Depression is the name given to the circumstance where 5 or more of the following symptoms stack up for two weeks or more and it’s not due to grief or substance abuse or other mental health issues. It’s depression, rather than simply “the blues” when it has a significant impact on your life and functioning.
- Depressed mood, feeling sad or empty or tearful
- Loss of interest in activities you used to enjoy
- Changes in weight or appetite not due to a specific health intervention
- Problems sleeping or sleeping too much
- Being slowed down or being restless and keyed up in your body
- Fatigue and loss of energy
- Feeling worthless or inappropriately guilty about things
- Difficulty concentrating or making decisions
- Thoughts of death or suicide
There are different types of depression and levels of impact on functioning.
In many cases depression results from too much stress over a long period of time. Our stress hormones such as adrenalin, cortisol and norepinephrine over function and whilst all the activity is centred in the stress management part of the brain, we get less blood flow and electricity to the smart brain, our frontal cortex. This means it is more difficult to see things in perspective. We tend to get stuck in thought loops that over estimate how bad things are and how bleak the future is. It is more difficult to be open to new moments and new experiences as the part of the brain that helps us with context (hippocampus) may become reduced in volume and effectiveness.
Depression can be seen as a protective response and often involves a lot of avoidance behaviour, withdrawing from social situations, goals and other life challenges in order to protect the person from potential blows to self-esteem and emotional balance that the person feels under-resourced to deal with.
There is a strong link between serotonin deficiency and depression, although the true nature of this relationship is still being understood. Seratonin is a neurochemical transporter in the brain that helps different parts of the brain talk to each other to manage functions such as mood, sex, appetite, sleep, learning and memory. This is the reason anti-depressants are often prescribed as a treatment for depression. Medications such as SSRI’s (Selective seratonin reuptake inhibitors) and SNRI’s (Serotonin–norepinephrine reuptake inhibitors) help make serotonin more readily available in the synapse between cells to support communication.
Non-melancholic depression: often results from an accumulation of life stressors and a gradual reduction in coping capacity or resources. Usually responds well to talk therapy and lifestyle changes.
Melancholic depression: more biological in nature, often manifests through a combination of genetic pre-disposition as well as stressful life events. Tends to benefit from anti-depressant support either for coping during periods of high stress or sometimes necessary for longer periods. Stability of lifestyle and general health and wellbeing practices very important.
Cyclothymia, Bi-polar 2 and Bi-polar 1 – under these scenarios you may experience periods of markedly elevated mood, as well as periods of stable or low mood. Sometimes the mood is more irritated than elevated, they key feature is the increased arousal. The periods of elevated mood will be associated with three or more of the following experiences and cause some disruption to your emotional stability and life management.
- Inflated self-esteem, grand sense that you can take on the world and achieve anything
- Less need for sleep
- More talkative than usual
- Rapid flight of thoughts and ideas
- Easily distracted
- Increase in goal-directed activity or agitation
- Participation in risky pleasurable activities that may have painful consequences, for example spending sprees, sexual indiscretions or foolish business investments
Managing a cycling type of depression involves tracking your moods and triggers and becoming very aware of the situations that trigger a change in mood – such as a late night, poor diet or stressful interpersonal interaction. Maintaining a stable and healthy lifestyle is important. There are also decisions to be made about medication, which most people find helpful in managing this kind of cycling depression. We also explore negative coping behaviours that may be impacting your wellbeing, such as alcohol or substance abuse.
Managing and healing from depression:
Everyone is different. My first goal is to listen to you and really hear how things are for you, what symptoms you are experiencing, how your life is being impacted by depression, what strengths and resources you have within you and around you. In session, we may use some or all of the following approaches:
- Diagnosing depression and the type of depression
- Uncovering the negative thoughts and core beliefs that impact your mood
- Evolve your thinking to be more realistic and supportive
- Make gradual changes to nutrition, exercise, sleep, rest
- Gradually increase the range of circumstances in life where you can safely use an approach strategy, not an avoidance strategy
- Improve communication and support available through relationships
- Enhance your exposure to pleasurable life events
- Get clear about your personal strengths and consciously engage them
- Tap into your values and what really matters to you in life
- Increase the actions you are taking in line with your values
- Review sleep practices to ensure you maximise your chance for a good night’s sleep
- Accept that healing may take some time and celebrate the small gains along the way
- Consider meeting with an integrative doctor to check for nutritional deficiencies or hormonal imbalance that may contribute to mood issues
- Be mindful of any enhanced self, life or spiritual awareness that comes as a result of changed circumstances
More information about depression here.
Black Dog Institute self-test for depression here.
Black Dog Institute self-test for bipolar disorder here.