Depression
Depression
Brian Hennessy.
DipT; BA; MEd; DipPsych.
Psychologist
Content
- What is depression?
- Types of depression
- Signs of depression
- Causes
- Treatment
- Types of treatment
What is depression?
Depression is a word that people often use to describe feelings of sadness which all of us experience from time to time. It is also a term that is used to describe a type of mental suffering called clinical depression. *
Because depression is so common, it is important to understand the difference between unhappiness and clinical depression. Everybody feels depressed occasionally. We feel unhappy. We feel ‘blue’. Our spirit or mood is low. Sometimes experiences of loss, disappointment, or frustration in life can cause us to feel this emotion. This is normal. This is not an illness. As long as our work or our social life are not affected, and as long as these feelings only last for a short time, there is nothing to worry about. Here are two examples of ‘normal’ depression:
Example 1. Kevin is a student in an expensive international school in Shenyang. He is a good son who knows that his parents work very hard to save money for his tuition fees. However, last term his exam results were not as high as he expected. He was very disappointed with himself, and his mood was low. He did not feel like going outside to play basketball with his friends and preferred to sit on his bed in his dormitory and listen to music on his MP3. During that time, he decided that he would be a better student and study harder. After a few days, his mood lifted, and he felt much better.
Example 2. When her husband got a new job in China as an engineer, Kate went with him. But China was so different from the life she had known in Australia, and she missed the familiar environment of her hometown in New South Wales. She had nothing to do during the day when her husband was at work, and would often cry on the phone to her mother and tell her how sad and lonely she felt in China. She wondered if it was a mistake to go there. However, after awhile, she met some ladies in her apartment building who were in a similar situation. She made the effort to build new relationships with these neighbours, and as a result, began to feel much happier.
Kevin and Kate’s feelings are normal. Everybody feels this way occasionally. In fact, sometimes we can feel this way without any good reason. This is part of life. Sometimes we feel good, and sometimes we can feel very unhappy. And in normal circumstances, we know that after awhile an unhappy mood will lift and we will feel better again.
However, if a depressed mood does not lift after a few days, and if the feelings of sadness and unhappiness become more intense, then we should seek help from a doctor or psychologist. These experts understand what is happening to you, and they can help you to recover. Here is an example of someone who needs to get help:
Example: Sharon could feel herself ‘going down’. There is no particular reason for feeling so bad. She just feels bad, and wonders what is happening to her. After coming home from work, she will lie on the sofa and stare at the ceiling. She is too tired to go out, and she can’t concentrate long enough to enjoy her favourite TV program or listen to her favourite music. She feels exhausted all the time, and on weekends has to make a big effort to do the simplest tasks such as washing her clothes or cleaning her apartment.
Sharon feels empty. She does not feel particularly sad, she just feels that her life has no meaning. She believes that she cannot change her life, and has lost hope that she will ever be happy again. During this time she exaggerates her minor character faults and suffers extreme guilt over small things that she has done wrong in the past. She feels worthless and alone. Particularly after a colleague at work told her that she should “snap out of it”.
Sharon needs help from a mental health professional to recover from this depression. She is unable to help herself. She has tried to help herself, but no matter what she does, she cannot lift herself out of what she describes as a “black hole”. She is incapable of “pulling herself together”. In fact, her inability to help herself after trying so hard to do so, has contributed to her downward spiral into severe depression. Sharon is clinically depressed and is suffering from an episode of major depression which needs medical treatment and psychotherapy. She has a good chance of recovery if she receives this treatment.
If you suffer from this illness, do not feel shame: if your leg is broken, you go to the doctor. Similarly, if your spirit is broken, you should also go to the doctor. Whatever the causes and symptoms of your depression, please remember that treatment is very effective.
[* The term ‘clinical depression’ refers to not just one illness, but to a group of illnesses in which people suffer from an excessive or long-term depressed mood which seriously affects their life. Clinical depression is often accompanied by feelings of anxiety].
Types of Depression
There are two main types of depression: 1. Depression caused by an external event (exogenous depression); and, 2. Depression caused by a chemical imbalance in the body (biological depression).
1. Depression caused by an external event
(a) When there is a present distressing situation; or
(b) When there is a bad experience in the past.
(a) Some people develop depression following the experience of a distressing situation. The breakup of a close relationship, or the loss of a job, for example, may result in an episode of depression. This type of depression is easier to treat – psychotherapy is often successful with these cases.
