If you feel sad, empty, and hopeless most of the day, nearly every day, if you have lost interest or pleasure in your hobbies or being with friends and family, if you are having trouble sleeping, eating, and functioning, and you have felt this way for at least 2 weeks, you may have depression, a serious but treatable mood disorder.
Of course, everyone feels sad or low sometimes, but these feelings usually pass with a little time. Depression—also called “clinical depression” or a “depressive disorder”—is a mood disorder that causes distressing symptoms that affect how you feel, think, and handle daily activities, such as sleeping, eating, or working. To be diagnosed with depression, symptoms must be present most of the day, nearly every day for at least 2 weeks.
Notably, depression is a common mental health disorder and can come about for a great many reasons, including for example as result of a traumatic life event or crisis, such as the death of a spouse or family member, loss of a job, or a major illness. However, when the depression continues to be present even when stressful events are over or there is no apparent cause, it may be classified as clinical or major depression.
There are two major categories of depression: ‘Major Depression Disorder’ (MDD) and ‘Persistent Depressive Disorder’ (PDD). Within those categories, there are a range of depressive related disorders, which manifest in a variety of symptoms and degrees, though, generally speaking, symptoms of depression manifest in persistent or regular recurrent feelings of sadness and/or a loss of interest in activities once enjoyed which lead to a range of emotional and physical problems and can decrease a person’s ability to function at work, school or at home.
Major depression is a serious disorder of enormous sociological and clinical relevance. Fortunately, depression, in most cases, is treatable.
As mentioned, significant and/or traumatic events in one’s life can cause some of those symptoms and behavioural manifestations, so to can chemical changes in one’s brain. Research suggests that continuing difficulties – long-term unemployment, living in an abusive or uncaring relationship, long-term isolation or loneliness, prolonged work stress – are more likely to cause depression than other life stresses.
Symptoms of clinical depression can include
- A depressed mood;
- Reduced interest or pleasure in activities once enjoyed;
- A loss of sexual desire;
- Major changes in appetite;
- Concentration difficulties;
- Unintentional weight loss or gain;
- Sleeping too much or too little;
- Agitation, restlessness, irritability and pacing up and down;
- Slowed movement and speech;
- Unexplained fatigue or loss of energy;
- Feelings of worthlessness or guilt;
- Difficulty thinking, concentrating or making decisions;
- Unexplained fatigue or loss of energy;
- Recurrent thoughts of death or suicide, or an attempt at suicide.
It is important though to realise that sadness is not necessarily the same as depression. We often experience feelings of sadness in our lives as a result of a great many things, but, that sadness usually lessens in its intensity over time, whereas, depression on the other hand is a mood disorder that involves a persistent or regularly recurrent feeling of sadness and loss of interest in things that were, or ought to be, important to that person, for example the affected person’s family or job.
Does depression look the same in everyone?
Depression affects different people in different ways. For example:
Women have depression more often than men. Biological, lifecycle, and hormonal factors that are unique to women may be linked to their higher depression rate. Women with depression typically have symptoms of sadness, worthlessness, and guilt.
Some types of depression are unique to females such as:
Men with depression are more likely to be very tired, irritable, and sometimes angry. They may lose interest in work or activities they once enjoyed, have sleep problems, and behave recklessly, including the misuse of drugs or alcohol. Many men do not recognise their depression and fail to seek help.
Notably, males with depression are more likely than females to:
- Drink alcohol to excess, display anger and engage in risk-taking;
- Avoid families and social situations;
- Work without a break;
- Have difficulty keeping up with work and family responsibilities;
- Display abusive or controlling behaviour in relationships.
Older adults with depression may have less obvious symptoms, or they may be less likely to admit to feelings of sadness or grief. They are also more likely to have medical conditions, such as heart disease, which may cause or contribute to depression.
Younger children with depression may pretend to be sick, refuse to go to school, cling to a parent, or worry that a parent may die.
Older children and teens with depression may get into trouble at school, sulk, and be irritable. Teens with depression may have symptoms of other disorders, such as anxiety, eating disorders, or substance abuse.
