‘Life’s just too hard: the world would be better off without me’  

Pic: http://static.vecteezy.com/system/resources/previews/000/021/212/original/GIVEN.jpg

Life is complicated for all of us, and it has its ups and downs. We also all have different ways of coping with the throws of the dice that life gives us, and unfortunately there are periods in life that test our ability to cope. More often than not, circumstances can arise which seem OK if they arrived one at a time, but life is sometimes like loaded dice: they can keep giving us the same rotten things despite our best intentions and sometimes a wildcard gets thrown in which makes several bad things happen at one time! It’s these times which can lead people the most susceptible to depression.

On a personal level, I’ve been battling with bouts of mild depression for most of my teen and adult life, in part because of my having to live with a disability, specifically Aspbergers’ Syndrome. 

Pic: http://4.bp.blogspot.com/_pAqjOzN3gbQ/TTQ8Ilf3kwI/AAAAAAAAAAY/v47bQM3iIdE/S660/d6.jpg

Although I’m OK with sharing this info online due to the platforms’ anonymity, I’m still not entirely comfortable with sharing this information face-to-face with many people (because my case is somewhat atypical of the condition) and so, therefore, I tend to hold a lot of emotion internally, and I’ve already had one nervous breakdown in my life as a result. After undergoing CBT with a psychologist, I know now that this approach is harming me more than it is helping me, and it’s been a long healing process due to the stigma associated with the more severe forms of my condition, but I’m gradually learning to integrate it as part of me rather than full-on denying it and therefore giving it more power to control me. I still have my bad days, but most of the time I’m now able to accept what life has dealt me. 

Depression (known in clinical circles as major depression, but is also known as clinical depression, major depressive disorder or unipolar depression) is something that happens often in our society, but due to the stigma associated with it, it can creep in insidiously and eventually claim lives in the most severe cases.  Unlike some other psychological illnesses, which are often genetically related and/or brought on by the environment that you are raised in, depression doesn’t discriminate. Anyone can succumb to depressive episodes, regardless of your age or your gender. It is also important to distinguish that depression is different from a case of the ‘blues’: people that are suffering from the blues tend to bounce back to their normal selves after a couple of days to a couple of weeks maximum, whereas depression tends to last months or even years, sometimes without even knowing the reason behind it. Also, like in cases of autism, depression also falls on a spectrum and symptoms can vary considerably, depending on where you are on the scale.

But hang on, isn’t depression a term also used somewhere else in media articles? 

Pic: http://i.telegraph.co.uk/multimedia/archive/01007/lehman_1007680c.jpg

Psychological depression is very different from fiscal (money-related) depression, albeit these two things can be interlinked, as has been shown in the Great Depression of 1929 and the recent GFC. Between the years of 1929 to 1934, many people lost their jobs due to inflation which left many companies unable to pay their workers wages, which subsequently led to people often losing their homes as well from either being unable to pay their mortgages or their rent. This compounding problem tragically resulted in some taking their lives because they couldn’t see any other way out. The crash of the Lehman Brothers bank back in September of 2008 caused a chain reaction due to its huge amount of toxic assets (in the hundreds of billions of $US)and incredible borrowing ratio (40:1) leading to massive debt (also in the billions of dollars) that bled into other financial districts and businesses internationally, resulting in a huge loss of confidence and eventually leading to the financial system around the world suffering a credit crunch. There are still several countries around the world that are still struggling today as a result of this and historians are still arguing today about whether the correct actions were taken to avoid a complete financial meltdown.

Are there any factors in life which can increase my chances of getting depression over those surrounding me? 

Actually, there are: some of which you can control directly and others that are seemingly out of your control. They include the following:

  • Family history

    Pic: http://static.comicvine.com/uploads/original/11116/111161483/4406461-3420454670-shutt.jpg

Despite the fact that depression is capable of inflicting its damage on anyone it so desires, it is more likely to happen within certain families. It’s important to note, however, that depression is not guaranteed to hit every member: other personal factors play a big role in determining whether it hits you particularly or not. 

