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Depression is a major disorder that is thought to affect approximately 1 in every 10 people within the United Kingdom at some point in their life.
When it is being clinically diagnosed, health professionals will use the definition from the Diagnostic and Statistical Manual for Mental Disorders (DSM) in order to decide if someone has the condition: “Depressed mood or a loss of interest or pleasure in daily activities for more than two weeks. The mood represents a change from the person’s baseline and they will also have impaired function: social, occupational, educational.”
A more accessible definition, which is likely to be better understood by the majority of people who are not medical professionals, is: “the state of being very unhappy, without hope for the future.”
It can also be defined as: “a state in which a person is very anxious and unhappy for long periods and cannot have a normal life during these periods.”
The difference between ‘Feeling Low’ and ‘Clinical Depression’
Occasionally, people who are simply going through a period in their life where they feel a bit unhappy use the term ‘depression’ very flippantly. However, there are some major differences between someone whose mood is low and someone who has clinical depression.
|Feeling Low (Low Mood)||Depression|
|The individual is sad for a short time but can see hope in their future and will eventually come to terms with what is causing their low mood.||Depression continues for weeks or even months and the individual feels doomed and can see no hope for their future.|
|The individual seeks help to overcome the problem as it is only seen as a short-term issue.||The individual will sometimes be reluctant to seek help as they feel that there is ‘no point’ due to the hopelessness of their situation.|
|The individual is usually aware of the cause of their low mood.||Depression sometimes arises with no identifiable cause and this can make it more difficult to deal with because resolution can only come about when the cause has been acknowledged.|
|The individual can usually be ‘cheered up’ with some persuasion by those who know them well.||The depression is ingrained and the individual cannot be talked out of their feelings.|
|Low mood does not usually cause physical changes in the individual.||Depression can cause an individual to experience physical changes such as disrupted sleeping patterns, gaining or losing weight and being more susceptible to minor illnesses such as colds.|
|Low mood does not normally cause an individual to experience thoughts of self-harm.||An individual who has depression is more likely to self-harm and have suicidal thoughts.|
|If an individual has low mood, they can usually get through their day without too much disruption to their normal activities.||Depression causes major changes to someone’s routine, often meaning they cannot go to work. Sometimes, serious depression means that someone cannot even face getting out of bed.|
Many people fear that they have depression when, in fact, they are simply going through a period of low mood that will resolve itself either with or without help from others. However, sometimes a person has depression and does not realise it, simply thinking that they are feeling sad and that they will ‘get over it’ in time. Undiagnosed depression can have a severe and debilitating effect on someone’s ability to live a normal life, so it is essential that anyone who thinks that their mood is having an effect on their life seeks professional advice so that support and treatment can be given if necessary.
Factors associated with Psychotic Depression
Psychosis is a medical health problem that causes people to interpret what is going on around them differently from everyone else.
Psychotic depression is a type of major depression and differs from a normal experience of depression because someone who is diagnosed with the psychotic type is likely to have hallucinations. These can be visual (where the individual sees things that are not there) or auditory (where they hear voices that are usually telling them they are no good or useless).
Psychotic depression also means that an individual will experience delusions, which are where the individual has intense feelings. These feelings could be that they are worthless or that they have done something wrong and are being punished for what they have done.
The major difference for someone who has psychotic depression is that they will be out of touch with reality. This means that they will have untrue or unrealistic thoughts about what is going on in their life, but these thoughts can be so real to them that they will believe that they are true. For example, someone can convince themselves that they have committed a terrible crime and that the police are coming to look for them. In severe cases, people can believe that they are possessed by the devil, that they are some kind of animal or that everyone around them is trying to harm them.
Other factors that are associated with psychotic depression include the individual neglecting their personal hygiene often because much of their day is spent in bed or not moving from the same position within their house. They may also start to have very irregular sleeping habits, such as staying awake all night and sleeping through the day.
Trying to speak with the individual who has psychotic depression is very difficult because, often, it can result in withdrawal from society where the individual does not want to interact with anyone. When they do interact, it can be difficult to understand what they are trying to say as they may be rambling and incoherent, whilst believing that they are making perfect sense to everyone else.
Many of the factors associated with psychotic depression are similar to those of schizophrenia; however, the difference is that the delusions that the individual who has psychotic depression have are almost always associated with their depression, such as feeling worthless. Whereas, in schizophrenia, delusions are more random and unconnected and are not linked to any kind of mood or emotional state.