Here are two examples of depression which have been caused by an external event:
Example 1: Amanda is a 22 year old Chinese language student in a Beijing university. Her boyfriend is also a student at the same university, and they had been together for two years. Their relationship broke up recently, and now she feels rejected and very sad. Her self-esteem is low, and she is not interested in socialising with her friends. She cannot sleep very well. In fact she feels tired all the time, and has difficulty concentrating on her studies. She spends most of her free time lying on her bed. Her friends report that she is more irritable now, that her appetite is poor, and that she has lost weight. Amanda is pessimistic about her future, and has difficulty making small decisions such as what clothes she should wear to her classes. She has been feeling like this for several weeks.
Example 2: Wang Qing is a middle-aged bus-driver who used to drive on the expressway between two cities every day. One morning in thick fog, his bus crashed into a truck which had stopped in the middle of the road. He was so severely injured in that accident that he cannot drive a bus anymore. He lost his job. Qing wonders how he can support his family. He believes that he is a failure as a husband and as a father because he can no longer earn a good wage. He feels worthless, and does not believe that he can find a good job again. He has difficulty falling asleep at night and is often angry over little things. He stopped going out to play mahjong with his friends, and sits in front of the TV all day. He has begun to drink more alcohol. He feels that his life is slowly grinding to a halt.
Amanda and Wang Qing are suffering from (exogenous) depression. They became clinically depressed after losing something that was very important to them: Amanda lost a long-term relationship, and Qing lost his job. Both persons should benefit from psychotherapy because the causes of their depressions are easily identified. They became depressed because of an external reason and not because of some internal biological cause. Psychotherapy will help them to adapt to their changed circumstances. They have a good chance of recovering from their illness.
(b) Sometimes the cause of depression can be linked to a bad experience in a person’s past. Combat veterans, victims of natural disasters, and sufferers of mental, physical, and sexual abuse fall into this category.
Example: Huang Nanfeng sought help from a psychologist for symptoms of depression. He had recently graduated from university with a degree in mechanical engineering, and was lucky to get a job with a large car factory in Guangzhou. However, his French boss is an impatient and abusive man. If Nanfeng does not produce perfect work, his boss will severely criticize him in front of the assembly-line workers. Because this boss behaves the same way to all the employees, Hans wonders why he is so sensitive to this man’s criticism. He wonders why he always feels so powerless and angry whenever he thinks about his boss’ behaviour.
Nanfeng is unable to express his anger directly to his boss. So he suppresses it. He buries it deep down inside his heart where he thinks it will stay buried. However, unexpressed anger is buried alive, not dead. In fact, it is more than anger. It is rage. A powerful rage against his own father who regularly verbally and physically assaulted him when he was a small and powerless child. This type of suppressed, unexpressed anger can cause depression.
Psychotherapy will help Nanfeng to understand why he is depressed. He will realize that his boss reminds him of his powerful father, and that once again he feels powerless to express his anger. When he understands this, with the help of his psychologist, Nanfeng will learn some new ways of coping with his boss and also with finding appropriate ways of expressing rather than repressing his rage.
2. Depression caused by a chemical imbalance
(a) When difficult to link to previous experience; or
(b) When there are other influences.
(a) Sometimes the cause is difficult to link to a previous distressing experience.
Example: Xiaojin recognized the symptoms. She knows from past experience that “the black dog of depression” is about to bite her again. A previous episode of this illness had lasted for two long months, and she remembers how bad she had felt during that period. She fears that she might not have the strength to endure another long episode. Her family and friends do not understand her suffering. They think that her ‘mental problem’ is a character weakness and that she should “pull herself out of it”. Sometimes she believes that they are correct, and that her intense suffering is her own fault.
However, Xiaojin’s illness is outside her control. Although she can go to sleep easily, she will often awake suddenly at about 2:00 or 3:00 am. When this happens, she cannot go back to sleep and as a result will feel exhausted the next day. Her appetite decreases, and she suffers from either diarrhea or constipation.
Then she loses interest in activities that she previously enjoyed, such as going out with friends, playing sport, or listening to music. Her interest in sex diminishes. She notices changes in her appearance, and believes that she is becoming more unattractive.
It is difficult for her to think clearly and concentrate on simple tasks. She forgets appointments, sometimes upsetting other people. The embarrassment exacerbates her irrational feelings of guilt. When someone visits her home, she makes a big effort to appear normal and to make her guest feel welcome. However, after the guest has departed, she collapses on her sofa or bed to rest and recover from that effort. She is constantly fatigued.
