Depression
Some of the information regarding types of depression in this article was adapted and expanded from Patient Education Materials from UNSW Dept of General Practice.
What Is Depression?
The term "depression" can mean different things to different people. Some may think of depression as a way of describing those times when they are feeling just "a bit flat" or have a touch of "the blues". Others may think of depression more in terms of a serious type of psychological disorder and one that can even become life-threatening. There is a whole range of feelings in between which people describe as "depression" as well.
Most of us can, and do, feel "a bit down" occasionally but generally these feelings don't last for too long. Perhaps we are just overtired, or we've had a stressful day for one reason or another. We may be feeling a bit "run down". In any case, we usually know that we'll feel better in a day or so.
Sometimes, however, these sorts of feelings can linger on and become disruptive to normal life. They may become more intense and if this happens, they can become harder to deal with, as time passes. This process may involve a number of things happening. Energy levels can begin to fall, sleep may become disturbed, changes in appetite and eating patterns can occur, motivation can dwindle. There may be weight loss or weight gain. Withdrawal from friends, family and from normal activities may begin to occur. A loss of interest in sexual activity may develop. There may be problems at work or in study, with a reduction in performance becoming evident, perhaps. If someone is feeling "run down" he or she might be inclined towards self-neglect and may be more prone than they normally would be to physical illness, such as colds or flu. A fall in self esteem often accompanies these sorts of changes. In extreme cases, suicidal thoughts or fantasies, or a preoccupation with death may become part of the picture, as well.
Of course, all of the things referred to above are relative. They may occur to a greater or to a lesser extent if a person is depressed. And it is important to remember that not all of these factors have to apply, in depression. Whatever the combination of factors involved or the extent to which they occur, feelings of depression are, at the very least, negative and unpleasant. We should do what we can to understand them better and to deal with them in ways that are constructive for us as individuals.
What Causes Depression?
Mild depression, that is, feeling sad and unable to gain pleasure from usual activities and perhaps having some of the symptoms listed earlier, is often related to stressful life events. People suffering from mild depression may have limited or even non-existent social support (family, close friends). The mechanisms with which they deal with life stress may be inadequate. They may become more vulnerable to feelings of depression as a result. They may also become very sensitive to the pressures they feel are building up in their lives. This can lead to feelings of isolation and loneliness at times.
On the other hand, major depression goes further than being just a transient feeling, or a short-term reaction to stressful events. People who are suffering from this type of depression feel that they just can't pull themselves out of it. They often feel guilty because they feel they're letting friends and family down, as well as themselves. They often experience extreme fatigue and physical lethargy. They may feel they have no hope at all for the future. Sometimes, major depression can occur with no clear precipitant. At other times, it may be triggered by some sort of crisis, such as the break-up of a close relationship, a serious illness, a job loss or a bereavement. Failure in studies can sometimes be a cause, perhaps associated with other factors. People with long term difficulties in the area of self esteem may be vulnerable to major depression. They may get into a pattern of isolating themselves from others, which tends to reinforce their depression over time. There can also be a possibility of a chemical imbalance which can usually be rectified with appropriate medication. Genetic make-up can sometimes be a contributing factor, as well.
What Are The Best Ways To Treat Depression?
A lot depends on the type of depression and its severity. For example, in its milder forms, depression often responds to, and is alleviated by, counselling and/or psychotherapy. A trained and experienced Counsellor (psychologist, social worker, doctor etc) can help a client to look at the underlying factors involved in his or her depression. By so doing, a person who is depressed may begin to regain some sense of control and see that change for the better is possible. This can lead to an increase in self esteem, confidence and ultimately, to a renewed ability to derive pleasure and satisfaction from daily activities. Counselling can also help people who suffer from depression to deal with their situation in a more relaxed and accepting and sometimes more rational manner, thereby helping to avoid the anxiety generated by feelings such as "I can't deal with all this.", "I'm a failure.", "I'll never be any different." These sorts of changes take time and effort of course, especially if the feelings of depression have been present for some time. With mild depression, antidepressant medication is generally not needed. What seems to help, particularly, is having a good relationship with a Counsellor you trust and can work well with, developing supportive relationships as far as possible (friends and family) and having pleasant events to look forward to on a regular basis. Recognising ones own qualities and strengths (i.e., self esteem development) and making plans for the future are also very valuable ways to deal with depression, particularly in its milder forms.
Different types of psychological treatment for depression are available. These include supportive counselling, cognitive-behavioural therapy, insight-oriented psychotherapy, short-term solution focused therapy, and marital or family therapy. If you suffer from depression, it would be worthwhile for you to talk with a Counsellor to find out about the sort of therapy that is most suited to your situation and your individual needs.
Some people tend to suffer more severe episodes of depression. This sort of (major) depression is described by some people as like being at the bottom of a deep, dark well, unable to climb the slippery sides to reach the light at the top. (Sometimes the light at the top isn't visible). Others think of it as if they are looking at the world through a thick glass barrier that distorts everything in sight. Whichever way it is experienced, it can involve feelings of helplessness, hopelessness and profound isolation. Not surprisingly at times, the intensity of the feelings involved can lead to thoughts of suicide. Major depression can often be treated successfully, using a combination of antidepressant medication prescribed by a doctor and psychotherapy. In some instances, for example, if a person has become acutely suicidal, or antidepressant medication hasn't worked, hospitalisation may become an option for treatment. Sometimes, if a severely depressed person is given some "time out" and has in-patient care it can lead to improvement that might otherwise have been hard to achieve. It can lead to a valuable respite for the family, as well.
