THE BLACK DOG OF DEPRESSION-
“A man has many skins in himself, covering the depths of his heart. Man knows so many things and yet he does not know himself. Go into your own ground and learn to know yourself there”- Meister Eckhart.
I have often sat with clients and heard them say “ I don’t know if I am depressed…what exactly is depression?”
This article is aimed at people who are wondering whether they, or someone close to them is suffering from depression. It will provide basic information relating to diagnosis, causes, psychological treatment modalities and offer some useful resources to explore.
Below is a depression checklist adapted from the DSM IV-TR (The Psychiatric “Bible”). If your symptoms (or someone close to you) are congruent with some/ or many on the checklist, this does not necessarily mean you are clinically depressed. If however you recognise 6 or more symptoms which have lasted for a period of 2 or more weeks, more days than not, it would be advisable for you to visit your healthcare provider.
- Significant loss of energy, fatigue, feeling slowed down
- Feelings of emptiness, persistently feeling low and/or anxious
- Loss of interest in pleasurable activities, including sex
- Disturbances in sleep patterns (insomnia, oversleeping. early morning waking)
- Moderate/significant appetite/ weight changes (gains or losses)
- Recurring thoughts about death/suicide or suicide attempts
- Pessimistic, hopeless feelings
- Feeling worthless, guilty and/or trapped
- Memory lapses, loss of concentration, inability to make decisions.
- Physical symptoms: aches and pains not caused by a recognizable physical cause or disease. (chronic back pain, stomach or headaches)
The many faces of Depression:
Listed below are some (and by no means exhaustive) examples of the many different paths that Depressive illness can follow.
- Dysthymia is a chronic low-grade depression which lasts for 2 or more years.
- Major Depressive Disorder is chronic, recurrent depression. It is characterized by sharp, severe episodes, which are often (but not always) triggered by environmental stressors (e.g. loss of employment). These episodes can also manifest when life is perceived to be going well.
- Single episode depression occurs when a person who has previously been unaffected suddenly develops severe depression.
- Postnatal (postpartum) depression is recognizable in that ‘feeling blue’ lasts longer than 1-2 weeks i.e. it is ongoing.
- Bi-Polar Disorder (previously called Manic-depression) This form of depression is called Bi-polar because the person alternates between one emotional pole (down/depressive) and another (up/manic). The manic episodes can last for weeks or even months, as can the depressive episodes.
Manic Symptoms include:
Decreased need for sleep
High levels of distractibility
Flights of ideas or racing thoughts
Some interesting statistics:
Although accurate South African depression related statistics are difficult to come by, the World Health Organisation claims that depression is one of the fastest growing illnesses on the planet. Depression can affect anyone, from any demographic, it does not discriminate with regards to age (approximately 3% of children and 5-8% of adolescents in the U.S. suffer from Clinical Depression). Those suffering from depression are 30x more likely to commit suicide than the general population. Approximately 2x more women attempt suicide than men. Men however are 4x more likely to die from their attempts due to using more lethal means.
So what actually causes depression?
Depression can come about because of personal loss, financial problems, physical illness and stress. Such events constitute environmental cues
Psychological and Chemical Factors
Powerful psychological forces also influence the course of depression. For example, an individual may have circular, self-defeating thought patterns which leave one feeling exhausted and “stretched”. When depressed, the mind often runs rampant, spewing all manner of toxic (often unsubstantiated) thinking into the thought stream. Imagine a swimming pool without a filter, soon the water becomes brackish and green. The brains neural highways carry this toxic thinking using neurotransmitters as surely as they carry any other feeling and thought in the human experience. Biochemical and psychological forces within the brain have a close relationship and need to be explored in order to re-establish equilibrium.
The origins of depression can also include genetic factors. Genetics, environment and biochemistry are also closely linked and while there clinical evidence of depressive heredity, it does not mean that one will develop depression if a relative has depression. Excessive pressure on genetic loading through biochemical and environmental stressors may activate depression within the individual but the converse is also possible, that with an effective, integrative strategy for managing low mood and stressors one can offset powerful genetic precursors.
The road to healing.
We are no longer in the Dark Ages regarding the treatment of depression. There are a variety of chemical and psychological treatments which have been show to be incredibly effective in the battle against depression. The list below is a brief descriptor of current psychological strategies for dealing with depression.
Cognitive-Behaviour Therapy (CBT)
The goal of CBT is to address the client’s self defeating patterns of thought and how those thoughts translate into negative attitudes and destructive behaviours. Therapy focuses on challenging self-defeating assumptions (cognitions/thoughts) as well as giving exercises designed to modify outward actions (behavioural aspects). CBT is a tool based, short-term intervention which can range anywhere from 6-20 sessions.
Exploratory Therapy (Psychodynamically orientated psychotherapies)
The core goal behind exploratory therapies is to resolve long-standing, sometimes unconscious conflicts and repressed feelings within an individual. An example of this type of work would be a thorough exploration of the complex relationship dynamics that exist between a parent and child (father and son, mother and daughter) and what the individual has internalized, repressed feelings, working models of the world (and how this model affects his/her world). Exploratory therapies are medium/long term interventions.
Mindfulness Based Therapy (MBCT/MBSR)
This type of therapy focuses on the restless nature of the mind and its role in generating depressive thinking. The individual is shown ways of developing the capacity to remain present as opposed to being caught in a ceaseless reactive or aversive cycle. I often tell clients that it shifts one from being an actor moving unconsciously through their script to a curious member of the audience who can observe the nature of their minds without constantly being caught up in the drama.
This brief outline is aimed at providing information and possibly a mere glimmer of hope to those of you in the grip of depressive illness. If you or someone you now is suffering from depression, I urge you or your acquaintance to undertake a journey into therapy. Healing is not only possible, it is probable.