At some point we all suffer from some kind of depression. It may be that something happens to us which makes us feel depressed, or we become depressed for no apparent reason. Usually this is just a temporary low – we gradually pick up again and get back to normal. However, sometimes it can go on and on and dominate our lives. We may not know how to find our way out and feel trapped and hopeless.
This leaflet is written for people who have recent experience of this sort of depression, and for their friends and family. It sets out to provide some basic information about depression: what it feels like, the possible causes and the various sources of help available. It also contains references to other reading material and to organisations which can provide further information for those who want to know more.
What is depression?
Very few of us could honestly claim we always feel good about ourselves or are entirely satisfied with our lives. Usually we are content with some aspects of our lives, but not all. We like ourselves in certain respects but not in others. We may be uncertain about what lies ahead of us in the future, but believe that on balance it is likely to be bearable. When we talk about feeling depressed in the everyday sense, we generally mean we have hit a bad patch and are feeling down. In time we emerge more or less intact and continue as before with our lives.
However the type of depression talked about in this leaflet refers to deep feelings of despair and hopelessness. These can affect both men and women of all ages and from all walks of life. When we experience depression in this way, everything becomes a struggle. We feel bad about ourselves, about everything around us and about the future. Nothing seems worthwhile.
‘I no longer felt part of the world I was living in. Everything felt strange and unfamiliar. I didn’t know why I bothered going on.’
Each person who is depressed will experience it in their own particular way. It can affect our thoughts and feelings. We may
- Dislike or hate ourselves.
- Feel we are useless or worthless.
- Feel as if a heavy weight or blanket is bearing down on us.
- Feel numb and empty.
- Blame ourselves for all sorts of things which are not necessarily our doing and feel guilty.
- Despair of things ever getting better.
The way we behave and the way our bodies function can also be altered if we are depressed:
- Concentration on even simple tasks can be difficult.
- Making even the smallest decisions can become impossible.
- Our usual sleep patterns may be disrupted so that we wake early and cannot fall asleep again, or we may sleep more than before.
- Appetite for food can also be affected. Some people may find they eat much more than usual and gain weight, whereas others lose all interest in food.
- We may experience physical aches and pains because we are depressed. These can of course be alarming for anyone. However some people become preoccupied with such bodily symptoms, and this in itself is a sign of depression.
- Our interest in other people and events often wanes when depression takes a hold.
We may feel more inclined to use tobacco, alcohol or drugs when we are depressed.
‘I just wanted to hide away and sleep and sleep. That was the easiest way for me to cope with my feelings.’
‘I couldn’t make up my mind or decide on anything. My thoughts got so muddled–I couldn’t concentrate at all.’
People are affected to different degrees by depression. Some may be able to struggle on with their normal life in the fact of a mild form of depression, although everything will require extra effort. Others of us will be overwhelmed by the feelings of hopelessness and despair. It can even seem as if the only way out is to kill ourselves.
Indeed part of depression is the feeling nothing can help and that we are not worth helping. It can be impossible to imagine things changing in any way. This means that the first and most difficult step towards coping more effectively with depression is to accept that there is a problem and that something CAN be done about it.
People do usually recover from spells of depression. They may even find they can use the experience constructively as an opportunity to take stock and to make positive changes in their lives as a result.
There are various possible explanations of what causes depression. It is likely that the reasons why depression develops will vary from one person to another. Sometimes the cause or trigger which sets off a depression will be obvious – a bereavement, redundancy or divorce for example. Sometimes there may be no apparent reason.
It seems, too, that at certain points in our lives we are more vulnerable to the effects of stress or of change and are more likely to react by becoming depressed (just as we are more prone to infection when our resistance is low). Hormonal changes may mean women are more likely to experience depression before their period, after childbirth and at menopause. Some people find they become depressed in the winter months because of the lack of daylight. This is known as Seasonal Affective Disorder (SAD).
Sometimes depression can be brought on by physical ill-health. It can follow on from an illness such as flu after the other symptoms have gone. Poor diet, a lack of exercise or the abuse of drugs or alcohol can contribute to depression.
Our childhood experiences can have an important effect on how we feel about ourselves in later years. It can be hard for us to value ourselves and believe we are worthwhile people if the attitudes of our parents or those who cared for us in our early years suggested we were not loved or were in some way ‘bad’.
These early experiences can be counteracted by what happens to us later in life but we may still be vulnerable if things go wrong. If our relationship with our partner breaks down, for example, we may feel that this proves we are unlovable and blame ourselves.