Many people who have psychotic depression are embarrassed or ashamed by their condition and therefore try and hide it from others. They feel that they will be judged or misunderstood and, for many, they believe that they will be sectioned under the Mental Health Act, meaning they will be hospitalised and treated against their will. All of these factors combined mean that individuals are less likely to seek treatment and this makes their condition very difficult to diagnose.
Diagnosis for psychotic depression is very important because episodes often reoccur when treatment has not been sought. Not having a diagnosis also means that the chances of developing bipolar disorder are increased and, sadly, those individuals who have psychotic depression are far more likely to attempt suicide.
Causes of Depression
As with many mental illnesses, researchers cannot identify a single cause for why depression occurs. There is a general belief that depression is likely caused by several factors which work together to bring about the symptoms. These include:
- Genetic factors
- Biochemical factors
- Psychological factors
- Behavioural factors
- Humanistic factors
- Social factors
Research indicates that if an individual has a first-degree relative, such as a parent or sibling, who has depression, this increases their risk of developing the condition themselves. For someone who does not have a close relative with depression, the chances of developing it are 1 in 10, whereas with some kind of genetic inheritance, the chances increase to 1 in 5.
Other research has shown that someone who has an identical twin (and therefore shares the same DNA) who has depression, in 46% of cases, they too are likely to develop the condition. This indicates that there is a substantial genetic component as to why someone develops depression.
However, it is difficult to identify genetic factors as being a sole cause of depression. It is believed that they merely make someone more susceptible to the condition and that the individual may actually need to experience a significant negative life event in order for the depression to be triggered.
Neurotransmitters are chemicals that send messages around the body to alert it to changes in the person’s environment. Amongst other things, they are responsible for the regulation of the heartbeat, breathing and digestion. It has been discovered that one particular neurotransmitter, norepinephrine, may play a significant part in the onset of depression. It has been found that individuals who have depression may have levels of norepinephrine that are too low. Additionally, the neurotransmitter serotonin, which is often referred to as a ‘feel good’ chemical, is also found to be very low in depressed individuals. This is why medication used to treat depression encourages the levels of these chemicals to be higher in order to rebalance them to increase the mood of the individual.
In his psychodynamic theory, Freud argued that depression as an adult is caused by the loss or rejection of a parent when the individual was in childhood. Many people are able to go through a period of mourning and then move on with their lives; however, according to Freud, depressed individuals are unable to do this and their period of mourning never ends. He further argued that these feelings of loss are often buried in the subconscious of the child, as they are too painful to deal with. When the child grows up and experiences another type of loss, even something symbolic, such as a job, then the subconscious memories will be triggered and linked to the original loss, causing the depression to present itself again.
Other psychological factors are researched by looking at cognitive reasons as to why someone might develop depression. In other words, this means that the way that someone thinks about things is examined and determined if it may be a risk factor in them experiencing depression. It has been found that many people who have depression think about things in a negatively biased way. What this means is that they fear the worst and assume that it will inevitably happen – this may be based on experiences that they had as a child.
Depressed people will see themselves as hopeless and this view will be projected onto how they view the world. These beliefs can be very overwhelming as they believe that they will not be able to handle any kind of barriers that may be put in their way. This can result in them seeing their future as meaningless. This inhibits them from finding ways to improve their condition because they ultimately believe that it will not work – and this is because of the negative view that they attach to everything.
Researcher Aaron Beck identified something known as the ‘negative thinking triad’, which shows how a depressed person thinks about themselves and the world:
This negative pattern of thinking causes depression because the individual can see no hope from the future. Beck believed that this was perhaps caused by experiencing a traumatic event in childhood, such as the death of a parent, parental rejection or peer group bullying. Although similar to the genetic theory of depression, it is thought that acquiring depression by this method is usually only possible if the individual experiences a negative event that triggers this type of negative thinking in later life.
As well as the triad (as identified above), Beck also identified the ways some individuals indulge in the following types of biased thought patterns:
- Selective abstraction: Focusing only on the negative aspect of any event
- Magnification and minimisation: All problems become bigger and all solutions become smaller
- Personalisation: Believing everything negative that happens in their own or someone else’s life is somehow their fault
When a person’s thought patterns are consistently negative, it is easy to see how they can be more susceptible to depression than someone who can see the positives in a situation and is willing to believe that there is a solution and hope for the future.
