Defeating Depression

What is Depression?

Although there are different kinds of depression there are two core symptoms present in any depressive disorder.

The first is that the individual feels depressed. This feeling of depression is expressed differently in various cultures. For example, the black cultures don’t have a single word for “depression”, so depressed black patients will often describe depression as “their heart's talking to them” or their heart's feeling “black”, “dark” or “heavy”.

The second core symptom is that the depressed individual experiences a noticeable loss of pleasure. Once again this will be expressed differently in different cultures. A white, Afrikaans female might describe her lack of pleasure manifesting in her not enjoying shopping anymore, whilst a black, Zulu mineworker might describe his lack of pleasure manifesting in not enjoying watching football anymore. 

Signs and Symptoms of Depression

There are two main types of depression and each type has its own set of signs and symptoms.

Major Depressive Disorder is characterised by one or more Major Depressive Episodes (as described below). That is, at least two weeks of depressed mood or loss of interest accompanied by at least four additional symptoms of depression.

Dysthymic Disorder is characterised by at least two years of depressed mood for more days than not, accompanied by additional depressive symptoms that do not meet the criteria for a Major Depressive Episode.

Major Depressive Episode

A.      At least 5 of the following symptoms over a period of at least two weeks:

• Depressed mood most of the day, nearly every day
• Markedly diminished interest or pleasure in all, or almost all, activities most of the day nearly every day
• Significant weight loss when not dieting or weight gain (e.g. a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day
• Insomnia or hypersomnia (sleeping all the time) nearly every day
• Psychomotor agitation or retardation nearly every day
• Fatigue or loss of energy nearly every day
• Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)
• Diminished ability to think or concentrate or indecisiveness nearly every day (either subjective account or as observed by others)
• Recurrent thoughts of death (not just fear of dying), recurrent suicidal thoughts without a specific plan, or a suicide attempt or a specific plan for committing suicide.

B.      The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

C.      The symptoms are not due to the direct physiological effects of a substance (e.g. medication or a drug of abuse, i.e. use of an illegal substance) or a general medical         condition (e.g. Hypothyroidism)

D.      The symptoms are not better accounted for by bereavement. 

Symptoms of Depression Made Easy

Although mood disorders and anxiety disorders are two different disorders (and must be treated as such), it is very common for people with a mood disorder to also have an anxiety disorder (a little less common the other way round).

Myths and Misperceptions About Depression

There are many myths and misperceptions about depression. This lack of understanding can itself make the depressed person feel even more helpless and isolated. It also means that people with depression are often reluctant to tell their friends and colleagues about their depression, which tends to perpetuate both the misperceptions and the illness itself. It is important to know what depression is not.

Myth: Depression is just feeling ‘a bit down’
Reality: Depression is much more than just feeling a bit down. Depression is an illness that can seriously impair all aspects of a person’s life, including personal relationships, performance at work and enjoyment of leisure activities.

Myth: Depression is a sign of weakness.
Reality: Depression has a physical cause just like other illnesses such as ‘flu or chickenpox. Depression is ultimately caused by an imbalance of special chemical substances in the brain called neurotransmitters, though genetics, personality and life events may have contributed to the imbalance. No one would ever think to say a person with chickenpox is showing signs of weakness!

Myth: Depression is a punishment because you are a bad person.
Reality: Depression is an illness that can affect anyone.

Myth: Depression is something to feel bad, ashamed or guilty about.
Reality: Depression is not caused by the individual and is not their fault.There is nothing to be ashamed of. Again, no one would ever think to say a person with chickenpox should feel bad, ashamed or guilty!

Myth: Depression will go away of you just ‘pull yourself together and think positively’.
Reality: Depression is an illness that requires specific treatment, just like any other illness does. Someone with chickenpox cannot just ‘think positively’ to make their spots go away!

Myth: Depression is a sign that you do not have faith in God. If you have faith depression will go away.
Reality: Depression is not a sign of a lack of faith. It is an illness. Even the saints got ill - some even died of their illness.

“A lot of people don't realize that depression is an illness. I don't wish it on anyone, but if they would
know how it feels, I swear they would think twice before they just shrug it.”
- Jonathan Davis 

What Causes Depression?

If you are dealing with a mood disorder such as depression it is only natural to ask yourself the question “Why?” It is important to bear in mind, however, that knowing the cause of your mood disorder does not necessarily cure it.

