Depression

Depression is one of the most common psychological conditions in Western society. There are various contradictory statistics, as it is not always easy to diagnose depression accurately (see below). However, major depression seems to effect about 6% of the population, whilst as many as 20% experience some form of depression during their lives. Trends suggest that rates of depression are increasing and that they are highest amongst young adults. Women are twice as likely as men to experience clinical depression (men are twice as likely to become alcoholics or abuse drugs). Although there is now some evidence that depression is on the increase amongst men too. Some statistics show that depression is most common amongst women in their 40’s, whilst others suggest 27 is the average age to develop depression.

WHAT IS DEPRESSION?
WHAT IS BIPOLAR?
WHAT CAUSES DEPRESSION?
DIAGNOSIS
TREATMENT

WHAT IS DEPRESSION?

We all have times in our lives when we feel very sad and might describe ourselves as depressed. This is often in response to life events, such as a death, relationship break up, redundancy etc. For most of us this is part of a natural grieving cycle and given time and the right support we can work through these difficult feelings and return to a more ‘normal’ mood. However, sometimes we get stuck in these low moods and need help to regain our balance. People use the term ‘depresson’ when they are feeling a bit “down” and when they are suffering from severe clinical depression, so it can be a bit confusing. According to the ‘Diagnostic and Statistics Manual-IV’ (DSM-IV), the clinical definition of a major depressive episode is - “Five or more of the following symptoms present during a two week period (at least one of the symptoms is either depressed mood or loss of interest or pleasure):

depressed mood
loss of interest or pleasure
poor or increased appetite/weight loss or gain
insomnia or hypersomnia
psychomotor agitation or retardation
loss of energy/fatigue
feelings of worthlessness, guilt or self reproach
poor concentration/indecisiveness
thoughts of death or suicide attempts”

When we feel deeply depressed we may experiance a range of symptoms in addition to the above, including, tearfulness, hopelessness, negative expectations, negative self concept, reduced libido, feelings of guilt, irregular menstrual cycle, constipation, etc. For some people depression may be a one off event in their lives, for others it may be a recurring theme.

In extreme cases people may develop psychotic depression. Here they become delusional and may have suicidal or murderous plans. They are also likely to neglect themselves. Such extreme cases need qualified medical care and are not covered in the information given on this site.

WHAT IS BIPOLAR?

Where depression occurs on its own it is called unipolar, where it appears with mania it is called bipolar. This condition used to be called manic-depression. A manic episode is defined in DSM-IV as:

“A period of persistently elevated, expansive or irritable mood, lasting at least one week, severe enough to disrupt work and social activities
At least three of the following symptoms:
- increased activity or restlessness
- rapid speech
- inflated self-esteem or grandiosity (thinking you can do anything)
- flights of ideas or subjective experience that thoughts are racing
- distractibility
- disinhibited behaviour (unrestrained buying sprees, sexual disinhibition)
- decreased need for sleep”

Bipolar disorder represents about 10% of all depressions.

WHAT CAUSES DEPRESSION?

There are a number of different theories about the causes of depression.

It is sometimes thought to be the symptom of an organic condition e.g. underactive thyroid, a viral illness followed by use of certain drugs (including alcohol). This is referred to as organically induced depression.

Some believe that the roots of depression lie in biology - that it is caused by a hormonal imbalance in the brain (and can therefore be treated with drugs) or by genetics or stress. Others believe that it is caused by emotional and psychological factors and that any inbalances in the brain are a symptom rather than the cause. At best drugs are therefore only treating a symptom and leaving the underlying cause untreated. Below I provide a brief introduction to some of the main theories.

NEUROTRANSMITTERS

Put simply neurotransmitters are chemicals which carry signals from one brain cell to another. The traditional biological approach looks towards the biology of the brain and in particular neurotransmitter and hormonal imbalances to explain depression. In the 1950’s it was discovered that taking a particular drug caused depression. The drug was known to reduce levels of certain neurotransmitters and it was therefore concluded that depression was caused by a lack of these neurotransmitters. This led to the idea that a lack of two particular neurotransmitters, serotonin and noradrenalin, caused depression. This in turn led to the development of drugs to help maintain the levels of these chemicals.

GENETICS

Some people believe that a tendency towards depression is inherited. There is some evidence that you have a greater risk of depression if someone in your close family has suffered from depression.. However, this does not necessarily mean that there is a genetic factor at work, there may be other environmental factors at play. There is some evidence from studies of twins that there may be a genetic link and certain genes have been detected which seem linked in some way to depression. However, so far no single gene for depression has been discovered and it seems likely that the condition is related to a whole range of factors including a number of different genes and environmental influences. There is also a theory that although our genes may carry the potential for a given disease, it is environmental factors that actually trigger the development of any such disease (see The Biology of Belief by Dr Bruce Lipton). Overall the good news is that even those scientists studying genetics are not claiming that anyone is destined from birth to develop depression.

