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Depression - A Modern World Illness
The Mental Health Foundation
What is the difference between feeling depressed and being depressed?
Most of us sometimes feel low or depressed. It’s difficult getting out of bed in the morning and everything is an effort. When we feel like this, if something upsets us, perhaps all we then want to do is withdraw from the world and stay in our cocoon. Feeling sad or having dark thoughts or finding it difficult to get to sleep does not necessarily mean that we are depressed. Moments of doubt and bouts of sadness are part of human experience. Luckily for most of us, this state lasts only a few days or weeks. However, in the case of clinical depression, these negative thoughts occur most days and come with a feeling of powerlessness that makes it difficult to imagine ever being able to escape from this state.
The difference between feeling depressed and being depressed is that in the latter case, the feeling is long-lasting and it is impossible to feel hopeful.
How do I know if I am depressed? What are the symptoms?
The symptoms are both psychological and physiological.
The most common symptom is to see everything from a negative perspective. There is no pleasure or meaning to life and one feels persistently low and sometimes desperate. There can also be a sense of being worthless or hopeless or feeling guilty. Recurrent suicidal thoughts and a strong wish to be dead can also be signs of depression.
Physically, depression commonly expresses itself by a lack of energy and a constant tiredness so that just getting up in the morning requires superhuman effort. However, for some people, it is the opposite and they feel constantly agitated, which affects their ability to concentrate.
Being depressed can lead to a change in eating habits, with weight gain or weight loss, and changes in sexual habits, with a loss of desire. Another sign to look out for is an increase in the consumption of alcohol or drugs to regulate their mood and try to numb the negative feelings.
Who is likely to be depressed?
One in five people worldwide will experience a depressive episode during his or her life. This condition can affect people of all ages and at all levels of society. However, depression is not always well diagnosed, especially in young people and the elderly. It is estimated that 1% to 2% of children suffer from depression and roughly 15% of teenagers. Regarding this last age group, depressive symptoms are often confused with adolescent surliness and the condition is not always recognised.
Teenagers and elderly people are less likely to seek help for their depression and therefore their condition can go untreated. Statistically, in France there are twice as many women as men suffering from depression. However, these figures may not reflect the true situation because women are more likely to seek help for their condition from their doctor.
There are several types of depression and symptoms can vary. Usually, depression occurs in episodes. Depression can be reactive, i.e., follow a stressful event such as a divorce, job loss or a bereavement. If the depressive episode is isolated, a few months of therapy can be very effective. Sometimes depressive episodes are recurrent and have no obvious cause. When depression becomes more or less continuous, it is called dysthymia or chronic depression. If a depressed individual is then subjected to a traumatic event, it can cause a double depression. In more severe cases, when the individual cannot manage their daily activities, or is actively suicidal, it can be necessary to provide residential care in a hospital for a period of time.
What causes depression?
There is no single cause of depression. Depression can be understood as a combination of biological, psychological and social factors. Biological factors can include the physical symptoms described above and take into account genetic predisposition and the dysfunctioning of neurotransmitters.
Psychological factors relate to the individual’s emotional life, and can include the feelings of guilt, worthlessness, hopelessness and sadness and, from this perspective, we can understand depression as unfinished grieving for earlier losses. Social factors can include the loss of social connections and interpersonal relationships, and other environmental influences, as triggers for depression. An initial negative event, for example losing our job, can diminish our sense of agency and our ability to hold our place in society, which can in turn increase our social isolation, as well as making us feel worthless and hopeless.
Today, it is possible to link all these factors as progress in neuroscience shows that positive and negative life events have an impact on brain chemistry.
It is not negative experiences themselves that cause depression, but how we respond to these experiences, which is determined by our resilience. Certain psychological and environmental factors protect against depression while others exacerbate the risk.
Past experiences can have a profound effect on how we respond to events in the present. An apparently unexplained depressive episode can have its origin in events from the past which could not be explored and resolved at the time.
The response we get from people around us is a vital determining factor because being heard and understood protects against depression. The reaction of our family and friends is crucial, but so is the reaction of wider society. Researchers at Liverpool University studied 165,000 individuals diagnosed with depression in 5 different countries. They found that in rural areas the rates of depression are relatively consistent, whereas in urban areas there can be big differences from one city to another. For example, in Santander in Spain 3% of the population suffer from depression, compared to 18% in Liverpool. These findings are surprising and can probably only be explained by taking into account the importance of environmental factors such dense social interactions in preventing depression.
What can I do to help myself if I am depressed?
Individuals suffering with depression often believe that they should pull themselves together, that they should cope on their own and asking for help is a sign of weakness. This is not true. Depression needs to be treated. The earlier it can be acknowledged and addressed, the less risk of it becoming established and the symptoms becoming more severe.
Psychotherapy is recognised as an effective treatment for depression as it seeks to explore the origin of the malaise and understand the negative feelings associated with depression in a safe and contained environment.
Therapy on its own is recommended for recent or mild depressive episodes. When a depressive episode is well established, or in chronic depression, medication in addition to psychotherapy can help reduce the symptoms and mental suffering.
Accepting help is a first step towards healing and regaining agency in one’s life.
How can family and friends help?
The friends and family of a depressed person can feel powerless and not know how to help them. It can be tempting to give advice and explain to the depressed person that she has no reason to feel depressed and that she should look at the bright side. Unfortunately, although well intentioned, this increases the person’s feelings of guilt and uselessness.
A depressed individual often needs to be looked after, to be reassured. An understanding ear and signs of affection, or simply spending time together, will provide valuable help.
However, support given by friends and family does not replace therapeutic work with an experienced and qualified professional. In this safe and non-judgmental environment, difficult feelings can be explored and reflection can take place.
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