Depression is a very common mental health problem which can range from mild to moderate to severe. As severe, it can be a life threatening condition and should be treated as such. However, mild and moderate depression should never be taken as something to be thought of as lesser as they can be stages towards the more severe form and can be very disabling to the individual.
I will give the common symptoms below, but later on explain that whilst these are correct, they are not the whole picture.
. Low mood and feeling sad
. Less energy and less interest in those around you
. Losing interest in other people, sex or things that normally interest you
. Loss of concentration and loss of self worth
. Linked to that, a sense of self blame, guilt, despair and being helpless
. Sleeping more or much less and possibly waking much earlier not feeling rested
. Crying a lot and often at things which seem unrelated to you, eg TV, newspaper article etc
. Eating less and loss of interest in food, but sometimes eating a lot more than normal
. Irritable and impatient
. Removing yourself from others, and feeling unreal which can make you feel you are going“mad”.
. Thoughts or acts of self harm and suicidal thinking
As you can see, many of these can be obviously depression, eg suicidal thinking, but some are very general and could apply to many people who aren’t necessarily depressed. Have you heard doctors talking of a physical illness with the words, “It starts with flu like symptoms”? That is like depression in that the start can be so general that people miss it completely. Others get low for a few days or a week and assume they are in depression, when in fact the causes may be in a life event which can be helped with some insight, such as a a burglary in the home, loss of a job, a serious row with a relative – reaction to which is totally normal.
The depressed person can feel the onset is so gradual they miss it completely and adjust their life to this feeling. Often a person will make excuses for this change, “Its just a phase and it will pass” or “work is particularly stressful, its probably that” and so forth. I have suffered from depression often in my life and before I learned to spot it, I would try to battle through these feelings telling myself off. I would feel I shouldn’t bother people with my needs and trying to explain how I felt would be very difficult and I would struggle to express it. Besides, I wouldn’t want to bother them as I wasn’t worth much. So as a rule of thumb, if you are feeling like this for at least four to six weeks and when you look back, the intensity is increasing, get help.
For some forms of depression it is known that exercise can be hugely beneficial increasing endorphins (the feel good hormones) and help a person to find causes and think through the feelings. Talking to others is often hugely important and letting friends or family reach out to you even if this is difficult to do. Making a mood diary, something simple, can help you find the times of day, types of events or people which trigger the feelings to be worse. A short course of CBT might be of great benefit and most GPs can offer this although there is often a waiting list.
Severe depression is whole different experience. It can be utterly debilitating and the ability to help yourself is often much more difficult. On top of the symptoms above, a person might experience strange sensations like paranoia that others are looking at them and high anxiety in all kinds of situations. Dissociation, meaning that you don’t feel real or the world doesn’t feel real, can be common. People in a severe depression often withdraw, feel the above emotions in an intense way and like a real inner pain and some have described it as an agony.
Tunnel vision, or the sense that you can only see the world from the perspective of your emotions, which I talk about as the “language of depression” which involves everything is deep black, there is no hope, there is no way out. Self harm can be used by people to try to alleviate these feelings as one intense feeling can temporarily give relief from the emotional pain. But it is temporary and then the feelings return, often more forcefully. It doesn’t work in the long run, it can alleviate for a while, but the urge to self harm returns more and more, and ultimately doesn’t get you the help you need and can be very dangerous.
Suicidal thoughts and wish to act on them can increase and increase, sometimes as a way to end the pain, sometimes with the belief that you are saving others from you. If you see a person who has been increasingly showing these signs and then suddenly becomes calm and organised, start to give away possessions and put their affairs in order, pay particular attention, this can be a sign that someone is planning a suicide soon.
But remember, these feelings do ebb and flow and that night time is the worst time for most people, alone with their thoughts. It is with severe depression that a person almost always needs intervention and can’t manage to “get over it” without professional help of one sort or another and the person might well need an advocate to help the professional understand the severity of the condition.
A combination of medication and talking therapies can be useful, with a close watch on the person whilst they wait for these to take effect. Unfortunately, medication takes at the very least two weeks to start to work and then the type of anti depressant might not be the right one for that person. I had to try 5 different medications in the past before the right one was found, and some people find none suit them. If one doesn’t work, or makes you feel worse, go back to the GP, nag them, and remember if your don’t, they think nothing is wrong! If things are getting worse, anyone who can be an advocate ( friend, family) might need to insist on further psychiatric intervention. Take these signs seriously.
But remember, depression can be overcome, can be treated successfully and nearly everyone who thought suicide was the only answer, often feels very glad that they didn’t die once the depression lifts.