Depression

More than the blues

Life is full of emotional ups and downs, and everyone experiences the blues from time to time, but when the downtimes last for a longer time or interfere with your ability to function at home, at work, or in any other area of life, you may be going through a phase of depression.

Depression affects your mood, mind, body, and behaviour. Research has shown that 5 – 6% of the population will develop a depressive disorder during the course of their lives and nearly two-thirds do not get the help they need. Treatment can alleviate the symptoms in over 80% of cases. Yet, because it often goes unrecognised, depression continues to cause unnecessary suffering.

What is depression?

Depression is not the same as a transient blue mood. It is not a sign of personal weakness or a condition that can be willed or wished away. People with depression cannot merely pull themselves together and get better. Without treatment, symptoms can last for weeks, months, or years.

However, appropriate treatment can help most people who are challenged with depression.

What causes depression?

Just as depression takes many different forms, it has many possible causes. In fact, depression is often caused by a combination of factors.

Why does one person become depressed while another remains unaffected under the same circumstances? There is no clear answer. For each individual, there is a complex, individual pattern of factors that work together to either allow or prevent depression at any given time.

Sometimes it is possible to point to a specific event (or events) that seem to have triggered a depression. Other times depression emerges for no apparent reason, even for individuals whose lives are going well.

Depression is not caused by any genetic or biochemical factors. Depression is caused by a helpless feeling of anger and a hopeless future.

Anger without enthusiasm

The father of Psychology, Sigmund Freud once said: depression is anger without enthusiasm. Once a person suffers from depression, it might mean that they might be angry at something or someone, but for some reason incapable of doing anything about it.

You may just be suppressing anger – to de-press it for several reasons:

1. You may feel helpless and powerless to deal with the anger related to past experiences that are over and done with and yet you feel powerless.
2. You may be angry at someone in a superior position, like a father or a mother, even a boss or the government, but feel helpless to do anything about it.
3. You may even have a spiritual anger. Anger towards God (or how you understand spirituality) may be present, feeling unable to do anything about your anger since you cannot do anything to revenge on the Divine, and a feeling of helplessness since nothing can be done to express this anger, rather than suppressing your anger.
4. You may be driven by guilt, therefore unable to express anger. It is generally regarded as a sinto be angry.
5. You might also be driven to fear the consequences of your anger, whether it be an irrational fear of rejection, abandonment, not feeling worthy, or any other so-called irrational fear.

Below is a list of all the different types of depression.  As you go through the list, keeping anger without enthusiasm in the back of your mind, you may start to develop critical questions deep within yourself about certain repressed anger you might experience, but not allowed. It may initially not make sense but trust your subconscious mind to tell you that there is something wrong.

You’re in good company

Depression can affect anybody. It is just not true that only weak people may become depressed. Depression is prevalent and can happen to anyone of us and can affect anybody.

Smart, brilliant, famous individuals and those who made significant contributions to humanity were simply human, and many of them were challenged with depression.  

Typical examples of famous people who suffered from depression are (to mention just a few):

• Winston Churchill, known for his reference to depression as the black dog following him. He was challenged with difficult and important decisions during the Second World War, especially when all the odds were against Britian;
• Ludwig von Beethoven, one of the greatest composers of all time became depressed after he learned he was becoming deaf since music was his life;
• Vincent van Gogh, one of the greatest artists in history had a history of depression, psychosis, and bipolar mood disorder;
• Leo Tolstoy, Russian writer, and author of most of the influential works of all time. He was so depressed and critical of himself for not having the courage to commit suicide. This caused him to write a book called A Confession, a most memorable book;
• Abraham Lincoln’s life was marked by numerous traumas, including the death of two of his sons at a young age, and his own experience of depression, yet he went on to become the President of the United States of America.
• Ernest Hemingway, one of the greatest authors of our time, committed suicide;
• Michaelangelo took longer to finish his works due to his depression, he had few friends, and did not even attend his own brother’s funeral, yet he painted some of the greatest paintings in history.

Depression does not have to be a condition. And it is certainly not a condition for weak people. All the above-mentioned historical characters had all the reasons in the world to let depression get the better of them, but they decided nonetheless to utilise their depression and made decisions not to become victims, but to become survivors or champions.  You too can utilise your anger to become enthusiastic.  That was the result of Churchill’s choice to win the war.  They were all artists, politicians, and authors who all contributed to society. It was the result of Beethoven’s choice to compose his Eternal Fifth Symphony, which was used as the theme song of the Allies when they decided to win the war. 