Depression is sometimes thought to be developed as a response to ‘learning’ it from the behaviour of role models. For example, someone who grows up in a household where someone has depression will see their behaviour that is caused by their depression on a regular basis. This is especially prevalent for a child who has a parent with the condition who will come to think that their behaviour is normal and the ‘correct’ way to react to certain life events. For example, a child who regularly sees their parent stay in bed all day who has withdrawn from most social situations and can often be extremely emotional, will think that when they experience a negative event that this is how they should react as well. Parents and other carers are very powerful role models because their behaviour is observed, internalised and then repeated.
Additionally, someone may learn to respond to depression in an unusual way if they like the attention that being depressed brings. For example, for someone who has experienced a period of depression, they may have found that during that time they were given more attention from family, friends and even health professionals. They may begin to like this behaviour and so, in the future, will likely react to an event in a way that will trigger the depression again. If, during the second period of depression, the attention they get is not as much as they received last time, it could lessen the chances of them becoming depressed again in the future because the positive feelings they had because of it have been lessened or extinguished.
Psychologist Abraham Maslow devised what he termed a person’s ‘hierarchy of needs’. He maintained that in order for people to feel worthy and valued they must have certain needs met for them to feel fulfilled. This is known as a ‘humanistic’ concept because it does not include factors from anything other than the person themselves.
Maslow argued that before anyone can feel completely fulfilled in their life, they must have certain needs met, and these are identified in the diagram below.
Physiological needs: This is the most basic level of the hierarchy and must be achieved first before a person can move onto the next. These types of needs include oxygen, water, food, sleep and warmth and are things that humans simply cannot survive without.
Safety needs: This level is concerned with security, stability and protection in everyday situations. That is to say that, at this level, people need to exist in a predictable and orderly world that they feel is mostly within their control.
Belongingness and love: In order not to feel isolated and anxious, the needs at this level are companionship, affection, intimacy and love. This can include things like being a member of a social group, having a stable and reliable set of friends or being in a stable and committed relationship.
Self-esteem needs: To satisfy these needs, people have to achieve and become competent and be recognised as such. Also at this level, intellectual needs have to be met, and so it is paramount that people have understanding and knowledge.
In the humanistic view, depression is thought to occur because people do not feel as though they are fulfilled due to having a lack of needs being met at various points within the hierarchy. This may be because they do not feel as though they have the resources to be fulfilled, such as being in a relationship or feeling like they are ‘stuck in a rut’ and cannot progress up the hierarchy due to other factors that they feel are out of their control.
Social factors are those that occur because of a person’s environment. This can include their family, health, employment, finances and where they live (amongst many other factors). These will be discussed in much more detail in a later section, but for now it is enough to say that social factors are often those that are responsible for triggering the underlying causes that have been discussed in this section. For this reason, they are extremely important and individuals should always be aware of the effect that their environment can have on their mental health.
Feelings when experiencing Depression
Depression can cause overwhelming feelings for individuals who have the condition. These overwhelming feelings caused by the depression can actually make the condition worse. Many refer to it as a ‘black hole’ from which there is no escape, whilst others compare it to being in a ‘waking coma’ where their lives become a simple existence with no meaning whatsoever.
Symptoms of depression, as stated by the NHS, include:
- Constant feelings of sadness or low mood
- Low self-esteem
- Constantly tearful
- Being guilt-ridden
- Being irritable and intolerant of other people
- Having no interest in activities that were once pleasurable
- Being unable to make decisions
- Finding no enjoyment in anything
- Being fearful or anxious
- Self-harming or having suicidal thoughts
Many individuals feel as though their depression makes them a burden to society and that because of this they cannot ask for help because they will be made to feel even more useless than they already do and they don’t want to bother anyone else with how they are feeling.
Guilt often manifests as a result of depression, especially if the individual’s condition impacts on other people, such as their partner or their children. Guilt is made worse when families try and help the individual as much as they can yet, despite all of their efforts, the individual still feels completely alone.
Feeling alone can be a very distressing experience for individuals who have depression because it leads them to believe that they are the only person in the world who has ever been depressed and that this makes them weird or strange. These feelings make individuals reluctant to open up to others about how they are feeling so it is a feeling that they carry with them constantly.
Frustration can also be felt by individuals because of comments made by other people who do not understand how severe an impact depression can have on someone. “Cheer up!”; “What have you got to be depressed about?”; and “It’s not the end of the world” are not helpful comments and can actually make the individual feel worse. This is because they likely know all of these things and yet still can’t come to terms with their illness.
