Overcoming Depression

Anyone who has experienced clinical depression or who has lived with someone who was depressed knows how debilitating this illness can be. It is like finding yourself in a dark hole with no apparent way to climb out.

Most people experience changes in their mood from time to time. It is normal to occasionally feel sad or down or to lose motivation temporarily to do things we typically enjoy. Usually these mood changes are short-lived and cause minimal disruption to our lives.

Sometimes, however, changes in mood become more intense, longer-lasting, and cause greater impairments in our ability to function at work, at home, or in our personal life. This is where low mood turns into clinical depression.

What is Depression?

Depression is characterized by changes in mood, thinking, social activities, and behavior that cause significant impairments in a person's day-to-day functioning. At the core of these changes is either a pervasive feeling of sadness or "the blues" or the loss of interest and pleasure in normally enjoyable activities (or both).

A major depressive episode is a clinical term that describes a time-period when a person experiences a cluster of depression symptoms daily or nearly every day for at least two weeks or more. As stated before, these symptoms negatively impact one's functioning.

In addition, there are other, milder forms of depressive disorders that do not impair functioning as much but that still have a negative impact on a person's life.

Estimates indicate that between 10-25% of women and 5-12% of men will experience an episode of clinical depression at some time in their lives. The risk is highest among men and women between the ages of 25 and 44.

How Can I Know If I Am Depressed?

Signs include the following:

Changes in Mood

• Persistent feelings of sadness, despair or "the blues"
• Loss of pleasure in activities that you normally enjoy
• Loss of motivation or interest in daily activities
• Feelings of inadequacy or worthlessness
• Unreasonable or excessive guilt
• Hopelessness
• Increased irritability

Changes in Thinking

• A persistent pattern of pessimistic, self-critical, negative thinking
• Thoughts of self-harm
• Difficulty concentrating or "foggy thinking"
• Poor short-term memory
• Indecisiveness

Changes in Behavior

• Sleep disturbances (insomnia, restless or disturbed sleep, or sleeping too much)
• Eating more or less than usual
• Withdrawal from family and friends
• Increased use of alcohol or drugs
• Frequent crying

Change in Physiology

• Changes in appetite (more or less than usual)
• Digestive problems
• Headaches or chronic pain
• Loss of libido
• Constant fatigue

Often family and friends are the first ones to notice that something is wrong. It is not uncommon for a person to be depressed and not realize it because the changes are so gradual. This can create problems when a person's low mood has a significant, negative impact on close relationships and the depressed individual does not recognize that they are depressed. For this reason it is important to be open to the feedback of caring family members and seek help if you suspect you may be depressed.

What Causes Depression?

There is no simple, clear-cut answer. We are complex, biopsychosocial-spiritual beings. Mood disorders can begin in any of these areas: physiological, psychological, interpersonal, behavioral, and spiritual.

Most likely these areas interact with each other. For example, changes in our thinking or emotions may invite changes in our biology and vice versa.

Possible Etiological Factors.

Physiological

Possible physiological causes include changes in brain chemistry and hormone levels, nutritional deficiencies in vitamins and minerals, and certain medical conditions such as anemia, hypoglycemia, or thyroid difficulties.

It is tempting to think of depression as caused by a chemical imbalance in the brain because this points so neatly to a logical solution. Be aware, however, that while neurotransmitters such as serotonin and norepinephrine are known to play a role, physiological causes of depression related to changes in brain chemistry are not yet well-understood and may not be as simple as the concept of chemical imbalance implies.

There is also evidence that depression runs in families, suggesting a genetic predisposition that may be activated by life stresses.

Another contributor to low mood may be acute life stressors that overwhelm our coping resources. Unrelenting stress is associated with high levels of stress hormones in the body which impact immune system functioning and lead to emotional and physical exhaustion.

If you suspect you may be depressed, it is a good idea to start with your physician or health care professional who can work with you to pinpoint possible health reasons for your low mood.

Psychological

Cognitive theories hold that focusing on negative, self-critical thoughts about ourselves, our worth, our relationships and the world around us leads to low mood.

Depressed individuals often view the world and themselves through a pessimistic or fatalistic lens. Thoughts such as, "I am a loser," "Things never work out for me," or "I'll never be happy," are common. Sometimes people feel they have lost control of their lives and believe that nothing they do will make a difference.

