It is also normal to feel a bit nervous or anxious about challenges, such as exams or presentations. These are signs that our body’s natural stress response is functioning normally. It can be difficult to identify depression because it isn’t a separate state of existence, totally different from the everyday ups and downs of life. Everyone has times in their life when things are hard, and when they don’t feel at their best.
How Do We Define Depression?
Gilbert (2007, p 5) defines depression across four different aspects of functioning:
- Motivation: apathy, loss of energy and interest – things seem pointless and hopeless
- Emotional: depressed mood plus emptiness, anger or resentment, anxiety, shame, guilt
- Cognitive: poor concentration, negative ideas about the self, the world and the future
- Biological: sleep disturbance, loss of appetite, changes in hormones and brain chemicals
(Gilbert, P. (2007) Psychotherapy and Counselling for Depression – 3rd Edition. London: Sage)
Like anxiety, there are different ‘types’ of depression diagnostically, but all are associated with similar presenting experiences, including:
- Loss of appetite or overeating
- Insomnia or hypersomnia
- Low energy or fatigue
- Low self-esteem
- Poor concentration or difficulty in making decisions
- Feelings of hopelessness
Causes for Depression
It is impossible to definitely say there is one particular cause for depression, as there are many different triggers. Likewise, it is impossible to say there is a definitive risk factor, that predisposes one person to depression above another. We all have our mental health to attend to and can all experience difficulties in our mental health, as we can our physical health.
Traumatic experiences, a family history, lack of support, isolation, other mental health problems (such as anxiety), use of alcohol and drugs and so on, can all play a part in becoming depressed. However, it is not uncommon for people to experience depression without really knowing what the trigger or cause was.
Coping vs not coping
If our coping strategies are working well, and if the threats and challenges are not overwhelming, we can deal with the situation and move on. However, if the situation is more complex, or our coping strategies aren’t effective, this normal stress response can go into overdrive or get overloaded. A period of chronic stress can quite often be the starting point for things escalating. This is when we may start to experience problems with chronic anxiety or anger and/or when we can start to get depressed.
Anxiety problems quite often occur leading into or alongside depression, but it is possible to have depression without significant anxiety. Because both anxiety and depression work in self-reinforcing spirals they can easily become worse and worse if nothing is done.
Even if you only have a few of the depression warning signs it is worth learning more about depression and to get tips for how to prevent it getting worse. Managing stress levels and dealing early with any sign of problems is very important for everyone’s mental health.
Not feeling yourself?
Sometimes, depression brings quite obvious changes. It is almost as if you can’t recognise yourself anymore. You might look at this new self and not like what you see, not realising that it is depression which has changed you. You can find out more information here about the effects of depression on our relationships and physical health , for example
Sometimes the tunnel vision brought on by depression means that you do not realise how much you’re being affected. In this case, it can be friends, family or others who point out that you’re different or that something isn’t right.
The changes depression brings will be different for each person. The changes may feel very subtle and internal, with the ‘public’ you seeming to go on as normal. Or the changes may be obvious and dramatic. It may feel as if you have been very suddenly affected, or you may look back and notice a long, slow slide down into depression.
What changes can you identify?
If you think depression may be affecting you, it would be useful to look more carefully for what specific changes have taken place in your life:
- Think back to when you feel fairly sure you weren’t being affected by depression (say 6 months ago, but it could be longer than this).
- Now reflect on each area of your life: work, social life, family relationships, sex life, and so on.
- Go through each area and note the changes: how is this area of your life different now from what it was like then?
Your answers can provide very useful information for a doctor or other professional who you go to for help. The downloadable Take Action worksheet has a checklist for noting down your answers, which you can then take with you to an appointment. It can also help in trying to work out why depression is affecting you, and in choosing strategies for tackling depression and finding what works for you.
Check the warning signs
The list below represents a number of warning signs for depression:
- Persistently sad, anxious, empty or generally low mood
- Loss of interest/pleasure in doing things
- Lethargy/decreased energy
- Problems with sleep (including too much)
- Appetite/weight changes
- Increased tearfulness
- Poor concentration/difficulty with decisions
- Feeling bad about yourself, guilty, or helpless
- Restlessness or being fidgety, or else markedly slowed down
- Thoughts of death or suicide
Going to see my General Practitioner (GP)
Your doctor is likely to ask you a number of questions about the changes you have noticed, and how long these changes have been happening for. Your completed Take Action worksheet will help you prepare for this discussion. Two key questions they might ask (‘screening questions’) might be:
- During the last month, have you often been bothered by feeling down, depressed or hopeless?
- During the last month, have you often been bothered by having little interest or pleasure in doing things?
Try also to provide very specific recent information too. Think back over the most recent two weeks and record how often you have experienced each of the warning signs relevant to you. It is likely that depression is affecting you if you have experienced:
- a persistently sad, low, anxious or empty mood, plus
- at least four more of the warning signs
- on most days over the last two weeks
A doctor would also want to assess in what ways and how severely depression is affecting your daily functioning.
Take it seriously and get help
If, having read this information, you believe you might be struggling with depression, then it is important to seek help. Depression reinforces itself in a downward spiral of worsening mood, and can be a serious and dangerous condition if left untreated.