What is depression?

The word depression is often used when we are feeling sad or miserable or fed up. Feeling sad or fed up is a normal reaction to experiences that are upsetting, stressful or difficult; those feelings will usually pass. Sometimes we know why we feel this way, sometimes we don't. We usually cope, we may talk to a friend about it but otherwise we don't need any other help. However, if these feelings don't change after a few weeks and they are so bad that they interfere with your daily life or if they come back over and over again for a few days at a time, it could be a sign that you are depressed in the medical sense of the term. In its mildest form, depression can mean being in low spirits; it mightn't even stop you leading your normal life but makes everything harder to do and seem less worthwhile. At its more severe, depression can have a significant negative impact on your life because it can make life seem pointless. Depression is not something you can just 'snap out of'. If you feel you are experiencing depression you should contact your GP for additional support and advice. Depression is a treatable condition. You should not suffer in silence, hoping it will go away.

Symptoms of depression

Depression presents itself in many different ways. Some people might not even realise they are experiencing depression thinking they are just run down or tired. However, if you experience five or six of the following symptoms, you should seek additional support:

• Loss of interest in life and difficulty enjoying things in life
• Feeling tired all of the time with a lack of energy
• Finding it difficult to make decisions
• Feeling restless and agitated
• Waking up early and having difficulty falling asleep at night
• Loss of interest in sex
• Loss of appetite and weight or the reverse where you put on weight
• Feeling useless, inadequate and hopeless
• Avoiding other people
• Feeling worse at a particular time of day, usually in the morning
• Loss of self-confidence
• Inability to cope with things as you used to
• Having a pessimistic view of the future
• Blaming yourself and feeling unnecessarily guilty about things
• Self-harming behaviour
• Thoughts of suicide

What causes depression?

As with our everyday feelings, sometimes there is an obvious reason for us becoming depressed. Like, for example, job loss, relationship breakdown or bereavement. These are known as environmental factors and this type of depression is known as reactive depression. Sometimes, however, there is no obvious cause. In this case it may be biological or genetic in nature. Often depression can be caused by a number of different factors - biological, genetic and environmental - and these factors will be different for everyone. Some of the risk factors for depression include the following: distressing events such as bereavement, loss of job, relationship breakdown or major life event such as moving house, being attacked, moving job or having a baby. It's not just the experience that causes depression but how we deal with it; if the feelings provoked are not expressed at the time, they fester and can contribute towards depression.

Past experiences have an effect on how we feel about ourselves in the present and if those feelings are very negative, they can be the start of a downward spiral.

Physical illness that can threaten your future like cancer, heart disease and illnesses that are long and painful, can cause you to become depressed. Under-active thyroid function can also cause you to experience various symptoms, for example, lethargy, weight gain and depression. Under-active thyroid function can be easily treated with medication. Over-active thyroid function can cause you to lose weight and have symptoms similar to mania.

Alcohol: heavy drinking has a big effect on how you feel causing us to feel more depressed. Alcohol has also been identified as a major factor in suicide.

Genes: depression can run in families. This does not mean if a close family member has depression, you will definitely get it too. However, if depression runs in your family, you should be aware of the symptoms.

Different types of depression

There are many different types of depression which include the following:

• Mild depression: this form of depression is often triggered by a specific event, such as the loss of a job. Symptoms include feeling low and anxious. Sometimes a change in lifestyle is all that is required to lift this kind of depression.
• Severe depression: this could potentially be a life-threatening illness. A person with severe depression experiences intense symptoms and the illness interferes significantly with their daily life. It is important that medical help is sought.
• Bipolar depression: this is also known as manic-depression or manic-depressive illness. A person with this condition experiences sustained high moods alternating with periods of sustained low moods. High moods can see the person feeling elated and needing less sleep or food than usual. Low moods can range from mild to severe depression.
• Dysthymia: this is a mild form of depression, but is more persistent. The condition may come and go, but if it has gone on for more than two months in a two-year time span, dysthymia may be diagnosed. One of the main symptoms is low self-esteem. People with dysthymia are at increased risk of developing full depression.
• Postnatal-depression: this is depression which arises after a woman has a baby. It can occur straight after the birth or, in some cases, it doesn't develop until up to a year later. Medical treatment is recommended, however, many women do not seek help as they feel that this is something they must endure or they put it down to tiredness or adjustment.

