Depression

Depression is a psychopathological feeling of sadness. There are two types of depression:

1. Reactive Depression – depression is a reaction to an external event.
2. Endogenous Depression – depression is caused from internal factors (genetic or biochemical factors).

Major Depressive Disorder

Five or more of the following symptoms have been present during the same 2 week period and represent a change from previous functioning.

At least one of the symptoms is (1) depressed mood or (2) loss of interest or pleasure.

1. Depressed mood most of the day, every day.
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
3. Significant weight loss or weight gain
4. Insomnia or hypersomnia nearly every day
5. Psychomotor agitation or retardation (i.e feeling speedy or slow)
6. Fatigue or loss of energy
7. Feelings of worthlessness or guilt
8. Can't concentrate/indecisive
9. Recurrent thoughts of death/suicidal ideation

15% prevalence in the general population; 25% for women.

Major depressive disorder occurs most often in people without close interpersonal relationships or in those who are divorced or separated

Minor Depressive Disorder

Same diagnostic criteria as above but must be at least 2 and no more than 5.

Causes of Depression

Often has a physical basis – at simplest level

• Lack of sleep Insufficient exercise
• Side effects of drugs
• Physical illness
• Improper diet
• PMS
• Postpartum depression as a result of childbirth
• Neurochemical malfunctioning
• Brain tumors
• Glandular disorders

Evidence to suggest

• Some depression runs in families – may have genetic basis
• Depression linked to brain chemistry and can be altered by anti-depressive drugs

NB: research reports are sometimes contradictory

"Whenever the body has experienced a period of high adrenalin demand, such as coping with an emergency, public speaking, or meeting a deadline, the adrenal system becomes exhausted and switches off when the demand is over. It is like the calm following a storm, except that the calm is more like a total switch-off. Most of us feel it as depression. It is the body's way of demanding rest; it turns you off to all interests and saps you of energy so that you are forced into a period of recovery., During this time the adrenal glands and other important systems are rejuvenated. The longer your system has been in a state of demand or energy, the longer it will take for it to rejuvenate ... The older we get, the less resilient is our adrenal system and the more depressed we become after an adrenalin high."

Scientists still do not know if depressed thinking causes biochemical changes or if a chemical imbalance in the brain causes the depression.

Depression is a significant mental health problem for 4-9 percent of general population – figures rise amongst young adults.

Background and family causes – some evidence suggests that childhood experiences can lead to depression in later life. (more likely when parents blatantly or subtly reject their children or set unrealistically high standards that children are unable to meet)

Teenagers in conflict with parents – young adults having trouble becoming independent of their families – may increase likelihood of depression in later life.

Stress and Significant Losses

Stresses of life stimulate depression, especially if they make us feel threatened or involve a loss. (Loss of opportunity, job, status, health freedom, contest, possessions or other valued objects can lead to depression)

Or loss of people – divorce, death, prolonged separations – known to be among the most powerful depression-producing events of life.

Learned Helplessness

One theory – depression most often comes when we encounter situations over which we have little or no control. Our actions are futile no matter how hard we try, or nothing can be done to relieve our suffering, reach a goal, or bring change. Depression may subside or disappear when a person can control some portion of their environment.

Cognitive causes

How a person thinks can determine how they feel. Think negatively, see only the dark-side of life, overlook positive.

According to psychiatrist Aaron Beck, depressed people show negative thinking in three areas:

• See the world and life experiences negatively – life seen as succession of burdens, obstacles and defeats
• Negative view of themselves – feel deficient, inadequate, unworthy and incapable of performing adequately – can turn to self-blame and self-pity
• View the future in a negative way – can only see hardship, frustration and hopelessness.

Sin and guilt

Guilt – self-condemnation, frustration, hopelessness, and other depressive symptoms. Cycle created of guilt – depression – guilt etc. Which comes first??

Anger

If anger is pushed out of our minds, it festers "under cover" and eventually affects us in some other way. See diagram

Most anger the result of hurt from disappointment or actions of another.

