Stress and Depression

INTRODUCTION

Conditions like anxiety and depression are the commonest forms of psychological health problems that we can suffer. The Royal College of Psychiatrists have estimated that 1:4 adults in the UK will develop anxiety and or depression at some point in their lives, and its been estimated that 3 million people in the UK suffer depression. The World Health Organisation has estimated that globally, nearly half a billion people suffer psychological health problems. In fact depression is so common that its often referred to as the common cold of the mind.

Despite so much suffering, there is still a lot of myth and confusion about depression which can impede successful treatment and recovery.

WHAT IS DEPRESSION

One of the major obstacles concerning depression is that the term "depression" is used by the public as an umbrella term to describe anything from the usual blues, that we can all suffer from time to time (and is not clinical depression), right up to suicide. To try to say that the blues is the same as real clinical depression is like trying to compare the common cold with pneumonia. It is partly due to this lack of knowledge that alot of depression goes undiagnosed and untreated. Depression is under-diagnosed and for 15% of people it can be fatal if not treated.

CAUSES OF CLINICAL DEPRESSION

Depression is a very complex condition and there is still so much we do not know about it, but gradually researchers are beginning to unlock the secrets of this condition. Very rarely is one disease caused by one factor alone and this is very true of depression. The research so far indicates that depression is caused by a matrix of interacting biological and psychological factors such as:-

genetic predisposition; chronic stress; certain physical diseases like diabetes can increase the chance of developing depression; poor diet; alcohol and substance misuse; gender; poverty; unemployment; difficult childhood; certain medications can exacerbate depression; biological imbalance of certain hormones in the brain like serotonin, noradrenaline that influence mood; etc.

It is not due to weakness, and you cannot just "snap out" of it.

THE BRAIN AND DEPRESSION

David Ornstein in his book "The Healing Brain" said, we tend to think of the brain as solely an organ for rational thought, but it's not. The brain also manufactures potent hormones that exert a very powerful influence on our physiology and biochemistry. One of these is called serotonin, which has been shown to have a powerful effect not only on our mood but also influences our perception of pain, motivation, sleep, appetite, sex, etc.

Researchers have found that people with depression have lower levels of serotonin. This is one of the biological causes of depression. Research has also indicated that there are psychological factors involved in the development of depression, such as excess anxiety and stress, which influence our brain biochemistry and predispose us to developing depression. One of the hormones that is secreted when we suffer chronic stress is called cortisol, and in excess levels, cortisol has been shown to inhibit the production of serotonin.

However it's not that simple, because not everyone who is chronically stressed will develop depression; but if you have a genetic predisposition to depression and then add chronic stress, then you are more at risk of developing depression.

SIGNS AND SYMPTOMS OF DEPRESSION

Depression can be a stealthy illness; we don't go to bed one night well and wake up the next morning clinically depressed, it can be a slow, gradual slide into depression.

Research has indicated that 50% of people with depression go undiagnosed and therefore untreated. The reasons for this are many but one is that there are different severities of depression; with Dysthymia people are often still functioning and so it is not detected. Some people can exhibit their depressed symptoms on a mainly physical level - like insomnia, back pain, etc, whereas another person with depression may have more psychological symptoms such as withdrawal. Because of the unfair stigma that is attached to psychological conditions, people can be reluctant to admit they are clinically depressed.

Symptoms below are from Diagnostic and Statistical Manual Mental Disorders DSM-IV, 1994:

More often that not, I am depressed for most of the day
I have lost my enthusiasm for most activities
I have problems sleeping (insomnia, early morning wakening, excess sleep)
I feel tired or fatigued for most of the time
I have a low opinion of myself. I usually feel worhless or guilty
I am unable to concentrate; I am indecisive
I feel overwhelmed; I feel a sense of hoplessness
I feel either edgy or slowed down
I have suicidal thoughts. I don't want to be here anymore
I have had a significant weight gain/loss not due to dieting

If you are experiencing any of these symptoms then it's wise to consult your GP.

(Reference: O'Hara V. (1995) Wellness at Work: Building Resilience to Job Stress, New Harbinger inc.)

DEPRESSION IS A BIOLOGICAL ILLNESS

There are unfortunately many myths and misconceptions that surround the subject of depression and to a degree it's still too much of a taboo subject. Myths such as - "depression is all in the mind", "it's not a real illness", "it's suffered only by people who have a weak character" and "people need to get a grip". All of these are incorrect and unhelpful.

Research using Positron Emission Tomography (PET) scans of the brain show physical differences in blood flow to the brain in comparisson to PET scans of the brains of people who are not clinically depressed. Depression is partly caused by a physical imbalance in hormones of the brain that affect mood. Nobody would think that a person with diabetes was lazy, that it was all in their mind, or tell them to get a grip. Diabetes Mellitus and Clinical Depression are both caused by physical, hormonal abnormalities; in the case of diabetes the hormonal imbalance is in the endocrine gland called the pancreas, in clinical depression the chemical imbalance is in the brain.

TREATMENT OF DEPRESSION

Depression is far too common a condition, and it can have devastating effects on the person who develops it as well as on their families. Fortunately depression is one of the most successfully treatable conditions that human beings can develop. We are fortunate that over the past 50 years (and especially over the last 20 years) there has been a revolution in effective psychological and pharmacological treatments for depression.

There are 2 main treatments for depression:-

Medication
Talking Treatments

MEDICATION

There are now over 30 different antidepressants on the market and more are currently in development. It's unfortunate that there are so many myths surrounding the use of antidepressant medication. All the evidence so far suggests that antidepressant medications are not addictive. They are a different class of medication to the tranquillisers that could cause dependency in some people. There is a lot of reluctance to take antidepressant medication because of the perceived side effects. The majority of side effects are relatively minor and usually resolved after being on the medication for a few weeks.

