What is depression?
Many factors contribute to depression
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The word 'depression' causes much confusion. It's often used
to describe when someone is feeling 'low', 'miserable', 'in a mood' or having
'got out of bed on the wrong side'.
However, doctors use the word in two different ways. They
can use it to describe the symptom of a 'low mood', or to refer to a specific
illness, ie a 'depressive illness'. This factsheet relates to depression, the
illness.
This confusion is made all the worse because it is often
difficult to tell the difference between feeling gloomy and having a depressive
illness.
Doctors make a diagnosis of depression after assessing the
severity of the low mood, other associated symptoms and the duration of the
problem.
Depression is very common. Almost anybody can develop the
illness; it's certainly NOT a sign of weakness.
Depression is also treatable. You may need to see a doctor,
but there are things you can do yourself or things you can do to help somebody
suffering from the illness.
What you cannot do is 'pull yourself together' – no matter
whether this is what you think you should be able to do or what other people
tell you to do.
People who have experienced an episode of depression are at
risk of developing another in the future. A small proportion may experience an
episode of depression as part of a bipolar affective disorder (manic depression),
which is characterised by episodes of both low and high moods.
Who gets depressed?
- Depression is very common.
- Women are twice as likely to get depression as men.
Getting depression is not a sign of weakness. There are no
particular 'personality types' that are more at risk than others.
However, some risk factors have been identified. These
include inherited (genetic) factors – such as having parents or grandparents,
who have suffered from depression, and non-genetic factors – such as the death
of a parent when you were young.
What causes depression?
- We do not fully understand the causes of depression.
- Genes or early life experiences may make some people vulnerable.
- Stressful life events, such as losing a job or a relationship ending, may trigger an episode of depression.
- Depression can be triggered by some physical illnesses, drug treatments and recreational drugs.
It's often impossible to identify a 'cause' in many people,
and this can be distressing for people who want to understand the reasons why
they are ill. However depression, like any illness, can strike for no apparent
reason.
So It's clear that there are definite changes in the way the
brain works when a person is depressed.
Symptoms of depression
Stress can lead to you to feeling 'down' and
'miserable'. What is different about a depressive illness is that these
feelings last for weeks or months, rather than days.
In addition to feeling low most or all of the time, many
other symptoms can occur in depressive illness (though not everybody has every
one).
- Being unable to gain pleasure from activities that normally would be pleasurable.
- Losing interest in normal activities, hobbies and everyday life.
- Feeling tired all of the time and having no energy.
- Difficulty sleeping or waking early in the morning (though some feel that they can't get out of bed and 'face the world').
- Having a poor appetite, no interest in food and losing weight (though some people overeat and put on weight – 'comfort eating').
- Losing interest in sex.
- Finding it difficult to concentrate and think straight.
- Feeling restless, tense and anxious.
- Being irritable.
- Losing self-confidence.
- Avoiding other people.
- Finding it harder than usual to make decisions.
- Feeling useless and inadequate – 'a waste of space'.
- Feeling guilty about who you are and what you have done.
- Feeling hopeless – that nothing will make things better.
- Thinking about suicide – this is very common. If you feel this way, talk to somebody about it. If you think somebody else might be thinking this way, ask them about it – it will not make them more likely to commit suicide.
Treatments for depression
Sometimes when we are going through a 'bad patch' in our
life, it's enough to talk through our problems with a friend or relative. However, this may not be enough and we may need to seek
professional help. The important thing to remember about depression is that
it's treatable. There are many different types of treatment. These include
medication and talking therapies (psychotherapy).
Psychotherapy
There are many different forms of psychotherapy.
- Simply talking to somebody or your doctor about your problems is a form of psychotherapy and can help greatly rather than 'bottling-up' your emotions.
- More formal psychotherapy includes counseling, cognitive behavioural therapy (CBT), interpersonal psychotherapy (IPT) and dynamic psychotherapy or psychoanalysis.
As a general, rule psychotherapies are as effective as
medication for the treatment of mild depression. However, for more severe
illnesses, medication is likely to be needed but may be supplemented with
psychotherapy. Exactly which type of therapy a doctor recommends depends on
the particular problems a patient is suffering from, the views of the patient
and local availability of psychotherapy.
Medication
- Antidepressant medication (for example fluoxetine) helps to correct the 'low' mood and other symptoms experienced during depression – they are NOT 'happy pills'.
- Antidepressants do not change your personality.
- Antidepressants are NOT addictive.
In the last few years, there has been an explosion of new
antidepressant medications. The main advantage of these new drugs is that they
have fewer side effects than older drugs and so are more pleasant to take.
What to do if you are depressed
- Talk to people about how you feel. Don't bottle things up.
- Although you may not be able to do the things you normally would (such as work), try to keep active as much as you can. Lying in bed or sitting thinking about your problems can make them seem worse. Physical exercise can also help depression and keep your mind off your worries.
- Do not increase your alcohol intake to try and 'drown your sorrows' or help you sleep better. Alcohol will only make the depression worse and harder to treat.
- If you are having problems sleeping, try not to lie in bed thinking about your problems and anxieties. Do something to take your mind off your worries, such as reading or listening to the radio.
- Self-help books may be helpful. Check out the health section of any good bookshop.
- If you are feeling suicidal or desperate contact a voluntary sector organisation, such as the Samaritans.
- Always remember that you are suffering from an illness. It is not you being weak, and you can NOT simply 'pull yourself together'. Your illness is treatable. You are also NOT ALONE. Depression is extremely common.
What to do if you know somebody who
is depressed
Sometimes people are not aware that they are depressed. This
can happen when the depression comes on slowly. In addition many people
suffering from depression blame themselves for not coping as they normally
would, rather than thinking there might be some illness that has caused them to
be this way. The illness can make a person think that it would be a sign of
weakness to seek help for their difficulties. If you think that this has
happened to somebody, you should try to talk to him or her about it.
Also try to remember the following.
- Listening can really help.
- Avoid saying, 'pull yourself together' or other remarks that make the person think that it is their fault that they are ill.
- If the person's problems do not sort themselves out in a week or so, suggest that the person seek professional help. Remind the person that this is not a sign of weakness or of being a failure.
- Don't nag the person or try to get them to do what they normally would. Remember they are suffering from an illness.
- Remind the person that they have an illness, it's not their fault and they'll get better no matter how hopeless they feel.
- Try to help them avoid resorting to alcohol, which does not help the situation. If the person talks of harming themself or committing suicide, take this seriously. Insist that they see a doctor.
- Remember that it does NOT increase the chances of a person committing suicide to talk to them about it.
Reviewed by Dr Ciaran Mulholland,
MRC clinical scientist, senior lecturer and honorary consultant psychiatrist
