Depression - Types, Symptoms, Treatment & Coping.

Taken from http://www.depressionalliance.org/

Depression is much misunderstood by the public, yet it affects many people of all ages. It is estimated that one in five people will suffer from depression at some point in their lives. Depression is an illness where the feelings of hopelessness and helplessness, linked to the inability to concentrate, may make it hard for some people to carry out normal daily activities. Depression is an illness with a wide range of physical and psychological symptoms, which sometimes make it hard to recognize and understand.

Personality may play a part in depression. Although anyone can become depressed under particular circumstances, some people seem to be more vulnerable than others. This may be because of things that have happened in childhood, such as abuse, or because of our individual make up (including body chemistry).

A lot of effective, intelligent and creative people suffer from depression and yet make an outstanding contribution to life. Often, information about their depression is only revealed after their death, as people misunderstand the illness. Amongst such people are Florence Nightingale and Sir Winston Churchill, who used to call depression his "black dog". Depression can effect anyone and does not reduce your value as a human being.

What causes depression?

The group of symptoms to which doctors and therapists use to diagnose depression ("depressive symptoms") including the important provision that the symptoms have manifested for more than a few weeks and that they are interfering with normal life, are the result of an alteration in brain chemistry. This alteration is similar to temporary normal variations in brain chemistry which can be triggered by illness, stress, frustration, or grief, but it differs in that it is self-sustaining and does not resolve itself upon removal of such triggering events (if any such trigger can be found at all, which is not always the case.) Instead, the alteration continues, producing depressive symptoms and through those symptoms, enormous new stresses on the person. Such stresses can include unhappiness, sleep disorders, lack of concentration, difficulty in doing one's job, the inability to care for one's physical and emotional needs, and the strain on existing relationships with friends and family. These new stresses may be sufficient to act as triggers for continuing brain chemistry alteration, or they may simply prevent the resolution of the difficulties which may have triggered the initial alteration, or both.

The depressive brain chemistry alteration seems to be self-limiting in most cases: after one to three years, a more normal chemistry reappears, even without medical treatment. However, if the alteration is profound enough to cause suicidal impulses, a majority of untreated depressed people will in fact attempt suicide, and as many as 17% will eventually succeed. Therefore, depression must be thought of as a potentially fatal illness. Friends and relatives may be deceived by the casual way that profoundly depressed people speak of suicide or self-mutilation. They are not casual because they "don't really mean it"; they are casual because these things seem no worse than the mental pain they are already suffering. Any comment such as, "You'd be better off if I were gone," or "I wish I could just jump out a window," is the equivalent of a sudden high fever; the depressed person must be taken to a professional who can monitor their danger. A formulated plan, such as, "I'm going to jump in front of the next car that comes by," is the equivalent of sudden unconsciousness: an immediate medical emergency which may require hospitalization.

Depression can shut down the survival instinct or temporarily suppress it. Therefore, depressed suicidal thinking is not the same as the suicidal thinking of normal people who have reached a crisis point in their lives. Depressive suicides give less warning, need less time to plan, and are willing to attempt more painful and immediate means, such as jumping out of a moving car. They may also fight the impulse to suicide by compromising on self-injury in an attempt to distract themselves from severe mental pain (such as cutting themselves with knives.) Again, relatives and friends are likely to be astonished by how quickly such an impulse can appear and be acted upon.

What is depression?

Being clinically depressed is very different from the down type of feeling that all people experience from time to time. Occasional feelings of sadness are a normal part of life, and it is that such feelings are often colloquially referred to as "depression." In clinical depression, such feelings are out of proportion to any external causes. There are things in everyone's life that are possible causes of sadness, but people who are not depressed manage to cope with these things without becoming incapacitated.

As one might expect, depression can present itself as feeling sad or "having the blues". However, sadness may not always be the dominant feeling of a depressed person. Depression can also be experienced as a numb or empty feeling, or perhaps no awareness of feeling at all. A depressed person may experience a noticeable loss in their ability to feel pleasure about anything. Depression, as viewed by psychiatrists, is an illness in which a person experiences a marked change in their mood and in the way they view themselves and the world. Depression as a significant depressive disorder ranges from short in duration and mild to long term and very severe, even life threatening.

