Depression Treatment and Depression Therapy
Depression (unipolar)
The term depression is often used by people to describe feelings of being down in the dumps, being fed-up or having the blues but it is more than this. It is a disorder that persistently and intensely affects your thoughts, feelings, behaviours and physical health day after day. A person who has been diagnosed with depression would experience a combination of the following symptoms:
- Depressed mood most of the day, nearly every day
- Insomnia or hypersomnia nearly every day
- Feelings of worthlessness, helplessness, excessive or inappropriate guilt
- Persistent feelings of sadness, anxiety and emptiness
- Pervasive negative thoughts and feeling pessimistic
- Markedly diminished or loss of interest or pleasure in daily activities including sex
- Marked loss of energy – feeling tired and fatigued
- Major sleep disturbances
- Significant increase or decrease in appetite nearly every day
- Significant increase or decrease in body weight
- Diminished concentration and ability to think and be decisive
- Feelings of irritability and restlessness
- Recurrent thoughts of death (not just thoughts of dying)
- Recurrent suicidal ideation with or without a specific plan
People can experience different degrees of depression, from mild to severe:
Mild depression is when a person has some of the symptoms of depression present. The person will usually feel distressed by their experience and whilst life generally feels more difficult and demanding, they will probably be able to continue with most of their daily activities.
Moderate depression is when a person has many of the symptoms of depression and will have great difficulty in continuing with day to day activities such as maintaining personal relationships, work/occupation, self care and socialising.
Severe depression is when a person has nearly all of the signs and symptoms of depression. The person will almost always be unable to engage in their regular activities and suicidal thoughts and acts are common.
Amongst the criteria for diagnosing a major depressive ‘episode’ would be that the symptoms are not directly connected to the physiological effects of a substance, be it medication or abuse of a drug (recreational or otherwise) and that the symptoms cannot be better attributed to the loss of a loved one (bereavement).
Causes of Depression
A major depressive disorder is likely to be caused by more than one factor. There will probably be a combination of influences including environmental and social, psychological, biological and genetic.
They include:-
- The neurochemical or medical model – a doctor or psychiatrist would diagnose that there is a chemical imbalance in the brain of a depressed person namely a reduction in monoamine, noradrenalin and serotonin.
- Family history and genetics – twin/adoption studies indicate a stronger genetic link for bipolar than unipolar
- Anger that cannot be openly expressed being turned back in on oneself
- Meaninglessness of existence
- Bereavement
- Parental modelling (children who had a depressed parent or parents)
- Response to social abandonment
- Social isolation
- The only acceptable role to have in the family
- Secondary gains or benefits (e.g. being taken care of)
- Post traumatic stress (after an overwhelming trauma) leading to a sense of the world feeling hopeless and pointless
- Alcohol and drug abuse
- Other prevalent psychiatric condition
- General medical condition, e.g. chronic and enduring pain
- ‘Stages of life’ issues such as significant role changes including: adolescence, parenting, midlife crisis and retirement.
Manic depression (bipolar):
Another form of depression is a condition called bipolar disorder where a person will experience mood swings from depression to mania (see below for description of mania). They experience extreme episodes of ‘highs’ and ‘lows’ with each episode lasting up to days to months. It is sometimes possible that between their highs and lows they will feel completely normal.
There has been much research on bipolar disorder which strongly suggests that a genetic predisposition to bipolar can be inherited in the same way that a predisposition to cancer, heart disease and other illnesses may be inherited. Other contributing factors include environmental influences such as life experiences, upbringing etc. and general medical problems such as head injury or later in life, organic brain disease. Whilst it has been found that each of these factors can play a part in the onset of bipolar disorder and any other mental health condition, there continues to be a great deal of debate around how significant an influence each of the factors are.
Bipolar disorder affects 1 in 100 people
Treatments for depression and bipolar disorder
There are three mainstream treatment approaches for depression and bipolar disorder. The first is medicine prescribed either by a GP or by a psychiatrist, the second is psychotherapy and the third is a combined treatment plan using both psychotherapy and antidepressant medicine. Other treatments include the use of light therapy and in the case of particularly severe depression, electroconvulsive therapy (ECT).
Mania and Hypomania:
Mania is not simply feeling ‘high’ or ‘hyper-active’. It describes a condition where a person has an elevation of mood in the form of elation or irritability that can last for days or even months. It is characterised by the following symptoms:
- Abnormally and persistently elevated, expansive or extreme irritable mood.
- Excessive ‘high’ or euphoric feelings
- Less in need of sleep (feeling rested after only 3 hours of sleep)
- Grandiosity, inflated self-esteem, unrealistic ideas about one’s status, abilities and powers
- Talking more than usual, talking faster, pressure to keep talking
- Racing thoughts and flight of ideas
- Poor judgment that is uncharacteristic of the person
- Easily distracted and drawn to unimportant and irrelevant stimuli
- Increase in sex drive / sexual disinhibition
- Excessive engagement in activities that give pleasure but that have a high potential for difficult or painful consequences (sexual indiscretions, uncontrolled buying sprees, bad business deals/investments)
- Denying that something is wrong
- Aggressive or intrusive behaviour
- Drug abuse, particularly alcohol, cocaine and sleeping medication.
**Hypomania symptoms are similar to those for mania but less severe