Depression is a common condition that will affect around one in 10 people at some point in their life. It is a complicated illness that affects each person differently and has a wide variety of symptoms and causes.
The unhappiness and low mood that characterises depression is very different to just feeling down or sad. Sufferers will experience a vast spectrum of troubling emotions and physical problems, all of which will stay with them instead of going away. Many will also begin to emotionally detach themselves from those around them. They will withdraw into an isolated world of their own - one that is commonly described as a 'prison with no windows or doors' or a 'black hole'.
As a result, living with depression can be very difficult, not only for sufferers, but also for those around them. Despite this, many sufferers will wait a long time before seeking help, especially if they fear it will see them rejected, ridiculed or deprived of a sense of control. Others may simply be afraid to confront their problems.
This page will explore the illness in more detail, looking into the various types of depression as well as causes and symptoms. It will also look into counselling for depression and how it can form an essential part of recovery and personal development for those living with the condition.
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Symptoms of depression
As aforementioned, the symptoms of depression are varied and complex. As a result, many people may not know they are depressed, and may confuse the condition and subsequent impaired functioning with a physical illness - especially if they lose weight.
Generally though, depression exists in the form of unrelenting low mood or sadness, a loss of interest in pleasurable things and an overwhelming sense of hopelessness. These symptoms will vary in intensity, and the frequency and length of episodes will also differ. Sometimes depression can last for weeks or months. Ultimately, the more symptoms, the stronger they are and the longer they last, the more likely someone is living with depression.
Other symptoms of depression that help to clarify diagnosis are:
- Feelings of worthlessness.
- Recurring thoughts of death or suicide.
- Feeling constantly anxious, tearful and worried.
- Poor concentration and indecisiveness.
- Irritability and intolerance of others.
- Not getting enough enjoyment out of life.
- Low self-esteem.
- Excessive and inappropriate guilt.
- Having no motivation or interest in things.
- Feeling like life is a 'black hole'.
- Hallucinations - in rare cases some people may experience psychotic symptoms.
- Changes in sleeping patterns - broken nights or oversleeping.
- Changes in eating patterns - loss of appetite or overeating.
- Tiredness and loss of energy.
- Persistent headaches and/or stomach upsets.
- Chronic pain.
- Moving or speaking slower than usual.
- Loss of libido.
- Changes to the menstrual cycle.
- Neglecting hobbies and interests.
- Increased isolation from friends and family.
- Taking part in fewer social activities.
- Productivity falling at work.
Types of depression
Depression will vary in terms of severity and how it impacts a sufferer's life. Below are the different types of depression:
- Mild depression - When symptoms of depression have only a limited impact on a daily life. Generally, sufferers of mild depression will experience a persistent low mood and spirit, and they may find it difficult to motivate themselves to do things they normally enjoy.
- Major (clinical) depression - A far more severe form of depression that can lead to hospital admission. Symptoms will be more prominent and will interfere with an individual's daily life - affecting their eating habits, sleeping, and other day-to-day activities. Some sufferers may feel suicidal and that life is no longer worth living.
- Bipolar disorder - A form of manic depression characterised by extreme highs and lows.
- Postnatal depression - A serious condition that can develop after childbirth.
- Seasonal affective disorder (SAD) - A form of depression that has a seasonal pattern.
Who gets depressed?
Anyone can become depressed - even successful and famous people will battle the condition. According to the Mental Health Foundation, depression is the most common form of mental disorder in the UK. Midlife is the most common time for depression to strike, but it can affect all age groups. Whilst one in five older people will experience depression, around 10% of children will show signs of mental health problems at any one time.
The way depression affects men and women and younger people is varied. Being aware of these differences can help to ensure that the problem is recognised and treated as soon as possible. See below for some of the common characteristics of depression in the different age and sex groups:
Depression in women
Rates of depression in women tend to be twice as high as they are in men, and this is generally due to hormones. Furthermore, symptoms of depression tend to be more prominent in women - especially in terms of guilt, excessive sleeping, overeating and weight gain. Women are also more likely to suffer from seasonal affective disorder (SAD).
Depression in men
Depression in men is harder to determine, especially as society has conditioned them to think of depression as a sign of weakness and excessive emotion. Many will conceal their feelings of hopelessness and self-loathing, but may show symptoms of fatigue, sleeping problems, and loss of interest in work and hobbies. Other signs of depression in men tend to be violence, aggression and reckless behaviour. Men are at higher suicide risk, so recognition of the condition is crucial.
Depression in teenagers
Irritability, hostility and grumpiness tend to be the most common symptoms in depressed adolescents and teens. Some may show sadness and others may experience unexplained aches and pains. If left untreated, depression in teens can lead to problems in personal development.
