Of all mental health issues, depression has been described as one of the most common. Indeed, it is estimated that about 1 in 10 individuals in Ireland are affected by depression at any one time. Despite its prevalence, depression can have devastating effects on an individual’s life, social relationships and on society, especially if it is not managed effectively. However, because of numerous issues in diagnosis, including fear of stigma, depression is often left undetected or untreated.
The causes of depression are still unclear, but may involve several interrelated psychological, biological and environmental aspects. Indeed, low self-esteem, habitual negative thinking, negative core beliefs and childhood experiences are all psychological issues that have been related to the onset of depression.
There are also numerous theories on the biological underpinnings of depression, including genetics, though this is unclear in milder form of depression. Malfunctioning of the brain chemical, or neurotransmitter, serotonin has also been linked to depressive episodes, and has become a popular model for antidepressant medications. Depression has also been shown to be associated with many debilitating physical conditions, including heart disease and chronic arthritis. Although this relationship is complex, involving both biological and psychosocial issues, where physical health issues and depression co-exist patients are likely to have poorer outcomes.
Social or environmental factors related to depression can include negative life events, such as bereavement and trauma. The impact of social class and gender may also be associated with depression, and this is reflected the epidemiology of the disease, which shows that women may be much more likely to develop depression. However, depressive episodes can also occur without any obvious trigger
Although the central component of depression is a continuous low mood, it can also involve a number of other symptoms effecting mood, motivation, psychological and physical domains, which are often interrelated. Loss of pleasure from previously enjoyed activities, feelings of hopelessness, helplessness and worthlessness are symptoms effecting mood and motivation that can often be experienced during a depressive episode. Psychological effects include an unwarranted or inflated sense of guilt, an overall negative attitude towards the self, an inability to concentrate, and suicidal thoughts. The physical symptoms of depression can involve lack of energy, insomnia and disturbed appetite leading to weight fluctuation. All these symptoms can interfere with social functioning, leading to issues in daily functioning, difficulties in family life and social withdrawal.
Types of Depression
Depression can occur in numerous forms, and each identified subtype aims to inform diagnoses and appropriate treatment.
- Major depressive disorder (MDD): Symptoms of this disorder are often more severe that many other forms of depression. Although some people may experience isolated episodes, MDD it is usually recurring, and an episode can last for several months if left untreated.
- Persistent Depressive Disorder (PDD): PDD, previously known as dysthymia, is characterised by episodes that can last up to 2 years, although the severity during this time can range from mild to severe.
- Bipolar disorder: Bipolar disorder is characterised by cyclical mood changes, from periods of intense feelings of euphoria, impulsivity and lack of sleep, to episodes of low mood and depression.
Depression can also develop under specific biological or situational circumstances. These can include –
- Postpartum depression: Depression that can occur in women after pregnancy in relation to new situational pressures, hormonal and physical changes.
- Seasonal affective disorder Depressive symptoms that appear to be triggered by limited exposure to natural light. The onset usually occurs during the autumn, and symptoms tend to improve during spring.
- Premenstrual dysphoric disorder: Depressive symptoms, mood instability and physical discomfort that can occur in women before the onset of menstruation, usually easing within a few days.
Antidepressant medication, as part of a wider treatment plan which includes psychosocial interventions, can be effective in more severe forms of depression. These medications generally work on neurotransmitters such as serotonin and norepinephrine, and in some medications dopamine. More recent medications known as selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) have been shown to have fewer side-effects than previous antidepressants. Although some individuals report experiencing headaches, insomnia and nausea, these generally ease over time. Sexual dysfunction can also be experienced while taking these medications, though this can sometimes be eased by adjusting the dosage or changing medication. With all antidepressant medication, effects may not be experienced until 4 to 6 weeks after starting the course. Even if symptoms improve, medication should not be stopped without medical supervision, as gradual adjustment will minimise the potential of a relapse.
Counselling, usually in combination with antidepressant medication can be effective is some circumstances, especially when targeting a particular area, such as relationship issues or bereavement. However, more structured psychotherapeutic interventions such as cognitive behavioural therapy (CBT) and interpersonal therapy (IPT) have been shown to be generally more effective that non-directive approaches, especially when combined with pharmaceutical intervention. CBT targets the negative thought processes that can lead to depressive symptoms and maladaptive behaviours by retraining the individual to interpret their environment and thoughts in a more positive way. IPT helps individuals understand and work through difficult relationships that may be exacerbating or triggering depressive episodes.
Finding motivation during difficult periods can be challenging, but there are certain steps individuals experiencing depression can take that may improve their mood and quality of life, or prevent the onset of a depressive episode. These steps include cultivating supportive relationships, which would enable the individual to stay socially active and open up to trusted friends. This could be as simple as going out for coffee and a chat with a friend regularly. Joining a support group is also a proactive way to interact with individuals who understand depression.
Learning to be self-compassionate can also aid in coping with depression. This can be achieved through challenging negative thinking, by first becoming aware of what triggers these thoughts, and offering more compassionate and realistic alternatives. Keeping a reflective diary can help with this process.
Caring for oneself both emotionally and physically can help in managing depression. For example, mindfulness and meditative activities such as yoga can help individuals regulate their emotions, physical responses and control stress. Partaking in enjoyable activities can also improve one’s mood and relieve stress. Exercising regularly, especially outdoors with sun exposure, can also have therapeutic effects. Further, eating a balanced diet and getting adequate sleep may also aid in managing depression.
However, if depressive symptoms worsen, professional help needs to be sought. These self-management tips can be used in combination with other interventions to help alleviate symptoms and prevent relapse.
Dr. Gillian Moore-Groarke, Consultant/Registered Psychologist.
Ms. Amy-Rose Hayes, Psychology Graduate PSI.
IrishPsychology.com, 5A Harley Court, Wilton, Cork.