How do I know if I am depressed, and what can about it?

How do you know if you are depressed?

Several clients I am working with were very surprised when they scored highly on the Becks Depression Inventory, and were in the category of clinical depression.

Whilst any assessment questionnaire is only a general indication, I thought that it might be helpful to identify the tell tale signs of depression more fully so that you can explore what your options are if you recognise them in yourself.

It’s normal to have times in our lives, when we feel lonely or sad.  This can be due to a recent change in our life, dealing with  bereavement or loss, challenges at work, redundancy, family/ relationship difficulties.

The difference between ‘normal sadness’ and depression however, is when these feelings of sadness, continue for some time and lead to feelings of being overwhelmed, unable to cope, hopelessness, and loss of interest in activities.  You no longer feel able to live a normal and active life, as it all feels like too much effort.  Your family and friends may have also commented on your ‘moodiness’ and you have started to withdraw from them too.

The signs and symptoms differ widely between people, however the following are generally most typical:

Psychological signs and symptoms:

• Persistent sadness or low mood
• Thoughts and feelings of worthlessness
• Feelings of self hatred
• A feeling of hopelessness
• A feeling of helplessness
• Feeling like crying
• A feeling of guilt
• Irritability - even trivial things become annoying
• Angry outbursts
• Intolerance towards others
• Persistent doubting - finding it very hard to decide on things
• Finding it impossible to enjoy life
• Persistent worry and anxiety
• Negative thinking, pessimism, cynicism
• Thoughts like - why am I here? What’s the point? It’s all too hard
• Thoughts of self harm
• Thoughts of suicide

Physical signs and symptoms

• Body movements slower
• Problems with memory, focusing and concentration
• Slower speech
• Eating patterns change, typically, eating less and losing weight. However, some people may eat more and gain weight.
• Reduced or no sex drive
• Lack of energy, tiredness, everything ‘too much effort’
• Restlessness – difficulty to keep still, or relax
• Unexplained aches and pains, headache, backache or digestive problems
• Sleeping disturbances – difficult to get to sleep, or waking up during the night and cannot get back to sleep.
• Studies have shown that over 80% of people with depression suffer from some kind of insomnia.

Social signs and symptoms may include:

• Under performing at work/ studies
• Avoiding keeping in touch with friends
• Avoiding people in general, too much effort to communicate
• Abandoning interests and hobbies
• Having family/home problems
• Increase in avoidant behaviours – not dealing with bills etc
• Increasing reliance on alcohol
• Increase in addictive behaviours, checking social networking sites, gambling, internet porn

What can I do about it? 

The fact that you are reading this is a good starting point. You have recognized that your mood and your behaviour is not right, and hopefully you want to address it.

Being aware, acknowledging it to yourself, and then to others that you are having problems, means that you can start to address them and take action.

Most people agree that getting support for depression is essential - talking to friends, family, trustworthy colleagues, medical professionals.   Opening up and asking for help, might feel difficult or ‘not normal’ for you, as you might normally be ‘someone who always copes’ and it can be difficult for you to admit that you are not.  However isolating yourself generally leads to the problems worsening, rather than helping the situation.

Going to your GP, and discussing openly and honestly, what is going on for you, is important.  They may prescribe medication, in the form of anti-depressants, or they may recommend counselling or psychotherapy to help alleviate the symptoms and deal with the underlying issues.  There is a lot of evidence to support medication in conjunction with talking therapies as an effective treatment of depression. (To find more information on the subject go to www.mind.org.uk).   However many people still have an aversion to taking antidepressant medication.

Some thoughts that others have found helpful in working through this issue…

• If it were any other illness, would I have the same reluctance to get treatment?   If not, why not?   Is my reluctance a result of the stigma I hold towards having depression myself?  Is it the depression that is making me feel this way rather than any logical reason?
• There are many illnesses – both physical and mental – for which there is no treatment.  We are fortunate that there are effective medications available for depression.
• Could taking antidepressants be worse than the depression?  Could taking antidepressants be worse than the impact of depression on my life, on my work, on my family?  

As with any condition or illness, the choice regarding treatment is ultimately our own.  No one can make us do anything we don't want to.  

With depression, while the combination of antidepressant medication and psychological therapy is the most efficient and effective treatment, there are other options available.

While they may not be as effective, the worst thing you can do is nothing.  The best thing you can do is to discuss your options with your doctor or other healthcare professional who is familiar with all the options available.

There is a large amount of evidence to support that CBT is an effective treatment for depression.  Giving you tools to help recognize your thought patterns, and be more in control of your feelings is especially helpful when you have been feeling hopeless and helpless.

My experience as a therapist is that it can be successful, however, it will depend on both yourself, and your willingness to engage in the therapeutic process and the skills and experience of the therapist. 

Having worked in mental health for almost 15 years, my own experience is that having counselling in any approach can improve your mood and lift depression.  The caveat being that you have an open and honest relationship with your therapist, and you fully engage in the counselling process.  Selecting a counsellor that you feel comfortable with is therefore essential.  So choose carefully, trust your instincts when asking the question ‘Can I work with this person?’ ask questions about experience, and validate qualifications, ideally check if they have membership of relevant professional bodies ie BACP or BABCP.

Other factors that you can do yourself are also helpful.  Being socially engaged with friends and family, talking to people, finding online or actual therapeutic support groups.  Exercise and physical movement is important for a whole host of reasons, feeling better about yourself, because you are motivated, feeling healthier, mixing with other like minded people, especially if you join a group, or go to a class.  A client who started playing 5 a side football said that it made him feel 7 again, in a good way.  Another client started yoga, and said that her class has made her reconnect with her body, which she recognized she had neglected and ignored for a long time. 

Volunteering and helping others can be rewarding and start to raise self esteem.  One of my clients recently started in a local volunteer project where she built her own bicycle, it has given her a sense of purpose, social inclusion and a new bike to get around on.

Another client has got involved in an art project in a local school where she is working with the children and developing a mural.

There are many projects where practical skills like gardening and cooking are being taught to people, giving sustainable skills, which they can feel a sense of achievement and pride.

 The key thing is to ask for support, even if it's a struggle for you to do so.  Go to your GP, talk to friends and family.
Ask them for Help.