Depression has been part of our common human experience from the beginning.
Over the centuries it has been documented in different ways and has been referred to by many terms. Even in ancient Greece, it was recognized as a condition that had interacting physical and psychological components and was referred to as melancholia, which they believed developed from excess black bile. While our modern view would discount the concept of black bile, we still recognize that depression has interacting components that contribute to the development of a state where an individual experiences an intense feeling of being, as the term suggests low and pressed down.
Most of us experience symptoms of depression at times. We can easily identify with feelings of sadness, anxiety, anger, and despair. We all experience difficulties with sleep, appetite and poor energy from time to time. Many of us have felt pessimism and hopeless about the future. However, when we have lots of these symptoms at one time or when they persist, we can feel overwhelmed. People sometimes describe feeling trapped in depression and helpless to find an escape as a consequence which can lead to suicidal ideas.
Depression is more common than a cold or chest infection. One in ten people experience depression at any one time. Too many people plod along with it, hoping that it will pass or trying to hide it. Unfortunately, just like a chest infection, it can’t be ignored because it can get worse over time.
The general rule of thumb is that an individual can be diagnosed with depression if they experience five or more of the symptoms for more than two weeks. In our experience, people take a lot longer than that to seek treatment.
We wouldn’t dream of dragging ourselves around with five or more symptoms of a chest infection for more than two weeks without seeking treatment, but, with depression, we tend to suffer on in silence - literally. Really, it’s unnecessary to suffer in silence because, with the right treatment, depression can be turned around within a few weeks.
It is always interesting to me that we live in the external world together, but each of us experiences that through the perspective of our internal world. If the landscape inside has become treacherous and difficult to navigate, it becomes a tainted lens by which we approach the world outside. Everything we look at through the lens of depression seems tainted. This has a huge impact on our relationship with ourself.
People tend to become extremely self-critical and blaming. Again, most of us are self critical at times, but the language that a person will use towards themselves when they are under the influence of depression can be quite bullying and vicious. We wouldn’t dream of saying to a friend "you are pathetic and useless", but it is common for a person to see themselves this way - or even worse - when they are experiencing depression.
It also has an impact on relationships with others and with how we view the outside world. I may believe that other people will reject me, don’t really want me or find me a burden and that the world is a lonely or desolate place. All of this can make the future seem very hopeless and barren, which can lead to thoughts of suicide.
Treatment of depression
Your GP is in a perfect position to provide advice, support and treatment and to help you access any additional support that may be required. There are lots of additional places to seek advice and information.
Obviously, there are also situations where a person will need more support than a GP can offer and may benefit from accessing treatment from mental health services or from coming into hospital. There are a number of different psychotherapy approaches that may be helpful in depression.
Within the Depression Recovery Prgramme here in St Patrick's Mental Health Services (SPMHS), we use many different approaches as a means of connecting with each individual's experience in a meaningful way.
Cognitive psychotherapy is of particular benefit because it explores the maintenance cycles that exist in any persisting problem we face. An individual is encouraged to identify thoughts, emotions, physical sensations and behavioural reactions that occur in particular situations and to recognise how they interact with each other and develop into vicious circles that are self-maintaining. Cognitive psychotherapy also explores core beliefs or fears that may have developed as a consequence of early life experiences and the way that we compensate for such beliefs or fears. This can help the individual to recognize long-term maintenance cycles that may be operating in their life and that may leave them vulnerable to depression at times.
Compassion-Focused Therapy (CFT) explores different ways that we regulate our emotions based on threat or incentive and the unintended consequences that occur. The individual is encouraged to develop a different approach that is based on affiliation, connection and compassion. A more compassionate self means that the individual can move away from self-criticism and beating themselves up to having a more balanced and view of themselves that takes account of their personal journey through life.
Mindfulness is a form of meditation that we use to develop the skill of being able to move our attention to focus in a particular way on what is happening in the moment. This is of particular benefit in depression recovery because an individual learns to move from living in their mind, where we follow and react to every thought, memory or worry that arises, and move our attention to fill our mind with observations of what is happening in the moment.