptoms cause you distress or impair your normal functioning, such as affecting your work performance; and
Symptoms occur most of the time on most days and have lasted at least two weeks; and
The symptoms are not due to a medication side-effect, or due to drug or alcohol misuse, or to a physical condition such as an underactive thyroid or pituitary gland (but see section later on depression and physical conditions).
What causes depression?

The exact cause differs from person to person. It is generally thought that depression is caused by very early wounding issues that occurred before we were conscious or had words to describe our experiences. Although most of us feel that we had a perfect childhood, no parents are perfect, in fact its important for our development that they are not perfect (more elsewhere), but how, why and when they might have let us down and how that might have impacted on us, is unknown because we dont remember! But just because we dont remember doesnt mean to say that it didnt have an impact on us! Sometimes in psychotherapy we can try and get to some of the origins of the depression, most times we dont. But we can re-experience some of the anger, sadness and loss that we might have felt and need to express now. In these cases, the depressed person has often felt depressed for much of their life, on and off. If this is you, then this is not uncommon and we can work to make you feel better

Other times, depression may have a very clear origin and you might be able to pin-point exactly when you started to feel bad. Often that is from any form of abuse, the break-up of a relationship, bereavement and loss, after chidbirth, being in a relationship with a bully either personally or at work, losing your job, etc. Again, this type of depression, is straight forward to work with and we can get good results

Depression is generally understood to be about the suppression of feelings. It is further thought that this is most likely to be the suppression of anger and sadness. Anger is a very difficult emotion and families usually have a specific way of expressing it that is passed from generation to generation. This is often why depression often occurs in families it isnt genetic but actually how the family copes with stressful situations.

Although you may not have any obvious worry or problem, depression can come at you for no apparent reason. I believe that there is always a reason you just dont know it.

Depression and physical conditions

Depression can also cause physical conditions. Also, physical conditions can make one feel depressed and out of control so there is a direct link between what is going on in our head with what is happening in our bodies.

Some physical conditions mimic depression so it is important to get these checked out if you are feeling low. These include:

An underactive thyroid gland can make you feel quite low, weepy, and tired. A blood test can diagnose this.

An underactive pituitary gland (hypopituitarism) the pituitary
Head injury even a relatively mild one,
Polymyalgia rheumatica t
Early dementia is sometimes confused with depression.
Certain drugs, both prescribed and illicit (street) drugs can cause side-effects which may mimic depression.

Treatment Options

This is difficult for me to write because I obviously have a bias! I believe that psychotherapy is the best option for long-term, deep-seated depression. I would always suggest that someone gets medical support if that is what they want. I will also suggest anti-depressants if someone is so depressed that they are over-whelmed with feelings and by their problems that they cannot talk about them. Anti-depressants will numb the feelings this can be both useful in therapy and counter-productive depending on how well you can cope. Obviously you need to feel something in order to heal it but you dont want to be so overwhelmed by it that it makes you feel worse. The decision is completely subjective and it is usually something that we talk about in a a session. I would also add that anti-depressants are not a long-term option I dont suppose anyone would say that they are a life-style choice, so I would hope that in time, you could reduce your reliance on them. In any event, in cases of severe depression, it is important that your GP knows that you are in therapy.

CBT is a common form of treatment for depression. The government, NHS and most medical insurance companies push and support CBT for the treatment of anything and everything for everyone. My experience with CBT is that it does not address any of the underlying issues and it works on the part of the brain that is to do with cognitions your higher cortex. CBT does not and cannot work with the deep brain which is why many people who have CBT have a recurrence in their symptoms over time. CBT aims to change your thoughts and behaviour but it does not address how you feel and experience the world that happens in a completely different part of the brain.

More about this in another Blog post just to say that I do not believe that any one treatment works for all people, for all mental health problems all the time. You have to find the treatment that fits for you.. and for the government to only push one type of treatment is unethical, morally wrong and dishonest. Dont be taken in find the treatment that works for you. you deserve to live without depression.

I hope that helps give some information about depression. If you would like any more information, I am happy to answer questions phone, email or leave a message below.

Mic Austen

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