What to do if you feel you have depression?

• Speak to your GP for advice and information.
• Exercise regularly to stimulate endorphins which have a positive effect on mood.
• Challenge negative thinking and replace them with more realistic thoughts. Check out the Challenge Negative thinking module in the Self Help section for more information.
• Eat well - you may not feel like eating but a good diet of vitamins and minerals can help how you feel about yourself and impact on your energy levels.
• Talk to friends and family members you can trust. It's good to share problems with others as it is part of the mind's natural way of healing.
• Avoid alcohol and drugs - they can seem like ways to get you through hard times but, in fact, they can make the situation worse. Alcohol may make you feel good for a short time but it doesn't last. Drinking can also stop you dealing with the issue and getting appropriate help.
• Sleep is a very restorative action for our body and mind. If you are experiencing depression you may find it difficult to get to sleep. If this is the case try to work out a strategy that works for you, e.g. reading or listening to music. You may also find it useful to check out the Sleep module in the Self Help section.
• Tackle the cause of your depression if you know what it is. This can be a very daunting task but addressing the problem can have a major impact. Check out the problem-solving module in the "Self Help" section.

What treatments are available for depression?

There are three main types of treatment for depression:

Self help

This includes self help books, leaflets or programmes. They are usually based on the Cognitive Behavioural Therapy approach which helps you identify your patterns of thinking and develop more helpful ways of thinking and responding. An example of a CBT-based self-help programme can be found in the "Self Help" section of this website.

Talking therapies

There are many forms of psychotherapy available which can be very effective for people with mild to moderate depression.

These include:

Counselling takes place where a counsellor sees a client in a private and confidential setting to explore a difficulty the client is having, distress they may be experiencing, or perhaps their dissatisfaction with life, loss of a sense of direction and purpose. By listening attentively and patiently, the counsellor can begin to perceive the difficulties from the client's point of view and can help them to see things more clearly, possibly from a different perspective. Counselling is a way of enabling choice or change or of reducing confusion. It does not involve giving advice or directing a client to take a particular course of action.

Cognitive behavioural therapy deals with how you think about yourself, the world and other people and how what you do affects your thoughts and feelings. CBT can help you to change how you think ("cognitive") and what you do ("behaviour"). These changes can help you to feel better. CBT focuses on present problems and instead of focusing on the causes of your distress or symptoms in the past, it looks for ways to improve your state of mind now.

Problem solving therapy: helps you deal with the problems in your life by applying techniques to break problems down into more manageable tasks.

Support groups are helpful in that you get to meet and share experiences with people going through similar events as you. Aware runs supports groups for people affected by depression throughout Ireland. To find out about your nearest group, contact Aware on 1890 303 302 or visit www.aware.ie

Bereavement counselling: helps you come to terms with the death of someone in your life.

Interpersonal and psychodynamic psychotherapy: tends to be longer-term treatment. It looks at how past experiences are affecting you now.

Anti-depressant medication

Anti-depressant drugs are the most common medical treatment for depression. They work on chemical messengers in the brain to lift your mood and make you feel less anxious and agitated and deal with your problem effectively. Anti-depressants can take a number of weeks for you to fully feel the effects.

How can I support my friend who is experiencing depression?

• Encourage your friend to seek help. This may be very difficult for your friend to do because of stigma associated with mental health problems. Assure your friend that they are doing the right thing dealing with their problem instead of just ignoring it.
• Spend time with your friend and encourage them to continue in the activities they find enjoyable.
• Listen to your friend talk. It is good to have someone to actively listen to your situation. This may be difficult as you may find yourself listening to something that you find tedious but to your friend it is important. By actively listening to your friend, they will feel supported. Try not to jump to solutions for your friend or offer advice on what to do. Support your friend to come up with their own solutions to their own problems.
• Avoid alcohol. If your friend is experiencing depression, alcohol will only make the problem worse. Try to suggest alternatives to alcohol or, alternatively, activity that does not involve alcohol.
• If your friend suggests or hints at suicide, take them seriously. Do not keep this information confidential. Seek help from someone you trust and encourage your friend to visit your GP immediately.

For more information on depression contact Aware on 1890 302 303 or visit www.aware.ie