Depression

What you need to know

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Depression is an illness of our time.  Already widespread in the UK before the pandemic it seems to have worsened significantly under the impact of the lockdowns.  Depression can seriously interfere with your capacity to to function day to day and to enjoy life.

Symptoms of depression

  • Major depressive disorder

There are different types of depression and different symptoms may be associated with each.  In so-called major depressive disorder (MDD – the classic form of the condition) the symptoms of depression are typified by an all-permeating dark mood, a loss of interest in things that are normally enjoyed, feelings of worthlessness and guilt, restlessness and agitation or – the opposite – sluggishness, difficulty concentrating and making decisions, problems with sleeping and even thoughts of taking one’s own life.  So we’re talking here about quite severe depression symptoms.  The latter can on occasion extend to psychosis – a break with reality.

  • Persistent depressive disorder

This is another of the common types of depression.  It refers to low mood which has gone on for two years or more and which may not be as intense as in MDD, thus permitting a person to cope better with daily life, albeit rather joylessly.  Other features of it may include sleeping too much or not enough and changes in appetite.

  • Bi-polar disorder

Formerly known as manic depression, bi-polar disorder again includes the familiar symptoms of depression but these alternate with periods of extreme high energy or activity, together with inflated self-esteem, over-ambitious and grandiose ideas, decreased need for sleep and increased risk-taking.

  • Other types of depression

 Among the different types of depression there are also recurrent depression and atypical depression.  The atypical variety is when someone experiences depressive symptoms such as excessive eating or weight gain, excessive sleep, acute sensitivity to rejection, a feeling of being weighed down and strongly reactive moods.  But the individual will suddenly brighten up when something positive happens to them.  Interestingly, the name ‘atypical’ suggests that the condition is rare but in fact it occupies a place in the more common types of depression.

Physical symptoms of depression

Across the spectrum of different types of depression bodily symptoms may also make themselves felt – some of them quite surprising.  Fatigue and low energy, decreased tolerance for pain, tension headaches, blurry vision, stomach pain or discomfort, digestion problems, irregular bowel routines and back pain or aching all over one’s body can be indicators of depression or of its imminent onset.  So if you’re thinking of visiting your doctor about any of these symptoms and you suspect that they may have an emotional component, it may be worth discussing the possibility that you’re actually experiencing physical symptoms of depression.

Symptoms of depression in women

Depression affects more women than men and it has often been thought that symptoms of depression in women differ from symptoms of depression in men But this is not to the point where the condition exists in two distinct forms.  That said, there are a couple of types of depression that are specific to women.

  • Perinatal depression

This condition embraces both minor and more severe depression symptoms occurring during pregnancy or the first year after giving birth (when it’s also known as postpartum depression).  The effects on a woman and on her infant and family can be very bad indeed.  She may experience severe mood swings, difficulty in bonding with the baby, thoughts of hurting herself or the child, social withdrawal and, in the case of postpartum psychosis, delusions, confusion or hallucinations.

  • Premenstrual dysphoric disorder (PMDD)

PMDD is a very severe form of premenstrual syndrome which can cause serious emotional and physical symptoms during the fortnight before a period begins.  Among them may be feelings of upset, tearfulness, irritability, anger, self-criticism and tension plus a sense of being overwhelmed.  Physical symptoms of depression can entail breast tenderness or swelling, muscle or joint pain, bloatedness and food cravings.

Symptoms of depression in men

In Britain men are 50% less likely to be diagnosed with depression than women.  This could, however, partly reflect social pressures around men admitting ‘weakness’ or the need for help and it may also reflect their unfamiliarity with talking about emotional issues.  A sobering thought is that men are four times more likely than women to complete suicide as a result of depression.

The symptoms of depression in men are probably broadly similar to the symptoms of depression in women and common types of depression (mild, major, persistent, bi-polar, recurrent, atypical etc) will also figure in males.  But some symptoms appear to be more likely to manifest in men than in women.  Not uncommonly one finds substance abuse, obsessive working, anger and agitation, reckless behaviour such as dangerous driving, controlling or abusive behaviour and a loss of interest in family.

Treatment for depression

I’ve tried to give a quick survey of some of the different types of depression that affect people.  Treatment for these will depend on the precise type and on whether a person is suffering from mild low mood or moderate depressive symptoms or severe depression symptoms.

  • Medication

Generally, though, a GP may prescribe antidepressants (such as an SSRI:  Selective Serotonin Reuptake Inhibitor) or an older type of medication called an MAOI (Monoamine Oxidase Inhibitor. Often associated with the treatment of atypical depression).  These medications can significantly alleviate debilitating symptoms.

  • Talking therapies

The so-called ‘talking therapies’ also have good track records in treating depression.  It may, incidentally, be appropriate to take antidepressants while having therapy in order to be able to engage with the process in an active and motivated way.

Cognitive Behavioural Therapy (CBT) is usually a time-limited  therapy lasting anywhere between six weeks and six months.  It’s focused on precise goals agreed with the client and uses structured sessions and ‘homework’.

Psychodynamic psychotherapy is very different.  CBT aims to consciously alter an individual’s unhelpful thoughts, perceptions and behaviours in order to change how they feel and behave.  Psychodynamic therapy aims to uncover why they are feeling and behaving as they are and works deeply with the unconscious mind to do that.  (Think of your mind as an iceberg with seventh-eighths hidden below the waterline – that’s the size of the unconscious!)

Psychodynamic therapy also works with past causes of a person’s present struggles whereas CBT tends to stay in the present.  Psychodynamic sessions are not structured as in CBT and the overall aim is not just symptom modification but also holistic change – growth in the whole individual.  Going, as it does, to the roots of a condition like depression, psychodynamic therapy often takes longer than CBT – a year upwards – although changes may start to be noticed after only a few months.

Ultimately the choice of CBT or psychodynamic therapy depends on what a person wants.  Which approach attracts you?  Along with the ‘conscious you’ are you interested in exploring parts of yourself that are out of your conscious awareness?  What are the financial and time considerations in your life?  Do you want to stay in the present or also look at your past?  These are the questions that only you can decide.

But if you’re in the grip of depression I would encourage you to be honest about it and willing to ask for help.  It’s out there and waiting.  And you deserve it.

© Brian Shand 2021

And more blogs here:  https://www.guildfordtherapy.co.uk/blog/

Brian Martin Shand

I have considerable professional experience in mental health settings, having worked both in the NHS and in private practice. I am one of the very few trained and qualified group psychotherapists in private practice in Surrey. I also offer individual therapy and counselling. Please see my website for more details.