Depression

Dr Brendan Lloyd, Clinical Psychologist

Depression is often overlooked by the person suffering, or by people who could otherwise be of help. Depression is, on the other hand, very treatable. There is no right way, but there are effective ways to defeat depression. For effective self-help it is important to have accurate information about your problem.

For example, depression is serious, not just feeling sad or moody. Feelings of sadness or moodiness will come and go and are a normal part of life.

Depression is common. At least a quarter of all people will experience depression during their lives in one form or another. Depression is often said to be the cause of suicide. Depression is also very often associated with anxiety.

“Is it more helpful for me to think about my depression as an illness, or a problem with living?”

How you think about your depression will lead you to make choices about what you will do about it. The key here is to be effective. You will know if what you are doing is effective, because you should see results within weeks. These positive results will last; and, if whatever you do is effective, it will prevent you from having a relapse.

It is clear that depression is not just marked by how you feel. It is associated with certain behaviours (what you do if you are depressed), head-chatter (the mental activity of depression), physical signs (what happens to your body when you are depressed), and last but not least how you feel.

“How do I decide whether my depression is an illness or a life-problem?” The answer here is really in what you want to do about it. Consider these two points of view.

1. If my depression is an illness, then all I need is medical help. In other words, all I need to do is go to a GP who will examine me, make a diagnosis, prescribe suitable medication, and then the disease will go away. It's a simple as that.
   
   
2. If on the other hand my depression is a life-problem, then I need to look at how I'm dealing with the problems of living. I will need to look for effective ways to manage the stressors in my life. I will need to look for an effective way to manage my head-chatter. And probably I will need effective ways to manage my dealings with other people.

From a psychologist point of view the choice should be clear. In my view, the illness model of depression is disempowering. If you have an illness, then you have no real personal control. It’s all in the hands of the doctors. It’s all to do with the medication. On the other hand, if depression is a life-problem, then you can take control. You need not see yourself as a victim.

But what about the chemical imbalance in my brain? The answer to that question is another question, which is, “which chemicals?” The chemical imbalance theory is a theory, not a chemical imbalance fact. There is no blood test to show which chemicals if any are out of balance. So which chemicals are out of balance? Is it noradrenalin, or is it serotonin, or is it dopamine? Who knows? And what caused the chemicals to go out of balance to begin with?

If I wanted to cause depression in someone, all I would need to do is stress the person beyond his/her ability to cope. On the other hand, if I want to help someone overcome depression, all I need to do is show this person how to develop effective strategies to manage stressors better, Mindfulness skills to effectively manage the head-chatter, and help this person to develop effective interpersonal skills to manage the biggest stressor of all, which is, other people.

At this point I must make it perfectly clear. It is your choice. You know what is best for you. If you don’t know yet, then the process of finding out will not do you any harm. The one thing you do need to do about depression is to do something. Doing something, so long as it is positive, is better than doing nothing.

So, if your choice is to see a GP about medication and if that works for you, why would you want to do anything else? If going to a psychologist for face-to-face psychotherapy is effective for you, then do that. If you are able to be effective with doing it yourself in the self-help way, then why wouldn’t you do that?

One thing is quite clear about treating depression, that is, it is very treatable. There is no evidence to say that one way is more effective than another. For example, there is a mountain of research out there. There is not one bit of evidence to say that one form of psychotherapy is more effective than another, or that medication is more effective than psychotherapy.

You can do CBT (cognitive behavioural therapy) IPT (interpersonal therapy), MCT (Mindfulness Cognitive Therapy), plain old behaviour therapy, plain old cognitive therapy, social worker counselling, peer counselling, all will be equally effective. There is no evidence that drug therapy is more effective than any form of psychotherapy. There is no evidence independent of drug-company research that says drugs and psychotherapy are more effective together than any one approach on its own. There is some consumer research, however, that says a relapse is less likely with a psychological treatment than with a drug treatment.

In general terms, there are four ways for anyone to defeat depression; these are…

1. Self-help, more common than the professionals realise
2. Psychotherapy, with a registered practitioner such as a psychologist
3. Medication, antidepressant drugs
4. Combinations of the previous three

Be aware of the “quick fix”. Be aware of fantastic promises. If it is too good to be true, then it probably isn’t true. As a psychologist, I of course want to help people without drugs.

11 Self-Help Things To Do

1. If you are depressed then don't go by how you feel. If you are depressed then you feel like doing nothing. This is no time to be in touch with how you feel. Don't look for the motivation. The motivation will come once you get going.
2. Take stock of your stressors. Ask yourself, "Do I just use avoidances, escape, suppression, denial, or blame when I'm faced with challenges, or demands, or threats, in my life?" We all need to develop adaptive or proactive strategies to address our stressors. For example, do I need to learn how to be more assertive? Do I need to be more accepting for the way things are? Do I know the difference between what I can change and what I can't?
3. Exercise. Drag yourself outside if necessary. Walk. Wander. Run. Go to a Gym.
4. Get a dog to take you for a walk. If you don't have a dog, then borrow one. Dogs are fantastic company. Their happiness is contagious.
5. Schedule pleasurable events. A lot of people end up depressed because they get bogged down in the daily grind. Make of point of doing a regular activity that you would normally like doing. Like, go to the movies, the beach, play with the kids. Do these things even if you don't feel like doing them.
6. Find a way to focus off your head-chatter. Don't let your head-chatter just bang-on endlessly. Practise Mindfulness meditation.
7. As an extension to Mindfulness practice, see if you can catch yourself out when you catastrophise, or get bogged down in the "what ifs".
8. Include yourself in social activities even if you don't feel like it.
9. Make sure that you're eating good food. Don't eat junk or do comfort eating. Get into fresh foods.
10. Try not to be dependent upon alcohol or other drugs.
11. Consider professional help for when you need it.

WARNING
For very serious psychological problems such as posttraumatic stress disorder, specific phobias, addiction, conduct disorder, or personality disorders, I strongly recommend that you seek out a local psychologist to tackle those problems in face-to-face consultations. For serious psychiatric disorders such as psychosis or bi-polar or schizophrenia you will need to consult with a psychiatrist face-to-face about suitable medication.