Depressive disorders come in different forms, just as do other illnesses such as heart disease. The three most prevalent forms are major depression, dysthymia, and bipolar disorder.

Types of Depression

What is major depression?

Major depression is manifested by a combination of symptoms (see symptom list below) that interfere with the ability to work, sleep, eat; and enjoy once-pleasurable activities. These disabling episodes of depression can occur once, twice, or several times in a lifetime.

What is dysthymia?

A less severe type of depression, dysthymia, involves long-term, chronic symptoms that do not disable, but keep you from functioning at "full steam" or from feeling good. Sometimes people with dysthymia also experience major depressive episodes.

What is bipolar depression (manic-depressive illness)?

Another type of depressive disorder is manic-depressive illness, also called bipolar depression. Not nearly as prevalent as other forms of depressive disorders, manic depressive illness involves cycles of depression and elation or mania. Sometimes the mood switches are dramatic and rapid, but most often they are gradual. When in the depressed cycle, you can have any or all of the symptoms of a depressive disorder. When in the manic cycle, any or all symptoms listed under mania may be experienced. Mania often affects thinking, judgment, and social behavior in ways that cause serious problems and embarrassment. For example, unwise business or financial decisions may be made when in a manic phase. Manic depression is often treated with Lithium, which evens out the mood swings.

What is Seasonal Affective Disorder (SAD)?

SAD is a reoccurring pattern of depressive illness which generally coincides with the approach of winter, starting with September and lasting until Spring brings longer days and more sunshine. This form of depressive illness often is accompanied by such symptoms as marked decrease in energy, increased need for sleep, and carbohydrate craving. Photo therapy - morning exposure to bright, full spectrum light - can often be dramatically helpful.

What is Post Partum Depression?

Mild moodiness and "blues" are very common after having a baby, but when symptoms are more than mild or last more than a few days, professional help should be sought. Post part depression can be extremely serious for both mother and baby. It can occur from about 2 weeks up to about 2 years after the birth.

How is bereavement different from depression?

A full depressive syndrome frequently is a normal reaction to the death of a loved one (bereavement), with feelings of depression and such associated symptoms as poor appetite, weight loss, and insomnia. However, morbid preoccupation with worthlessness, prolonged and marked functional impairment, and marked psychomotor retardation are uncommon and suggest that the bereavement is complicated by the development of a Major Depression. The duration of "normal" bereavement varies considerably among different cultural groups.

What is Endogenous Depression?

A depression is said to be endogenous if it occurs without a particular bad event, stressful situation or other definite, outside cause being present in the person's life. Endogenous depression usually responds well to medication. Some authorities do not consider this to be a useful diagnostic category.

What is atypical depression?

"Atypical depression" is not an official diagnostic category, but it is often discussed informally. A person suffering from atypical depression generally has increased appetite and sleeps more than usual. An atypical depressive may also be able to enjoy pleasurable circumstances despite being unable to seek out such circumstances. This contrasts with the "typical" depressive, who generally has reduced appetite and insomnia, and who is often unable to find pleasure in anything. Despite its name, atypical depression may in fact be more common than the other kind.

Symptoms of depression

The most common symptoms are set out below. If these have been experienced for more than two weeks it is essential to seek help from a professional. People may suffer from two or three of these symptoms but are unlikely to experience them all.

