What is depression?
Depression is a mood disorder; it makes the person feel emotionally very low, affects motivation to perform any activities, changes sleep pattern, increases or decreases appetite, adversely affects brain function, particularly memory, concentration and ability to think. Depression is a common disorder which affects all age groups and both men and women. Depression is one of the most commonly undiagnosed disorders which people suffer silently.

It is quite normal for everyone to feel sad when there is a bad news, losing a loved person, losing a good job opportunity, losing an increment, etc. Sadness, even if it is intense, the person will overcome it in a few weeks. The common remedies to overcome sadness do not help to cure depression because it is much more severe than just sadness.

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Types of depression

There are mainly two types of depression:
Reactive Depression
Biological Depression.

Reactive Depression is caused by life circumstances like loss of a loved one, loss of property, separation, etc.

Biological Depression is caused due to changes in the neurochemicals in the brain.

There are two types of Biological Depression: Unipolar Depression and Bipolar Depression.

In Unipolar Depression, the person will be repeatedly having episodes of depression whereas in Bipolar Depression the person will experience both low mood as well as unexplained excitement.

There is another condition called Dysthimia; by nature the person will have the characteristics of a patient with depression.

How does it affect a person?

Depression corrupts the thought process and makes the person think very negatively of self, others and the future. The person will have repeated negative thoughts about themselves; “I am no good”, “I am a failure”, “whatever I do I will not succeed”, “people don’t like me”, “others are very successful”, etc.

Similarly, they will think that those around them are very unhelpful and uncaring. It is common to hear “no one cares for me”, “others don’t worry about my problems”, “others are very unhelpful”, etc. They will not have hope about the future; instead of looking at the present as a difficult phase, they will assume that their life is going to be dull and problematic. Also, they will look at all the situations as problematic and difficult to deal with. This can physically be exhausting and mentally tiring.

Risk of suicide in depression!

The risk of suicide is very high among people who suffer depression. Approximately 10 per cent–15 per cent of severely or clinically depressed patients will end their lives. The risk of suicide is increased in patients who live alone, who are divorced, abuse alcohol and drug and those with history of previous suicide attempts. Patients who are depressed are at high risk for suicide so they should be monitored all the time and if possible, hospitalised for in-patient treatment to help them overcome the suicidal ideas.

Cause – Neurobiological

Clinical depression has been studied from the perspectives of neurobiology, neurotransmission, physical disorders, insult and injury to the brain and various psychosocial factors. Antidepressants such as imipramine and monoamine oxidase inhibitors work by boosting the level of the neurotransmitter norepinephrine. Scientists postulated that depression might be caused by a deficit of norepinephrine in certain nerve cells throughout the brain. However, with the discovery of fluoxetine (Prozac); another very effective antidepressant acts on serotonin, thus it became evident that other neurotransmitter systems may be involved in depression as well.

Cause - Physical Disorders

Depression may also be caused by a number of physical disorders; the most common of which is decreased thyroid function (hypothyroidism). Occasionally, people who have paralysis can also get depressed. Depression may occur in women during pregnancy or shortly after childbirth (postpartum depression). Alcohol and drug abuse and certain medications may also cause depression.

Cause – Life circumstances

Life circumstances like a broken relationship, divorce, loss of property, losing a job, misfortunes in life, experiencing natural disaster, continuous criticism and harassment can lead to depression.

Mr S, aged 37, a very competent professional, due to constant harassment and taunting by his boss, developed depression. Apparently, his boss felt very insecure by Mr S’s competence and success, so he made every effort to demoralise Mr S, to break his confidence. Every time Mr S returned from a visit abroad, his boss used to withdraw a facility enjoyed by him. Mr S used to make 4 to 5 trips abroad in a year, whereas his boss used to make one visit in 4 to5 years. Mr S was first stripped of his separate room, then the Internet connection, then the printer, then the computer and finally he was moved to a seat next to an administrative staff in a big hall. Mr S was deeply hurt by the attitude and behaviour of his boss. He felt that all his efforts to improve the organisation went unappreciated and was keen on proving to him about his loyalty. Thus, more than the life circumstances how the person perceives and behaves can lead to depression.

Depression can also be self-induced by setting unrealistic goals, having expectations far beyond ones capacity to achieve, etc. If the goal-setting is not realistic to the skills, knowledge and resources of the person, then they are likely to face repeated failures. After a couple of failures, they will start thinking that they are failures. Similarly, expectations from work, life or relationships have to be in tune with reality, if they have high expectations, then they are bound to develop disappointments and over a period of time. Repeated disappointments can lead to depression. Many marriages fail due to the unrealistic expectations based on movies and storybooks. When they find real life being very different they will not be able to cope with it, so they break up.

