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by Stuart Sorensen - RMN
Physiological Symptoms of Depression
Many depressed people can actually feel a change in their bodies. For some it is a churning feeling, particularly in agitated depression. Others experience a sensation of heaviness with lethargy and even physical pain. Some have difficulty digesting food.
Which is one reason for the appetite disturbance which is a very common feature of depressive illness. Others have difficulty sleeping.
One thing common to almost every form of depressive illness is treatability. The approach may vary depending upon the nature and severity of the illness but the prognosis is usually excellent – so long as the sufferers are prepared to take an active part in their own treatment. In fact most types of therapy are based upon the client’s own choices and participation. Even those which begin with little more than medication usually lead up to active client participation. The more the depressed person does to help themselves the greater the chances of continued success.
Cognitive Symptoms of Depression
The cognitive or psychological symptoms of depression – what we think about are just as important as the physiological ones. Some people believe that psychological symptoms are more important but this is not necessarily true. After all there is no such thing as the 'mind/body split'. Actually they are one and the same –just two sides of the same coin. That’s why we need to consider both.
Depressed people tend to think in a particular way. They tell themselves the same sort of gloomy, pessimistic things over and over again. This is what psychologists call negative thinking. After a while this pattern of thinking becomes a habit. When that happens it is described as automatic negative thinking. This habit formation is one of the most damaging aspects of depression as it locks the sufferer into a downward spiral which drags them deeper and deeper into despair. Later we’ll consider ways of breaking the cycle but for now it’s enough simply to recognize some of the more common thought patterns and the effect they have on depressive behavior.
THINGS WILL NEVER GET ANY BETTER.
If we believe this then we also believe that there’s no point in trying to improve things. This one thought stops depressed people from joining in with their treatment plans. These people become lethargic and apathetic. Not the most helpful start to recovery.
PEOPLE WOULD BE BETTER OFF WITHOUT ME
It’s not difficult to see where this thought pattern is leading. Many depressed people are so convinced of their own worthlessness that they come to see themselves as nothing more than a burden to others. This idea can lead to withdrawal, social isolation, shame and even self harm or suicide. Once again this is not a helpful way to think about oneself.
I CAN’T HELP BEING DEPRESSED AFTER WHAT I’VE BEEN THROUGH
This is a remarkably common depressive thought. It also seems quite reasonable at first glance. People who’ve been through difficult times are almost expected to become depressed. The problem is that such a belief system takes away the individual’s choices. If you believe depression is inevitable you won’t really struggle against it and so you won’t change it until you believe you’ve suffered enough.
Some people ‘wear’ their depression like a badge. It’s as though they think they’ve earned it and no one’s going to take it away from them. Of course it’s true that they have a perfect right to feel as depressed as they like for as long as they like. The question is – why would they want to?
DEPRESSION RUNS IN MY FAMILY – IT’S GENETIC
This attitude is called determinism. That’s the idea that people are helpless victims of fate. They believe that because their parents suffered from depression they also must. Of course it’s true that depressive illness does often run in families but that’s not always because of genetics. Sometimes it’s simply because of the coping skills we learn from our parents. Skills which can be unlearned or altered – often with surprisingly little effort. Even those cases where the problem does appear to be genetic can be helped considerably once they let go of their deterministic attitudes. Any thought which implies helplessness is deterministic and extremely damaging
There are many more depressive thoughts – too many to cover in this handout. However people who recognize themselves and their own style of thinking in the paragraphs above may well benefit from the wide range of ‘talking cures’ available.
Now let’s consider some different types of depression.
Reactive Depression, as the name implies, is a reaction to circumstances or life events. It’s usually responsive to counseling or psychotherapy but may require drug treatment in more severe cases. Reactive depression is also known as adjustment disorder.
Endogenous depression is also known as Biological Depression and is generally considered to be genetic in origin. This type of depression is usually treated with medication in the first instance although cognitive and lifestyle interventions still have a major role to play.
Psychotic Depression is one of the most bewildering forms of depressive illness, both for the sufferer and for those around him or her. Psychotic people can be said to have lost touch with reality. That is to say they perceive the world in a radically different way from everyone else. They may be hallucinated (hearing voices, seeing visions) or suffer from a range of thought disorders which cause them to completely misinterpret events. Often psychotically depressed people become paranoid or come to believe that their thoughts are not their own (thought insertion) or that others can ‘hear’ their thoughts (thought broadcasting).
Other symptoms of Psychotic Depression include ideas of reference (the belief that everyday things have some special significance for them), nihilistic delusions (in which the sufferer believes that part of their body is changing or in some cases that they are actually dead). This is far from an exhaustive list of psychotic symptoms.