Possible causes of clinical depression
There are many possible causes which are thought to trigger depressive related symptoms and behaviours. Some possible causes include a combination of biological, psychological and social sources of distress. Increasingly, research suggests that these factors may cause changes in brain function, including altered activity of certain neural circuits in the brain. Some factors that are likely to play a role in the development of a depressive disorder include:
- Genetic and epigenetic features;
- Changes in the brain’s neurotransmitter levels;
- Work without a break;
- Environmental factors;
- Psychological and social factors
- Having a history of extreme or persistent anxiety;
- Additional conditions such PTSD/PTSI or bipolar disorder;
There is growing evidence that depression is in part an illness with a biological basis. For example, it is more common in individuals with close relatives who have been depressed. Research on the physiology of the nervous system suggests that the level of activity of neurotransmitters, such as norepinephrine and serotonin changes in long standing depression.
Depression is not a homogeneous disorder, but a complex phenomenon, which has many subtypes and probably more than one etiology. It includes a predisposition to episodic and often progressive mood disturbances, differences in symptomatology ranging from mild to severe symptoms with or without psychotic features, and interactions with other psychiatric and somatic disorders.
The psychopathological state involves a triad of symptoms with low or depressed mood, anhedonia, and low energy or fatigue. Other symptoms, such as sleep and psychomotor disturbances, feelings of guilt, low self-esteem, suicidal tendencies, as well as autonomic and gastrointestinal disturbances, are also often present in clinical depression.
Depression is not to be taken lightly, it is a potentially life-threatening disorder which affects hundreds of millions of people all over the world. It can occur at any age from childhood to late-life and is a tremendous cost to society as this disorder causes severe distress and disruption of the sufferer’s life, and if left untreated, can be fatal.
Some common variants of depression are
‘Dysthymic Disorder’ – is a depressed mood most of the day for more days than not, for at least 2 years, and the presence of two or more of the following symptoms that cause clinically significant impairment in social, work, or other important areas of functioning:
- Poor appetite or overeating;
- Insomnia or sleeping too much;
- Low energy or fatigue;
- Low self-esteem;
- Poor concentration or difficulty making decisions;
- Feelings of hopelessness.
‘Cyclothymic Disorder’ – is a chronic state of cycling between hypomanic and depressive episodes that do not reach the diagnostic standard for bipolar disorder.
‘Substance-Induced Mood Disorder’ – is a common depressive illness of clients in substance abuse treatment. It is defined in DSM-IV-TR as “a prominent and persistent disturbance of mood . . . that is judged to be due to the direct physiological effects of a substance (i.e., a drug of abuse, a medication, or somatic treatment for depression, or toxin exposure)”. The mood can manifest as manic (expansive, grandiose, irritable), depressed, or a mixture of mania and depression. Generally, substance-induced mood disorders will only present either during intoxication from the substance or on withdrawal from the substance and therefore do not have as lengthy a course as other depressive illnesses.
‘Mood Disorder Due to a General Medical Condition’ – is not as common to find depression due to a general medical condition in substance-abuse treatment settings, but it is important to note that depression can be a result of a medical condition, such as hypothyroidism or Parkinson’s disease. The criteria for diagnosis are similar to ‘Major Depressive Episode’ or a manic episode; however, the full criteria for these diagnoses need not be met. It is important in diagnosis to establish that the depressive symptoms are a direct physiological result of the medical condition, not just a psychological response to a medical problem.
‘Adjustment Disorder With Depressed Mood’ – is a psychological reaction to overwhelming emotional or psychological stress, resulting in depression or other symptoms. Some situations in which an adjustment disorder can occur include divorce, imprisonment of self or a significant other, business or employment failures, or a significant family disturbance. The stressor may be a one-time event or a recurring situation. Because of the turmoil that often occurs around a crisis in substance use patterns, clients in substance abuse treatment may be particularly susceptible to adjustment disorders. Some of the common depressive symptoms of an adjustment disorder include tearfulness, depressed mood, and feelings of hopelessness.
The symptoms of an adjustment disorder normally do not reach the proportions of a ‘major depressive disorder’, nor do they last as long as a Dysthymic Disorder. An acute adjustment disorder normally lasts only a few months, while a chronic adjustment disorder may be ongoing after the termination of the stressor.
‘Melancholic Depression’ – was first described by Hippocrates, “melancholia” or melancholic depression was considered a specific condition that commonly struck people out of the blue – and put them into the black. In modern times, it came to be described as “endogenous depression” (coming from within) in contrast to depression stemming in response to external stressors.
