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Depression

What is depression?

Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest in things and activities you once enjoyed. It can also cause difficulty with thinking, memory, eating and sleeping.

It’s normal to feel sad about or grieve over difficult life situations, such as losing your job or a divorce. But depression is different in that it persists practically every day for at least two weeks and involves other symptoms than sadness alone.

There are several types of depressive disorders. Clinical depression, or major depressive disorder, is often just called “depression.” It’s the most severe type of depression.

Without treatment, depression can get worse and last longer. In severe cases, it can lead to self-harm or death by suicide. The good news is that treatments can be very effective in improving symptoms.

Causes of Depression

There’s no single cause of depression. It can occur for a variety of reasons and it has many different triggers.

For some people, an upsetting or stressful life event, such as bereavement, divorce, illness, redundancy and job or money worries, can be the cause.

Different causes can often combine to trigger depression. For example, you may feel low after being ill and then experience a traumatic event, such as a bereavement, which brings on depression.

People often talk about a “downward spiral” of events that leads to depression. For example, if your relationship with your partner breaks down, you’re likely to feel low, you may stop seeing friends and family and you may start drinking more. All of this can make you feel worse and trigger depression.

Some studies have also suggested that you’re more likely to get depression as you get older, and that it’s more common in people who live in difficult social and economic circumstances.

It’s thought that your chance of getting severe depression may be partly affected by the genes you inherit from your parents. 

The primary contributors to depression are as follows:

  • Stressful events: Most people take time to come to terms with stressful events, such as bereavement or a relationship breakdown. When these stressful events occur, your risk of becoming depressed is increased if you stop seeing your friends and family and try to deal with your problems on your own.
  • Personality:You may be more vulnerable to depression if you have certain personality traits, such as low self-esteem or being overly self-critical. This may be because of the genes you've inherited from your parents, your early life experiences, or both.
  • Family history: If someone in your family has had depression in the past, such as a parent, sister or brother, it's more likely that you'll also develop it. It's thought that severe depression in particular may be partly caused by the genes you inherit from your parents. But depression is usually caused by a combination of triggers such as life events, so having a family history of depression does not always mean that you'll develop it.
  • Loneliness:Feeling lonely, caused by things such as becoming cut off from your family and friends, can increase your risk of depression.
  • Alcohol and drugs: When life is getting them down, some people try to cope by drinking too much alcohol or taking drugs. This can result in a spiral of depression. Cannabis can help you relax, but there's evidence that it can also bring on depression, particularly in teenagers. "Drowning your sorrows" with a drink is also not recommended. Alcohol affects the chemistry of the brain, which increases the risk of depression.
  • Illness: You may have a higher risk of depression if you have a longstanding or life-threatening illness, such as coronary heart disease, cancer or a condition that causes long-term pain. Head injuries are also an often under-recognised cause of depression. A severe head injury can trigger mood swings and emotional problems. In some people an underactive thyroid (hypothyroidism) can cause depression.

Signs and Symptoms of Depression

If you have been experiencing some of the following signs and symptoms, most of the day, nearly every day, for at least 2 weeks, you may have depression:

  • Persistent sad, anxious, or “empty” mood
  • Feelings of hopelessness or pessimism
  • Feelings of irritability, frustration, or restlessness
  • Feelings of guilt, worthlessness, or helplessness
  • Loss of interest or pleasure in hobbies and activities
  • Fatigue, lack of energy, or feeling slowed down
  • Difficulty concentrating, remembering, or making decisions
  • Difficulty sleeping, waking too early in the morning, or oversleeping
  • Changes in appetite or unplanned weight changes
  • Physical aches or pains, headaches, cramps, or digestive problems without a clear physical cause that do not go away with treatment
  • Thoughts of death or suicide or suicide attempts

Not everyone who is depressed experiences all these symptoms. Some people experience only a few symptoms, while others experience many. Symptoms associated with depression interfere with day-to-day functioning and cause significant distress for the person experiencing them.

Depression can also involve other changes in mood or behaviour that include:

  • Increased anger or irritability
  • Feeling restless or on edge
  • Becoming withdrawn, negative, or detached
  • Increased engagement in high-risk activities
  • Greater impulsivity
  • Increased use of alcohol or drugs
  • Isolating from family and friends
  • Inability to meet the responsibilities of work and family or ignoring other important roles
  • Problems with sexual desire and performance

Treatment Approaches

Depression, even the most severe cases, can be treated. The earlier treatment begins, the more effective it is. Depression is usually treated with psychotherapy, medication, or a combination of the two.

  • Behavioural Therapy: Behavioural therapy focuses on the relationship between behavior and mood to target current problems and symptoms and focus on changing patterns of behavior that lead to difficulties in functioning.
  • Cognitive Therapy: Cognitive therapy entails modifying pessimistic evaluations and unhelpful thinking patterns with the goal of disrupting these and reducing their interference with daily life.
  • Cognitive-Behavioural Therapy (CBT): Cognitive-behavioural therapy targets current problems and symptoms and focuses on recognizing the relationship between behaviors, thoughts, and feelings and changing patterns that reduce pleasure and interfere with a person’s ability to function at their best.
  • Interpersonal Psychotherapy (IPT): Interpersonal psychotherapy focuses on improving problematic relationships and circumstances that are most closely linked to the current depressive episode.
  • Mindfulness-Based Cognitive Therapy (MBCT): Mindfulness-based cognitive therapy combines strategies of cognitive therapy with mindfulness meditation to modify unhelpful thoughts and develop a kinder, more loving self-view.
  • Psychodynamic Therapy: Psychodynamic therapy focuses on unconscious thoughts, early experiences and the therapeutic relationship to understand current challenges, improve self-awareness and support the patient in developing more adaptive patterns of functioning.
  • Supportive Therapy: Supportive therapy offers a supportive relationship that focuses on helping people explore and understand their experience in their current situation. The focus is on strengthening a person’s ability to make choices that help them cope effectively with various life stressors, from a stance of genuine empathy and supportive listening.
  • Medications: Medication is often prescribed for the treatment of depression in adults. As each patient varies in their response and ability to tolerate a specific medication and dosage, medications must be tailored to the individual.
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