A Simple Guide to Depression
Depression (major depressive disorder or clinical depression) is what we call a set of symptoms that occur together and last for an extended amount of time. In medical circles depression is considered to be a mental health illness though there are no lab tests that one can take to confirm the diagnosis. Depression is said to impact a person’s brain and body, including cognition, emotions, behaviour, immune system, digestive system and nervous system.
How common is depression?
According to DSM-4, between 10% to 25% of women and 5% to 10% of men will experience depression at some point during their life. The Office of National Statistics (2000) in the United Kingdom reported that 9.2% of the general population experienced mixed anxiety and depression in 2000. According to Aware, depression affects 1 in 10 people – 450,000 people in Ireland. It is estimated that globally, depression is the 4th most common illness in women and 7th in men. What’s more, it has a high mortality rate as according to the American Psychiatric Association, 15% of those affected take their own life.
How is depression diagnosed?
As mentioned earlier, the only way to diagnose depression is by identifying the symptoms. According to the diagnostic manual called DSM-5, depression can be considered a disorder if it affects several aspects of a person’s life to the extent that it impairs their functioning and interferes with social, family and work life. The formal diagnosis requires that a person experiences constant and oppressive symptoms for over two weeks.
Symptoms of depression
There are three types of symptoms that a patient might experience:
- Somatic symptoms of depression: these include physical symptoms such as fatigue, insomnia, agitation, headaches, muscular pain. A person might have problems falling or staying asleep, but they might also sleep excessively (hypersomnia). They might be restless, or experience a sense of slowness. The appetite might be affected which can be reflected by weight gain or weight loss.
- Cognitive symptoms of depression: these symptoms refer to a person’s mental abilities such as thinking, focusing or making decisions. A person might have an impaired concentration, struggle with memory, become indecisive, and even self-criticism
- Affective symptoms of depression: a person’s mood might be “depressed” which often means feeling sad, low, empty or hopeless. One might experience a loss of pleasure, joy and interest in life, which is especially visible when it comes to things that one used to enjoy in the past. Feelings of worthlessness, guilt, weakness and helplessness can also be common.
In some cases, people who experience symptoms of depression might begin to have recurring thoughts of wanting to die, or to take one’s own life.
The tricky part of diagnosing depression
While all the above symptoms may sound straightforward in theory, in reality depression is much more complex than that. Everyone’s experience of depression can be different. Each of us can have different, and even opposing symptoms. What is more, the symptoms can also be indicative of a physical illnesses, of other psychological disorders, or they can even be side-effects of some medications.
Diagnosing depression in Ireland
Often in Ireland, your GP can make a diagnosis based on your symptoms that you report during consultation. In such cases, a GP might prescribe you with medication aimed at altering your mood. Some GPs might also suggest psychotherapy. At the moment, the access to public mental health resources is limited, and the waitlists are long (on average 6 months depending on location). If your GP believes you could benefit from therapy, they might suggest working with a psychotherapist in a private practice.
Treating depression
The two approaches mentioned above to addressing symptoms of depression include medication and psychotherapy. Additionally, your doctor, especially if they have more of a holistic view, might suggest a change of lifestyle to include more time in nature, more movement and stress-release practices, joining support groups, altering your diet or taking supplements. It is not uncommon for a GP to run blood tests when you present with symptoms of depression. This is to rule out any physical causes such as thyroid issues that might resemble depression.
Treating depression with psychotherapy and counselling
In terms of counselling, the medical system tends to favour Cognitive-Behavioural Therapy approach to working with depression. In short, this model of therapy proposes that the source of depression is in one’s thinking patterns and hidden beliefs. Changing core beliefs and automatic negative thoughts can result in decrease of symptoms. Working this way is usually more time-effective than other approaches. It is goal-focused and directive. Your therapist might offer psychoeducation, give you specific feedback, challenge your thoughts and ask you to practise your learnings between sessions.
Apart from CBT, there are numerous other approaches to working with symptoms of depression. Many of these are built on the belief that depression is a natural response of the body and mind to something that happened in life. This could have happened recently, or much earlier in the past, even in early childhood. These therapies propose that if a person is offered a safe, accepting and holding environment, they can process and integrate the events that led to their depressive symptoms. Examples of some of the therapies that follow this view include humanistic, gestalt, person-centred, or psychodynamic therapies.
Furthermore, body-based and trauma-based approaches to psychotherapy suggest that additionally to working with uncovering the events of the past and working on the cognitive level, a person needs to regulate their nervous system and discharge the energy from their body as a part of their healing.
How to choose the right psychotherapeutic approach for depression?
There is no right or wrong approach to working with the symptoms of depression. According to research, the methods and techniques that a therapist uses are less important than the quality of the relationship between the client and the therapist. When choosing your therapist, it is good to pick one that works in a way that resonates with you and that is aligned with your values and beliefs.
Treating depression with medication
Medications used for treating depression are called antidepressants. The most commonly prescribed antidepressants are SSRIs (selective serotonin reuptake inhibitor).
While antidepressants work fast, they are not as effective as initially believed. Numerous studies have shown that the effectiveness of antidepressants is not much higher than placebo. For instance, this study found that antidepressants help 40 to 60 out of 100 people. At the same time, placebo helped 20 to 40 out of 100 people.
According to HSE, between 50% to 65% of people who take antidepressant will see some improvement.
Summary
Depression is a set of emotional, mental and physical symptoms. There are numerous theories as to what causes depression, though none of the theories is empirically verified. This might suggest that there is a mixture of factors that lead to the development of depressive symptoms, as opposed to their being one clear cause. What we know for sure is that it is possible to heal from depression and that there are different ways to approach the healing process. Those looking for help can use a mixture of different tools and methods: one-on-one psychotherapy, support groups, medication, alternative medicine such as energy healing or Chinese medicine, adjusting diet and supplements and bodywork.
It might take time to find what works for you, but healing is absolutely possible.
DMS (The Diagnostic and Statistical Manual of Mental Disorders) – is what the medical industry in the US uses to diagnose mental health illnesses. The manual has been updated several times. The latest version of the manual is DSM-5. The European version of DCM is called ICD, it was published by WHO (World Health Organisation) and it is slightly different to DSM.
DSM V offers a full list of depressive disorders including Disruptive Mood Dysregulation Disorder, Persistent Depressive Disorder, Major Depressive Disorder (MDD) and other. ICD 10 also proposed several different mood disorders such as Depressive Episode, Persistent Mood (Affective) Disorder, Recurrent Depressive Disorder and others. These different types of depression were defined in order to facilitate clinical assessment and treatment because depression is so heterogenous.