Why am I depressed?
Depression, sometimes referred to as clinical depression or major depression, is a mood disorder that affects 1 in 20 people over their lifetime (Murray & Lopez 1996). Depression can be debilitating and not only affect the person with depression but also those around them. Symptoms of depression include feelings of hopelessness and/or worthlessness, irritability and anger, loss of interest or pleasure in activities once enjoyed, low energy and fatigue, changes in appetite and weight (often decreased), problems concentrating and making decisions and impaired sleep patterns. It is important to note that everyone experiences these symptoms from time to time; however depression means that someone's everyday life is severely affected by such symptoms.
What causes depression?
There is no clear cause of depression and it is thought that a number of factors can contribute to depression occurring. For example, being female, being a teenager or young adult, having difficulties with relationships and experiencing financial stress have been linked with depression. There are also certain genes associated with depression so if depression runs in the family there may be a higher chance of developing depression. The majority of people who have depression have not been diagnosed with any other mental illness although people who suffer from depression are more likely to develop anxiety disorders as well (Murray & Lopez 1996). Depression can also result from biochemical factors such as low levels of neurotransmitters which regulate moods in the brain (Howlin et al 2004).
Treatment options for depression
The main treatments for depression are psychological therapies and medication. Therapy is aimed at helping people change how they think about themselves, others and the world which in turn will help them to feel less depressed. There are various types of therapy including interpersonal psychotherapy, psychodynamic psychotherapy, cognitive behavioural therapy (CBT), social skills training/behavioural activation and activities scheduling. CBT is a talking based therapy that helps people to identify negative thought patterns that contribute to depression and then looks at ways to identify these thoughts when they arise in everyday life so that they can be challenged by more realistic thinking. An important part of CBT is looking at behaviors linked with depression such as low self care or withdrawing from friends and family members so it may focus on increasing self care activities and improving relationships (NICE 2004).
Medication for depression is aimed at regulating chemical imbalances in the brain. Tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOI's) are commonly used medications to treat depression. These medications work by increasing the level of neurotransmitters such as serotonin or noradrenaline which can influence moods positively (NICE 2004). Newer types of antidepressants called Serotonin-noradrenaline reuptake inhibitors (SNRI's) work in a similar way but also affect certain neuroreceptors found throughout the body including heart rate, breathing rate and digestive processes which makes these medications more suitable for people with depression that have additional problems such as anxiety or physical symptoms (NICE 2004).
The side effects of antidepressants include nausea, headache, involuntary movements, sexual dysfunction and weight gain. It is recommended to start on a low dose medication when depression has been diagnosed before increasing the dosage slowly so any side effects may be noticed. It can take 4-6 weeks for antidepressant medications to become effective in depression but during this period it is recommended that therapy sessions are continued to address the negative thought patterns which contribute to depression (Murray & Lopez 1996). The use of medication for depression should always be discussed with a doctor particularly if someone has previously had negative experiences or side effects from taking medications that were not prescribed in the past. (NICE 2004)
It is important to find a treatment that works for depression and it will often require trial and error to try out different therapies and medication until the most effective form of depression management is found. It may help to write down the pros and cons of each type of depression treatment so they can be compared more easily. Also, if you don't know where to start with depression management, it's okay! Try not to panic. You might want to check out NIMH's article on How Do People Get Depression? There are also several questions below that you can ask yourself as a way of evaluating your depression.
Ways to manage your depression.
cbt - cognitive behavioral therapy
- interpersonal therapy
- psychodynamic therapy
- activity scheduling
- antidepressant medication (serotonin reuptake inhibitor)
other forms of depression management?
how has depression impacted your life in the past week: positive and negative ways. How much impairment does depression cause you day to day? What things can you no longer do due to depression? Depression causes very high levels of impairment and prevents people from doing activities that they previously enjoyed, such as going out with friends or engaging in physical exercise. For mild/moderate depression, it is recommended that these activities are started gradually so that there is less chance of relapse. For more severe depression, some people are too unwell for these activities to be possible. If depression is impacting your work it may be necessary to inform your employer or ask for special arrangements such as having flexible working hours or performing some of the required tasks at home.
How does depression affect your family members?
Depression impacts people physically and psychologically due to the depression symptoms such as loss of energy, loss of interest in activities and poor attention. There may also be financial implications for depression management depending on what treatments are used and how often.
D
epression can be very difficult to deal with especially when it becomes more severe or chronic. However, there is a lot that can be done to help depression including medication, therapy and lifestyle changes to name a few things:
- medications (NICE 2004)
- reducing alcohol intake
- getting more exercise (walking/swimming/yoga etc.)
- keeping stress levels down by avoiding stressful situations if possible
- taking time out for yourself such as doing something relaxing such as knitting or watching TV you enjoy
- getting more sunlight by going outside for a walk during the day and avoiding bright screens in the bedroom at night
- sleeping well to avoid depression symptoms worsening
- eating healthily especially foods containing omega 3 fatty acids are thought to have anti depression properties can help with depression, but there is limited research into this area. It may be worth looking into supplements containing these vitamins if depression has been difficult to manage in the past. - psychological treatments (NICE 2004)
If you find it difficult to cope emotionally, please seek support from family/friends or mental health professionals. There are also helplines available which can provide advice on depression management and offer emotional support when someone is depressed.
Conclusion.
Depression can cause high levels of impairment in day-to-day activities. A depression management plan should be made to see what depression treatments are most suitable for you.
If you have depression, it may help to write down the pros and cons of each depression treatment so they can be compared more easily. Please seek support from family/friends or mental health professionals if depression becomes too much to manage. Please call or contact Gupta Psychiatry for help.
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