Understanding and Managing DepressionAn APS Tip Sheet
What is depression?
The word depression is used to describe various and sometimes overlapping experiences. To many people being depressed means feeling sad, ‘blue’, downhearted, disappointed, detached or upset. However, a person can feel all these emotions without being ‘clinically’ depressed. Feelings of sadness or the ‘blues’ are generally brief and have slight effects on normal functioning.
Clinical depression is an emotional, physical and cognitive (thinking) state that is intense and long-lasting and has more negative effects on a person’s day-to-day life. Approximately one in five people will experience an episode of clinical depression in their lifetime.
It is also important to distinguish depression from the sadness we naturally experience after loss, such as during bereavement. Although the grief associated with loss is often intense and long lasting, such emotions are a healthy response to loss and allow people to adjust to their new life circumstances. Depression on the other hand, can have significant and detrimental effects on many aspects of a person’s life. It is generally important to consider what is causing and maintaining the depression for improvement to take place. This may involve a person approaching life stresses or relationships differently, making lifestyle changes, regaining self-esteem or reconnecting with his or her values.
Finally, it is helpful for depressed people to understand what depression is and isn’t. It is not something to be ashamed of or to feel guilty about. It is not a character flaw or a sign of weakness, or a lack in discipline or personal strength. It is not just a ‘mood’ that someone can ‘snap out of’. Most importantly, depression is not permanent – that is, the chances for recovery are very good. A number of psychological and pharmacological treatments (antidepressant medication) are effective, affordable and readily available.
What are the causes of depression?
The causes of depression are often not due to one factor but are likely to be the result of a number of inter-related factors. Factors that may play a role in the development of depression are listed below.
There is evidence that some people have a genetic predisposition to developing depression. Having a family history of depression does not mean that a person will necessarily develop depression, but it does mean that the risk of developing depression can be higher than if there is no family history. There are usually other situational factors involved such as a stressful life event or chronic illness that may act as a trigger for the onset of a depressive episode.
People who are depressed demonstrate abnormal functioning of some chemicals in the brain. Neurotransmitters are naturally occurring chemicals that send signals from one part of the brain to the next. In people who are depressed the mood-regulating neurotransmitters do not function normally, which interferes with signals sent to the brain and causes mood to be affected.
Stressful life events can act as a trigger for depression. While most people will experience some level of depressed mood following a stressful event such as a relationship break-up, this often reduces over time. However, for some people the depressed mood will persist and lead to clinical depression. There is evidence that life events that put a person at a higher risk for depression are those that impact on the person’s self-esteem, such as experiencing a relationship breakdown or a financial or job loss.
Some personality types are more likely to develop depression. There is evidence that people who experience high anxiety levels, are very sensitive to criticism, or have a perfectionist personality have a higher risk of developing depression.
What are the symptoms of depression?
Loss of interest in pleasurable activities and daily routine
People who experience depression are often unable to complete daily tasks and do not enjoy activities they previously took pleasure in. They miss out on positive experiences associated with a sense of achievement and on the pleasure derived from completing daily tasks. The people around them may also suffer as a result.
Worrying and Negative Thinking
People with depression often worry about the future and have negative thoughts about themselves and their circumstances. These thinking patterns are very unhelpful in that they reduce a person’s ability to focus on recovery and tend to increase their vulnerability to other unhealthy emotions and behaviours.
Irritability, agitation and fatigue
People with depression often experience irritability and agitation, and may complain of exhaustion. Sometimes they feel frustrated with their rate of recovery or the level of support available and annoyed that they don’t have the energy to do anything. They may become more easily upset with those around them. Irritability, agitation and fatigue are often made worse by changes in sleeping patterns and other symptoms associated with depression, such as negative thinking.
Changes in Sleeping Patterns
Changes in sleeping patterns (either sleeping too much or having trouble sleeping) are common in individuals experiencing depression. Disruptive sleeping patterns can make a person feel worse and make routine communication and activities seem overly difficult and frustrating.
People who are depressed usually feel trapped or hopeless about their situation, and suicidal thoughts and feelings are commonly experienced. When their mood lifts these feelings are replaced with a more positive perspective and options for the future.
How is Depression Treated?
There are two major forms of treatment for depression that may be used individually or in combination, depending on the type of depression.
Psychological treatments for depression provide a supportive environment for a person to work through difficulties. Psychologists help by providing skills and strategies to change negative thinking patterns and behaviours that contribute to depression and to lessen underlying sensitivity to future episodes of depression. There are a number of psychological treatments that have research evidence supporting their effectiveness.
One defining aspect of clinical depression is a change in the balance of chemicals in the brain that impact on mood. When some specific chemicals in the brain are very low or lacking, this can contribute to feelings of low mood, sadness and fatigue. Antidepressant medications are drugs that help restore the brain’s chemical balance to improve mood.
For some types of depression, particularly more severe depression, a combination of both antidepressant medication and psychological treatment has been shown to be most helpful. Antidepressant medication helps change a person’s mood and increases their responsiveness to psychological treatment. The psychological treatment provides support and strategies to change depressed thinking and behaviour, and improves long-term coping skills to minimise future relapse.
Your general practitioner will be able to provide you with more information on these treatment options.