Different types of depression

There are many different types of depression. If you think you might be depressed, you may be asking yourself: what type of depression do I have?

Gaining a deeper understanding of the different types of depression can help to begin the journey to understanding and recovery.

• Major depressive disorder (clinical depression)

The DSM 5 outlines the following criteria to make a diagnosis of depression. The individual must be experiencing five or more symptoms during the same 2-week period and at least one of the symptoms should be either (1) depressed mood or (2) loss of interest or pleasure.

1. Depressed mood (feels sad, empty, or hopeless) most of the day, nearly every day
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
3. Significant weight loss when not dieting, or weight gain, or decrease or increase in appetite nearly every day
4. Insomnia or hypersomnia nearly every day
5. Psychomotor agitation (feelings of restlessness) or retardation (feelings of being slowed down) nearly every day
6. Fatigue or loss of energy nearly every day
7. Feelings of worthlessness or excessive or inappropriate guilt nearly every day
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day
9. Recurrent thoughts of death, recurrent suicidal ideationwithout a specific plan, or a suicide attempt or a specific plan for committing suicide

To receive a diagnosis of depression, these symptoms must cause the individual clinically significant distress or impairment in social, occupational, or other important areas of functioning. These symptoms must also not be a result of substance abuse or another medical condition.

Major depressive disorder is associated with high mortality, much of which is accounted for by suicide. As a result, if you think someone you care about may be suffering from depression it is important to know the warning signs of suicide and to take suicidal statements extremely seriously. An active statement by someone with suicidal ideation might be something like, I’m going to kill myself, but other passive statements such as, I wish I could just go to sleep and never wake up, are equally worrying. If someone with depression exhibits these verbal markers, encourage them to consult a mental health professional immediately.

Depressed individuals also present with irritability, brooding, and obsessive rumination, and report anxiety, phobias, excessive worry over physical health, and complaints of pain.

The latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the DSM 5, added two specifiers to further classify diagnoses:

• With mixed features – this specifier allows for the presence of manic symptoms as part of the depression diagnosis in patients who do not meet the full criteria for a manic episode.
• With anxious distress – the presence of anxiety in individuals may affect prognosis, treatment options, and the individual’s response to them. Clinicians will need to assess whether or not the individual experiencing depression also presents with anxious distress.

Major depression is manifested through a combination of symptoms that interfere with your ability to work, sleep, eat, and your enjoyment of pleasurable activities. These disabling episodes of depression can occur once, twice, or several times in a lifetime.

• Dysthymia (persistent depressive disorder)

Dysthymia is a long-term form of depression that lasts for two years or longer.   The symptoms of dysthymia are not as severe as those of a major depressive disorder but still evoke feelings of sadness, hopelessness, and loss of pleasure. It can interfere with daily life, work, and relationships.

People with dysthymia may appear to be fully functional, but they might often find it difficult to be happy even on typically joyous occasions. They may be perceived as gloomy, pessimistic, unsatisfied, or always complaining. Unlike major depressive episodes, their symptoms can come and go over time, and the intensity of the symptoms can change, but symptoms generally don’t disappear for more than two months at a time.

• Bipolar disorder (manic depression)

Bipolar disorder can cause extreme fluctuations in mood and changes in energy, thinking, behaviour, and sleep. You might go through cycles of feeling low and down in the dumps the one moment, followed by periods of euphoria and boundless energy, only to be succeeded by the next period of sadness and depression.  This is a rollercoaster of emotional extremes.

I am discussing this challenge in more depth in my article on Bipolar mood disorder on this website.

• Postpartum depression (peripartum depression)

Some women may experience sad feelings and crying bouts after the birth of a child.  This is more commonly known as the baby blues. Many women who gave birth, struggle with sadness, anxiety, or worry. Signs and symptoms of PPD include:

–  feeling down or depressed for most of the day for several weeks or more

–  feeling distant and withdrawn from family and friends

–  a loss of interest in activities (including sex)

–  changes in eating and sleeping habits

–  feeling tired most of the day

–  feeling angry or irritable

–  having feelings of anxiety, worry, panic attacks, or racing thoughts

Postpartum depression may be the result of a variety of factors including the physical changes resulting from pregnancy; anxiety about parenthood; hormonal changes; previous mental health problems; lack of support; drug abuse, a complicated pregnancy or delivery, and/or changes to the sleep cycle of the mother.