  • Drugs and alcohol

Many people turn to drink or to drugs as a crutch in a futile attempt to deal with their problems. However, using these escape mechanisms only tackles the surface issues without getting to the very heart of why you’re down and out in the first place, not to mention that these things will eventually wreak havoc not only on your wallet, but your liver and your health in general. 

  • Personality types

Perfectionism, like I’ve talked about in other parts of this series, is a particularly nasty bedfellow: it may seem like a good thing on the surface, but ultimately, perfectionism can play a major role in people succumbing to depression, because no matter what these people try and how much they accomplish in the process, they feel that they are always worthless and/or hopeless. 

  • Current chronic medical issues

    Pic: http://m.cdn.blog.hu/me/media20/image/dr-house-13.jpg

Being sick at all is an inconvenience, but being sick for long periods of time, particularly if the illness in question leaves you bedridden can really test your sense of emotional stability. If you’ve watched House before, you’ll probably be familiar with the complex main character (played by Hugh Laurie), who takes drastic measures to take the constant, excruciating pain away from his leg (which had dead thigh muscle removed due to a blood clot) and uses his brilliant mind to diagnose patients with rare and/or life-threatening medical conditions in an effort to distract himself from his own neuroses brought on by the drug Vicodin and depressive episodes. 

What warning signs should I look out for? 

There are multiple symptoms,  which can be physical, emotional and psychological, which can indicate that what you are feeling is not just a temporary sad phase in your life that you can bounce back from after a couple of weeks.

Behavioural Patterns

Some behaviours which are strong warning signs include:

  • Becoming a social recluse when you are normally outgoing

On that note, it’s normal to want to recharge and distance yourself occasionally, but it’s all a matter of degree: if you’re normally a social butterfly and you find yourself retreating constantly that’s a bad sign, whereas some people tend to prefer their privacy. 

  • Having every activity turn into a chore

This is more than just boredom from mundane, repetitive tasks setting in: even things that you normally consider fun suddenly become ‘meh’ to you. 

  • Failing grades

    Pic: http://cdn.teachhub.com/sites/default/files/styles/large/public/grades_3.jpg

It’s important to distinguish here between people who play hooky or just don’t do well at school and those that generally do well but seem to not want to put in the effort, because it suddenly doesn’t seem that important to them. 

  • Becoming reliant on sedatives

These can include alcohol and drugs: these are used to dull pain that they are feeling. This is more than just a social drink with friends: this is a real problem as it can develop into full-blown alcoholism or drug addiction. 

  • Being more withdrawn

This is particularly noticeable in those who are social butterflies normally; but even those who tend to keep to themselves under usual circumstances

can find themselves doing this more in order to prevent their true emotions from being shown. 

  • Lacking focus

    Pic: http://www.yurtopic.com/tech/gadgets/images/static-tv.jpg

Being depressed, particularly in more severe cases, can make the mind feel similar to the white fuzz that you sometimes see on TV screens, like in the picture alongside. This feeling can leave you drained and unable to devote the power of your mind to any particular project, because of your inability to concentrate on anything. 

Physical Symptoms

Some of the  physical symptoms which can be associated with depression include the following:

  • Tiredness

This type of tiredness is not the type that can arise occasionally from a bad nights’ sleep and be resolved by a quick power nap: this tiredness is constant and does not abate. 

  • Feeling ill

Your mind and body are very much intertwined: if your mind is not coping very well, sooner or later your body will start to show it. This is true in cases of chronic stress, and a similar effect happens in people who are depressed: the immune system starts to lose its efficiency and opportunistic cold and flu infections can creep in. 

  • Headaches and muscle pains

Again, this is similar to cases of chronic stress: people who are depressed have difficulty keeping up with the demands of day-to-day life and therefore start to develop tension headaches. The diet may also be affected and magnesium levels may start to drop, leading to muscle pain. 

  • Churning gut

This is common in people who are depressed: another key feature is a change in appetite similar to what happens when some people are grieving the death of a loved one. Some people cope by not eating because their stomach feels like a rock or they don’t feel like eating, whereas other people tend towards the opposite extreme and gorge excessively (usually on highly calorific foods) to dull the pain in a similar manner to which others approach alcohol and/or drugs. 