The Internet is full of sites that tell you the horrendous side effects of taking medication. This is an imbalanced view. Medication can be life saving. People forget that there are also side effects to not treating depression. Research has shown that 15% of people who are clinically depressed and not treated, end in suicide. Other studies have indicated that untreated depression increases your chances of developing osteoporosis, infertility, heart disease, stroke, irritable bowel syndrome and pain; there are also higher levels of divorce, and relationship difficulties. As if all of this were not enough depression can erode a person's quality of life and make life very difficult, to say the least. There are cases of depression that won't be lifted without medication. So it comes down to weighing up the problems of medication against the problems of not treating depression. Clinical depression is a very serious condition that must not be treated lightly. If depression remains untreated it doesn't go away; if untreated it can develop into a more serious form that is more difficult to treat. Research indicates the sooner a condition is diagnosed and treated then the better the long-term outlook is for the person.

One of the problems is that many people who are diagnosed with clinical depression are given a prescription and, due to health economics and time constraints in the National Health Service, are not given information on - what depression is, the causes of depression, how to improve their depression resistance, what dietary and lifestyle factors can be used to help in the recovery from depression, information on medication or how their family can help (with a chronic illness it's not just the person with the condition that is affected, the whole immediate family is affected also.) The lack of this knowledge and information can impede the treatment of depression.

Depression is caused by a matrix of interacting physiological, and psychological factors. The medication addresses the brain chemical imbalance but it doesn't teach you psychological strategies to help overcome the psychological causes. For example research indicates that people with depression have a more sensitive stress alarm response. By learning stress management strategies you can reduce your chance of developing a depression relapse at a later time. Exercise for example has been shown to help us recover from depression and if carried on when you have recovered helps to reduce your chance of suffering a future depressive episode.

TALKING THERAPY

Medication as we have said can be vital. However research has indicated that clinical depression can actually affect our thinking; something which psychologists refer to as "depressed thinking". We can become more pessimistic about ourselves, our future, other people and the world in general and this can actually fuel and maintain the depression. Research has indicated that receiving a form of counselling called Cognitive Behavioural Therapy (CBT) can help us to identify this depressed thinking, teach us a new way of more accurate thinking and again this not only helps us to recover from the present depressive episode, but can also help to reduce our risk of developing a future depressive episode. Ideally depression should be treated by a twin track approach of medication (if needed) and talking therapy.

Cognitive Behavioural Therapy is the most researched and proven of the 400 or so different types of talking therapy that are available. Cognitive Behavioural Therapy says that our thoughts influence our feelings and that it is not so much difficult situations but the way we interpret and explain these situations that cause us the problems.

The problem is that there are too few cognitive behavioural therapists and too many patients needing their services. In an ideal situation (which we don't have) it's far superior to receive cognitive behavioural therapy on a one to one basis with a fully qualified therapist. However with only hundreds of CBT therapists and millions of depressed people you may have to wait months if not years for an appointment. ( In the Maidstone area of Kent, at present there is an 18-month waiting list.)

However research has indicated that we can learn and use some of the cognitive behavioural approaches ourselves. Books and useful articles and websites for cognitive behavioural therapy are given at the end of this depression page.

COMPLEMENTARY MEDICINE

As well as treatment from your GP you can also use complementary therapies such as head massage, acupuncture etc., to help boost recovery. It would be very unwise to use only complementary therapies to treat depression, but research is indicating that therapies such as Tai Chi, Acupuncture, Reflexology, Stress Management, Relaxation Training, Massage etc. can all help in the overall treatment of depression.

YOUR FUTURE

Depression can be a crippling, painful and life sapping experience to say the least. It can sap your energy to such a degree that it's difficult to get out of bed. But at the same time there is a great deal of realistic hope and effective treatments.

SELF HELP

One of the problems with western medical care is that it treats the patient as being passive in the treatment plan; but things are slowly changing. Research has shown that if you become active in your own recovery plan by using self help strategies like exercise, relaxation, reading about your condition, improving your nutrition, keeping a diary, using massage, etc, then you are likely to recover more quickly and reduce your chance of a future relapse. However for these self-help strategies to work you have to actively use them - "It is not enough to know, one must also apply."

It's vital to use these techniques not just while you recover, but carry them on after recovery, because this helps reduce your risk of suffering a future depressive episode. Many people make the error of only using them while they recover and stop them when they are well.

There are a whole raft of strategies on this website that can help stress, anxiety and depression. Don't hesitate to use them.

There are some self-help guides listed at the end of this page.

ADVICE FOR FAMILIES AND CARERS

You need to be aware that people, who are not qualified to give advice but are well intentioned, may try to give you advice about your depression ("the road to hell is paved with good intention"). It's important to take this with a pinch of salt. Some people don't have up to date information about depression, it's causes, it's treatment and it's management. Just as you wouldn't dream of letting them perform surgery on you, you need to be a bit cautious about following their advice. Depression is a complex condition. On our help line people have been told to:

1. Stop taking their medication

2. Their illness is all in their head

3. They are weak willed

4. They have a weak character and need to get a grip and pull their socks up

5. They are lazy.

These can hurt; they don't make the situation better and can make it very much worse. I've never met a lazy depressive; depression is too much hard work. You battle on with work, home and social life everyday of your lives like most people do, but also have a heavy burden of depression to carry. Depression is not due to a weak character, just as diabetes or cancer isnt due to weak character. You wouldn't say these things to a person who has cancer or diabetes and they shouldnt be applied to people with depression.