Knowing the cause of your mood disorder is also not necessary to manage it. Many of the treatment approaches do not depend on a knowledge of what causes the mood disorder to be effective.

It is also important to be wary of the idea that there is any one cause for a mood disorder and that by removing that cause, your mood disorder will be cured.

Mood disorders are brought on by a variety of causes working on numerous different levels. These levels include heredity, biology, family background and upbringing, conditioning, recent stressors, your self-talk and personal belief system, your ability to express feelings, and so on.

Generally, the thinking today is that predisposing factors and precipitating factors influence each other and result in the mood disorder, which is then maintained by various other factors. This theory is known as the ‘Diathesis – Stress Model’ and for more information on this model please read my article called ‘Understanding Mental Disorders’

An outline of the causes of mood disorders is presented below:

I.               Long-Term, Predisposing Factor

A. Heredity (First degree relatives of people with depression have a higher incidence of the illness, whether they are raised with this relative or not).

B. Childhood Circumstances

1. Your parents communicated an overly cautious view of the world
2. Your parents were overly critical and set excessively high standards
3. Emotional insecurity and dependence
4. Your parents suppressed your self-assertiveness.

 C. Cumulative stress over time.

II.              Biological Factors

A. Neurotransmitter imbalances

B. Medical conditions that can cause depression

III.           Short-Term, Precipitating (Triggering) Factors

A. Stressors that precipitate mood changes

1. Significant personal loss
2. Significant life change
3. Legal and/or financial difficulties
4. Job problems
5. Stimulants and recreational drugs

 B. Illness in self or loved one

 C. Drugs and medications that cause depression

D. Nutritional deficiencies - vitamin B deficiency causing depression

IV.           Maintaining Causes

A.      Avoidance of social support and activities
B.      Lack of support system
C.      Self-talk
D.      Mistaken beliefs
E.      Withheld feelings
F.       Lack of assertiveness
G.      Lack of self-nurturing skills
H.      Depressants and other dietary factors such as vitamin deficiencies
I.       High-stress lifestyle
J.       Legal and/or financial difficulties
K.      Job difficulties
L.       Drugs and medications that cause depression
M.      Lack of meaning or sense of purpose

Do I Have Depression?

Complete the Depression Scale below to find out.

The feelings and symptoms listed below are 20 of the more common symptoms of depression.
Do you have any of these feelings or symptoms? If the answer is yes, how badly do you experience them?

Score yourself like this:                          

0 No
1 Slight
2 More than slight
3 Moderate
4 More than moderate
5 Severe

Add up your scores for each question and use the following scale to interpret your score:

Note: If the score for suicidal thoughts is 4 or 5, then hospitalisation is essential for the protection of the person’s life.

Prognosis

Major Depressive Disorder has a better prognosis than other mood disorders in that medication and therapy have been very successful in alleviating the symptoms. However, many people with depression find that it can be episodic, in that periodic stressors can bring back symptoms. In this case, it is often helpful to have an ongoing relationship with a mental health professional just as you would a physician if you had diabetes or high blood pressure.

Treating Depression

When it comes to depression, there are a number of treatments that can be used. (They have all proven to be effective to some sufferers some of the time, but none of them have been effective to all sufferers all of the time!)

It is generally acknowledged that a combination of medication and some form of psychotherapy produces the best treatment response rates. Combination treatments are advantageous as they bring about more rapid relief from symptoms, and usually result in lower relapse rates.

Treatment options to consider are:

Psychotherapy (Professional Counselling)

This is also known as ‘talk therapy’ because the individual and the psychologist work together to uncover emotional conflicts that may underlie the depression. By talking about these conflicts and gaining a better understanding of them, the individual is helped to overcome their difficulties.

There are a number of different psychotherapeutic approaches. When it comes to treating depression, the two most common therapies are:

Psychodynamic Therapy

Psychodynamic therapy focuses on events of the past and making the patient aware of the ramifications of long-buried issues.

Cognitive – Behavioural Therapy (CBT)

This is a combination of cognitive therapy - which aims to modify or eliminate thought patterns contributing to the individual’s symptoms - and behavioural therapy, which aims to help the individual to change his or her behaviour.

Support groups and other social institutions offer further support and encouragement.

Pharmacotherapy (Treatment with Medication)

Medications, although not cures, can be very effective at relieving symptoms of depression. Today, thanks to research, there are more medications available than ever before to treat mood disorders. In addition, new medications are under development.