Treatment

The primary medical treatments for depression are medications and psychotherapy. When the person is suffering from Reactive Depression some clinicians may choose to first try psychotherapy before prescribing medication.

Antidepressants

Antidepressants can be divided into two general groups:

• The Tricyclic and Tetracyclic antidepressants (TCAs) and the Monoamine Oxidase Inhibitors (MAOIs).

• The newer antidepressants are Selective Serotonin Reuptake Inhibitors (SSRIs), Bupropion (Wellbutrin SR), Nefazodone (Serzone), and Venlafaxine (Effexor XR). The newer antidepressants are not necessarily more effective than the TCAs, but they are safer and have fewer side-effects than the older antidepressants.

Psychotherapy

Psychotherapy is very helpful to overcome depression. The psychotherapist will develop rapport and provide emotional support to the person. This is essential to set the platform to work on all the faulty thoughts, perception and emotional processing of information.

Understanding depression

The psychotherapist will enable the person to understand how depression affects the body, thoughts and emotions. This understanding is very important because the person will suffer from various manifestations of depression and think of all of them as different problems rather than as different manifestations of one single problem.

Mr K, a case of chronic depression, experiences low mood, lack of interest, poor ability to concentrate, poor ability to interact with people. He used to be very worried about his difficulties thinking that they are all different problems he has developed over a period of time. When he realised that they are just different manifestations of one single problem of depression it was a big relief for him!

Correcting the errors in thought process

Then the psychotherapist will enable the person to identify the distortions in his thoughts. Interestingly, there can be many mistakes in the thought process even for a normal person. Errors in the thoughts can be much more in a person with depression. When we feel lonely we think ‘no one loves me’ or ‘others have more skill than me’ or ‘I am a failure’.

Mrs P used to think whenever she gets depressed that her husband does not care for her. This used to hurt her husband very much as he really cared for her. Once the mistake is identified then it is easy to correct with the help of the psychotherapist. The mistake can be in the form of exaggerating a failure – when a person is not able to succeed in a project thinking that “I am absolutely not good in anything, my life is gone - I will lose my job”! In reality, the team leader may simply shift him to another project without even thinking about his competency. A few others have the tendency to read “others’ mind” ‘so and so will think badly of me’, ‘this person must be thinking I am no good’, etc.

Common errors in thoughts

Improving the mood
Lack of activity for a prolonged period of time like a week or more can cause low mood. The psychotherapist will enable the person to schedule activities that have a positive influence on the mood. Scheduling is very important because it will be very difficult for the person to make a decision to choose an activity – so a pre-planned schedule will be very helpful. Similarly, the therapist will encourage the person to take up activities like watching a favourite programme, reading a book or visiting a favourite friend to enable them to improve their mood. The therapist will also enable the person to identify those behaviour that adversely affect the mood; some people have the habit of sitting in the dark, sitting alone in the terrace, avoiding social contacts, being in the house all the time, sitting and brooding about some problems repeatedly, etc. Such behaviour can affect a person’s already affected mood much more.

Perception and interpretation
More than the life event, the way in which the person perceives the situation and interprets will affect the person. The above case study shows how Mr S was affected by his boss’ behaviour; because he perceived it as a sign of ungratefulness. The psychotherapist enabled him to change his perception by taking other interpretations for this event.

In Mr S’ case the boss is a very insecure person who is very paranoid about other’s growth instead of feeling happy for other’s growth. The situation is such that his boss does not want those in the organisation to grow – so being loyal or contributing to the organisation would be immaterial for his boss. Understanding the boss’ true nature enabled Mr S overcome his decision to prove his loyalty to the boss. This made him look for better opportunities and once he moved out of the organisation; he not only got out of depression but also became very successful.

Conclusion:

• Depression is a common problem experienced by both men and women.
• Risk of suicide is very high among persons with depression.
• Faulty thought process can lead to depression.
• Life circumstances can lead to depression.
• Setting unrealistic goals and expectations can lead to depression.
• Neurochemical changes in the brain can cause depression.
• A few symptoms do not necessarily amount to diagnosis of depression.
• Depression is to be diagnosed and treated by professionals.
• Depression can be cured completely. If it is a recurrent type, then it can be kept under control.

Common sense solutions that help to relieve sadness do not help to overcome depression!

Do not mistake a person with depression as being lazy!

Ravi Samuel
MA, MPhil, PGCARM (Lond)
Psychotherapist
www.urclinic.com

More Articles	Published on Sept 4th, 2007
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