In addition to feelings of low mood, symptoms of depression include poor concentration, lack of motivation and loss of pleasure. There are also “biological symptoms” such as poor sleep patterns with early morning waking or oversleeping, poor appetite or overeating and lack of interest or pleasure in sex. Furthermore, low mood, hopelessness about the future and despair are likely to be the most difficult to acknowledge, even to oneself. Fluctuating mood is often a symptom. Some people have wildly changing moods, feeling very good one minute, terrible the next. At other times, irritability, anger, feelings of emptiness can all be accompanied by constant anxiety. Many show examples of self-destructive behaviour: drinking too much, using drugs, self-harming, impulsivity risk-taking and procrastination. Churchill famously described his depression as his “black dog”, his way of describing a condition that can come and go, stay for a time or disappear completely for a while. People tend to think of depression as depressed feelings; lowness, emptiness, hopelessness or despair. Low feeling (dysphoria) is a most recognisable feature of depression, although it is possible to be depressed without realising it.
Living with someone with depression can be problematic. Watching a loved one go through periods of despair and hopelessness one minute and appearing in high spirits, happy and full of life the next. This can be confusing and may bring a sense of chaos or unpredictability to the relationship, never knowing what is going to happen next. The instability in the relationship or the inability to form stable relationships in the first place could also contribute to an underlying personality disorder of the unstable or borderline type.
Sadness is a normal healthy emotion and different from depression. Many people try to avoid or block becoming sad at all costs since this makes them anxious. They feel it would be too painful to bear or impossible to escape from. Some become numb to it and even do not know that it is there. They fill their life with work with lots to do to distract the painful feelings. Avoiding deep sadness may work for some people, as it has become a coping mechanism to life’s difficulties, but it can cause depression if it is continually being evaded. Sadness can usually connected with loss; loss of a loved one, a relationship that has gone wrong, or some other aspect of life that causes great disappointment. People can be sad at wasted years of their life when they should have had more enjoyment, the absence of love, or the loss of a hope or dream that can never be, feelings of failure and never being good enough
Bipolar affective disorder/manic depression: We can all be manic at times, but some people have more extreme periods of mania when they become overactive, elated and even deluded about their achievements. Periods of elation alternating with periods of depression may be a sign of bipolar affective disorder, for which medication can be effective. Unipolar depression is an extended period of depression with some of the biological symptoms described above.
There can be many causes of depression. Vulnerability to depression is often associated with adverse experiences during childhood such as emotional neglect, physical neglect or abuse affecting growing children in their development. However, a recent survey in the field found that over half people who have depression have not had these experiences. There is strong evidence to demonstrate that if one of the main caregivers (parent) had a depressive illness, any offspring may be more likely to develop depression. That is not to say that depression is always inherited. Examples of causes of depression include:
In psychodynamic psychotherapy, the therapist will try to explore the current cause of the depression in the context of the whole person, including important experiences in their life such as their childhood. People adapt their behaviour in given situations as a direct result of their childhood experiences, good and bad. In cognitive behavioural therapy (CBT), the therapist addresses the symptoms more directly without looking at underlying emotions. People vary as to which approach they would prefer. It is not uncommon to try CBT first and if it does not work, have psychodynamic therapy. As all of our therapists work integratively they use a combination approach so that the therapy can be tailored to individual needs. Sometimes therapy can resolve depression, whilst for others, the client may continue to have depression but it is less severe and more bearable. Always we will give clients more “life” tools to help manage their life more effectively.
In therapy, it is important to explore sadness if it’s there, gradually and slowly if it’s painful, and mourn the loss of whatever it is that the sadness is connected with. If depression has been the case for many years therapy may be needed a more long-term to overcome deep-seated problems. From a diagnostic perspective, depression is measured by the number and severity of symptoms and it is important to have a confirmed diagnosis of depression from a suitably qualified healthcare professional, i.e. your GP or psychotherapist.
There are many medications such as anti-depressants that can be prescribed for depression by a GP and it is important that your therapist knows what prescription and/or over the counter medicines are being taken. Some medications can affect your libido and your sexual function so if this is causing problems it is important to let the therapist know.
Above all it is important to seek help if any of the symptoms described here affect you, causing distress or affect your personal relationships with others (i.e. your partner). There is a wealth of experience and support available at the Mary Clegg Clinic and we will encourage you on your journey to enjoy life as much as you can.