The medication prescribed by a doctor to treat depression is in the form of tablets called anti-depressants. There are many different types of anti-depressants which work in different ways, so if one drug is not successful, there are usually others to try. Be aware that some of the anti-depressants are physically addictive.

As far as medication is concerned, there are four classes of medication:

• Selective Serotonin Reuptake Inhibitors (SSRI’s)
• Tricyclic Anti-depressants
• Benzodiazepines
• Monoamine Oxidase Inhibitors (MAOIs)

The drug the doctor chooses to prescribe is based on considerations of safety, efficacy, and the personal needs and preferences of the patient.

Remember to ask your doctor as many questions as you need to, to find out everything about the medication you are being prescribed. You have a right to be fully aware of what you are taking and why, as well as what side effects you can expect and how to manage them.

Generally, when it comes to anti-depressants, the medication will only start to work after about two weeks of taking the tablets. Many side effects may be experienced in the beginning, which usually lessen after a while, but may never go away totally.

Individuals taking anti-depressants must understand that it is very important that they follow the doctor’s orders completely. They must not self-medicate. In other words, they must not change the dosage or stop taking the medication without discussing it with their doctor first. Even when they feel much better, they must continue to take their medication. If they suddenly stop taking the anti-depressants they could actually become even more depressed than before they started on the tablets! (Anti-depressants will only work if a certain dose is maintained for a period of time. When it comes to stopping the medication, the dose needs to be gradually reduced over time).

Homeopathy

Homeopathy is a natural system of treating all kinds of diseases. It is a subtle, yet powerful, system that works with the energies of life and produces genuine long-term cures of many complaints. It is based on holistic principles. This means that the medicine treats the whole person, not just one part or one disease.

It is possible to take homeopathic remedies with orthodox medicines as both medicines work unaffected by each other. (The main exceptions are antibiotics and oral steroids; these usually stop homeopathic remedies from working.) Once the homeopathy is working, most orthodox medicines for the treatment of depression can be stopped. This must, however, be done with your doctor’s knowledge and guidance. Never just stop taking your prescription medicine – the dose must be reduced gradually.

Herbal treatments

There are a number of plant and herbal remedies known to have positive effects on mood disorders, but they should only be used under guidance of well-trained health advisers as they can have serious even fatal side effects.

St. John’s wort (Hypericum Perforatum) is a good example. Although St. John’s wort has been used for centuries for mental health conditions and is widely prescribed for depression in Europe, the herb is known to affect how the body uses and breaks down a number of drugs and can cause serious side effects:

• Serotonin is a brain chemical targeted by anti-depressants. Combining St. John’s wort and certain anti-depressants can lead to a potentially life-threatening increase in serotonin levels – a condition called serotonin syndrome. Symptoms range from tremor and diarrhoea to very dangerous confusion, muscle stiffness, drop in body temperature, and even death.
• Psychosis is a rare but possible side effect of taking St. John’s wort, particularly in people who have or are at risk for mental health disorders, including bipolar disorder.
• Taking St. John’s wort can weaken many prescription medicines, such as:
  • Anti-depressants
  • Birth control pills
  • Cyclosporine, which prevents the body from rejecting transplanted organs
  • Digoxin, a heart medication
  • Some HIV drugs including Indinavir
  • Some cancer medications including Irinotecan
  • Warfarin and similar medications used to thin the blood.
• Other side effects of St. John’s wort are usually minor and uncommon and may include upset stomach and sensitivity to sunlight, especially in fair skinned people. Also, St. John’s wort is a stimulant and may worsen feelings of anxiety in some people.

A word of caution – ‘natural’ does not automatically mean ‘safe’!

Many people assume that because a substance is made from “natural” ingredients, it is automatically ‘safe’. This is not always the case. Poisonous mushrooms and arsenic are natural! So are cocaine and opium. Even something seemingly harmless like Vitamin A can kill you if you take too much.

‘Natural’ substances are very powerful and you should not just use them because ‘they helped your friend’. We are all different, and what works for one person can harm another.

It is important to seek qualified advice before using such remedies, and inform the health practitioner of all other medicines you are taking, as well as of any medical conditions you may have. People must NOT take these alternative substances at the same time as they are taking anti-depressants prescribed by a doctor, without the doctor’s full knowledge and agreement.