STRESS

Not all depressed people respond to antidepressant drugs and our current understanding of the brain suggests that there are more complex mechanisms at work. An alternative theory is that depression may be caused by stress. Stress hormones are thought to restrict the growth of certain brain cells. In some chronically depressed patients the hippocampus (a part of the brain important for memory and spatial awareness) and the prefrontal cortex (a part of the brain thought to be important for setting and achieving goals and decision making) have been found to have physically shrunk. Other studies show that people with depression have a lack of functioning in their left prefrontal cortex, an area that is thought to process positive emotions and suppress negative ones.

PSYCHOLOGICAL MODELS

This isn’t one theory, but a whole range of theories. They all share the underlying idea that depression has an emotional or psychological, rather than a biological cause. Some view depression as linked to actual or perceived loss, others believe that it relates to unrealistic expectations of themselves which they can never live up to. For many depression is linked to formative experiences in early childhood, although it may be triggered by a more recent event. So, for instance why does one person who is made redundant develop depression, whilst another uses the opportunity to start their own business and looks back on it as the best thing that could have happened? One individual is more adaptable to life events and holds a more secure self image. Their identity is not threatened by the loss of their job. (These ideas are expanded further in the section on treatment below).

COGNITIVE MODELS

These theories view the way a person thinks (their cognitive functioning) as related to how they deal with life events. To put it crudely persistent negative thinking leads to depression. The individual gets stuck in negative thoughts that are not corrected by life events and ends up viewing the world through a negative filter. These negative thought processes may well have started in childhood, due to an inappropriate or dysfunctional family environment. So two people may experience the same life event and one of them will recover reasonably quickly, whilst the other will get trapped in their negative thinking and fall into a depression.

BEHAVIOURAL MODELS

Behavioural theories suggest that our behaviour is a result of reward and punishment, a ‘carrot and stick’ approach. According to this view depression results from a lack of positive reward. This lack of positive reward may be because the depressed person unconsciously behaves in a way that invites a negative response; or it may be because their friends and family tend to react negatively to everything (due to their own emotional issues). So again a dysfunctional family environment may lead to a child growing up surrounded by negative responses, with no opportunity to learn that positive responses are possible, or how to encourage them. This has many similarities with the cognitive approach and the two have been combined to produce cognitive behavioural therapy.

SOCIAL MODELS

These look at the link between multiple negative life events and depression. It does seem that those suffering from depression report more negative life events than those not suffering from depression. The life events most likely to be linked to depression are ‘Exit’ events, such as relationship break-up. However, not everyone who experiences these life events develops depression, so they seem to be contributing factors, rather than the whole picture.

Social models also look at other factors such as racism and unemployment. Studies show no definite link to racism, but unemployment is a definite risk factor for men.

SPIRITUAL MODELS

Again there are many different spiritual approaches to depression. One view is to see depression as a spiritual crisis in which the lack of meaning and hopelessness is related to a lack of spiritual meaning. It could therefore be seen as an unresolved existential crisis. Another view is to see depression as a very low energy state. In this model we are viewed as beings of light temporarily occupying physical bodies. In order to interact with the physcial world we have had to lower our energy levels (lower vibrational frequency) in order to interact with matter. Those suffering from depression have lowered their energy too far and need to raise their energy levels again.

MAKING SENSE OF IT ALL

With so many competing theories it can be very confusing for someone suffering from depression. How do we make sense of the conflicting evidence and come to a conclusion about the cause of depresion? My personal view is that depression is a complex condition with multiple causes and triggers and that each individual’s experience is unique. It may even be that what we call depression is not actually one disease, but a cluster of symptoms that can have many different causes and therefore can respond to many different treatments.

You can read more about the different potential causes of depression in my new book ‘THE DEPRESSION TRAP: TEN WAYS TO SET YOURSELF FREE’.

DIAGNOSIS (in the UK)

If you want a definite diagnosis of depression then your best option is to see a psychiatrist. They have been trained in the diagnosis of psychological conditions. Most GPs have very little training in this area and although many will tell you that you have depression if you describe some of the classic symptoms, they may not really be qualified to give this diagnosis. Before starting to take drugs which many claim can be addictive and have side effects you may want to consider getting a second opinion from someone who specialises in this area. Although you may well be referred to a counsellor or psychotherapist to help you recover from depression, they are not usually qualified to diagnose the condition. For many of them a diagnosis is not important, as their approach is to work with the individual as a whole person, rather than to think in terms of disease.

Please note that this information relates to the UK and the situation may well be different in other countries.

TREATMENT

In order to decide on a treatment we need to have some understanding of the cause. From the brief look at causes above you will see that this is not a simple matter. There are many different approaches to treatment just as there are many different models to help us understand it. Your GP is most likely to offer you antidepressants and counselling. However, in many areas there is only limited counselling available on the NHS. I have collected together some of the treatments available and hope that you find this information useful. This information is covered in more detail in my book ‘The Depression Trap: How to Set Yourself Free’, which will be published in early 2008.