Thinking in absolutes or giving ourselves negative labels often leaves us feeling helpless, hopeless, or inadequate. Since we tend to see only that which supports our beliefs, when a person has a strong belief that no one likes them or that they will never be good enough they often become blind to clear evidence that would suggest otherwise.

It is not always clear whether negative attitudes and thoughts are a symptom of depression or a cause of it. There are convincing arguments for both propositions. Changes in our body can affect the way our minds work and the way we habitually think and feel can affect our physiology.

People do, however, often begin to improve their mood when they focus on thinking in more hopeful, optimistic ways combined with taking care of their physical well-being.

Interpersonal

We human beings are social creatures. One of our basic needs is a sense of belonging and connection to others. When we feel excluded, disconnected, lonely or unwanted there are emotional and psychological consequences, one of which is often depression.

Chronic and unresolved conflict in our important relationships at home or at work can threaten our sense of security and peace. Marital arguments, workplace conflict, or strained parent-child relationships often create prolonged stress, worry, and anxiety. Isolation, having few friends or loss of social support may also be part of the problem.

Another factor to consider in the social area of our lives is loss. The death of a loved one, being fired from a job, divorce, or a relationship break-up all can cause intense emotional pain and grief.

Not all losses stem from inherently negative events, however. Some losses arise from major life changes and role transitions that are usually considered positive. Examples include becoming a parent, switching careers, graduating from college, or entering retirement. These changes can be very difficult, even though they seem rewarding, because of the associated losses involved and the challenge of unfamiliar stresses.

Sometimes a person's emotional adjustment is made more difficult in these situations because of the perceived pressure to "be happy" at these times. Adjusting to change, even positive changes, particularly multiple changes, can be very challenging.

Behavioral

One possible cause of depression is behavioral inactivity and loss of natural rewards. People who are depressed often become less and less active. They stop engaging in rewarding activities that normally help to buffer against stress, which, in turn, deprives them of opportunities to feel good, opportunities that normally motivate them to continue being active in the future.

It feels good, for example, to accomplish tasks we've been putting off, to exercise our bodies, to spend time with friends and family, to enjoy the outdoors, to be involved in hobbies, and so forth.

The more we withdraw from these activities the fewer opportunities for feeling good we have, which in turn invites more depressed mood, which invites more behavioral inactivity, and so on.

Spiritual

Sometimes people become depressed because they feel a void of meaning or purpose in their lives. They get up day after day, follow the same routines and wonder how they are making a difference.

This void of meaning may be thought of as a spiritual issue. A very broad definition of spirituality is the ability to invest our lives and our adversities with meaning and purpose. Another definition is the relationship we create with God or with a universal Power higher than our own.

Spirituality is not necessarily the same as religion, which involves a unifying set of beliefs, practices and ritual observances that are generally agreed upon by a group of people. One can be spiritual without being religious and vice versa.

Spirituality has received increased attention in recent years among the mental health professions as a legitimate field of study. Research has indicated that having strong spiritual resources such as faith, hope, gratitude, the use prayer, charitable service to others, and/or commitment to a moral code is associated with greater emotional resilience and happiness in life.

How is Depression Treated?

The first priority in treatment of depression is to ensure safety. Suicidal ideation is a common symptom of depression, so reducing the risk of self-harm is essential.

The next priority is to assess and identify, where possible, the root causes of one's mood change and then create an action plan that will help alleviate these challenge areas.

Suggestions for Treatment Include:

Physical

Working closely with one's health professional to identify and treat any underlying medical conditions that may be influencing the symptoms of depression is important.

Pharmacological treatments such as anti-depressants may be helpful, particularly where a person's symptoms have been intense and/or chronic.

One advantage of anti-depressants is that they can help restore a person's equilibrium and energy so that they feel more capable of taking further constructive actions such as exercise, building social support, talking to others, and changing thought patterns that will eventually facilitate full recovery.

Medications are an attractive option because they are easy to implement and often bring fast results. Keep in mind, however, that they work well for some people but not for everybody. In addition, if the medications do not help address the root problems behind your low mood the depression may return upon discontinuing the medication.

Current thinking indicates that a combination of pharmaceutical treatment and psychotherapy works better than either strategy alone.

If you are uncomfortable with the use of medications and their associated side-effects the use of natural therapeutic supplements may be a possibility. St. John's Wort, for example, is a promising natural treatment for mild to moderate forms of depression.