Individuals can also feel fear because they may not know what is happening to them. They may fear that they will injure themselves or that they are ‘going mad’. One of the most frequent fears for anyone who has depression is that if they seek help they will be forced into hospital against their will and a doctor will not think that they are fit to care for their children and so they will be taken into care. This can be another major factor in why people who have depression are reluctant to seek help.
Hypercriticism is something that individuals who have depression often revert to because they feel as though they are useless and worthless and nothing that they do is right. This leads into a negative thinking cycle that, as we have already seen, was identified by Beck. Many very successful people experience depression because, despite their successes, they still do not feel as though they are good enough. Many famous individuals have been open about their struggles with depression:
- Stephen Fry – as part of his bipolar disorder
- Denise Welch – who had debilitating postnatal depression after the birth of her first son
- Owen Wilson – the actor attempted suicide in 2007
- Catherine Zeta-Jones – she revealed she had a type of bipolar disorder that results in severe depression
Due to many factors that result from depression, individuals may feel aggressive or angry and this may be in complete contrast to their usual temperament. This behaviour may occur because the individual feels completely out of control with their condition, and by lashing out the individual is expressing their feelings in the only way that they are able. Feeling unable to focus or concentrate can also result in aggressive behaviour, as can feelings of stress and anxiety, which are experienced very commonly alongside depression.
The symptoms of depression can also result in the individual feeling as though they no longer want to socialise. This lack of interest in seeing friends and family can result in feelings of guilt, which will almost certainly feed into the cycle of depression. A lack of wanting to socialise can result from the individual feeling embarrassed or ashamed of their condition because they feel that others will see them as weak and vulnerable.
Finally, one of the most debilitating feelings of someone who has depression is despair. This usually results from them having the idea that everything is hopeless and that there is no end to their suffering that has been brought on by their condition. Despair can often result in individuals feeling as though they having nothing worth living for, with one individual describing depression as “waking up and wishing that you had died in your sleep.”
How depression affects people
Depression, at its most severe, can have a devastating effect on individuals and their ability to live their life in a way which is fulfilling and meaningful. It can affect individuals in several ways:
Many individuals who have depression will notice a change in their sleeping patterns. This may mean that they are having problems getting to sleep or staying asleep (insomnia) or that they are sleeping more (hypersomnia). Changes to sleeping patterns can result in extreme fatigue even when the individual is sleeping too much. Fatigue means that the person has little or no energy and so does not feel like getting involved in activities. In extreme cases, it can even affect an individual’s ability to accomplish a simple task such as making a cup of tea.
The individual may also see a noticeable change in their eating habits, which can lead to weight gain or weight loss. Some people who have depression will not feel like eating a meal or preparing it, whereas others will end up eating more than they normally would to comfort themselves in the face of their condition.
They will almost certainly have a constant feeling of ill health brought on by unexplained aches and pains that are not directly linked to their depression. Depression is sometimes caused by anxiety and stress, which can both result in a reduction to the function of the immune system. When someone’s immune system is compromised, they cannot fight off illness as well as they usually would and this results in them having more infections (such as colds) that may take them longer than usual to recover from.
In cases of severe and long-term (chronic) depression, it has been found that people have problems making choices that promote good health. With this in mind, they are more likely to experience lifestyle related illnesses such as Type 2 diabetes and coronary heart disease because of their poor choices; for example, eating too many foods high in saturated fats and doing little or no exercise.
For women, depression can result in a change to their menstrual cycle making it more irregular or, in some cases, stopping it altogether. This is thought to be caused by the underlying stress that the person who has depression is experiencing.
Finally, many individuals who have depression will find they have a loss of libido (their interest in sex) or it will cause them to have sexual problems. Additionally, many of the different types of medication that are used to treat depression can also have the same side effect of someone losing their interest in sex, so this can be problematic in more than one aspect of depression.
As a consequence of depression, many individuals find that they no longer want to go out with their friends or see their family, and this puts them at risk of social isolation, which can serve to make symptoms of depression even worse. The reasons for this can vary but many individuals feel as though they do not want to burden others with their problems or that they are too ashamed to admit that they are experiencing depression because they fear judgement from others.