DRUGS

There are a number of different antidepressant drugs that you might be prescribed. You can find out more information about these on the Depression Alliance website. I address the use of antidepressants in more detail in Chapter 2 of my book. Plus also see my blog posting ‘Drugs No Better Than Placeb?‘

COUNSELLING

Cognitive Behavioural Therapy is the type of counselling most often offered by the NHS for the treatment of depression. There are studies that point to its effectiveness as being at least as good if not better than drugs. Other talking therapies have not been studied to the same extent, however a recent study on the effectiveness of various types of counselling showed that the relationship between the therapist and client is more important than the type of counselling employed. Different people find different approaches helpful and it may be worth taking some time to work out what is best for you. I cover counselling and psychotherpay in more detail in Chapters 2 and 3 of my book. Plus you can find out more about some of the approaches to counselling by following the links below:

Cognitive Behavioural Therapy
Gestalt Counselling
Person Centred Counselling
Psychodynamic Counselling

HYPNOTHERAPY

Hypnotherapy involves the inducing of a trance-like state, in which you are actually in an enhanced state of awareness, concentrating entirely on the hypnotherapist’s voice. In this state, the conscious mind is suppressed and the subconscious mind is accessed. The therapist is able to suggest ideas, concepts and lifestyle adaptations to the subconscious which are more easily accepted than when in a normal state of consciousness. However, the hypnotherapist can not make you do anything that you don’t want to do.

There are many hypnotherapists working with depression who claim to have excellent results. There has also been at least one clinical study which supports the effectiveness of hypnotherapy for treating depression (Alladin and Alibhai, 2007). I cover hypnotherpay in more detail in chapter 4 of my book. You can also find out more here .

ST JOHN’S WORT

St John’s Wort is a plant that has been used in herbal medicine for thousands of years. It has a reputation for helping with depression and studies have generally shown positive results. It is widely prescribed in Germany where most of the testing has been carried out. It should not be taken if you are already taking antidepressants (if you are taking any prescription drugs its best to check for interactions before taking St John’s wort). I cover herbs in general in chapter 7 of my book and you can find out more here.

EXERCISE

Exercise is now seen as a promising treatment for mild to medium depression. It’s not yet clear why this is the case. It may be the exercise itself which has an impact on the body’s chemistry, it may also be the camaraderie associated with prescribed exercise. Yoga is also thought to be good for depression, especially the breathing exercises. I cover this in more detail in chapter 5 of my book.

DIET

Many people believe that diet can play an important part in combating depression. Three separate clinical studies in Britain, Israel, and the U.S. indicate that an increased intake of omega-3 fatty acids had “a substantial impact” on depression and bi-polar disorder. (Read more here.) Deficiencies in certain vitamins, espiecally the B complex, are also thought to be linked to depression.

You can read about the latest research on my blog here.

It is also best to avoid certain food and drink when suffering from depression, especialy alcohol, caffeine and sugary foods. Some people have even found that their depression was linked to food intolerances, so having an allergy test can be helpful in some cases. I cover diet in more detail in chapter 6 of my book.

MEDITATION

Recent research indicates that meditation has a effect on mood. However, this research was based on experienced meditators, so the results might be different for beginners. Cognitive Behavioural Therapy recommends the use of mindfulness meditation in helping to combat depression and there has been some evidence to show that this is effective. I have also come across a number of anecdotal cases where individuals have found meditation helpful in recovering from depression. Meditation can be helpful for those suffering from depression, but there is also a danger that in some cases it can heighten feelings of helplessness, despair etc. For this reason it may be less suitable for those with severe depression. However, there is some evidence that meditation can help those with severe depression too if they are under the constant guidance of an experienced teacher. This suggests that it is not meditation itself that is potentially harmful, but rather the misapplication of it by inexperienced students. I cover meditation in more detail in chapter 8 of my book, plus you can find out more here.

COMPLEMENTARY THERAPIES

A number of complementary therapies are reported to have helped some people suffering from depression. I cover these in more detail in chapter 9 of my book and you can find some general information about each therapy by clicking on the links below

Acupuncture
Homeopathy
Reflexology
Reiki

MUSIC THERAPY

We all have experience of how music can effect our mood. Some claim that it can actually help with depression. Read more in chapter 10 of my book and here.

SELF HELP

There are a number of things that you can try to help with your depression whilst undergoing treatment. It can help to feel that you are doing something, that you have some control over your recovery. The following suggestions are covered in more detail in chapter 10 of my book.

Laughter has been said to be the best medicine and there have been a number of studies linking a well developed sense of humour with recovery from stress, depression and suicidal thoughts. So why not try watching funny films, reading funny books, collecting jokes you enjoy, etc.
Pet Therapy. For many people pets can be a lifeline, connecting them to the world and providing unconditional companionship and acceptance.
Aromatherpy. Certain oils are said to help with depression. These can be released in an oil evaporator or applied in a base massage oil.
Positive Input. Be careful what influences you allow into your mind. Avoid negative inputs such as The News, depressing TV programmes, films and books and people who bring you down. Surround yourself with positive influences instead.
Sunlight and Colour. Some people find that a lack of sunlight makes their depression worse. If you always feel worse in the winter then you might want to try a full spectrum lamp. Colour can also have an impact on our mood, so surround yourself with colours that lift your mood. Read more on my blog entry ‘Do You Feel Better When the Sun Shines?’

The Depression Trap