What is it?
Many people who haven't experienced depression think that it is just a long period of sadness. While depression may involve intense sadness, in fact it is a more complex condition that involves thoughts, beliefs, actions and physical symptoms, not just emotions. Some common aspects of depression are:
- Fatigue (tired all the time)
- Aches and pains
- Unusual weight loss or gain
- Sick, run down, under-the-weather
thoughts / beliefs
- "I am worthless"
- "It's my fault"
- "People would be better off without me"
- "I'm never going to be able to..."
- Difficulty making decisions
- Avoiding activity, especially with others
- Stopping normal enjoyable activities
- unable to concentrate or see things through
As you can see, depression is much more than just sadness. It infiltrates every aspect of our lives and can change our entire personality. The first time I experienced depression I felt it as a series of health complaints: sickness, aching muscles, and intense fatigue. It was only a few weeks later that I realised (because a doctor pointed it out) that the physical symptoms actually pointed to depression, not as I thought some rare tropical disease.
How does it work?
People often experience depression as a cycle. A personal example: I felt very sad and down about the end of a relationship. Thoughts and feelings about this left me tired and unmotivated, so I didn't do normal everyday tasks, and chose not to see family and friends as much. I felt overwhelmed by the housework, and angry at myself for not doing it, but still couldn't face it, so went back to bed or did something else to avoid it. Because I wasn't in touch with friends or family much, I lost some perspective on myself, and was consumed by negative thoughts and beliefs about myself. This led me to avoid going out and exercising as normal, which in turn left me with less energy and so less likely to do normal everyday tasks. I was tired all the time but struggled sleeping so my health was also taking a hit.
I hope this short example illustrates the way that thoughts, feelings, actions and symptoms operate in a kind of vicious cycle. The good news is that the cycle doesn't have to continue turning. Part of therapy is exploring and understanding your own cycles, and then working out the best way to interrupt them. If you would like to discuss your own experience of depression over email or phone, get in touch.
Why do we have it?
Why do some people become depressed while others don't? There are two different ways we can look at depression:
The Psychosocial Model
Psychosocial models don't necessarily disagree with the medical model, but highlight other important factors, such as our social circumstances or personality. For example, research shows that people who live in poverty are more likely to become depressed. Similarly, depression is often triggered by life events that leave us feeling out of control or vulnerable, or by a social situation where we feel unheard or undervalued. Depression can also be a behaviour that we learnt from others - for example if a parent was depressed we may unconsciously learn their behaviours as a potential way to deal with distress.
The medical model
The medical model of depression tells us that it comes about due to an imbalance in brain chemicals. For example, it is known that amine levels in the brain (dopamine, serotonin, etc.) can have significant impacts on mood and depression. This is why GPs and mental health professionals will often prescribe SSRI's, which change the way our brains deal with these chemicals, to depressed patients. There is also evidence to suggest a genetic component to depression - meaning that some people are just born with a greater likelihood of becoming depressed.
Overall, I think that both models have a lot to offer, but in my experience as a counsellor what matters most is finding a way of understanding your depression that makes sense to you. When I work with clients experiencing depression, my aim is always to build a shared understanding of their experience which makes sense to them and helps them to change in the way they want to change. A large part of depression is about feeling out of control, and helping to give the control in defining and understanding depression back to the client is often the first step in overcoming it.
Can depression be changed?
Yes. Depression can be approached in a variety of ways, all of which have been shown to be effective in helping to alleviate the symptoms of depression. The first step is normally to explore how you experience depression and how it impacts on your life. After that we may:
- explore and understand where your depression comes from, and deal with the issues that this brings up;
- talk in depth about your current experiences - often having someone to listen carefully and non-judgmentally, without giving you empty reassurance, can be enough to reduce some of the loneliness and worthlessness that often accompany depression
- discuss and develop ways to communicate your depression clearly. One of the worst effects of depression is to isolate us - expressing feelings in a way that those close to you can understand is often a very useful strategy to overcome depression
- explore exactly how your depression manifests and develop strategies and tools to stop the vicious cycles of thoughts, feelings and behaviours
- work on action plans to change your behaviour in the short-term, as this can often kick-start recovery
In all of these I seek to empower my clients to find their own way through depression, with my support. There is no one-size-fits-all model, and together we create our own model that you can continue to use long after our work has finished. If you would like to discuss your experience of depression and find out whether I may be useful to you, get in touch today.
What role does medication play?
Anti-depressants are some of the most prescribed medications in the world. Generally they have a positive effect which reduces the extremes of felt emotion (both positive and negative). However, people's experiences vary hugely - some will get an almost immediate benefit with no side-effects, others will experience side-effects which impact negatively on their day-to-day life, with little impact on their depressive symptoms. As with any medication within mental health, I believe the most fruitful approach is to engage in some talking therapy alongside the medication, and this has generally been shown to have the largest and most long-lasting impact.
Can you be depressed and anxious?
Yes. Although they may seem very different, depression and anxiety can be seen as different responses to the same situation: both are ways of dealing with feeling powerless and out of control. Anxiety tries to keep us active so we can wrestle back control; depression tries to keep us as passive as possible and withdraw from the situation as a whole. A lot of people who experience either will experience the other, in an ongoing cycle.
How long will it take to overcome depression?
This varies a lot. Some people will only need one session, some will need more than twenty. This is often related to the length of time that you have experienced depression, and the intensity of it. It also depends on how much change you want to see: some people are happy to just get out of the hole they are in, some want to continue and build a stronger life after they've emerged from the hole. Again, the initiative lies with the client, not with me. If you want to talk about your depression, and how you might be able to overcome it, get in touch today.