Nutritional Therapy

Most of us are aware that our diet affects our physical wellbeing, but many of us don’t realise that what we eat can also affect our mental wellbeing. What you eat affects the way you feel! Develop an awareness of your body and eliminate the things from your diet, which are depression and anxiety producing.

Foods to be avoided include:

• Refined sugar – brown or white – is a ‘mood altering’ substance. The effects of sugar include mood elevation, hyperactivity, fatigue, mood instability, depression, headaches and exaggerated moods.
• Caffeine – limiting caffeine in the diet can lessen the intensity of mood swings. Caffeine can cause mood elevation, nervousness, hyperactivity, insomnia, irritability, anxiety, restlessness, headaches, pounding heart and shakiness.
• Dairy products – negative effects of dairy products can include fatigue and irritability which are classic symptoms of depression.

Foods to increase include:

• Complex carbohydrates – a diet high in complex carbohydrates can increase your level of serotonin, a neurotransmitter that has an anti-depressant action. (Prozac is an anti-depressant that increases the level of serotonin in the brain). Food that is high in complex carbohydrates includes pasta, rice, millet, quinoa, potatoes and vegetables especially those in the cabbage family.
• Food rich in Vitamin B – a diet high in vitamin B has been shown to have an extremely beneficial effect on reducing depression. Food rich in vitamin B includes meat, fish, eggs, dairy products, legumes and wholegrain cereals.

You should also try to:

• Reduce or eliminate processed meats and other processed food.
• Reduce your consumption of red meat.
• Increase your intake of dietary fibre.
• Drink more water! (At least one 250 ml glass of water per 10kgs of body weight).
• Eat more raw, fresh vegetables.
• Reduce animal fat.
• Do not drink alcohol (it is a depressant) or smoke.
• Take a high potency B-Complex vitamin and a high dose of vitamin C.

Other Treatment Considerations

In addition to these treatment approaches, you may also find that practising relaxation techniques and breathing skills, and incorporating exercise into your daily routine, may contribute to making your life more balanced. You could also benefit from improving your social and interpersonal skills. For example, your assertiveness and conversation skills. (Please see the talks and courses I run on interpersonal skills such as these).
Also please read my articles: Attention on Assertiveness, The Five Communication Styles, The Art of Conversation, Seven Common Conversation Errors... and How to Remedy Them, Coping With Conflict and Face up to Feedback

An Holistic Treatment Approach

Human beings have 4 aspects to their being:

• Physical (the body)
• Psychological (thoughts, emotions, will)
• Social (relationships)
• Spiritual (beliefs, values, meaning to life)

Every disorder, including depression, needs to take all four of these aspects into consideration for holistic treatment and recovery purposes.

Physical

• Visit a doctor
  • Have a thorough physical examination to rule out any medical illness that could possibly be the cause of the depression or anxiety. Hormonal imbalances are a   common cause of depression, pre-menstrual tension, post-natal depression etc. Thyroid problems are also known to cause depression.
    
  • Ask whether anti-depressant medication will work for you. (Sometimes the first anti-depressant you are given does not work. Keep trying until you get the right one). Remember that most anti-depressants will have side effects. Ask your doctor what you can expect and how to manage these side effects. Do not keep quiet if the medication continues to make you feel worse.
  • Sometimes your doctor will refer you to a psychiatrist,–who is a specialist doctor. Being referred to a psychiatrist does not mean that you are mad or crazy. It just means your GP would like you to see someone who specialises in the illness you are suffering from.
  • Some medications actually cause depression or symptoms of anxiety. (For example, some heart tablets and some blood pressure tablets). Doctors don't always remember what medication you are on, so ask your doctor if the medication you are taking can cause depression.
• Improve your physical appearance
  • When you look good, you have more self-confidence
  • Lose weight if you need to
  • Wear clothes that suit your figure
  • Wear colours that suit your skin and hair colour
  • Wear make-up (women)
  • Get your hair restyled
  • Smile (it draws people to you)

• Release endorphins
  Endorphins are the body's natural feel-good hormones. There are three activities that will cause endorphins to be released:
  • Exercise - it is important to do the type of exercise that you enjoy. Try to exercise for 30 minutes three times per week.
  • Laugh - hire funny videos, watch comedians, and listen to happy music. Avoid sad music and movies.
  • Have sex with your partner - it is common for people with depression to lose the desire for sex and one of the side effects of anti-depressants is a lower libido. Try to consciously relax enough to have sex at least once a week. Ignoring your sexual relationship will start to cause problems in your relationship with your partner.

