A Few Thoughts on Depression
The World Health Organisation estimates that depression affects 300 million people worldwide. In the UK the number affected nears 3 million. We also know that 50% of those suffering from one episode of depression will experience a relapse. Episodes can last an average of 6-8 months. To complicate matters further, depression and associated psychological symptoms of low mood, low self-esteem, ruminating thought patterns, shame and guilt, often result in unhelpful, yet understandable, attempts to cope.
Some of these maladaptive coping strategies may include drug and alcohol use, isolating from previously supportive networks, self-harm and even, for 6000 people in the UK each year, suicide. We know from research that objectively, some of these methods are unlikely to be effective. For example, research by Baumeister and colleagues has shown that a sense of belonging is a basic human need, the absence of which, can have negative psychological effects. Most of us are aware of the anti-depressant effects of cardiovascular exercise due to the brain’s release of endorphins. The problem however seems circular; depression’s symptoms include fear, guilt, shame, lack of energy and a tendency towards avoiding others yet we are asked to do the things which we feel least capable of doing. How can we be expected to go for a run when we can’t sleep and have no energy or motivation? How do we find the strength to socialise and develop a sense of belonging when depression is telling us we are worthless and inadequate?
I am not suggesting that knowing what is good for us isn’t helpful. There are times when we feel lethargic and can still pull off a short brisk walk in the woods or a 10-minute run. At other times we feel inadequate yet manage to find the motivation to attend a social engagement, even of just for a couple of hours, and feel better for it. What I am saying is that sometimes depression’s grip can be so physically and psychologically paralysing that we may need to speak to a professional with experience in treating depression therapeutically.
Although medication such as SSRI’s play an important role in the treatment of depression the recommended treatment usually includes talking therapies. As a psychotherapist, counsellor and addiction therapist I will highlight how talking therapy may be able to help.
One way in which therapy can help is in making sense of what key experiences have contributed to becoming depressed. You may have felt unable to cope with and process a loss, betrayal or disappointment. Maybe certain beliefs about who we are, and how others perceive us, are contributing to our depression. Sometimes we have no idea of what the impact of our childhood experiences is having on our mental health since we tend to normalise and justify these for fear of blaming or judging those who in many ways cared for us growing up. The right therapist will work with you and help you understand how things are impacting you and look at ways to process them.
You may come to understand what internal and external triggers put you at risk. Internal triggers can include beliefs, attitudes and unrealistic expectations of self and others whilst external triggers may include certain people in our lives as well as our environment. You will also be able to explore some of the coping mechanisms that may not be working for you and introduce new ways of coping which are supportive of your well-being.
Depression often carries stigma and shame. We somehow feel responsible for our depression in ways that would make no sense with most physical illnesses. Few of us would blame ourselves for having appendicitis but we somehow feel that we are to blame for feeling depressed. I have often heard clients say things along the lines of “I have such a good life. I shouldn’t feel this way!”. Unhelpful social beliefs which confound depression with sadness aren’t very helpful either and contribute to the stigma. “Snap out of it!”, “chin up!” we hear people say. As Stephen Fry puts it, “asking someone what they have to be depressed about is like asking someone with cancer what they have to be cancerous about”.
After having worked with hundreds of clients suffering from depression over the years, I am aware of how big a step it can be to seek professional support. Depression, as we have seen, is often characterised by lack of motivation, lethargy, fear of social contact and negative thinking. These symptoms are likely to influence our decision-making process when it comes to accessing therapy. We may wonder if therapy would help in any way or we might find it impossible to imagine being open with a stranger. At The Practice we are aware that not everyone will feel able to take that step. This is why we think it’s essential to offer a free and confidential opportunity to call or email our experienced staff with any questions. We also offer sessions via the phone and on Skype in case attending a face-to-face session straight away feels like too much for you.
If you are feeling depressed, there is support available. Please look at our website for a list of additional resources that may be of support for you. I have also added a list of books which I often recommend to my clients as a way of understanding depression.
Matt Haig, Reasons to Stay Alive
Johann Hari, Lost Connections: Uncovering the Real Causes of Depression – and the Unexpected Solutions
Dr Steve Ilardi, The Depression Cure: The Six-Step Programme to Beat Depression Without Drugs
Dr Linda Gask, The Other Side of Silence: A Psychiatrist's Memoir of Depression