A depressive disorder can affect your whole self, from the way you eat and sleep to how you feel and think about yourself. Many people talk about "being depressed", but real depression is not a passing low mood that will be gone tomorrow through a little effort of will. In fact it cannot be willed away and there is no use in friends telling you to "pull up your socks and get on with life". Appropriate treatment can help the great majority of those who suffer from the disorder, but untreated the condition can last for many months or years.
Depression may be experienced very differently from person to person. The symptoms need to be severe enough to interfere with daily living and/or work activities to be considered an indicator of major depression. Four or more of the nine symptoms below, lasting for two weeks or more, require professional help.
- Noticeable change in sleep pattern
- Noticeable change in appetite
- Decreased ability to experience pleasure, e.g. Loss of interest and pleasure in things formerly enjoyed
- Feelings of worthlessness, hopelessness, helplessness
- Inappropriate guilt and self blame
- Problems with thinking, concentration and attention
- Recurrent thoughts of death or suicide
- Overwhelming sadness and grief
- Physical symptoms, fatigue, loss of libido
People also report the following symptoms:
- Depressed mood
- Decreased ability to make decisions
- Physical aches and pains
- Lack of motivation
- Becoming withdrawn
- Preoccupation with negative thoughts
- Excessive drinking
- Mixed-up thoughts
- Irrational fears and phobias
Some people experience hallucinations - seeing, hearing, tasting, smelling or touching - things that are not there or perceiving things as distorted. Others experience delusions - beliefs that appear real to the person but are really false.
If the person also experiences abnormally high or elevated mood for a period, it is likely that another diagnosis, such as bipolar or manic depressive disorder be considered.
Certain events or states predispose the person to depression. These include:
- Marriage problems or divorce
- Unemployment or redundancy
- Financial difficulties
- Moving house
- Having experienced incest or other traumas as a child
You will notice that several of the occurrences above are related to inevitable life changes that can be extremely stressful. While stress is not the whole picture, continuing high stress in our lives may make us susceptible to recurrent episodes of depression.
Who is at Risk?
Depression can be experienced at any age from children to much older people. Men often have their first episode in middle age (~50). It is now commonly diagnosed in children, and young people in their teen years are also at risk.
Cause or Causes
Researchers are at present focusing on particular chemicals in the brain such as norepinephrine and serotonin, which they think are involved in causing depression. However, these remain theories for which there is as yet no definitive proof.
Depression has to be present for two weeks before it can be diagnosed. At present there is no diagnostic test for the disorder so that a detailed history must be taken by the physician to determine the symptoms that the person and/or his family have noticed over the previous two or more weeks that are different from normal. The doctor must also rule out other physical or mental conditions that could be responsible. In general to diagnose depression the following must be present: depressed mood; diminished interest in life; insomnia; fatigue; weight loss/ gain; diminished concentration. To consider a diagnosis of depression the person should not have been experiencing psychotic symptoms in the absence of mood symptoms for the previous two weeks.
Course of Illness
Depression can affect a person at any time in his life from adolescence or youth to advanced age. It may be of short duration, or continue for months or years, or it may appear episodically at different times during a person's life. Some people fully recover, while others may suffer throughout their lives. Degrees of severity may differ. When the condition is experienced mildly over years it is called disthymia.
There are a number of effective medications to treat depression. These are called antidepressants and fall into the following categories:
- Tricyclic antidepressants
- Monoamine oxidase inhibitors (MAO inhibitors))
- Serotonin selective reuptake inhibitors (SSRO's)
- Noradrenergic and specific serotonergic antidepressants (NaSSA)
- Serotonin Noradrenaline reuptake inhibitors (SNRI)
- Noradrenaline and dopamine reuptake inhibitors (NDRI)
- Noradrenaline reuptake inhibitors (NRI)
When hallucinations or delusions are present, antipsychotic medications
may be prescribed. None of these medications is a cure for depression,
but they can alleviate at least some of the symptoms.