• Expose yourself to natural light
  Get as much natural light as possible (especially if you work in an office environment with neon lights). Research has shown that full spectrum light bulbs help to reduce depression and anxiety. (These are difficult to find in South Africa, but some hardware stores as well as some nurseries stock them.) Install a full spectrum light bulb wherever you spend most of your day indoors. You may need to get permission from your boss to have a lamp on your desk.

• Get enough rest
  Being overtired causes you to feel worse. When you are tired, you cannot cope as well.

• Create a bright positive environment
  Redecorate. Create a pleasant environment around you. Use light colours that you like. A brighter living space leads to a brighter mood! (Even the action of redecorating may make you feel better). Bring fresh flowers into your home.

Psychological

• Get psychological help
  
  • If you can possibly afford it, try to see a psychologist. A psychologist will be able to assess why you have the problems you have and help you to either overcome them or manage them in order to live effectively within your particular set of circumstances.
  • You may not like the first psychologist that you go to. If you do not like that particular person, you do not have to continue to see them. You may ask your doctor to refer you to another psychologist.
    
  • If you are unable to afford a private psychologist, you can attend a government hospital or clinic. A lot of churches have counsellors who will help you at no cost. Some community centres also have free counselling facilities.

• Learn new life skills
  You may find that you are anxious or depressed because you lack effective skills to deal with various situations in your life. Try to improve your skills. For example, learn:
  
  • Time management skills
  • Communication skills
  • Conflict management skills
  • Self-esteem enhancement skills
  • Problem-solving skills
  • Stress management skills
  • Negotiation skills

• Do good deeds for other people
  Consciously do good deeds for other people. This will take your focus off yourself and make you feel better about yourself and your situation. You may also find that their appreciation of your good deed makes you feel good. You will feel needed which is very important for all of us.

• Gather together happy, funny material
  Put together a library of happy videos, tapes, books, jokes etc. Make a point of reading, watching and listening to these things frequently. Share them with others.

Social

• Associate with positive people
  Being with people who are negative and miserable will bring you down. (Especially when you are so vulnerable). You will end up having a pity party. Choose to be with encouraging, uplifting people.

• Join a support group
  Make sure that it is actually helpful to you. Some support groups also have pity parties, which will do you no good. Either change the group or start another group.

• Start a hobby
  This takes your mind off yourself. You meet new people and when you complete your first article/task, you will get a sense of achievement. Examples:
  
  • Make greeting cards, sweets, chocolates, porcelain dolls, wooden toys.
  • Take up art classes, pottery, sewing, knitting, weaving, crocheting, embroidery, photography, cookery classes.
  • Go hiking, walking, running, dancing.
  • Do gardening, woodwork, flower arranging.

• Join a charitable organisation
  Once again, by helping others it will take the focus off yourself and you will feel needed.

• Participate in social activities
  
  • Consciously choose to participate at social gatherings. Choose NOT to withdraw.
    
  • Ask family and friends to tell you about behaviours that hinder you from getting on in your particular social circle. It will hurt when they do, but don't stop there. Go   to your counsellor with your problem behaviours and work on them together.

• Involve family and friends
  Ask family and friends to warn you when they see that you are becoming depressed or anxious again. Promise to take action as soon as the signs and symptoms begin, so that the length and severity of the symptoms is not so bad.

Spiritual

• Join a church or other place of worship.
  Choose a place where you will be comfortable. Get actively involved in the activities of the church.

• Forgive others
  Choose to forgive those who have hurt and angered you. It is important that you understand that forgiveness is for your benefit, not for the benefit of the person who has offended you. If you do not forgive, you will become resentful and bitter. Bitter people are not nice to be around.

• Pray
  • Pray for yourself (many depressed/anxious people are unable to pray for themselves. Do not feel guilty about praying for yourself. Guilt is one of the symptoms of depression).
  • Ask others to pray for you too.

• Confess your sins
  Acknowledge your sins and confess them. Then try to stop sinning. Research has shown that confession reduces guilt and depression significantly.

“It's often difficult for those who are lucky enough to have never experienced what true
depression is to imagine a life of complete hopelessness, emptiness and fear.”
- Susan Polis Schutz