The word ‘depression’ means different things in different situations. It is normal to feel stressed out when you have a lot on, or to have times when you feel a bit low when you’ve experienced a setback.
It is also normal to feel a little 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 that stands apart from the normal ups and downs of everyday life. Everyone has times in their life when things are hard, and when they don’t feel at their best. However, there is a point at which these things get out of control: depression.
How Do We Define Depression?
Gilbert (2007, p 5) defines depression across four different aspects of functioning:
(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, like those highlighted in the above diagram.
Causes For Depression
It is impossible to identify one particular cause for depression, as there are several 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, family history, lack of support, isolation, other mental health conditions (such as anxiety), use of alcohol and drugs, and many more, can all contribute to the onset of depression. However, it is not uncommon for people to experience depression without really knowing what the trigger or cause actually was.
Coping vs Not Coping
If our coping strategies are working well, and if the threats and challenges we face are not overwhelming, we can deal with the situation and move on. However, if the situation is more complex, or our coping strategies are less effective, then this normal stress response can go into overdrive and become 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, anger, and/or depression.
Anxiety problems can often occur in conjunction with, or prior to, depression, but it is possible to have one without the other. One of the crucial things to remember with both depression and anxiety is that they are self-reinforcing, meaning that they can lead to vicious cycles that continually spiral out of control if nothing is done to address them.
Even if you only have a few of the depression warning signs, it is worth learning more about depression and discovering ways of preventing it from getting worse. Managing stress levels and dealing with early signs of depression 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 actually depression that has changed you. You can find more information here about the ways in which depression can impact our relationships and physical health, for example.
Sometimes the tunnel vision brought on by depression means that you don’t realise just 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. Conversely, 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 at specific changes that may 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?
- Try writing your answers down if it helps
Your answers can provide very useful information for a doctor or other professional who you may 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 best for you.
Check the Warning Signs
The list below presents a number of warning signs for depression:
Having read this list, 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 above warning signs
- on most days over the last two weeks
Thoughts of death or suicide in particular should be taken seriously – get the help you need and deserve, and don’t let the feelings escalate.
Going to See My General Practitioner (GP)
Your doctor will want to assess the ways in which depression is affecting your daily functioning, and how severely. They are likely to ask you a number of questions about the changes you have noticed, and how long these changes have been taking place. Your completed Take Action worksheet will help you prepare for this discussion. Doctors really understand that putting your feelings into words can be difficult, and having something written down in preparation can help make it that little bit easier.
Two key ‘screening’ questions the doctor might ask are:
- During the last month, have you often been bothered by feeling down, empty 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 past 2-3 weeks and record on paper how often you have experienced each of the above warning signs relevant to you.
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.