Dr Phil: Depression

If you're interested enough to be reading this article then possibly not. Each year, about 40% of the population have feelings of depressed mood, unhappiness and disappointment, and 1 in 5 of us will experience clinical depression at some stage in our lives. The term "depression" is often misused as a blanket term to cover everything from being a bit peeved because Arsenal didn't win to feeling you're a worthless piece of burnt out blubber who doesn't deserve to be on God's earth a moment longer. The latter is more serious.

You're likely to be if you've lost interest or pleasure in almost all usual activities (anhedonia) and you're feeling despondent, disenchanted, irritable, indecisive, negative and exhausted. You may also experience some or all of the following:

It's hard to say. As with most illnesses we don't fully understand, a variety of causes have been proffered from which you can take your pick. Your genes probably have a lot to do with it (if your identical twin is depressed, it's very likely to happen to you) and losing a parent in childhood, unemployment and chronic ill health don't help. Women seem to suffer more from depression than men, although this is partly due to men's macho refusal to even consider the possibility. People who lack a sense of humour, are obsessive or who are natural pessimists may also be prone to gloom, as may those who make a living out of their humour. Freud deduced that those who turn their anger inwards rather than letting it out are more likely to loathe themselves and might benefit from some of his psychoanalysis.

 

At the biochemical level, depressed people seem to be short of certain brain neuro-transmitters, such as serotonin, dopamine and noradrenaline, and antidepressant drugs may work by replenishing them. Other hormones such as thyroxine, cortisol and melatonin also play a part and drugs which interfere with their secretion can precipitate depression. Not everyone with a tendency to depression will become depressed; often a trigger factor is needed too. Loss of job, driving licence, loved one, marriage, money, health or favourite pet are common triggers, as are viral infections, professional isolation, having a baby and being mugged or burgled. However, depression can often creep up on you out of the blue.

I don't know. In a perfect world where mental illness carried no social stigma then the answer would of course be yes. But those who admit to depression may still be discriminated against, even if they’ve recovered. So think carefully before you discuss your depression with people who are not close to you and whose reaction may be unhelpful.

GPs should be able to diagnose your depression, though this isn’t always the case in a busy surgery with six minutes a patient. And because of the difficulty many of us have owning up to mental illness, we often talk about physical symptoms (constipation, poor sleep) and leave it to the doctor to guess our mood. If you can, it's better to be up front about how you’re feeling, and it can help to take a friend or relative in with you for support. ‘I think I’m depressed’ is a good opening line.

At the Arsenal end of the depressive spectrum, talking things through may be all that's needed. However, for moderately severe depression that doesn't look like lifting on its own, an antidepressant is likely to be prescribed. These are not the same as tranquillisers, although they can have side effects especially if you come off them too quickly. Like all drugs, they’re not as effective as the drug companies would have us believe but they do work, particularly for severe depression. They aren’t a miracle cure and they do take a few weeks to kick in. Often, they need to be taken for six months or more.

 

There are lots of different antidepressants and people have individual responses to them, so if one tablet isn’t working for you, or makes you feel worse, go back and see a doctor, preferably the one who prescribed it. Continuity and talking things through are equally important in treating depression, and in the longer term talking therapies such as CBT (Cognitive Behavioural Therapy) may be most beneficial. It’s slowly becoming more widely available, but there are still long waits and you might be offered an interactive computer version first. In very severe depression that’s resistant to other treatments, suicidal thoughts can often be averted by electro-convulsive therapy.

No. Being in the company of a depressed person can make you a bit ratty if your tolerance of mental illness is low, but it won't make you depressed. Psychiatrists do seem prone to depression and suicide, although less so than anaesthetists, dentists and farmers, but it is probably the overall stress of their jobs that triggers it rather than anything they catch from their patients. 

"Worse things happen at sea"
"These things were sent to test us"
"But you've got everything any man could possibly want"
"You're a bit of a grumpy chops today, aren't you?"
"Cheer up, it might never happen"
"Stop feeling sorry for yourself"
"You're not the only one with problems"

If you want to help a depressed friend, first you have to accept that they feel abysmal and that this feeling may elude your rational analysis. The trick is to be empathic. "I'm sorry you feel like shit - why don't you tell me about it?". Then listen to them, avoiding the temptation to interrupt and offer simplistic or judgmental solutions. Once they've told you their story, you can point out that medical help is available and it works, and that most episodes of depression get better. Practical help with the shopping, cooking and the accounts can be very useful, but above all keep in touch. Take suicidal threats seriously and get urgent help.

Depression Alliance (www.depressionalliance.org), the Mental Health Foundation (www.mentalhealth.org.uk) and Depression UK (www.depressionuk.org) all offer support and information for sufferers and carers.

 

Written by: Dr Phil Hammond
Edited by: Dr Phil Hammond
Last updated: Wednesday, July 13th 2011

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Comments on this article

Posted by Tee on 03/05/2011 at 06:53

Don't really know what to say. I have always had an active life but in the past 12 months or more all friends have settled down and moved away. Last 2 moved on two weks ago. I work hard and long hours but have nothing to come home to. So bored and lonely. Days off consist of walking around the shops and this just kills me. Help

Posted by Ruth Shane on 23/02/2011 at 03:07

As a practitioner and supervisor of therapists, I am distressed to read that you only mention CBT as a possible treatment for depression. The arguments against this approach are beyond the scope of your website, but surely those hugely effective psycho-analytic and psychodynamic therapies deserve a mention?

Posted by Optional on 29/06/2010 at 06:21

I've been having suicide thoughts but am afraid to tell anyone. Please help me. I try to resist them but it almost hurts to. Also later I think back and realize what a stupid idea it was. But my stupid ideas always come back.

Posted by Sue on 25/02/2010 at 06:35

I have suffered anxiety stress and depression for most of my life and I still can't seem to get the help I need. I have become a recluse on anti-dpressants and havn't got a clue how to proceed. Finaly admitting to me problems I would like counciling, but my doctor has said they only do private counciling, which i can't afford, especially if it doesn't work. Any advice would be helpfull.