What Should I Do If I'm Depressed?
If you feel that you may suffer from depression it is important for you to remember that good help and effective treatment is available. The University Counsellors have wide experience in helping people deal with depression. They can offer a range of counselling and/or psychotherapy and will tailor what they have to offer to your individual needs. The services they offer are free to all students and Macquarie University staff, and services are confidential as well. (There are some very rare occasions for example, in a life threatening situation, when a Counsellor may be professionally obliged to break confidentiality, but this would only be done after the Counsellor consulted with his/her colleagues. If you would like more information about this, one of the Counsellors would be happy to talk with you.)
If you feel that you may have a serious problem with depression, then you may need some help from a doctor as well. The Counsellors can discuss this with you and, if necessary, they can arrange an early appointment for you to see one of the medical practitioners at the University Medical Services. You can, of course, go to see your own G.P., if you prefer. Sometimes, medication can give the help that is needed to deal with the immediate problems that can come with major depression but ongoing counselling can provide real long term benefits, in terms of helping you to devise strategies for the future. The Counsellors also have wide knowledge of community resources that can be of assistance. They can arrange referrals to private psychiatrists and other professionals in the community, as well as to community agencies (e.g. local mental health services, self-help groups) if the need arises. Counsellors can assist you with getting in touch with your lecturers or with the University administration, if the need arises. Remember, though, that if you want a Counsellor to support a request for special consideration for examinations, you generally need to have had prior contact with a Counsellor, or have had some treatment from a private professional (e.g. doctor) for your depression. If you are seeking special consideration, please consult the Special Consideration Information ~ doc.
Some Strategies That You Can Use To Deal With Depression
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Try to develop a sort of early warning system. What signs might there be that you are on the verge of a bout of depression?
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Think of things that have helped in the past, if you've experienced depression before. Write these things down and remind yourself to keep using them. Allow yourself the time for them to have an effect.
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Don't be passive and allow depression to take over, if you can help it. Make some plans for each day. Seek professional help. (Don't talk yourself out of it by saying that you're too embarrassed to see someone or that there are people more needing of help than yourself.) If medication has helped in the past, go and have a talk with your doctor again about it.
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Daily exercise and a nutritious diet are important. (Try not to skip meals!)
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Go easy on alcohol. Its a central nervous system depressant and it may make your depression worse.
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Try to have regular sleeping patterns. Cut down on caffeine (and other drugs). As you become depressed, the urge to escape everything by just staying in bed can become stronger. Try to resist this (unless you are genuinely physically tired) as it can make things harder to deal with. Sleeping during the day can make it more difficult to sleep at night.
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Try to have a plan of what you need to do day-to-day and week-to-week. Make it realistic and review it regularly. Use it to check your progress. If you're getting behind in your study (e.g., essays are overdue), try to talk with your lecturer or talk with one of the University Counsellors.
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Keep in contact with your friends. Cultivate those friendships that are close and supportive, in particular. If your family are supportive, try to tell them how you feel. Consider the advice and help that others might try to give you as a positive thing in your life. It's evidence that people care!
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Remember to do some of the things that you have enjoyed doing in the past. Reading, movies exercise, playing sport, ringing friends, getting back to nature, etc (What works for you is what is most important). Sometimes, just having a routine to follow can give you a sense of structure in your life.
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Try to avoid falling into the trap of "automatic negative thinking". Identify your negative thoughts, learn to monitor them and learn to challenge them. (i.e., look for evidence to support your negative thoughts or assumptions about yourself). Then you can begin to substitute more positive and therefore more useful patterns of thought. Try writing these things down in a notebook. A Counsellor can help you to develop this approach so that you can be more realistic about those things in your life that are positive. (There are always some).
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Practice ways to distract yourself away from negative patterns of thought. Activity is good in this respect. Negative thoughts can generate feelings of anxiety. Learning relaxation techniques can help a great deal. A Counsellor can help you to learn a variety of physical and mental relaxation techniques that will be useful for you in the future.
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Try to explore the way you are feeling. If you can recognise your emotions, talk about them with friends, and/or with a Counsellor. Write them down, and see how they may relate to your own thinking about yourself or to things that happen in your life. By so doing, you can avoid them controlling you. Then you can begin to get some control back in your life.
And What If I Know Someone Who May Be Depressed And Who May Need Help?
Counsellors can help you to decide what to do if you have a family member, or a friend who may be depressed. They can give you ongoing support if needed.
And Finally...
Feel free to come down to the University Student Services Building and find out more about what we have to offer. The Counselling Service is located on Level 2 of the Lincoln Student Services Building (next to the Library). Normal office hours are 9am to 5pm but earlier and later appointments are available.
There is a lot of useful material available on depression, especially on the Internet. The Commonwealth Department of Human Services and Health put out a National Mental Health Strategy Fact Sheet entitled "What Is Depression?" For further information refer to the section Other Resources on the Counselling Service website.
Further Reading
Beating the Blues Tanner, Susan and Ball, Jillian
Breaking the Patterns of Depression Yapko, Michael
Feeling Good - the New Mood Therapy Burns, David
Mind Over Mood Padesky, Christine and Greenberger, Dennis
Reinventing Your Life Young, Jeffrey and Klosko Janet