  • Feelings of helplessness and hopelessness
  • Feeling useless, inadequate, bad
  • Self hatred, constant questioning of thoughts and actions, an overwhelming need for reassurance
  • Being vulnerable and "over-sensitive"
  • Feeling guilty
  • A loss of energy and motivation, that makes even the simplest tasks or decisions seem difficult
  • Self injury or self harm
  • A fairly noticeable loss or gain in weight
  • Difficulty with getting off to sleep, or (less frequently) an excessive desire to sleep
  • Agitation and restlessness
  • Loss of sex drive
  • Finding it impossible to concentrate for any length of time, forgetfulness. A sense of unreality
  • Physical aches and pains, sometimes with the fear that you are seriously ill

In severe depression, these feelings may also include:

  • Suicidal ideas
  • Failure to eat or drink
  • Delusions and/or hallucinations

It is important for people to know that:

  • Depression is an illness that can affect anyone at any age.
  • It is not connected with and does not develop into insanity.
  • Depression can be treated. People may be offered antidepressants and/or talking treatments

Treatments For Depression

Anti-depressants

Many different types of antidepressant can be used to help treat people suffering from depression. Antidepressants and electro convulsive therapy (ECT) probably work by producing changes in the receptors for major neurotransmitters: certain forms of psychological treatment may also produce these same changes.

How long do they take to work?

Typically antidepressants take a week or two to begin to work, although many people who respond to antidepressants begin to feel better from the very beginning of treatment. It is usual to be troubled by side effects of treatment before they feel significantly better, and this may cause some people to stop taking the treatment. Thankfully, side effects are usually at their worst in the first three weeks of treatment, though some effects, such as weight gain, are seen only after longer treatment.

The main classes of antidepressant drugs:

  • Monoamine oxidase inhibitors (MAOIs),
  • Tricyclic antidepressants (TCAs) and
  • Selective serotonin re-uptake inhibitors (SSRIs).

MAOIs

MAOIs aren't used very much now, even though they are effective antidepressants, mainly because people taking MAOIs have to follow a special diet that excludes cheese and other foodstuffs. However, MAOIs are sometimes still used, particularly when a person hasn't got better with other forms of treatment.

TCA

The TCAs are still used very often when treating people with depression. Like the MAOIs, TCAs take a week or two to begin to work. Unfortunately, most TCAs have quite troublesome side effects in some patients, causing problems like sleepiness, dry mouth, blurred vision, constipation and weight gain. Most are also dangerous if taken in overdose, and are probably best avoided when treating people with suicidal thoughts.

SSRIs

Finally, the SSRIs are also effective as antidepressants. They cause rather fewer side effects than TCAs or older MAO1s, and many depressed patients find them easier to take than other antidepressants. However, the SSRIs can cause problems such as sexual difficulties or worsened anxiety, in a minority of patients.

The 'Other' class

There are a number of new antidepressants that don't 'belong' to the three main classes - for example nefazodone, mirtazapine, reboxetine and venlafaxine. All are effective antidepressant drugs and somewhat better tolerated than older TCAs. Their side effect profiles differ from each other and from the other classes of drug. More information on antidepressants can be found in the Depression Alliance leaflet, 'Antidepressant Drugs'.

Talking Treatments

"Talking treatments" is a way of referring to therapies which treat depression by exploring what's made you depressed and what's keeping you depressed. Most people who see their General Practitioner (GP or Family Doctor) for depression are prescribed antidepressant medication. Medication can lift your mood and help with the symptoms of depression but does not tackle underlying problems. This is where the "talking treatments" come in. Some talking treatments work directly on helping you to overcome the symptoms of depression as well. People can become depressed for many reasons. You may have experienced a high level of stress over a long period. You may feel overwhelmed by the problems of life, such as bereavement. redundancy, or divorce. Some people believe things about themselves or about life which actually make them more vulnerable to depression.

There are many different kinds of talking treatments or therapies and you will need to decide which may be best for you, based on your own experience. However, research suggests that the most effective treatments for depression are the ones which begin by focusing on the "here and now" and concentrate on specific problems. These sorts of therapies tend to be fairly short term, from three or four sessions up to around twenty sessions. The three most promising treatments at the moment are cognitive-behaviour therapy, interpersonal therapy and problem-solving therapy.

