All of us have gone through times in our lives when we were sad, and sadness is healthy to express our emotional responses to life events. But when sadness takes over completely and prevents a person from leading a normal life, and when symptoms persist and intensify and don’t improve over time, it’s perhaps more than just the blues. Depression is much more than just feeling blue once in a while.
Often, no precise event can explain the appearance and persistence of the symptoms.
It is the constant, enduring sadness that we recognize first in a person who is depressed. He or she feels alone and desperate, is no longer interested in family and friends, feels isolated, tired, and cries easily.
Along with these external signs of depression comes guilt and low self-esteem. The depressed person may become very self-critical and accuse himself or herself of every wrong; he or she feels quite guilty and consequently puts himself or herself down and loses self-esteem. At times, he or she expresses thoughts of death and suicide. As well, sexual interest is often lowered or absent. There is a profound loss of interest in everything that interested him or her before. The depressed person no longer gets any pleasure from life.
A severely depressed person may experience an acute loss of appetite as well as substantial weight loss. He or she suffers from severe insomnia and from a general slowing down of all his or her activities. All daily activities required call for a superhuman effort – getting up, eating, even speaking seem to be beyond his or her capacities.
Secondary depression, which is also characterized by a disproportionately depressed mood, generally occurs after a particularly painful experience.
This type of depression generally presents several characteristics of a major depression. It is differentiated by the intensity of certain symptoms and by the presence of psychotic characteristics.
Psychotic depression is recognized by false beliefs or by hearing voices. The person affected may be bombarded by thoughts that make him or her unjustifiably feel that they do not deserve to live; they feel guilty about being unworthy, or might feel persecuted. These feelings of unworthiness, guilt and persecution, while unfounded in reality, are so intense that suicide may seem the only solution.
Some physical illnesses may present symptoms similar to those of depression. That is why a checkup or a medical examination should be done in all cases of depression.
- Excessive irritability
- Depression or constant sadness (frequent desire to cry)
- Excessive worrying
- Difficulty making decisions
- Loss of interest and pleasure in all activities
- Appetite disorders: loss of or increase in appetite and/or weight
- Sleep disorders: insomnia or hypersomnia
- Agitation or slowdown
- Loss of concentration and/or memory
- Lowered or loss of sexual interest
- Fatigue or lack of energy
- Self-deprecation, self put-downs, loss of self-esteem
- Sense of being unworthy and of persecution or excessive guilt
- Difficulty concentrating, indecisiveness
- Sense of isolation, loneliness
- Recurrent thoughts of death or suicide
- Withdrawal or social dependency
Negation or resistance
Depression is a complex illness with many genetic, psychological and social causes. However, the results and analyses of recent studies suggest that depression is fundamentally a brain disorder, often triggered by external events.
- Certain genetic factors play a role in creating a chemical imbalance in the brain when a person is experiencing a depression.
- The loss of a loved one, or a deterioration in professional status (e.g., losing a job) or conjugal relations, that lead to lowered self-esteem.
A physical illness may well lead to depression in an otherwise very active person. Depression then complicates the physical illness that, in getting worse, deepens the depression.
Who is at risk?
Depression is one of the most common psychiatric disorders. According to a survey conducted by public health authorities in Quebec, about 8% of people aged 12 and older reported experiencing an episode of depression during the last 12 months.
Prevention and care
Depression is an illness that should never be taken lightly. Consequently, it is important to consult a doctor as soon as the first symptoms appear in order to be quickly diagnosed, since depression can deepen and even lead to suicide.
The first person to talk to about your symptoms is your family doctor, who will know what steps to take. If diagnosed well, depression can be treated easily and quite quickly. A combination of psychotherapy and antidepressants is unquestionably the best therapeutic formula.
Hospitalization is rarely necessary during treatment and there are many mutual aid and support groups that can help.
Psychotherapy works on the psychological and social aspects that could be related to a depressive episode.
Several types of psychotherapy are possible, but two have proven to be scientifically effective in treating depression: cognitive-behavioural and interpersonal therapy.
- Cognitive-behavioural therapy
Very structured, cognitive-behavioural therapy is considered a short-term treatment and is very focused on the present moment. It aims to change the dysfunctional thinking that accompanies depression and that may be triggering or
perpetuating the depressive episodes. This therapy can be effective in helping those with a minor or moderate depression. It can also help prevent relapses. A distortion in thought patterns disturbs what the person thinks of himself or herself, their relationships with others and their rapport with the world in general. In the course of the therapy, these distortions in thought patterns are identified and new patterns are developed. The patient is given exercises to put these new patterns into practice. Cognitive-behavioural therapy is intense and consists of about 20 once-a-week sessions; the treatment usually lasts five to six months.
- Interpersonal psychotherapy
This is a short-term therapy aimed at alleviating the symptoms of depression. The starting hypothesis is that the majority of depressed people have disturbed interpersonal relationships. This is part of the illness. Therapists who employ this technique believe that if the difficulties with these interpersonal relations can be resolved, then the symptoms of depression can also be stabilized. In interpersonal therapy, the therapist concentrates, with the patient, on improving one of the following aspects, usually by focusing on the one that is the most problematic:
- Sorrow or grief
- Adaptation to a new role
- Interpersonal tensions (e.g., constant conflict with a work colleague)
- Interpersonal deficiencies (e.g., an inability to communicate, which impairs relationships)
Generally, the therapy consists of one session a week for about 16 weeks. It may be followed by monthly follow-up sessions until the person no longer feels the need. It is as effective as antidepressants in the case of minor or moderate depression. Studies show that better results are obtained if antidepressants are used along with interpersonal psychotherapy.
Antidepressants can normalize neurotransmitters and quickly – usually in two to three weeks – help restore normal sleeping habits, appetite, energy, pleasure and positive thoughts.
Contrary to popular belief, antidepressants do not create a dependency. The medication must be prescribed for about four to six months to minimize the risk of a relapse. However, the biological treatment will need to be continued if depressive disorders persist.
Studies indicate that better results can be achieved if antidepressant use is associated with interpersonal therapy.
A doctor can also prescribe phototherapy treatment, which uses a special light that acts as a stimulant, for people who suffer from a seasonal depression.
What to do if a loved one is suffering from depression
- Listen to the person who is depressed so he or she can share what they’re feeling.
- You can contribute to the treatment by encouraging him or her to first see a doctor and, if needed, a depression specialist.
- Be patient with him or her: since he or she already puts himself or herself down a lot, he or she is even more sensitive to criticism.
- Be understanding when he or she withdraws from his or her usual activities: he or she sometimes lacks motivation and energy.
- Your understanding and empathy can contribute to the recovery of the person who is depressed.
Most of all, reassure the depressed person. No matter how desperate the situation may seem to him or her, it is not hopeless. Depression can be treated!
Association québécoise de prévention du suicide
514.723.4000 or 1.866.277.355
Association des médecins psychiatres du Québec
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