Melancholic depression is a form of major depressive disorder (MDD) which presents with melancholic features. Although melancholic depression used to be seen as a distinct disorder, the American Psychiatric Association (APA) no longer recognises it as a separate mental illness. Instead, melancholia is now seen as a specifier for MDD — that is, a subtype of major depressive disorder.
Melancholia has a strong genetic contribution, with sufferers likely to report a family history of “depression”, bipolar disorder or suicide. It’s largely biologically underpinned rather than caused by social factors (stressors) or psychological factors, such as personality style.
‘Psychotic depression’ – is a type of severe depression combined with psychotic episodes, such as hallucinations (seeing or hearing things that others do not) or delusions (having fixed but false beliefs). The episodes may be upsetting or disturbing and often have a theme.
‘Seasonal affective disorder (SAD)’ – is another type of depression that occurs during certain seasons of the year. It typically starts in the late autumn or early winter and lasts until spring or summer. Less commonly, SAD episodes may also begin during the late spring or summer. Symptoms of winter seasonal affective disorder may resemble those of a major depression. They tend to disappear or lessen during spring and summer.
Other mental-health disorders of which depression can be a primary symptom
Sometimes depression is symptomatic of another mental disorder. This is particularly true when the nature of the mental disorder causes excessive distress to the individual. While, in this context, the depression is a symptom, it is still important to recognise its impact on the person and his or her ability to respond to substance abuse treatment.
Some of the psychiatric disorders in which depression can play a major role include:
A. Post Traumatic Stress Disorder (PTSD)
Symptoms include episodes of reexperiencing the traumatic event or reexperiencing the emotions attached to the event; nightmares, exaggerated startle responses; and social, interpersonal, and psychological withdrawal. Chronic symptoms may include anxiety and depression. PTSD is categorised as an anxiety disorder.
B. Anxiety Disorders, including Panic Disorder, Agoraphobia (fear of public places), Social Phobias, and Generalised Anxiety Disorder
Symptoms of anxiety disorders are most often on the anxiety spectrum, but the chronic stress faced by individuals with anxiety disorders can produce depressive symptoms including irritability, hopelessness, despair, emptiness, and chronic fatigue.
C. Schizoaffective Disorder and Schizophrenia
Individuals with schizoaffective disorder have, in addition to many of the symptoms of schizophrenia, a chronic depression with most of the features of Major Depressive Disorder. Because of the difficulty individuals with schizophrenia have in coping with the daily demands of living, depression is often a symptom. With both schizoaffective disorder and schizophrenia, the depression adds an additional dimension to treatment, specifically in helping the person mobilise in the face of their depression to cope with their illness.
D. Personality Disorders
People with personality disorders are particularly susceptible to depression. These individuals are at high risk for substance use disorders. As a result, it is not uncommon to find clients in substance abuse treatment with all three diagnoses. Because personality disorders are categorised in DSM-IV-TR as Axis 2 disorders (see DSM-IV-TR for a description of multiaxial assessment), it is common to find their depression diagnosed separately (from the personality disorder) as an adjustment disorder, dysthymia, or major depressive disorder.
Depression can also be one phase of bipolar disorder (formerly called manic-depression). But a person with bipolar disorder also experiences extreme high—euphoric or irritable —moods called “mania” or a less severe form called “hypomania.”
Getting help for depression
Psychotherapy helps by teaching new ways of thinking and behaving, and changing habits that may be contributing to depression. Therapy can help you understand and work through difficult relationships or situations that may be causing your depression or making it worse.
CBT is a great option if you’re struggling with Depression or Anxiety
Cognitive behaviour therapy (CBT) is an effective treatment for a range of mental and emotional health issues, including for anxiety and depression. Research has shown CBT to be particularly effective in the treatment of panic disorder, phobias, social anxiety disorder, and generalised anxiety disorder, major depressive disorder (MDD) among many other conditions.
CBT is the most widely-used therapy for Anxiety & Depression related disorders. To learn more about CBT please click on the following link – about CBT >>
While it is never too late to seek out professional help, the sooner you do the better the possibility of assisting you identify and alleviate the problems affecting you.
We at CBT Counselling & Psychotherapy look forward to helping you.