Pharmacotherapy can be enhanced by psychosocial treatments such as Cognitive Behavioural Therapy. CBT is a therapy that has been demonstrated to be effective in many patients with depression. This course of treatment is based on the premise that peoples' ideas about themselves can be changed.
For people with a severe depression that does not respond to other treatments there is Electro Convulsive Therapy (ECT), a course of controlled treatment administered under general anaesthetic. ECT had very bad press in the past, owing to primitive methods of administering it, but it is now given under strict controls and the patient remains comfortable throughout.
Neither psychoanalysis, nor insight oriented psychotherapy have been demonstrated as effective treatments for people with a depressive disorder.
Caring for Someone with Depression
When a close relative becomes depressed the whole balance of family life is disturbed. At first it is difficult to grasp what is happening and family members may become aggravated, angry and disbelieving at what the person with depression is telling them and the way they are behaving. It is important to remember that the person cannot help the symptoms and behaviours and that s/he himself is very distraught about what is happening. Loving care is vital to help someone who is depressed.
To better understand how depression affects your relative you should do all you can to learn about the condition. This will help you adapt your own behaviour to be supportive to your relative. It will also help you to realize that the person needs medical/ psychiatric help and that you must put aside your frustrations in favour of giving encouragement (even if it is not well received at first) and helping the person not to lose hope. You should avoid indulging in self-blame or guilt and concentrate on helping your relative work towards recovery. Your natural concern should be tempered by consideration for your relative's need for privacy at times.
In Living with a Stranger (Gaskell Press, 1997), Valerie Stillwell offers this useful advice:
There is a fine line between keeping cheerful... and being insensitively over-cheerful. In other words, jollying him along telling him to cheer-up and pull himself together. He cannot. That is what the illness is all about, so however tempted you may be to utter the words-don't... Urging him to do so hurts because he thinks you are blaming him for his condition, criticising behaviour, which is entirely beyond his control..
It goes without saying that you should not criticize or reproach him, but you may find it difficult not to argue with him. ...It is better simply to stick to positive statements, such as 'I know that you are suffering and I can't imagine what it might be like, but I do know that you will come through it eventually.'
However irritated you are with the constant repetition of negative thoughts, try to switch off. Do your best to hide your anger and frustration when you are with them. It is hard, I know. Keep biting your tongue.
An excerpt from Rodney Elgie, President of GAMIAN-Europe, offers some insight into how men, in particular, deal with depression:
Men suffering from the symptoms of depression - poor sleep patterns, fatigue, agitation and lack of appetite - are often reluctant to accept the true diagnosis. They will more readily find some other explanation, stress for example, for experiencing these symptoms. Stress is viewed as positive and acceptable, an acknowledgement that one is functioning to the limit of one's capacity. Depression on the other hand is negative, an indication that a man cannot cope and needs help. It is viewed unsympathetically by many. Men persuaded to consult their GP will often deliberately mask their depressive symptoms, concentrating instead on a variety of physical ailments, which can make an accurate diagnosis impossible.
By not acknowledging that a problem exists and by endeavoring to shoulder the burden alone, without adequate professional help, a number of men become overtaken by feelings of helplessness and hopelessness. Many self-medicate with alcohol or illicit drugs.
Risk of Suicide:
From the site All About Depression
Although most people who are depressed do not kill themselves, untreated depression can increase the risk of possible suicide. It is not uncommon for depressed individuals to have thoughts about suicide whether or not they intend to act on these thoughts. Severely depressed people often do not have the energy to harm themselves, but it is when their depression lifts and they gain increased energy that they may be more likely to attempt suicide.
Families must always be aware that there can be a high risk for suicide in people with depression. We direct you to our booklet 2 in the publications section of the site, where some of the risk factors are described. More recently a guidebook has been developed entitled: Mental Illness and Suicide - A Family Guide to Facing and Reducing the Risks. You may download this on the WFMH site at the Center for Family and Consumer Advocacy and Support.