Instead of admitting hurt – individual ponders it, mulls it over and becomes angry to hide the hurt. If not expressed or dealt with, anger leads to revenge – thoughts about hurting someone. Rather than committing a violent or revengeful act, the individual tries to hide the feeling – this takes energy that wears down the body so emotions may appear in psychosomatic symptoms – or depression.

Depression can be used as a means to express anger and get revenge.

This does not account for all depression – but does explain some.

Dealing with depression

Individuals suffering depression should seek help!

Preventing Depression

Trust in God

Writing from prison, the Apostle Paul wrote of how he had learned to be content in all circumstances. Paul's trust in God helped prevent depression. A conviction that God is alive and in control gives hope and encouragement. If we can encourage this attitude in others – discouragements need not hit as hard as they might otherwise. If a person is already depressed – they need our understanding and support – an attitude of "we are with you in this pain and are praying for you, even though we don't completely understand it." – not to be told "trust in God and the depression will go away".

Expect Discouragement

Jesus warned that we would have problems and James wrote that trials and temptations would come to test our faith and teach us patience. Christ himself was deeply distressed at the time of his crucifixion and openly acknowledged his agony. Jesus trusted in His Father but still expected pain and was not surprised when it came.

If we are realistic enough to expect pain and informed enough to know that God is always in control – then we can handle discouragement better and keep from slipping into deep depression.

Be alert to depression-prone situations

E.g, after loss of loved one – for some time after the loss – anniversaries or other special days. If we anticipate sad times of others and offer support we can prevent predictable depressions from becoming worse. Holidays can be depression-producing times for some. E.g Christmas (people separated from loved ones, without friends or money to buy presents, worried about relatives who drink too much, pressured by demands of season, reminded of deaths or other traumatic experiences that took place the previous December). These people may need special encouragement and understanding at these times to avoid slipping into deep depression.

Learn to handle anger and guilt

Avoid dwelling on past injustices or failures. Ask God to help us to forget the past and forgive those who have sinned against us and forgive ourselves. Dwelling on past events and wallowing in anger, guilt and the misery of discouragement - Is this an excuse for avoiding responsibility or seeking/giving forgiveness? Anger or guilt should be expressed and dealt with.

Principles for dealing with anger:

• Admit and express anger
  • Consider the source of the anger
  • What is making me feel angry?
  • Why am I feeling anger and not some other emotion?
  • Am I jumping to conclusions about the situation or person who is making me feel angry?
  • Is there something about this situation that threatens me and makes me feel afraid or inferior?
  • Did my anger come because I had some unrealistic expectations?
  • How might others, including the person who is angering me, view this situation?
  • Is there another way to look at the situation?
  • Are there things I can do to change the situation in order to reduce my anger?
• Focus on humility, confession and forgiveness (of self and others)
• Learn self control – we can be angry without hurting others
  • Grow spiritually
  • Slow reactions
  • Avoid angry mind-set
  • Use "I" statements
• Build a healthy self-concept (hostility and anger often indicate a person is feeling inferior, insecure and lacking in self-esteem).

Challenge thinking

Listen to our self-talk and challenge negative messages. "What is the evidence for the view I am incompetent?" "In what areas am I incompetent? Where am I more competent?" "Is it OK to be incompetent in some things?" "How can I become more competent in the areas that matter?"

Learn coping techniques

Those who resist depression are those who have learned to master and cope with the stresses of life. If individuals feel they have some control over circumstances, they are less likely to feel the helplessness that leads to depression.

Finding support

Those less lonely and isolated are those less inclined to get depressed or attempt suicide. Churches and other social institutions can become therapeutic communities where people feel welcomed and accepted. A concerned group of people who have learned to be caring can do much to soften the trauma of crises and provide strength and help in times of need. People in crises are able to cope better if they are aware they are not alone.

Reaching out

AA has proved that needy people help themselves when they reach out to help others. Those who reach out to help others are the ones who benefit and are helped the most. Although sometimes depressed people can pull another down.

Creation of a caring community is an indirect way to prevent depression.

Encourage Physical fitness

Poor diet and lack of exercise can make people depression prone – a healthy body is less susceptible to mental as well as physical illness. Individuals can be encouraged by word and example to take care of their bodies.