While the reasons behind our experience of depression can be difficult to unravel, it may be helpful to look at how we feel about ourselves. Whether or not we feel good about our lives depends on all sorts of things, such as our current circumstances and how these measure up to our expectations and hopes. Often, we can come to feel depressed because of outside events or circumstances beyond our control. We may be trapped in unemployment or living in poor housing or in a low-paid job with no prospects. We may face illness or disability. In situations like these, if we become depressed, it is easy to feel that we are in some way to blame for what has befallen us.
‘One by one, things started to go wrong. I couldn’t see any way out of it. I felt helpless, that I must have done something to bring all this on me. I ended up blaming myself.’
How we react when things go wrong can also have a bearing on whether or not we become depressed. Each of us has our own way of coping with whatever difficulties we encounter in life.
Some of us may immediately seek out our closest friend for support and consolation. Some of us may feel we have to carry on as normal and play down our true feelings. It is probably more helpful in the long run if we can find a way of expressing our worries and feelings to other people, rather than bottling them up and putting on a brave face.
There is also a condition called manic depression which leads people to behave in highly excited and uncontrollable ways in between periods of depression. Details are given at the end of the leaflet about where you can get more information on this condition.
What can you do?
By its very nature, depression feeds off itself. If it becomes very difficult for us to concentrate on any sort of task, we are likely to feel despondent at our apparent incompetence and become even more depressed. People who are depressed sometimes withdraw from others and may then regard their growing isolation as a sign of their own worthlessness. The negative way of thinking which is part of depression can absorb a huge amount of our energy and attention and become a major preoccupation. However, there are steps we can take to escape from this vicious circle. More will be said below about getting help from other people, but there are things we can do to free ourselves from depression and move on. What works for each of us may be different, but these are some of the things people have said help them:
- Taking up a physical activity like swimming or just going for a walk.
- Getting involved in something practical, maybe making something for yourself or your home, or even cleaning out a cupboard.
- Getting in touch with a friend or relative. It’s easy to feel that people don’t want to hear from us if we’ve been out of touch for a while. But they may be thinking just the same about us, and would love to hear from us.
- Giving yourself a treat or doing something that really interests you. Maybe there was something you used to enjoy but haven’t done for a while.
- Acting more confident than you really feel. Sometimes just acting differently can have the effect of changing your feelings, even though it may feel false at first
It’s not easy to take action when we’re depressed. There may well be major difficulties in our lives which these ideas cannot solve. But it is important to find ways of coping with these difficulties without becoming overwhelmed, and people really do find that they help. ‘The hardest bit was that I just couldn’t see how anything was going to change. I couldn’t imagine ever feeling any better. I really had to force myself to do some of the things my counsellor suggested. It was hard going, but it gradually got easier.
Getting help from others
It may be that what we can do on our own is not enough. Sometimes it is useful to talk things over with someone outside our immediate circle of family and friends. It can be a big step to take up such help, but we should not feel ashamed of needing it. There are various sources of support available to people who are depressed, each offering different kinds of help. It is worth contacting one of the organisations listed later to find out what is available in your area.
A lot can be gained from meeting with other people who have similar experiences of depression and hearing how they have coped. It can overcome the sense of isolation and provide a chance to help others, too. Self-help groups often provide advice and training in relaxation and information on complementary therapies, such as art therapy, music therapy or aromatherapy.
Counselling and therapy
Counselling and therapy are sometimes called ‘talking treatments’ because they give people a chance to talk through their difficulties.
Therapy – of which there are many types – tends to be longer-term and to be concerned more with explaining and coming to terms with past events.
Counselling is more practical and focuses on present day feelings and difficulties. In either, it is important to find a counsellor or therapist you can relate to and trust.
‘It was the feeling that someone at last understood me– understood what I was going through– that’s what helped most.’
Cognitive therapy can be useful in helping people who are depressed overcome negative ways of thinking. We may not necessarily feel we have to find out what caused us to become depressed, but may want to use counselling and therapy to help us bear the pain of depression.
Many people go to their family doctor when they are feeling depressed. Medical involvement can be important in that the physical symptoms of depression can resemble those of other conditions and need to be checked out. Your doctor is most likely to treat you him- or herself, but s/he may refer you to a psychiatrist for specialist help.