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 per The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the handbook used by health care professionals in the United States and much of the world as the authoritative guide to the diagnosis of mental disorders. DSM contains descriptions, symptoms, and other criteria for diagnosing mental disorders.
 ‘Depression During Pregnancy and after Childbirth’ – Peripartum depression refers to depression occurring during pregnancy or after childbirth. The use of the term ‘peripartum’ recognises that depression associated with having a baby often begins during pregnancy. Those who develop postpartum depression are at greater risk of developing major depression later on in life. Symptoms might include insomnia, loss of appetite, intense irritability and difficulty bonding with the baby. Untreated, the condition may last months or longer. Treatment can include counselling, antidepressants or hormone therapy.
 Premenstrual dysphoric disorder (PMDD) is a health problem that is similar to premenstrual syndrome (PMS) but is more serious. PMDD causes severe irritability, depression, or anxiety in the week or two before your period starts. Symptoms usually go away two to three days after your period starts.
 ‘Hypomania’ is usually described as a mood state or energy level that is elevated above normal, but not so extreme as to cause impairment — the most important characteristic distinguishing it from mania. ‘Bipolar disorder’ is a disorder associated with episodes of mood swings ranging from depressive lows to manic highs. The exact cause of bipolar disorder isn’t known, but a combination of genetics, environment and altered brain structure and chemistry may play a role. Manic episodes may include symptoms such as high energy, reduced need for sleep and loss of touch with reality. Depressive episodes may include symptoms such as low energy, low motivation and loss of interest in daily activities. Mood episodes last days to months at a time and may also be associated with suicidal thoughts. Treatment is usually lifelong and often involves a combination of medications and psychotherapy.
 DSM-IV codes are the classification found in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision, also known as DSM-IV-TR, a manual published by the American Psychiatric Association (APA) that includes almost all currently recognized mental health disorders.
 Hypothyroidism is a health condition characterised by unusually low hormone production. It is when your thyroid gland becomes underactive and cannot produce enough hormones to regulate your metabolism. If your thyroid can’t secrete enough hormones into your bloodstream, your body’s metabolism slows down rapidly. Hypothyroidism’s deficiency of thyroid hormones can disrupt such things as heart rate, body temperature and all aspects of metabolism. Hypothyroidism is most prevalent in older women. Major symptoms include fatigue, cold sensitivity, constipation, dry skin and unexplained weight gain. Treatment consists of thyroid hormone replacement. Parkinson’s disease is a progressive, degenerative neurological condition that affects the control of body movements. It causes trembling in the hands, arms, legs, jaw, and face; rigidity or stiffness of the limbs or trunk; slowness of body movements; and unstable posture and difficulty in walking. Nerve cell damage in the brain causes dopamine levels to drop, leading to the symptoms of Parkinson’s. Parkinson’s often starts with a tremor in one hand. Other symptoms are slow movement, stiffness and loss of balance. Medication can help control the symptoms of Parkinson’s.
 Schizophrenia is a serious mental disorder in which people interpret reality abnormally. Schizophrenia may result in some combination of hallucinations, delusions, and extremely disordered thinking and behaviour that impairs daily functioning, and can be disabling. Schizophrenia is characterised by thoughts or experiences that seem out of touch with reality, disorganised speech or behaviour and decreased participation in daily activities. Difficulty with concentration and memory may also be present. Treatment is usually lifelong and often involves a combination of medications, psychotherapy and coordinated speciality care services. Schizophrenia is usually a condition treated by Psychiatrists and/or other medical suitable qualified professionals.
 Medications called antidepressants can work well to treat depression. They can take 2 to 4 weeks to work. Antidepressants can have side effects, but many side effects may lessen over time. Talk to your health care provider about any side effects that you have. Do not stop taking your antidepressant without first talking to your health care provider. Please Note: Although antidepressants can be effective for many people, they may present serious risks to some, especially children, teens, and young adults. Antidepressants may cause some people, especially those who become agitated when they first start taking the medication and before it begins to work, to have suicidal thoughts or make suicide attempts. Anyone taking antidepressants should be monitored closely, especially when they first start taking them. For most people, though, the risks of untreated depression far outweigh those of antidepressant medications when they are used under a medical doctor’s careful supervision.
Author: Charles Pratten
Principal CBT Counselling & Psychotherapy
Title: About Depression