  • Gaining or loss of weight

This is a result of change of appetite: those that restrict their intake will eventually start to shed the pounds, and those that gorge will convert the excessive food to fat. 

  • Changes in sleeping patterns

Like eating, depression can swing sleeping patterns either way. Some people sleep excessively, which can exacerbate the feelings of depression because of the altered balance of the emotional hormone serotonin with the sleep hormone melatonin. Others may suffer from insomnia due to worry and this can also lead to illness developing more quickly due to a suppressed immune system.

Internal Feelings and Thoughts 

  • Feeling low in some form: i.e. being sad, miserable
  • Lacking in confidence in your own abilities (more than usual)
  • Being irritable due to frustration
  • Inability to make decisions
  • Feelings of disappointment in yourself or something else
  • Being overwhelmed at day-to-day activities

    Pic: http://41.media.tumblr.com/cafe7e900cdd93c8aee3bd861ae0d1a1/tumblr_ngsfdulXUE1takqvvo1_500.jpg

These feelings are triggered by the thoughts that tend to wander through the mind. Unfortunately, such thoughts can be very dangerous if they linger around and you repress or deny them rather than talking about them with somebody else, whether it be a close confidant or a therapist, so it’s best to seek help for these as soon as possible.

Such thoughts include the following:

  • ‘I’m hopeless/worthless/a failure’
  • ‘Everyone else would be better off I weren’t here’
  • ‘It’s all my fault’
  • ‘I’m not worth loving/I’m unlovable’
  • ‘Life as it is isn’t worth living’
  • ‘All that’s good in life happens to everyone else but me’

What other depression-related disorders are there?

As well as major depression, which can fall in the mild, moderate or severe categories, there are several more specialized types of depression that each have their distinct symptoms. These include the following:

  • Melancholia

Is a severe form of depression which is characterized by a distinct loss of pleasure of everything that once brought the sufferers joy. Another feature of melancholia that is common is a lower degree of mobility i.e. sufferers have lost the spring in their step that they once had and therefore they tend to move more slowly without any obvious physical impediment.

  • Dysthymic disorder

This is a milder form of depression which tends to hang around for years as opposed to months, which is typical for regular sufferers of major depression. Typically, dysthymic disorder is diagnosed when a person has been suffering with the symptoms of mild depression for more than 24 months.

  • Seasonal affective disorder

This disorder is commonly found in people that live in polar regions due to the short days and long nights that they experience, and is relatively rare in regions such as here in Australia where the days and nights range from an 10hr day/14hr night ratio in winter to a 16hr day /8hr night ratio in summer. People that suffer from this disorder tend to experience depressive episodes during the winter months and tend to return to normal when the duration of sunlight begins to increase again. Other symptoms that may creep in are similar to those exhibited by the condition known as cabin fever, and they include the following:

  1. Gaining of weight due to excessive binging
  2. Having a craving for high-carb foods
  3. Excessive sleeping due to the long nights
  4. Lack of energy due to sleeping too much
  • Post-natal or antenatal depression

    Pic: http://www.abc.net.au/radionational/image/5105640-4×3-340×255.jpg

This is a common type of depression that often arises in women after childbirth. This tends to happen for two reasons:

  1.  Due to both the wild hormonal swings, particularly with the oxytocin levels skyrocketing and then falling as well the regular oestrogen/progesterone cycles that occur monthly, the emotions can also radically change from elation to depression
  2. Let’s face it: having a kid is stressful for anyone because your whole life gets turned upside down, and it only gets worse if the pregnancy or labour does not go by the book.
  • Bipolar disorder

This disorder was once known as manic depression, and it is characterized by two distinct phases:

  1. The manic phase: people in this phase are hyper-energetic and are experiencing the non-drug equivalent of being put on speed: they speak rapidly, stay up all night and do things sporadically without any real sense of focus. Additionally, people in this phase may become both frustrated and irritated by the ‘slow’ speed with which the rest of the world runs.
  2. The depressive phase: In this phase, people may appear either depressed or more ‘normal’.

