Depression

Everyone feels down sometimes. But when health professionals talk of depression, they are referring to a very different condition, which interferes with your life in all sorts of ways.

This information is taken from our book Manage Your Mood by David Veale and Rob Willson published by Robinson

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What is “depression”?

Everyone feels down from time to time but this usually passes fairly quickly and doesn’t interfere too much with the way we live our lives. When most people say ‘I’m depressed’ they mean that they are feeling low or sad, or stressed maybe. These feelings are normal facets of human experience.

When health professionals talk of depression, however, they are using the term in a different way. They are referring to a condition which is qualitatively different from the normal ups and downs of everyday life. This is the type of depression we will be discussing: it is more painful than a normal low, lasts longer and interferes with your life in all sorts of ways. However there is probably a continuum between normal sadness and depression with no clear dividing lines.

How depression affects the way you think, feel, and act

The best of way of thinking about your depression is to divide the symptoms into the way you think, the way you feel and the way you act. Not everyone experiences the same symptoms – it partly depends on the severity of your problem and your culture.

Thinking negatively

When you are depressed, you tend to think negatively about your self; the situation you are in; what you have done in the past, and your future. You might believe that you are weak or a failure and that the future is hopeless.

Throughout this book we’ll be emphasising the importance of recognising that thoughts about your self and the future are just that – thoughts, not reality. Learning to accept these negative thoughts willingly as “just thoughts” and not buying into them is an important part of overcoming depression.

Self-criticism

When you feel depressed you might be self critical and ‘label’ yourself as useless, stupid or a failure. More severely depressed people tend to view themselves as totally worthless, unlovable or bad. You may frequently focus on past mistakes which seem to confirm your negative view of yourself.

However when you are depressed, thoughts become fused with reality and accepted as facts. As a consequence, you develop a pattern of thinking which is like holding a prejudice against yourself. You are then more likely to avoid challenges or situations in which you believe others will put you down.

You will learn in this book to notice when you are thinking about yourself in this prejudiced way by prefacing it “I had a thought that I was a failure” thus underlining that it’s just your thought or a mental event. When self-criticism is strong then you would learn to develop a compassionate mind.

Helplessness and hopelessness

When you are depressed you may think that you are helpless to solve problems or you may feel trapped. You might believe the future to be hopeless and even want to end your life as a way of escaping from your problems. In depression, believing the future to be hopeless has become fused with reality and you think things cannot get better or can only get worse.

It is quite common for people who are experiencing depression to have thoughts of suicide, without taking the further step of acting upon those thoughts. However if you feel very hopeless about the future and are planning ways to end your own life, seek help as soon as possible. There’s every chance you could still use the advice in this book to overcome your depression, it’s just that you may need support and assistance from a health professional as well.

When ‘thinking solutions’ are part of the problem – ruminations

There are several ways in which you might be trying to improve the way you feel, which may in fact be making you feel worse.

(a) avoiding thinking about the situation you are in. This might bring temporary relief but results in problems being left unresolved or building up.

(b) controlling your thoughts or suppressing them, which can mean they enter your mind more frequently. You are probably trying to ‘put right’ or make sense of past events by ruminating on them, perhaps mulling them over and over. Unwittingly you are probably trying solve problems that cannot be solved, or analyse a question that cannot be answered. This usually consists of lot of “Why?” type questions. For example “Why am I so depressed?” or “Why did my partner leave me?” Another favourite “If only…” fantasies as in “If only I had taken her advice…” “If only I looked better…”. Alternatively you may be constantly comparing yourself against others and making judgements and criticising yourself. Rumination invariably makes you feel worse as you never resolve the existing questions and may even generate new questions that cannot be answered.

What causes depression?

Our understanding of the cause of depression is that it is a consequence of avoiding or trying to control unpleasant thoughts, feelings and problems and trying to find reasons for the past or to solve unsolvable problems. This is called ruminating. The effect is that you become being inactive and withdrawn. This in turn leads you to feel worse and you miss out on experiences in life that normally bring satisfaction or pleasure. Furthermore the way you act has an effect on others and the environment around you that further feeds your depression.

Depression is thus highly understandable given the context you find yourself in (e.g. a conflict in your relationship, a loss of your job). The appeal of shifting from an emphasis on ‘internal defects’ (e.g. lack of serotonin, faulty thinking) as an explanation for depression is that many people find that it helps them to feel less blamed or stigmatised for their problem. By focussing on the context and whether what your reaction works in helping you to achieve what you want in life, it is a highly practical approach. Crucially it’s also a highly scientific perspective in the sense that the approach been scientifically proven to be effective and it rests on testable theories.

Treatment of depression

There are a number of evidence based talking treatments and medication for depression which are outlines in the NICE guidelines. Recommended talking treatments include Cognitive Behaviour Therapy, Behavioural Activation, and anti-depressants. We also discuss in the book the role of exercise, diet, sleep and light therapy.