Social isolation can also lead people to take time off work and this can become so bad for some individuals that it leads to them leaving their position altogether. This is more likely to be the case if they work for a company which is unsympathetic to their needs or that they feel as though they will never see a time in the future when they will be able to carry out their role successfully again. This can lead to further problems that cause stress and anxiety such as financial issues (this will be discussed in further detail in a later section). In order to cope with their condition, some people will resort to substance abuse as a way of helping them get through their day. Whilst the individual may feel some initial sense of escape from their problems, in the long run, abuse of alcohol or drugs will have a negative impact on their condition and their ability to cope with it. Finally, an individual who has depression will very likely find that they can no longer enjoy previous interests or hobbies. This may be because they no longer have the energy to take part in them or because they feel as though they no longer have meaning and therefore there is no point in carrying them out.
Cognitive functions are anything that involve a person’s memory, perception, reasoning and overall thinking skills. Someone with depression may find that they have problems with their short-term memory and that they are unable to focus in a way that they used to. This may mean that they are unable to make decisions and their levels of concentration are drastically reduced. This can affect their ability to carry out their job role but can also mean that they are unable to focus their attention on watching TV or reading a book.
For some individuals, cognitive effects of depression are more serious and can cause them to have hallucinations; this is more common in psychotic depression, as we saw in an earlier section.
How Depression affects people and those around them
The effects on other people who are in the life of the individual who has depression will depend upon the condition’s level of severity. However, at its worst, depression can cause upsets in relationships that can be very difficult to resolve. For example, the depressed person may self-isolate and this means that they will find it very difficult to be involved in social situations. If their partner is outgoing and likes to socialise, this will cause problems because their lifestyles, which may once have been perfectly compatible, are now completely at odds.
Depression can have an effect on the amount of reliance that the individual has on other people. For example, when someone is so depressed that they can barely function, this puts pressure on others around them to carry out caring duties. In some cases, these caring duties will fall to the children of the individual whose own lives will then be disrupted. It is estimated that in the UK, there are around 240,000 young people under the age of 19 who have some form of caring responsibilities, and of these about 23,000 are under the age of nine. Many young carers will be looking after someone who has some form of mental health problem and this can lead them to having problems of their own, as they are twice as likely to not be employed or in education. Children need to be able to rely on the adults around them, and when depression makes this difficult, children may well believe it is their fault that their family life is unstable. This can lead to the adult with depression feeling guilt, making their problem with depression feel worse.
Depression can make other people involved in a person’s life feel as though they are not doing enough to help. Many friends and family members will find it very troubling to watch someone struggle with depression and feel as though they are powerless to help them. In severe cases, many family members and friends may feel responsible that they were not quick enough to help or did not notice significant changes if the individual tries to harm themselves. If there is a constant fear that this might happen, it can be intensely distressing for everyone involved.
Whilst it can be stressful and tiring for others to be around someone who has a depression, care should always be taken to ensure that the attitudes of others do not make their condition worse. The person who has depression has not asked to have the illness and so they should not be made to feel guilty about the effect that it has on themselves and on others.
Daily life with Depression
Without realising it, the daily demands of someone may actually be negatively affecting their well-being. If left unmonitored, this can lead to some serious physical and mental health conditions that, if noticed earlier, could have been treated at the outset and not left until the individual’s normal life was disrupted.
Examples of how daily life may contribute towards depression are very varied and individuals may experience more than one at the same time. Some examples are:
- Experiencing seasonal affective disorder (SAD)
- Being bereaved
- Going through a divorce
- Experiencing a short- or long-term period of stress
- Unemployment and financial issues
- Physical illness
- Problematic relationships
- Where an individual lives and the quality of their home
Seasonal Affective Disorder
Seasonal Affective Disorder is a type of depression that occurs in winter months when hours of daylight are reduced. During this period, some individuals find that their mood and energy levels are significantly lower than in other months where daylight hours are longer. Effects are felt most strongly in December, January and February and then tend to disappear when spring begins. However, individuals who do experience SAD can find that it does return to them each year. These individuals are likely to have problems going about their day during the winter months because they are affected by the symptoms of depression.
Bereavement can cause a huge upheaval in a person’s life, and when the feelings of sadness that someone associates with the loss of a loved one do not disappear, this can easily result in the individual developing depression. Grief and depression present themselves in very similar ways and, because of this, someone may mistakenly believe that they are still grieving, when in fact they are actually experiencing depression. This can make it difficult to diagnose and, as such, more difficult to treat.
An unusual form of bereavement is something known as ‘empty nest syndrome’ where all children who have previously lived in the household have now grown up and left home. This tends to produce depressive symptoms in women more than in men.
