Welcome to the first article in our series our Managing Mental Health series. In this series, we’ll be de-mystifying a number of mental health conditions to find out what living with and managing a mental health condition is really like. In this article, we explain depression and how it can be managed.

What is depression?

Depression is one of those words that many of us often use, but rarely mean in a literal sense. We say we are depressed to mean feeling fed-up, bored or just lacking energy. But that’s not really what the word means. It’s far more severe than just feeling ‘down’. Depression is a persistent low mood and loss of interest in everyday things that impairs normal day-to-day functioning.

A low mood is not depression. Low moods improve over time and are often short-lived. Depression is more long-term and far more difficult to overcome than typical experiences of sadness. Depression is deemed chronic if it lasts for more than two years and women are twice as likely to develop depression as men. We should be a little suspicious of taking this at face value though, as women will generally report a mental health condition more often than men. It’s not that men have better mental health than women, they’re just not seeking support as often as they should.

It’s normal for us to feel down every once in a while, due to a lapse in confidence and even longer-term feelings of sadness associated with bereavement, loss and relationship breakdowns are also normal and to be expected. Unhappy events are part of life, after all and it’s normal for feelings of sadness to result from them. However, continual feelings of sadness not associated with any particular event may be a sign of clinical depression. If you feel sad for no obvious reason, then it’s possible you are dealing with clinical depression.

These feelings of sadness might also be accompanied by a loss of interest in things you used to enjoy. There may be a general irritation and intolerance towards others. There may also be difficulties associated with sleep such as waking early and not being able to get back to sleep and trouble getting to sleep or even sleeping excessively. There may be the feeling that life is not worth living and of wanting to die. It’s important to know that someone with depression is not weak if they feel like this. They are dealing with an illness that can be debilitating. Carrying on in the face of this shows true strength – certainly not weakness.

Depressive feelings and behaviours

Depressive feelings include guilt, shame, sadness, anxiety, irritability, apathy and helplessness. A depressed person will have consistently low moods characterised by these negative feelings. They may also experience a total enveloping darkness in which they feel like they are suffocating or drowning.

A constant lack of energy or apathy may result in a person with depression just wanting to pull the covers over their head and hide from the rest of the world. Depression can result in loss of or increase in appetite so weight loss or gain may be likely. Working and social activities may becoming increasingly difficult as the inability to concentrate or make decisions in normal situations. Their sadness and feeling of utter helplessness may result in them withdrawing from social events and becoming more and more isolated and feeling very lonely.

Psychotic depression

Between ten to fifteen percent of people with severe clinical depression will go on to develop psychotic depression. This is characterised by hallucinations and delusions. It is unclear why some people suffer from psychosis and others do not. Consequently, it’s hard to tell which of those suffering from severe depression will go on to develop psychotic depression. 

Factors associated with psychotic depression include:

  1. Delusions and hallucination that reflect their depressed mood. These feelings are usually negative, self-critical, self-punishing and self-blaming making people feel more anxious.
  2. Psychomotor agitation which means they are unable to sit still. If those suffering from psychotic depression experience acute or severe anxiety this could lead to psychomotor movements such as fidgeting, rocking or moving their legs a lot.
  3. People suffering from severe psychotic depression can become detached from reality. Psychotically depressed people experience paranoia or believe that their thoughts are being controlled or listened to.

Possible causes of depression

There are a number of factors that can cause depression. These can be categorised as biological, psychological or social. It is very often a combination of these factors rather than one specific reason which leads to depression.

Biological factors include a change in brain chemistry, genetics, hormonal factors and physical illness. Depression is not purely a change in brain chemistry, although this is often associated with depression. A chemical imbalance in the brain may well be a consequence of depression rather than a cause. Hormones also contribute to positive and negative emotions and moods. Depression may even have a genetic component where it runs in families. Depression is also more common amongst people experiencing physical illness.

Exercise is not only for physical health. It also improves mood through the release of endorphins. Food can also affect our mental state, as certain foods contain essential fatty acids that are good for the brain. Misuse of alcohol and other substances can cause depletion of these fatty acids.