She also ruminates on her own failings, and misinterprets the behaviour of others in a negative way. For example; if someone passes her in the street and fails to recognize her and say hello, she will automatically assume that that person does not like her.
Worst of all is waking up in the morning feeling extremely depressed, and knowing that she will have to endure another day without hope or joy. This is when thoughts of suicide automatically intrude into her thinking. She will worry about her ability to resist this temptation to put an end to her daily suffering. Sometimes her thinking is distorted, and she imagines that she is a burden on her family and friends, and that their lives would be better if she was not alive. Just getting through each day is physically and mentally exhausting, and she wonders how long she can keep doing this.
Xiaojin wonders if she has a severe physical illness. If so, then her symptoms could be explained by the more socially acceptable diagnosis of a medical condition? But no. There is no physical illness. No cancer. No biological explanation for her intense suffering. Is she a malingerer then? Is she inventing all this suffering? No. Her suffering is real.
Then she despairs, believing that all hope is lost and that she is beyond help. So she drags herself through each day, hanging on to life by the thin and dangerously stretched thread of a failing willpower. How long can she keep living like this? God has abandoned her, friends and family will be next to do so…more distorted thinking…
Her suffering is so intense that she feels it in her body. A heavy ache in her heart. A pressing burden on her shoulders. A thick fog in her brain. Sometimes there is a backache, a neck-ache, or a headache. And always, always, there is the wet blanket of exhaustion which threatens to smother the life out of her one day. Life is grim. Life is too hard. It shouldn’t be like this…
Xiaojin is suffering from an episode of major depression. The cause of this illness is biological. That is, there is a chemical imbalance in her brain. So, in a way, she is correct when she thinks that there might be a physical cause for her suffering. It is just that we cannot pinpoint its location. For example; a doctor can’t point to a part of the brain and say: “here is the source of your suffering, we will operate on you tomorrow and remove this part of the brain which is causing your distress”. Neither can an X-ray or CT Scan locate the exact spot where the distress comes from. We know it is in the brain, but there is no special spot that can be identified as the place or cause of depression.
In fact, in biological terms, depression is a process, rather than an identifiable abnormality like a brain tumour. A bio-chemical process. Something is wrong with the process of transmitting information from one brain cell to another.
Please bear with me as I try to explain this idea. Think of the brain as a computer. A computer is ‘hard-wired’. That is, there are physical circuits which the computer uses to encode, store, and retrieve information. It uses an electro-numeric process to do this. However, if there is a reduction in the electrical current, the computer cannot function as it is supposed to function. Usually, it will slow down. Sometimes it will behave in an abnormal way, and sometimes it will shut down completely.
The human brain is also hard-wired. There are physical connections and circuits (nerves) which help to encode, store, and retrieve huge amounts of information. The process of doing this is similar to the process that a computer uses. However, the brain uses a more sophisticated electro-chemical rather than an electro-numeric process to do this. It uses its own natural chemical substances called neuro-transmitters to communicate information from one cell to another.
If there is a reduction in the number of neurotransmitters in the brain, the brain cannot function as it is supposed to function. It may slow down (e.g., fatigue, difficulty making decisions etc.). Sometimes it may behave in an abnormal way (e.g., distorted thinking, irrational guilt, etc.). And sometimes, it may shut down completely (e.g., when a patient is so depressed, that she cannot get out of bed in the morning).
Cynthia (above) has a problem with the electro-chemical process of transmitting information throughout her brain. A shortage of some specific neurotransmitter substances is interfering with the normal functioning of her brain. Thus, treatment for this severe type of depression is medicine. Medicine which will stimulate her brain to produce the amount of neurotransmitter substances which she needs. Once Cynthia’s biochemical resources are restored to normal, her depressed mood should lift.
(b) Sometimes, other influences may cause depression.
For example: Some people are vulnerable to episodes of depression in winter or in tropical summers; and some women develop a ‘post-natal’ depression after the birth of a baby. Although these types of depression are more severe, they can be treated successfully. Usually with a combination of medicine and psychotherapy. Please note: Depression often overlaps with anxiety and with other health problems.
Signs of depression
Although each person is different, depression can be recognised when several of the following problems coexist. However, please remember that it is normal to experience some of these symptoms during a life crisis. As we know, life crises do not last forever…things settle down in time, and we get on with our lives.