Once again this type of depression is best treated with medication although studies have shown that training in skills such as assertiveness or anxiety management make relapse much less likely.
Manic depression or Bi-Polar Affective Disorder is characterized by extremes of mood. Sufferers experience absolute highs (mania) and absolute lows (depression). Treatment options are similar here as for Psychotic Depression although the medication prescribed may vary. Interestingly some psychiatrists consider both Psychotic Depression and Bi-Polar Affective Disorder to be different presentations of exactly the same illness. As with so much in psychiatry today the jury’s still out on that one.
The Chemistry of Depression
The best way to understand the chemistry of depression would be a medical qualification followed by years of specialist study in psychiatry – or pharmacological training. However – here are some useful basics.
The brain is awash with chemicals called neurotransmitters. These chemicals are used to carry electrical signals through the nerves, which is how human beings think and feel. We need adequate amounts of neurotransmitters in the correct balance in order to function properly.
There are several neurotransmitters which affect mood but here we will consider only one. This neurotransmitter is called serotonin. Put simply the more serotonin in the brain the higher a person’s mood. If the level of serotonin drops we become depressed. That’s why many of the drugs prescribed to treat depression have an effect on the serotonin level.
Serotonin also affects sleep which is why depressed people tend to sleep poorly, often finding it difficult to drop off in the first place, waking repeatedly through the night or sleeping solidly but for only a short time. It’s often to do with serotonin.
Incidentally, that’s why people who drink a lot of alcohol tend to be depressed and often have trouble sleeping. It’s because alcohol destroys serotonin. So much for cheering ourselves up with a few drinks. We may find it easy enough to drop off to sleep when we’re drunk but drink regularly and you’ll soon find yourself waking up in the middle of the night. Then you’re on the slippery slope to depression. And you thought the advice to avoid mixing alcohol with anti-depressants was just doctors being mean! If you want the tablets to work lay off the booze.
What You Can Do
The following suggestions are designed to combat the physiology of depression as well as its psychology. Try as many or as few of these as you like – it really is up to you. Just remember that the more of these you practice the greater your chances of recovery. The choice is yours.
Avoid alcohol – particularly in excess.
Don’t smoke – it starves the tissues and brain of oxygen and causes lethargy.
Eat a healthy diet designed to give you plenty of energy.
Take regular aerobic exercise. A brisk walk is usually sufficient.
Give yourself time to rest.
Get involved in some project which will ‘take you out of yourself’.
Stop talking/thinking about depression and concentrate on doing things instead.
Keep your mind active. Try enrolling in a night class to boost concentration. Even reading the newspaper or doing crosswords will help.
Write goals – even little ones and praise yourself for their achievement.
If you can’t sleep get up and do something. You’ll sleep when you’re tired enough. It’s important not to ruminate on depressive thoughts.
However tempted you may be avoid using determinism as an excuse for depression.
Study assertiveness and anxiety management.
If necessary visit the doctor.
Avoid comfort eating – you’ll only get more depressed every time you look in the mirror.
Helping others is often a good way to boost self esteem and distract yourself from your own problems.
Understand the difference between a problem and a fact.
Resolve to make the best of every situation.
Adopt happy physiology – stand straight, move quickly, smile. Remember the mind and body are linked and changing the way you act will affect your mood – and quickly too. Try it, you may be surprised.
Stop talking about how bad things are and start planning to make them better – remember you’re responsible for how you feel. What are you going to do about it?
Always remember that if you’re waiting for someone else to come along and ‘fix’ you nothing will ever change. You have to do most of the work yourself.
Take action to lift your mood every day – and give yourself praise for doing so. Your self-esteem needs the boost.
Become an ‘inverse paranoid’. Expect good things to happen to you every day. They will.
Use affirmations regularly.
Count your blessings – write down and talk about all the things you’re grateful for in your life regularly. Thank people who’ve been nice to you.
Don’t expect too much from others. Remember nobody gets their own way all of the time.
Never give up.
I hope that this brief overview of depression has been useful. As you can appreciate there is much, much more to learn but these are the basics. The information here won’t get you a degree in medicine but it will help you overcome depression – so long as you apply it. Remember however, that this is not intended as a substitute for qualified medical help. If you need that sort of help then my advice is to go and get it – NOW!
Bond A. & Lader M. (1996)
Understanding Drug Treatment in Mental Health Care
John Wiley & Sons Ltd.
Compliments of Stuart Sorensen – RMN