Social factors at play include life experiences and lifestyle factors such as diet, exercise and substance misuse. Depression can be triggered by stressful experiences such as grief from the death of a loved one, especially in someone with a history of being depressed. Physical illness can also be a precursor to depression. Feel unwell for long periods or finding oneself at a constant low ebb can be a tremendous emotional strain. In some cases, medication prescribed for a condition can also increase the risk of depression. Life-changing events such as puberty, retirement, unemployment, divorce, starting a new job, the birth of a new child, getting married, moving house or even going on holiday can be overwhelming for some people. Financial worries over debt and the threat of poverty, as well as poor living conditions and homelessness, can all be causes of depression.

Psychological factors include learned negative thinking styles and coping mechanisms. Children pick up these from their parents or primary caregivers. Bringing a child up in a positive, supportive environment where the day-to-day challenges of life are seen as normal and to be coped with will equip them with psychological coping mechanisms that will stand them in good stead later in life.

Cultural attitudes also play their part. The expectations of others that adopt the attitude of “grin and bear it”, or “keep calm and carry on” may exacerbate issues for some rather than help.

How depression affects the individual and others

Depression can affect people in every aspect of their life. It may be seen as poor performance at school or work, withdrawing from social activities, distancing themselves from friends and family, and relationship breakdowns. The individual will often become isolated.

Physical health problems may be increased from poor diet and lack of exercise, so a lowered resistance to the common cold may be experienced or the inability to relax and therefore not being able to sleep, which leads to low energy levels during the day and left with the feeling of being wiped out. Untreated depression will also lead to memory loss, thoughts of all impending doom and being preoccupied with suicide attempts. there may be attempts at self-medication using legal or illegal drugs, which can make the symptoms worse.

It is not easy to be around someone with depression. Living with someone who suffers from the symptoms can be difficult and exhausting. Feelings of inadequacy such as “I’m rubbish”, “nobody loves me” and “there’s no point in going on” may result in friends and family becoming more and more frustrated thus leading on to arguments. With a lack of interest in things that used to be pleasurable or expected of them, such as leisure pursuits with friends or having a lack of interest in their home surroundings, becoming typically more withdrawn and uncommunicative and irritable, this leads to friends and family actively avoiding the depressive person because of their negative mood or irritability and this an make things worse. Unfortunately, this often results in the depressed person feeling more isolated and intensifying the depression.

Managing depression

There are a variety of resources and treatments that can help people suffering from depression. A combination of different approaches often works best.

Local resources  

Resources available to individuals with depression include self-help groups where people are encouraged to talk to each other about what they may be feeling and offering each other face to face support. If facing others proves to be too much then there are online alternatives where conversations can be had anonymously.

A Community Mental Health Team (CMHT) can do home visits. This team may include a psychiatrist, community psychiatric nurse, social workers or peer support workers. Crisis resolution services – teams of doctors and nurses who provide support so a person can stay at home in times of crisis. There are also countless books providing resources for self-help these are available online, in shops and local libraries

Treatments  

A GP can prescribe medications such as the antidepressants Citalopram, Fluoxetine or Sertraline. This may also be in conjunction with regular counseling.

There are self-help treatments such as learning relaxation techniques and meditation to control stress. A balanced diet and exercise to release the ‘feel good chemicals’ endorphin, oxytocin, serotonin, and dopamine can help. 

Managing psychotic depression

Psychotic depression often requires hospital care and ongoing check-ups by a mental health professional. The Community Mental Health Team may be involved as an alternative to hospitalisation so support will be given in a person’s home. Psychological therapies should also be part of a package for severe depression according to The National Institute for Health and Clinical Evidence.

Treatments for psychotic depression are a combination of antidepressants and antipsychotic medications, which have proved to be effective in reducing the symptoms. Psychotic depression treatments include electro-convulsive therapy, where an electric current is passed through the brain, and only given with a patients consent. This treatment is only used if urgent intervention is required or that no other treatments have helped. These treatments are effective and psychotic depression can be recovered from but this takes time.

Learn more

To find out more about depression and other mental health conditions, you can get started with our bite-size Mental Health Awareness online course.

Delphis also offers on-site mental health workshops delivered and developed by highly educated business managers, academics and teachers. We guide companies along the path to creating mentally healthy, productive and rewarding working environments for their staff. The financial argument is compelling and caring for your employees is the right thing to do.

One major multi-national client says this about our workshops:

“Very relevant and informative with an engaging and inclusive style. Worth spending a whole day on. Loved the takeaway workbook, pretty much perfect, we  need to roll out to whole company.”

Get in touch to discuss how we can provide customised mental health training for your organisation that fits your needs.