Perth Western Australia
What is it?
People use a variety of words to describe their depression: feeling down in the dumps, sad, despondent, gloomy, bored, unable to cope, or out of sorts. In some the predominant mood is irritability or anger. Chronic boredom in children or adolescents can be an indicator of depression. A characteristic of a deeper depressed state is the loss of pleasure or interest in almost all activities. known as anhedonia. Other symptoms of depression include feelings of hopelessness, worthlessness, and inappropriate guilt. Physical symptoms include loss of energy, reduced or inefficient activity, disturbed sleep patterns, disturbed appetite, loss of libido, psychosomatic symptoms (e.g. various aches and pains). Behavioural symptoms include social withdrawal, loss of confidence, indecision, poor concentration. Generally for depression to be diagnosed there needs to be at least several of these symptoms present. Anxiety is often present with depression and sometimes, obsessive preoccupations can also occur. Occasionally, in more severe forms of depression delusional thinking, hallucinations, and manic episodes may be seen.
Who is at risk?
- People with chronic, life threatening physical illness, or with severe or disabling symptoms
- People who suffer unexplained pain, hypochondriasis, or prolonged fatigue
- Elderly people, living alone
- People who abuse substances, particularly alcohol and amphetamines
- Women in the postpartum period
- People who have suffered recent significant loss
- People who are experiencing a deteriorating relationship
- People undergoing life changes or role transitions such as retirement
- Children with chronic, mild dysphoria or irritability and deteriorating school performance who state that they feel unloved
- Adolescents presenting with irritability, behaviour change or a deterioration in school or work performance
A significant number of people experience depression with no obvious cause or trigger. Long-term low-grade depression is common and often unrecognised. Children of depressed parents, or those who experienced inadequate parenting in some way (and often this inadequacy can be quite subtle) can grow up with an underlying depression that surfaces at different times. Psychodynamic theories might describe this as unexpressed or incomplete mourning of early loss of sufficient emotional nourishment.
What to do about it?
Depression is not something to be ashamed of, or guilty about. It is not a character flaw or a sign of a weak personality lacking in discipline or personal strength. It is not something that one can just "snap out of". The difference between a mood and depression is that a mood is usually brief, not generally too intense, and non-repetitive, whereas depression more seriously affects longer-term happiness and diminishes healthy functioning. Most importantly, depression is not intractable. With proper help the chances of complete recovery are excellent.
Depression can be treated either with counselling (also known as psychotherapy) or anti-depressant medication, or a combination of both. Lifestyle changes may also need to be addressed, such a reduction in drug usage, escape from abusive or stressful relationships, and poor health regimes. Sometimes these changes may be all that is needed.
Counselling not only provides a supportive and expert environment for us to share and work through our difficulties, but also assists in providing skills and strategies to change thinking patterns, emotional response patterns, and behaviour, which contribute to depression. Good counselling is often a very powerful means to relieve and cure depression and other forms of emotional unhappiness. The non-emotional symptoms of depression tend to disappear or reduce as psychological issues are addressed.
When a person feels so depressed that they cannot function well or even want to die, or when the depression clearly has organic origins (e.g. post- or antenatal depression) medication may be necessary. As with all emotional changes, mood states affect brain chemistry and vice-versa. Antidepressant medications are drugs that assist in restoring the chemical balance in the brain. Although they have some limitations, modern antidepressants can be very effective in treating some of the symptoms of depression. Studies show that 70 to 80% of depressed people will improve significantly when placed on antidepressants. However, to address the underlying psychological causes counselling is recommended.
(Main source: A manual of mental health care in general practice by John Davis)
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