Stress often triggers the manic phase, so in order to prevent this from happening, it’s best to try and remove as many stress-related factors as possible, and for those that are unavoidable, it’s best to keep relaxation techniques handy.

  • Cyclothymic disorder

This is a less severe form of bipolar disorder: the difference between the two phases is less pronounced due to the symptoms of the manic phase being less extreme (it is known clinically here as hypomania or mild to moderate mania) and the symptoms of the depressive phase are more immediate. Another major difference between true bipolar disorder and cyclothymic disorder is that the symptoms of the latter disorder tend to appear more irregularly and when they do appear, they last for a shorter period of time.

  • Psychotic depression

    Pic: http://www.boro.gr/contentfiles/photos/psyxologia/katathlipsh/psychoticDepression1.jpg

Occasionally, depression may be accompanied by losing touch with reality. Psychosis may be brought on as a side effect of a drug that they may be taking (whether illegal or prescribed) or it may simply occur without any other intervention in the brain as the result of another brain disorder such as schizophrenia.

Psychosis can involve two things: delusions and/or hallucinations, and religious overtones are often used in both cases due to the negativity often associated with these psychotic attacks.  

  1. Delusions are the belief that things are there when in reality they are not. A common example is paranoia i.e. the belief that people are either watching or following them, even when it is clearly not true, or the belief that they are the direct cause of all world evils.
  2. Hallucinations can be both visual or auditory (both seeing and/or hearing things that are not there, respectively).

How do you nip depression in the bud?

There are multiple approaches that can be used in order to help tackle depression, both pharmaceutical and non-pharmaceutical.

Pharmaceutical therapy

Pic: http://img.timeinc.net/time/daily/2008/0802/360_prozac_0226.jpg

If you believe that you are genuinely having trouble coping with whatever life throws at you, you could go to your local GP and they may prescribe you an anti-depressant. I must say this, though,  from first-hand experience with taking SSRIs, although these drugs can reduce the symptoms that you may be feeling, they are not guaranteed to make you feel better in the long term nor do they make you feel happy all the time as they do not tackle the elephant in the room that is triggering the depressive episodes in the first place.

Some drugs that you may be prescribed include SSRIs, SNRIs, RIMAs, TCAs, NARIs, NaSSAs or MAOIs. For more information about each of these specific classes of drugs, you can click here.

Not every anti-depressant is guaranteed to work on you either. Some people have adverse reactions to certain types of these drugs whereas other ones work beautifully with your unique biochemistry: I can testify to this as I once had taken Zoloft after I had my nervous breakdown and I felt completely flat emotionally, whereas when I switched to Lexapro I felt more like my old self again. Sometimes side effects such as headaches appear, but they usually disappear after a couple of days once your body has had adequate time to adjust. If they don’t disappear after a week, however, it’s best to discuss with your GP about alternatives. The antidepressant that you may end up with ultimately depends on your prior medical history.

Non-pharmaceutical therapy

There are multiple therapies which can be conducted between you and a counselor, a psychologist or a psychiatrist which can help determine the source of the depression. Before an appointment with a psychologist or psychiatrist, a mental health check must be conducted with a GP.  The types of approaches that the therapist may use include: 

  • Cognitive behavioural therapy or CBT
  • Behavioural therapy
  • Interpersonal therapy

Additionally, there are groups which you can join where sufferers can offload about their condition and discuss different methods with which to tackle them. These groups use techniques based on mindfulness based cognitive behavioural therapy. 

Recovery from Depression 

Graphic: Original
Graphic: Original

There are five distinct stages associated with recovery from depression, as this graphic below shows. Recovery is not an easy process as it forces you to dig deep into your psyche, and the statement ‘one size fits all’ does not apply here. Everyone gets better at their own pace depending on what triggered the depression in the first place, and the worst thing you can do to someone recovering from depression is to tell them to ‘get over it’: more often than not this kind of judgement can cause someone to relapse to an earlier stage. Some people recuperate rather quickly, whereas others get stuck at a certain stage and require help in order to get themselves past it.