However, if the symptoms persist for a long period of time, and if you have thoughts of suicide, seek help immediately. Forget about any feelings of shame and so on. This is an illness, and it can be treated. It is not a defect of character.
Table 1. Symptoms of Depression:
_____________________________________________________________
- Persistent sad, anxious, or empty mood.
- Feelings of hopelessness or pessimism.
- Feelings of guilt, worthlessness or helplessness.
- Loss of interest or pleasure in activities that were once enjoyed, including sex.
- Decreased energy, fatigue, being “slowed down”.
- Difficulty concentrating, remembering or making decisions.
- Insomnia, early morning awakening or oversleeping.
- Poor appetite and/or weight loss, or overeating and weight gain.
- Thoughts of death or suicide, suicide attempts.
- Restlessness, irritability.
- Persistent physical symptoms that do not respond to treatment, e,g; headaches, digestive disorders, chronic pain.
_____________________________________________________________
If you are suffering from several of the above symptoms, please visit a doctor, psychologist, or psychiatrist. Take this checklist with you. It will help her to assess your symptoms.
Causes
Heredity:
Research shows that the tendency to develop depression runs in families. This is similar to the tendency to develop other illnesses such as high blood pressure and heart disease.
Biochemical imbalance:
Some types of depression are caused by a chemical imbalance in the brain. This can be corrected with anti-depressant medicine.
Stress:
Depression is associated with stress and is more common at certain stages in life. For example; the menopause and childbirth in women, and retirement in men.
Personality:
People with certain types of personality are more vulnerable to depression. Perfectionists who set very high standards for themselves and others, and who find it difficult to adjust their ideas and standards to changing circumstances, are often easily depressed. Also, people who are very dependent on others are very susceptible to depression if they break up with the person on whom they depend.
Learned response:
In some situations, a person who is exposed to repeated losses or stress learns that life is difficult and understandably feels helpless and depressed.
Treatment
Many new treatment strategies for most types of mental illness have been developed over the last few decades. In particular, major advances have been made in developing strategies for treating and preventing depression.
Not all treatments will work in all cases. Different people respond differently to treatments. We know, however, that some strategies work most of the time for most people. These well-known strategies are tried first.
If you are suffering from symptoms of depression, do not hesitate to contact a doctor. He may be able to help you. And if he is unable to help you, then ask him to refer you to someone who can help. Such as a psychologist or a psychiatrist.
Sometimes another illness, or recovery from a severe accident or injury, may hide the fact that a person is depressed: For example: a serious illness such as cancer may hide the fact that the person is also suffering from depression. Persons who are recovering from major surgery such as a heart-bypass operation may also suffer from an episode of depression. Someone who is recovering from severe injuries as a result of a car-accident may also be seriously depressed.
And sometimes, the illness itself may contribute to the depression: For example: persons who suffer from the physical illness of diabetes may also suffer from the mental illness of depression. Recent research suggests that diabetes may cause depression in some people.
Please note that understanding from family and friends is very important. It is no use saying to a depressed person: “Pull yourself together”. This sort of well-meaning advice from family and friends may cause the depressed person to feel worse. They will feel more helpless and hopeless. It is better to provide encouragement and support so that the depressed person can ask for help without feeling any shame.
Types of treatment
The type of treatment depends on the type of depression and how severe it is. Some types of depression can be treated with psychotherapy. This type of treatment helps people to sort out practical, real-life problems and conflicts. It can support them through difficult times and assist them to understand the reason for their depression
In other forms of depression, medicine may be needed as well as psychotherapy. The antidepressant medicines may help to relieve the depression, and prevent a recurrence. These medicines are not addictive, and any side-effects are minimal. These days, doctors have a range of sophisticated medicines to choose from. It is much easier nowadays to match an appropriate medicine to an individual sufferer.
In the more severe types of depression, the person may need to stay in hospital for awhile. Although medicine is the main treatment in a hospital, sometimes electro-convulsive-therapy (ECT) is used for persons whose life is in danger. Although ECT is safe and effective, it is used as a last resort.
Conclusion
Medical and psychological research have helped us to understand mental illness. New treatment strategies involving medicine and psychotherapy are helping persons with depression to recover. If you think you may be suffering from depression, please do something about it. It is an illness, and it can be treated. There is hope. A doctor, a psychologist, or a psychiatrist can help you to recover.