• Seasonal depression (seasonal affective disorder)

Seasonal affective disorder is a type of depression related to the change of season. They may experience symptoms of depression, such as hopelessness, fatigue, and loss of interest or pleasure in activities during a certain season, normally winter. It can also happen in summer, especially in the Southern hemisphere where Christmas is celebrated in summer, and the individual may be reminded of the loss of loved ones during the festive period. Seasonal depression may also be a constant reminder of a lost one during the anniversary of the time of loss every year on that specific date.

• Psychotic depression

Around 20 percent of people with depression have episodes so severe that they develop psychotic symptoms. Psychosis is a mental state characterised by disorganised thinking or behaviour; false beliefs, known as delusions, or false images or sounds, known as hallucinations.

Psychosis refers to the period when a person first starts to appear as though they are losing contact with reality. The early signs of psychosis include delusions or hallucinations, inappropriate emotions, trouble thinking clearly, a decline in personal hygiene, and a drop in performance.

• Premenstrual dysphoric disorder (PMDD)

Premenstrual dysphoric disorder may also be related to a depressed mood and anxiety. For a PMDD diagnosis, a woman needs to have exhibited symptoms in the majority of menstrual cycles over the past year, with a noticeable impact on work or social functioning.

Premenstrual dysphoric disorder (PMDD) is a more serious condition than premenstrual syndrome (PMS). The symptoms present with PMS do not generally interfere with everyday function and are less severe in their intensity. While it is normal for women to experience fluctuation in mood in the days leading to menstruation, the psychological symptoms of severe depression, anxiety, and suicidal thoughts do not occur with PMS.

• Atypical depression

People suffering from atypical depression do not necessarily show the typical symptoms of depression. People suffering from atypical depression may not experience persistent sadness or hopelessness, yet they may experience symptoms of oversleeping, overeating, irritability, heaviness in the arms and legs, sensitivity to rejection, and relationship problems.

• Situational depression (reactive depression)

Situational depression, also known as reactive depression or adjustment disorder, is a short-term, stress-related type of depression. It can develop after a person experiences a traumatic event or a series of changes to their everyday life.

Everyday traumatic experiences, such as divorce, retirement, loss of a friend or loved one, career change, moving house, illness, and relationship problems may cause situational depression. Situational depression can also be regarded as a type of adjustment disorder.

This type of depression is normally a short-term episode and will subside once the stressor diminishes or subsides.

• Disruptive mood dysregulation disorder (DMDD)

DMDD, diagnosed primarily in children, is a form of depressive disorder characterised by difficulties in regulating moods and emotions in an age-appropriate manner.  Children with DMDD exhibit frequent temper outbursts in response to frustration, either verbally or behaviourally. In between outbursts, they experience chronic, persistent irritability.

Is depression an illness?

Depression is often described as the illness of our time.

First of all: depression is not an illness. People are not depressed because of genetic factors, circumstances, other people, history, etc.  You can never be depressed. You can only become depressed through the choices you make. You can decide to be a victim or an ingenious survivor of everything that happened to you throughout your life.

The first step to overcoming depression is to recognise that you are not a victim, but that you are angry and that you have a right to be angry and to act out your anger.

Treatment

Depression is one of the most treatable disorders. Between 80 and 90% of all people doing depression respond to treatment and nearly all depressed people who receive treatment see at least some relief from their symptoms.

Many people think that depression will go away if the sufferer just makes an effort to think positively or to go out and enjoy themselves. This lack of understanding can cause the depressed person feel even more helpless, isolated, and angry. It also means that people with depression are often reluctant to tell their friends and colleagues about their condition.

Therapy, including BWRT, hypnosis, and NLP can help you uncover your anger and empower yourself again by allowing you to experience your suppressed anger, act out on it, and give your anger enthusiasm again. To put you back in control again. After expressing and embracing your anger, forgiveness will arise more easily and spontaneously.  Please refer to my article on Forgiveness on this website.