by Counsellor, Leamington Spa, Warwickshire

Depression

‘Some days are worse than others. I don’t even want to get out of bed and face the world. I want to pull the duvet over me and want everyone to leave me alone. I feel sad and find myself bursting into tears for no reason. My body hurts. I feel alone. Just me and this thing they call depression. It’s been around for a long time. In fact I can’t remember a time when it wasn’t there. I just want someone to understand how I feel and to be kind. That would really help for a start.’

What is depression?

Mental distress is a growing problem. The World Health Organisation (2001) estimates that it affects 1 in 4 people and predicts that by 2020 depression will be the second largest cause of disability, after heart disease.

Depression is common, impacts on the quality of an individual’s life and may also impact on others, for example family members. Depression affects emotional and physical wellbeing and influences thoughts, feelings and behaviours over a period of time. Depression can result in a vicious circle which reduces activity levels.

How do I know if I am depressed?

If you think that you are depressed it can be helpful to discuss this with your GP. There are questionnaires to measure the symptoms of depression and you may be asked some questions to find out the best way to help you.

Depression is associated with suicide and it is important that an appropriate risk assessment is carried out. You may be offered antidepressant medication and/or referred to a Counsellor or another type of mental health worker.

Some people feel anxious about telling their GP that they are feeling down and it may be helpful to consider that the Department of Health (2000) indicates that 25{715e623df01486ed312d8f1b83ff0cc3fd44a590896731e6d51361f497f187b9} of GP consultations relate to common mental health problems such as depression and anxiety. Seeking help may prevent a mild problem from becoming more serious.

Depression is characterised by a low mood or a loss of pleasure in activities. The following are some of the symptoms which may indicate depression:

Physical symptoms of depression

Sleep problems.
Lethargy and/or tiredness.
Changes in appetite.
Feeling agitated or slowed down.

Thoughts associated with depression

Poor concentration.
Lack of confidence.
Feeling negative.
Lack of motivation.
Loss of hope.

Feelings associated with depression

Crying.
Feeling lonely.
Sadness.
Feeling guilty.
Loss of interest.
Loss of enjoyment.
Irritability.

Behaviours associated with depression

Lack of self care.
Avoiding other people.
Avoiding previously enjoyed activities.
Poor diet.
Use of alcohol or drugs.
Poor decision making.

Why am I depressed?

The onset, severity, duration and frequency of depression are variable. Depression affects people of all ages and many factors may influence the onset of depression. Genes, life events, early childhood experiences, psychosocial stressors, socio-economic changes, poverty, the effects of physical diseases and culture may be relevant factors.

The ability of an individual to cope with life stressors is also influential in whether an individual develops the symptoms of depression.

It is important to distinguish between grief and depression. Distressing events such as bereavement, divorce or redundancy may trigger feelings of sadness and it is natural to grieve following a loss. Sometimes grief can develop into depression and it is important to seek help if this happens.

What may help to overcome depression?

There are a wide range of interventions which may be helpful to those suffering from depression. There is evidence to suggest that exercising regularly and following a healthy diet are helpful. The following are some of the options available:

Antidepressants

Please speak to your GP about medication for depression and any possible side effects. It can sometimes take 2 to 4 weeks before the benefits of antidepressants are felt and your GP will be able to advise you about this and the best way to take your medication. It is also important to consult your GP about stopping antidepressant medication.

Counselling

There is evidence that people prefer ‘talking therapies’ such as counselling (see Mental Health Foundation, 2006). The use of medication to treat mild and moderate depression is increasingly being challenged (Leader, 2008). Some people are reluctant to take antidepressants or have a poor response to antidepressants and discontinue use. It is possible that the problems may recur when the medication is stopped and that exploring one’s underlying beliefs, which many believe are central to causing depression, may be helpful.

Counselling can be helpful to understand any underlying issues which are causing low mood. Clients often say that they cannot talk to anybody about how they are feeling and that they do not want to worry their family or friends. Sometimes clients feel that their family and friends are fed up with their low mood. Talking to a Counsellor about concerns and worries may help the client to feel ‘less alone’. The Counsellor will not tell the client to ‘pull yourself together’ but will try to understand the client and use the skills of empathy, acceptance and congruence to facilitate a process of deeper understanding, acceptance and change.

Behavioural interventions

There is an increasing evidence base for the use of behavioural activation for the treatment of depression (Veale, 2008). Behavioural activation seeks to break the ‘vicious cycle of depression’ and address the role of avoidance in depression. It is common for clients to say that they have stopped activities that they had previously enjoyed and this can contribute further to depressed feelings.

Behavioural activation involves identifying routine, pleasurable and necessary activities, making a hierarchy of these activities, planning activities, implementing exercises and reviewing progress. I integrate behavioural interventions into my work as a Counsellor if the client wishes to try this approach. Clients often find that even making some small changes in their daily routines can help to improve their mood significantly.

Challenging unhelpful thinking

It is believed by some that negative automatic thoughts and underlying beliefs are causal in depression. It is suggested that people suffering from depression are negative about themselves, the world and the future. Understanding the link between thoughts, behaviour and physiological symptoms and using thought diaries and evidence recording sheets may help the client to challenge their negative automatic thoughts and unhelpful thinking.

As a Counsellor I will comment on unhelpful thinking during the process of counselling. If I feel that using thought diaries may benefit the client I will offer this way of working to the client and explain the rationale and let the client decide if they would like to try this approach.

Self help activities and books

There is evidence to suggest that self help activities and books are helpful in overcoming depression. Unfortunately, one of the symptoms of depression can be a lack of motivation which may prevent clients from making use of such resources. Some people do find self help activities and books sufficient, while others prefer to use such resources in addition to counselling.

References

Department of Health (2000). The NHS Plan. London: HMSO.

Leader, D (2008). Prozac: Is this the end? the guardian, 27.02.2008.

Mental Health Foundation (2008). While we are waiting: Experiences of waiting for and receiving psychological therapies on the NHS. [World Wide Web]. Available: http://www.mentalhealth.org.uk/publications/?EntryId5=62499 [2009, January 6].

Veale, D (2008). Behavioural activation for depression. Advances in Psychiatric Treatment. 192: 326-330.

World Health Organisation: 2001. World Health Report. Mental Health: New Understanding, New Hope. Geneva: WHO.

Copyright 2010 Christine Bonsmann. All rights reserved.