Be aware that natural supplements may interact with other prescription medications you may be taking. There may also be unanticipated side effects. Be sure to consult with your health professional first before exploring the use of such remedies further.

Psychological

Learn how to identify and change automatic, negative patterns of thinking and constraining beliefs that maintain low mood. This is the focus of cognitive therapy (and its more well-rounded cousin, cognitive-behavioral therapy), a well-researched and empirically-supported form of treatment for depression.

Increase self-esteem through practicing self-acceptance, setting and achieving meaningful goals, identifying and challenging constraining core beliefs that perpetuate low self-esteem, and building meaningful relationships with others.

Interpersonal

Learn constructive ways of handling conflict and difficult situations at work or in the home through positive communication, developing social skills and assertiveness, and learning to manage anger.

If needed, participate in couples counselling focused on strengthening your marital friendship, fostering intimacy and emotional closeness, and developing communication skills. Marital therapy has been shown to be an effective treatment for depression, particularly where a person's low mood is a factor of unresolved issues in the marriage.

If needed, participate in bereavement counselling and grief support where one's low mood is result of significant losses.

Develop ways to strengthen your social support systems, build or renew friendships, become involved in community work, participate in a support group, or join a social club that interests you.

Behavioral

Evaluate where you may be exhausting your resources and becoming overstressed. Make conscious choices that will help you to manage stress more effectively. Stress management strategies include learning to relax, using deep breathing, taking breaks, setting healthy boundaries and limits, managing time, and creating more balance in your life.

Increase positive coping behaviors and rewarding activities such as regular exercise, setting and achieving goals, overcoming procrastination, visiting friends, making lists, writing in a journal, reading books, etc.

Spiritual

Reflect on ways to invest your life with more meaning. What is important to you? What are you passionate about? Imagine if you lived to be eighty-years old and your family and friends gathered to celebrate your birthday. What would you want them to say about you? Begin to map out a plan for bringing more passion and purpose into your life.

Give meaningful service to others. One of the best ways to feel better is to forget your own problems and go to work helping others.Make a difference in the life of someone else, even if only in small ways. Look for opportunities to help out in your community, your city, your church, your school, and your home.

Read books that inspire and uplift you and that will help you gain perspective on your problems. Listen to uplifting music or watch a movie that has an enlightening message.

If appropriate to your belief system, use prayer to help you overcome discouragement and despair or study sacred texts that are important to you for inspiration on topics such as hope and healing. To the extent that you are so inclined, develop a close relationship with your Higher Power, as you understand it and seek out the fellowship and help of others who can assist you on this path.

Above all, remember that no matter how you approach the goal of getting better, full recovery is often gradual and a factor of daily and consistent effort. A good recovery plan typically involves a combination of strategies and approaches across several of the areas outlined here. As you may have noticed from reviewing the previous list there can be a great deal of overlap between the biological, psychological, social, behavioral and spiritual.

Recommended Reading

Feeling Good Handbook by David Burns This book is a highly recommended self-help manual for overcoming depression and anxiety. It includes a section on improving communication in your relationships. Dr. Burns uses a cognitive-behavioral approach to treatment, focusing on changing patterns of thinking and taking positive behavioral steps to increase rewarding activities. In Canada? Click here to order from Amazon.ca instead

Where Can I Get More Information?

The following links lead to online resources that may help further:

National Institute of Mental Health
An informative site on the topic of depression produced by the NIMH. Includes signs and symptoms, treatment options, depression in men, depression in women, and information about medications.

American Association for Marriage and Family Therapy Clinical Update
A brochure produced by the AAMFT providing information on depression.

St. John's Wort
A very helpful website about St. John's Wort, a non-prescription, herbal remedy that has demonstrated efficacy on par with anti-depressant medications but with far fewer side-effects. In Germany, St. John's Wort has widespread use as the pharmacological treatment of choice for depression over prescription anti-depressants. There is also information on this site for loved ones seeking a better understanding of how to support a family member with depression.

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We appreciate your interest in our services and hope this information has been helpful to you. Please do not hesitate to call if you have any questions.

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Disclaimer: In listing other websites on this page, Cobb & Associates Inc. and its subsidiary the Calgary Couples Counselling Centre gives no direct or implied assurance that the content on these other websites is 100% accurate or credible. This determination must be made by individual consumers of online information. In addition, the information on this page is intended for educational purposes only and is not meant to be used for diagnosis or treatment. If you suspect that you are depressed, I strongly advise that you consult with a health professional.