Cognitive behaviour therapy

Cognitive-behaviour therapy is based on the idea that how you think largely determines the way that you feel. In depression your thinking changes and becomes very negative. You might start thinking 'I'm a failure, my life is hopeless, I'll never get better". These are very upsetting thoughts and produce feelings of hopelessness and worthlessness. These thoughts and feelings may lead to changes in your behaviour. For example, you may stop going out or doing things that you used to enjoy. A vicious circle can easily develop in which thoughts, feelings and behaviour push you further and further down into depression.

Cognitive behaviour therapy treats depression by:

  • Helping you to recognize vicious circles that keep you depressed.
  • Teaching you to examine your behaviour and make changes if necessary.
  • Identifying your negative thoughts.
  • Challenging your negative thoughts and teaching you to think more realistically.
  • Helping you to recognize beliefs and assumptions that contributed to your depression and showing you how to change them.

Cognitive-behaviour therapy tackles both the symptoms and the underlying problems that have contributed to your depression. It also helps to reduce the chance of getting depressed again in the future.

Interpersonal therapy

Interpersonal therapy concentrates on your relationships with other people. The focus of the therapy is on improving relationships, learning to communicate more effectively, and improving your view of yourself. The emphasis in treatment is on the here and now and on specific problems. Interpersonal therapy often looks at the following four areas:

  • Grief - How you deal with loss has an important effect on your relationships.
  • Changes in role - These can cause a lot of stress and affect your mood and your health. For example, becoming a parent can be difficult for many people.
  • Disputes with other people - Constant fighting, arguing or bickering creates a lot of stress and unhappiness. You may need to learn new skills so that you can behave differently.
  • Putting other people down - If you are always negative and are constantly belittling friends and relatives your relationships will suffer. You may need to learn better ways of communicating.

Problem solving therapy

Problem solving is often a part of other therapies however, more recently, problem solving has been used as a short term therapy in its own right. It is usually brief, often around four to six sessions and involves the following stages:

  • Identify your current problems.
  • Recognize your strengths and weaknesses and what sources of help are available from family, friends, support groups etc.
  • Learn a systematic way of tackling problems that can be used now and in the future.
  • Learn to put solutions into practice and to deal with the obstacles and setbacks.

Coping Sources

Self Help

Self help starts with learning more about depression and discovering ways of coping. This can be done on an individual basis and through contact with other people to share experiences. Helping yourself to understand depression and to find ways of managing it can reduce the feelings of helplessness and hopelessness that often arise. Self help is complementary to professional treatment and should not be seen as an alternative. A valuable step forward in helping yourself get out of depression may be to join a self help group, if there is one close to your home.

Relaxation

Depression frequently causes tension and anxiety which can affect many aspects of life. People may become ultra-sensitive and irritable. There are many ways to relax - exercise, cassette tapes, yoga, meditation, aroma therapy, massage etc. can all be effective in reducing anxiety and tension.

Exercise

Many people who are depressed may become exhausted and totally lacking in motivation. If you can manage some form of exercise, however gentle, it will help you feel better and more positive. It seems to be even more effective if taken in fresh air.

A Change of Lifestyle

Some people who have depression are perfectionists who drive themselves too hard. Impossible standards may need to be lowered and workloads reduced, so that life can be lived at a slower pace. These changes do not make us less valuable people, but put us in command of our life, rather than being a member of the "rat race".

Breaks

Holidays or short breaks bring relief by breaking up the routine which so easily lets us get into a rut.

Diet

Under or over eating can be symptoms of depression, and it can be easy to eat junk food. If we miss out valuable nutrients we are more likely to feel tired and run down, so try to eat regularly and well. Try to include some fresh vegetables and fruit in your meals.

Interests

It can help to occupy your mind with absorbing subjects, interests or hobbies. Studying, watching a special TV program or film or listening to music can be difficult as concentration is often impaired, but this can be improved with practice.

Things to avoid

Props such as smoking, non-prescribed drugs and alcohol can be damaging. In particular, alcohol is a depressant and despite giving us a temporary "lift" can make matters worse as we try to retain the "lift" by drinking more and more.

*Remeber there's always someone out there that cares about you and wants you safe.*

 

Other Websites Offering Support Groups For Depression