Tips on how to help manage the symptoms of depression
Loss of interest in pleasurable activities and daily routine
There is evidence to show that increasing activity levels and participating in pleasurable experiences can
help reduce depressive symptoms. The following points provide guidelines for increasing pleasurable activities and the sense of accomplishment you experience.
- Make a list of activities you need to complete as well as some that you find (or used to find) enjoyable. Make sure you write down as many activities as you can. Remember to also list activities that are only marginally enjoyable.
- Plan to take part in an activity each day. Activities should be achievable and should provide a sense of accomplishment when completed. Include enjoyable activities and try to increase the amount of time each day available for these.
- Think about what you have accomplished once you have completed a daily task. When participating in pleasurable activities, think about their enjoyable aspects. Talk to others about activities they enjoy and reflect on positive experiences.
- Remember that during a depressive episode you often lack motivation to work through daily routines and things you enjoyed previously may not seem as enjoyable. Focus on the positive, no matter how small, and remember that as you recover, the enjoyment you experience will increase.
Worrying and negative thinking
Changing negative thinking patterns and reducing worry is not as easy as it may seem. This is an area where people often require the assistance of a psychologist or other mental health professional. Below are some suggestions for learning to control worry and reduce negative thinking.
- Take time to think about how realistic your negative thoughts are. Try to find some different and more helpful thoughts and explanations for circumstances. Write down some of these more helpful ways of thinking.
- Avoid excessively discussing negative thoughts and feelings with colleagues, family or friends. Instead, try to focus on positive aspects of situations. Negative thinking and dwelling on negative topics will not help you feel better.
- Keep yourself busy and your mind focused on tasks. Avoid unstructured time where you have nothing planned, as your mind may wander and dwell on negative themes.
- Try to think positively. There are many things you can do to address the cognitive (thinking) component of depression. These include: making a list of your skills, talents, and achievements; identifying the three most beautiful things in your environment; reminiscing about a time when you were really happy, successful or content.
- Set aside a daily “worry time” of 15 minutes when you do nothing but ruminate about your problems. Once this time is finished, leave all your concerns behind and begin working on thinking more positive thoughts. If during the day you begin to focus on your worries, remind yourself that there is a designated time for this and move your thoughts away from your problems. After some time of practising this, people often complain that they have difficulty filling 15 minutes with their worries.
- Keep a journal of your thoughts. Identify negative and unhelpful thoughts and try to correct them.
- Do not make any major life decisions, such as quitting your job or breaking up a relationship, while depressed. Remember, you may not be seeing yourself, the world, or the future in a clear way when you are depressed.
Irritability, agitation and fatigue
Being irritable or agitated is a normal part of depression. It is important that people close to you are aware of this so that they can be more patient and understanding, rather than annoyed and unsupportive. Below are some tips to help you deal with irritability and agitation.
- Make sure you take the time to educate and advise key support people, such as close friends, family and colleagues, of what you are going through. Help them to understand that if you appear irritable or agitated it is not because you are unhappy with them, but rather because you are recovering from depression. Thank them for their support and provide feedback on how they can best continue to support you.
- When you are feeling irritable or agitated, stop and settle yourself down. Ask yourself what is driving your emotions. If it is negative thinking, then use strategies outlined previously to tackle negative thoughts. If you are tired, pace out your workload to allow for this. If you feel unmotivated, try and incorporate some enjoyable activities into your schedule.
- Practise regular relaxation and meditation activities and organise regular times to talk with a support person about how you are coping and implementing new coping skills. By taking time out to relax regularly and to communicate with supportive people, you greatly reduce the impact of potentially irritating and frustrating experiences.
- Be as active as possible despite fatigue. Try to schedule activities to fill up the spare hours of the day. Activities may include exercise, social interaction or even routine household chores. If activity seems impossible, try to force yourself to do three things each day, such as getting out of bed, getting changed out of your pyjamas and brushing your hair. Even the smallest amount of activity is better than no activity at all.
Changes in sleeping patterns
Regular healthy sleeping patterns are extremely important for people recovering from depression. Listed below are a few key points to assist you in establishing healthy sleeping patterns.
- Make sure you get up around the same time every morning regardless of how tired you feel.
- Avoid sleeping during the day or taking naps in the early evening.
- Reduce tea and coffee intake to a maximum of four cups per day and do not have any tea or coffee after 4pm.
- If you wake up during the night, do not lie in bed trying to sleep for more than 30 minutes at a time. Get up, go to another room and engage in a relaxing activity, such as reading, listening to music or a relaxation exercise. When you feel sleepy, return to bed and sleep.
If you feel that your situation is hopeless and particularly if suicidal thoughts are present, it is essential to seek help and to speak to someone about how you are feeling.
- Speak to someone you trust who you know will listen and try to understand how you are feeling. It is important to be honest with this person about any plans you might have to harm yourself. It is in your best interests to allow them to protect you.
- As much as possible, spend time with others so that you are not alone.
- Call a crisis line or seek help from a mental health professional.
- If urges to act out the suicidal thoughts become overwhelming, a brief stay in an inpatient clinic might be extremely beneficial.
- Remember that these feelings will pass.