Divorce, in some ways, is similar to bereavement in the way that the individual experiences a sense of loss. Due to this, it also means that just as depression can result due to bereavement, it can also result due to divorce. It is thought to be caused by overwhelming feelings of stress and anxiety linked to the change in a person’s lifestyle. When stress and anxiety become too much, this can lead to someone withdrawing from society because they feel as though they cannot cope with daily activities and situations. This can cause someone to become isolated, and this is a major factor in the onset of depression.
Stress itself can be caused by many different factors in a person’s life. When someone is stressed, they are less likely to feel able to take part in normal activities and, as such, feel overwhelmed and unable to cope (just like with the divorce example above). Additionally, stress is associated with the release of less ‘feel good’ hormones, which can bring on symptoms of depression.
Unemployment and Financial Issues
Unemployment not only leads to problems such as financial issues but can also affect someone very personally. This is because it can lead to lowering of self-esteem and confidence associated with the removal of the rewards and achievements that someone feels when they are productively employed.
As we saw from Maslow’s hierarchy of needs, in order to feel fulfilled, people need to have their esteem needs met. When this does not happen, such as when someone becomes unemployed, they can become stuck at that particular level on the hierarchy and this can lead to depression.
Financial issues associated with unemployment can lead to stress, which, as we have also seen, can be a major factor in the onset of depression.
Physical illnesses, especially those which mean that someone has to spend much of their time indoors, can lead to isolation. Additionally, someone may feel as though there is no end to the physical pain they feel and this can also mean that they start to exhibit signs of depression. When someone is diagnosed with a terminal illness, they may initially become depressed with the diagnosis before eventually coming to terms with it. However, this does not always happen and someone can have depression alongside their illness until it takes their life.
Some of the most common illnesses that are thought to bring about depression include:
- Parkinson’s disease
- Alzheimer’s disease
- Multiple sclerosis
- Heart disease
- Cushing’s syndrome
- Ongoing viral infections
Relationships can be a source of depression if the individual involved feels as though they have no control over their involvement within it. For example, someone may live with a domineering partner who decides everything on behalf of them both. This can lead to a lack of confidence and self-esteem, which can lead to stress and anxiety and ultimately become depression.
Depression is also more prevalent in relationships where there is abuse. This may be due to the fact that the individual feels isolated and feels like they cannot tell anyone what is happening to them. The abusive partner makes them feel worthless through emotional abuse, which is designed to trap them in the relationship because they are led to believe that ‘no one else will want them’.
Finally, one other cause of daily life that might lead to depression is an individual’s hormones, which can fluctuate wildly, especially for women around the time of menopause. The reduction of certain brain chemicals is thought to lead to low mood as well as the increase of stress-related hormones. When these are combined together it can bring about depressive symptoms that can come and go and are dependent on the cycle of the hormones.
Local resources for help with Depression
An individual’s GP or other health professional will be an excellent source of support for someone who is experiencing depression. GPs can refer individuals for counselling or they can prescribe medication that they think might be useful in the interim to lift someone’s mood so that therapy will be more effective for them.
Medication is sometimes offered to individuals whose depression may be affecting their ability to carry out their normal day-to-day activities. The most common type of medication that is prescribed is some form of antidepressant. These usually work by increasing the amount of serotonin available in the brain. Serotonin is a ‘feel good’ hormone and its reduction is thought to be directly linked to low mood and depression. The most common type of antidepressants are SSRIs – selective serotonin reuptake inhibitors – which stop too much serotonin being reabsorbed so more is available in the brain. These in turn will lift or maintain a person’s mood and can help with anxiety and panic disorders, which might be the cause of someone’s depression.
Sleeping pills and tranquillisers can sometimes be prescribed for people suffering from depression if they are undergoing extreme cases of fatigue. They help break a pattern of not sleeping in the hope that a normal pattern can be returned to. These are, however, not usually prescribed for long-term usage as they can become addictive and will not help treat depression on their own.
A GP can also offer to refer someone for therapy, of which there are a number of choices:
- CBT – cognitive behavioural therapy – works by enabling the individual to look at their thinking patterns, which, as we have discussed previously, can have an effect on the way that someone views their condition. CBT will help to enable an individual to come out of their negative thinking cycle, which can help give them hope for the future.
