Depression

iStock_000012143104SmallThe idea of “being depressed” has entered into modern language. It is not unusual to hear a loved one, friend, or colleague say they are depressed. But what is depression? Is it really the same as just being sad? Or does it mean a mental illness?

Like most human states, the experience of depression falls along a continuum. This means that the experience of depression varies in severity over time. Understanding the difference between a state of low mood and an episode of clinical depression is important – it changes how we approach, adapt, and recover from this experience.

So, let’s start with the first question: What is depression?

Depression can describe a range of feelings, not just sadness. This low mood may include sadness, but also restlessness, anxiety, worry, guilt, emptiness, hopelessness or helplessness, irritability and hurt. More specific physical problems include loss of appetite or over eating, insomnia or excessive sleeping, aches/pains, and digestive complaints. Problems with decision making, concentration, and memory can also be reported, particularly by those with psychotic or melancholic presentation.  Thoughts, perspectives on life and relationships, behaviours and physical well being can be negatively affected. Not surprisingly, a person experiencing depression may no longer want to participate in activities that were once pleasurable.

Suicidal thoughts or tendencies may also be present. If you are reading this article in Australia and would like to talk to somebody about issues of suicide right now then freecall Lifeline on 13 11 14. Lifeline supports are available 24/7.

The more common presentations of clinical depression are listed below, but additional categories do exist:**

  • Major Depressive Episode
  • Major Depressive Disorder
  • Persistent Depressive Disorder
  • Disruptive Mood Dysregulation Disorder
  • Bipolar or Manic Depression, if a manic episode has also occurred
  • Seasonal Affective Disorder, also known as the winter blues
  • Postpartum or Post-natal Depression
  • Premenstrual Dysphoric Disorder

There is no age limit for depression, it can be experienced at any age. Depression can be a common and quite understandable response to life events, such as experiencing loss. It can also be a symptom of a medical condition or the side effect of medical treatment.

Major Depressive Episode 

iStock_000015267335SmallPersons experiencing clinical depression exhibit a number of key symptoms. http://behavenet.com/major-depressive-episode

Diagnosis often occurs through a combination of self-report, feedback from loved ones and/or colleagues, as well as assessment conducted by a mental health worker. As indicated by the term “episode”, the MDE diagnosis reflects a specific time frame rather a chronic presentation. To be categorized here, a substantial change in functioning is required, with depressive symptoms present every day for at least two weeks. MDE symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

There is no set end-point, and length of episodes can vary.  Some people experience only one MDE, others have recurrent episodes.

Major Depressive Disorder

If a person has experienced at least two MDEs, then this may indicate a chronic health problem termed MDD. Whilst an MDE can resolve without medical or psychological intervention, unresolved symptoms have been shown to increase likelihood of recurrent episodes (Thase, 1999). Repeated episodes of depression require ongoing treatment with the aim of prevention – stopping MDEs from escalating into chronic MDD.

There may be reasons explaining why MDE outcomes are poor. These include:

  • the severity of initial symptoms (including psychosis)
  • the presence of another mental health or medical condition
  • the number of prior MDE, with more worsening prognosis
  • early age of onset
  • inappropriate treatment
  • incomplete recovery after 12 months
  • complex family relationships

For severe cases of depression, evidence shows that anti-depressant medication can help. Medication taken four to six months post MDE have shown to reduce a recurrent MDE by 70% and the preventative effect may last for as long as three years post treatment (Geddes et al, 2003). The role of anti-depressant medication should be discussed with your treating doctor or psychiatrist.

Next question: Is it really the same as just being sad?

Clearly the answer to this question is no, depression is not the same as being sad.  The symptoms and prognosis are both more complicated and more serious.

Persons experiencing depression can get help. Psychotherapy is a proven effective treatment either alone or, in the case of severe presentation, delivered in combination with anti-depressant medication. Evidence based practice supports use of:

  • cognitive behavioural therapy (CBT)
  • mindfulness-based cognitive therapy (MCBT)
  • rational emotive behaviour therapy
  • interpersonal psychotherapy (IPT)
  • acceptance and commitment therapy (ACT)
  • existential logotherapy

Final question: Is it time to book an appointment?

Amanda WhiteDr Amanda White is a qualified and experienced therapist capable of delivering tailored treatment plans to successfully address the experience of depression.

She has found that focused psychological strategies work best when a) they meet your problem solving style, and b) are taught in a supportive learning environment.

If you would like to book an appointment for yourself or a loved one with Dr Amanda White, freecall 1800 877 924 or book online today.

 

 ** Following requests for information, here is a list of DSM mood disorder categories

Major Depressive Disorder

Bipolar Disorder (also known as bipolar affective disorder, manic-depressive disorder, or manic depression)

– Bipolar I

– Bipolar II

– Bipolar Disorder Not Otherwise Specified BD-NOS

Persistent Depressive Disorder

Seasonal Affective Disorder

Cyclothymia

Psychotic Major depression

Catatonic Depression

Other

Circumstantial Mood Disorder

Alcohol induced mood disorders

Benzodiazepine induced mood disorders

Substance induced mood disorders

References

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). Washington, DC: Author.
  • Cox, W. et al (2012). Stereotypes, Prejudice, and Depression: The Integrated Perspective. Perspectives on Psychological Science. 7(5): 427–449.
  • Geddes, J.R. et al (2003). Relapse prevention with antidepressant drug treatment in depressive disorders: A systematic review. Lancet. 361(9358):653–61.
  • Kabat-Zinn, J. (1991). Full Catastrophe Living: Using the wisdom of your body and mind to face stress, pain, and illness. Trade Paperbacks.
  • Morris, B.H. (2009). Does emotion predict the course of major depressive disorder? A review of prospective studies. Br J Clin Psychol 48 (Pt 3): 255–73.
  • Raphael B. (2000) Unmet Need for Prevention. In: Andrews G, Henderson S (eds)Unmet Need in Psychiatry:Problems, Resources, Responses. Cambridge University Press; 2000. p. 138–39.
  • Seligman, M. (1975) Helplessness: On depression, development and death. San Francisco, USA: WH Freeman.
  • Thase, ME. (1999). When are psychotherapy and pharmacotherapy combinations the treatment of choice for major depressive disorder? Psychiatric Quarterly. 70(4):333–46.