Doctors may well recommend a course of anti-depressant drugs. These are not tranquillisers and they are not addictive. They do not in themselves cure depression, but they do lighten your mood to allow you to cope more effectively. They work for a lot of people but not for everyone, and they can have side effects, especially at first. Feeling drowsy, a dry mouth and constipation are some of the most common ones.
Most anti-depressants take 2-4 weeks before they have any effect so it is important not to give up too quickly if you don’t feel better straight away. Your doctor may suggest that you keep taking them for a few more weeks after you do feel better, because this can prevent the depression from coming back. These are just some of the facts about anti-depressants. It is important that you get your doctor to explain the treatment offered. You are entitled to information about the likely benefits and disadvantages of each drug prescribed for you. You may also want to talk about the alternatives to drug treatment, such as counselling, therapy or self-help. Your doctor may be able to put you in touch with other sources of help.
Friends and relatives
As a relative or friend you can help by being patient and understanding, by showing a real interest in the person themselves, not just in their problems. You can show your concern by listening sympathetically, and being prepared to spend time with them. This is important as people who are depressed need help to sort out what has to change to enable them to get over the depression.
Your role may be to encourage your friend or relative to talk about their feelings rather than bottle things up. This can take a lot of time, going over the same things again and again, but try to be patient. Someone who is depressed is already carrying a heavy load of guilt, so try not to criticise or blame them. Praise and realistic encouragement are likely to be more effective than telling someone to pull themselves together.
‘I found it hard to be patient all the time. It’s hard to show you care when the other person seems so remote and so negative about everything.’
Family and friends can also help by challenging the depressed person’s negative ways of thinking, and their preoccupation with their problems. If someone feels, for instance, they are never any good at anything, you can help by pointing out situations or tasks they have handled successfully. Doing things together which they can succeed at may help, too.
Someone who is depressed is likely to need a lot of prompting and encouragement to seek help. You can be of assistance by finding out about local support groups or relaxation classes and possibly by accompanying that person to the group or to a doctor’s appointment.
However it is not easy to live with or be in regular contact with someone who is depressed and help them cope.
It is very upsetting to see someone you love appear to change so much, with no apparent interest in the world or anything in it (including you). You may worry that in some way you have contributed to the depression.
You will often feel helpless. You may feel bewildered and resentful that this has happened to someone you care for.
You may feel annoyed with the person because you are at a loss as to how to help. Depression can cause someone’s moods to change so that you feel you don’t know the person as well as you used to. You might feel like giving up trying to reassure someone, when he or she does not seem to be trying to help themselves any more.
If your friend or relative is severely depressed you may find yourself doing things on their behalf such as looking after their physical needs. You may worry about how they will cope in your absence and about the risk of their contemplating suicide. This is a lot to bear on your own and you may need support and advice. If possible get others to help you and share the load. Talk to your family doctor about your concerns. Discuss your own feelings with relatives and friends. You may want to get in contact with a local support group for people in your situation.
‘Sometimes I felt I was being dragged down by his depression. I had to fight hard to keep myself from going down, too.’
Of course the person who is depressed is important, but there is a danger that the lives of friends and relatives come to revolve totally around the person’s depression and this helps no-one.
‘I feel a great burden has been lifted from my shoulders.’
Recovering from depression can take a long time and many people worry they will never fully recover. We should not forget that someone who has been deeply depressed and has got over it will still experience ‘highs’ and ‘lows’ just like everyone else, so we should try not to be too sensitive to these normal moods.
Learning to relax and to free ourselves from the stress that builds up can be enormously important when recovering from depression. It can also help prevent us becoming depressed again in the future. There are now many relaxation classes in local schools, leisure or community centres (Community Education Offices or Public Libraries will be able to tell you more). There are also many books and cassettes which teach relaxation techniques.
While it often needs a big effort to make ourselves do something, it can be very satisfying to achieve even a small goal by ourselves. Part of getting over depression is learning to do things which we want to do, which make us feel good.
Joining a self-help group can be a good idea if we find it hard to motivate ourselves to do things on our own. It can provide support while we are depressed and help build up our confidence. After depression has lifted, it can be important to learn to recognise early warning signs that it may be returning. A group can also be very useful in this respect.
I have a better understanding of myself now. I’m beginning to understand why I got depressed and what the signs are I need to watch out for, so it never gets that bad again.’
Depression is often a painful and deeply distressing experience for those affected by it and for people close to them. It is probably one of the biggest challenges someone will face in their lives. It forces us to look at ourselves and our lives and consider how to change things. We may even come to see it later as a useful experience, although at the time we are completely overwhelmed by it.