- Psychotherapy is another type of ‘talking therapy’ that may be useful in getting to the root cause of the depression. It is more useful for severe depression, which is often caused by subconscious trauma that the individual cannot bring into their conscious mind because it is too painful. Because they cannot think about it, they cannot identify the cause and therefore it cannot be resolved.
Exercising can be a very effective way of reducing the symptoms of mild depression because it encourages the release of ‘feel good’ hormones. If someone exercises alongside having a good diet this can make them feel better about themselves and can lift their overall feeling of well-being.
Libraries are an excellent local source of information where individuals can educate themselves about their condition. Often, the understanding of why someone is behaving in the way that they are can act as a way of reducing anxiety levels, and this can lead to a decrease in the symptoms of depression. If someone cannot face leaving their home, they can access information and some online therapy courses from their home but they must ensure that this comes from a reputable source.
Support groups are very common for mental health problems. Organisations such as Mind offer them in many towns. It is said that the people who experience the issue are the biggest experts about it, and joining a support group can be rewarding on many levels. Individuals feel understood and accepted when they are speaking with others who have gone through, or are continuing to go through, the same thing that they are. Helping someone else is also good for an individual’s self-esteem and confidence and it can also be very rewarding.
Local mental health teams may be accessible for people who have more severe depression and are currently relying on others to care for them in some way. These teams consist of a variety of health professionals who may be able to help someone live with their depression or take steps to overcome it. For example, there may be psychiatrists, counsellors and support workers who, along with the individual, will put together a plan of support so that everyone can work together in enabling the individual to retain a sense of normality and live in a meaningful manner.
Treatment for Psychotic Depression
Due to the fact that it is more severe and serious in nature, treatment and resources for psychotic depression are more wide-ranging than those for just depression. Treatments and resources such as the ones in the previous section will be tried first but, due to the differences in the types of depression, these treatments are less likely to be successful for psychotic depression.
Hospitalisation is sometimes necessary in order to stabilise someone who is having a psychotic episode because of their depression. Many individuals will realise that their condition is serious enough to warrant hospital treatment and, as such, will voluntarily attend in order to be supported. However, some individuals may not realise this and they will have to be detained under the Mental Health Act 1983 – sometimes referred to as being ‘sectioned’. This happens when the individual is seen to be a threat to themselves or to others, and is actually quite a rare circumstance.
When someone is detained under the Mental Health Act, two different health professionals will have separately assessed them, one of whom must be a specialist in mental health conditions, such as a psychiatrist. When both have agreed that this is needed, the person can then be detained in hospital and treated against their will.
Whilst in hospital, the person may have an injection to calm them down so that they are able to discuss what is happening to them in a more rational manner. Some may behave aggressively but this is not as common as people may be led to believe. However, whilst someone is in hospital, they will be closely monitored to watch for signs of suicidal behaviour or behaviour that may harm others.
As part of their treatment, whilst in hospital, the individual may be given antipsychotic medication. Antipsychotics tend to be prescribed in cases of schizophrenia, bipolar disorder and severe depression or anxiety. They work by boosting or reducing the effect of certain chemicals in the brain. The way in which the drug is administered will determine how quickly it works – if it is taken in regular tablet form, it can take up to several days before any difference is noticed. However, if it is administered by a direct injection into a muscle, it can work within an hour, and this may be the method that the individual experiences if they have been admitted to hospital. Examples of antipsychotic drugs include chlorpromazine, clozapine and flupentixol.
ECT – electro-convulsive therapy – is only used on individuals for whom all other types of treatment have failed. It is used for someone who is at severe risk of suicide and is classed as being a danger to themselves on a consistent basis.
Someone undergoing ECT will have electrical currents sent through their brain in order to try and relieve some of the symptoms of the depression. No one is certain how ECT actually works but it is believed that it changes patterns of blood flow and of chemicals in the brain. It is quite a controversial treatment, often depicted as cruel and barbaric in the media; however, for some, it can be a lifeline back to a normal life and is thought to be successful in up to 75% of cases, but this is only in cases where the individual also has a course of medication or follow-up ECT treatments as well.
Local mental health teams are vital in supporting someone with psychotic depression once they have left hospital. Before leaving, individuals are encouraged to plan ahead so that when they are discharged they are capable of acting independently. More often than not, this will initially be with the support of the local mental health team who will bring together many different roles to ensure that the individual is supported in their recovery in order to prevent relapse and further hospitalisation.
Interested in a mental health qualification?
We offer the TQUK Level 2 Certificate in Mental Health Awareness, which has a full unit on Understanding Depression.