Causes of depression
There is no known cause for depression, and no explanation of why in some people it develops suddenly, whilst in others it is more gradual. The condition is however predominantly thought to be the result of negative interaction of genetic factors, body chemistry and life events. Science has shown that depression is linked to chemical imbalances in the neurotransmitters in the brain, but it is inconclusive as to whether this is the cause or result of the illness.
In many cases depression is triggered by upsetting or stressful events that spark a sense of loss, such as divorce, bereavement, redundancy and financial problems. Certainly, sadness and downswings in mood are a normal reaction to life's struggles and set-backs, but depression is an illness that is far more complex. Often people will develop the condition after experiencing long-term stress. Some experts consider depression to be an ingrained defence mechanism that the body adopts in order to escape the impact stress can have on normal functioning. Long-standing and/or life threatening illnesses, alcohol and drug abuse are other potential triggers of depression, whilst head injuries and thyroid problems are also linked to the condition.
Other people have a tendency to become depressed from time to time for no apparent reason. In many cases they may not be upset or experiencing any worry or stress. This is sometimes described as endogenous depression, which appears to arise from changes, often hormonal, inside the person. Pregnancy, childbirth, the menopause are common triggers of endogenous depression in women. In other cases, factors such as family history, low self-esteem and being overly self-critical can make people more at risk of developing the condition.
When is it time to seek help for depression?
If you experience symptoms of depression for most of the day, every day, for more than two weeks, you should seek help from your GP. Recognising you have a problem will be evident in how much your negative feelings are impacting your daily life, including your work, relationships, interests and overall sense of happiness and enjoyment. Thoughts of suicide and self-harm are also warning signs that your condition is getting worse and that you may need to consider treatment for depression.
For many, being treated for depression can seem impossible, but the sooner help is sought the sooner symptoms can be alleviated. In some cases, the illness may disappear without treatment, but there is the danger that living with depression may put significant emotional and physical strain on a person's health and well-being. Therefore, many people with depression opt for treatment.
In the initial stages, your GP will diagnose the condition by taking a blood sample and urine test to rule out other problems such as an underactive thyroid. They will then ask various questions about your general health and how your feelings are affecting your mental and physical well-being. From here, the appropriate treatment options will be pursued. These will depend on the nature of the depression and an individual's personal needs and circumstances.
Treatment for depression
Even in its most severe forms, depression is highly treatable. A range of treatment options are provided, but the two main forms tend to be psychotherapy (counselling) and medication, which are often used in combination - particularly in more severe cases of depression.
Counselling for depression
According to guidelines issued by the National Institute for Health and Care Excellence (NICE), cognitive behavioural therapy (CBT) is among the recommended therapies for treating depression. This typically involves self-help books and sessions with a therapist, but specific methods will depend on the type of depression and intensity of symptoms.
Other therapies may also be used, such as interpersonal therapy and mindfulness-based cognitive therapy, but the essential aim of counselling is to help sufferers to understand their illness and its triggers. Counsellors will work with clients to uncover and explore the underlying reasons that have contributed to symptoms of depression, whilst helping them to change their feelings and learn to manage them more effectively. Counselling for depression is also useful for tackling low self-esteem, relationship issues or persistent negative thinking that may be exacerbating the illness.
Typically, most counselling sessions for depression will take place over 12 to 20 weekly sessions of around one or two hours in length. These can be carried out in one-to-one sessions with a counsellor or in the form of group or couples counselling, depending on the circumstances.
Alongside counselling, medication is prescribed by GPs to help sufferers who are experiencing moderate to severe depression. Antidepressants can help to ease common symptoms such as poor sleep, low mood, and poor concentration which can help sufferers to function more normally and can even increase the ability to deal with difficult situations and problems if they arise. Such medication however is not effective for everybody, which is why counselling for depression is recommended in combination with medical intervention.
What should I be looking for in a counsellor or psychotherapist?
There are currently no laws in place stipulating what training and qualifications a counsellor must have in order to treat depression. However, the National Institute for Health and Care Excellence (NICE) have developed a set of guidelines that provide advice about the recommended treatments, including the following:
- Possible first treatments for mild to moderate depression include a self-help programme, a treatment called computerised cognitive behavioural therapy and a physical activity programme (exercise). If you decide not to have these treatments or they are not available, you may be offered cognitive behavioural therapy (CBT for short) in a group with other people who have similar problems.
- If self-help, computerised cognitive behavioural therapy and/or physical activity have not helped you, your healthcare professional should discuss with you whether to try either an antidepressant or a psychological treatment.
- Psychological treatments include one-to-one cognitive behavioural therapy (CBT) or interpersonal therapy. You may also be offered a treatment called behavioural activation. If you have a regular partner you may be offered behavioural couples therapy.
Read the full NICE guidelines:
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Content written/edited by Denise Pickup BACP (Accred) in 2008. All content displayed on Counselling Directory is provided for general information purposes only, and should not be treated as a substitute for advice given by your GP or any other healthcare professional.
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