1c. Fundamentals (Foundations 1/3) – Mental Health: Depression (PDD)

Introduction

If you or someone you know are having thoughts about hurting or killing yourself, please consult a medical professional immediately, call the emergency services or go to the Emergency Department at the nearest hospital. Failing this, call a helpline or a friend.

Go here for emergency numbers and helplines: https://www.opencounseling.com/suicide-hotlines or https://findahelpline.com/i/iasp. Do not be alone at this time. These thoughts will pass. If this is not an emergency but you have been experiencing thoughts about suicide or hurting yourself, read ‘Suicide’.

If you suspect that you may be experiencing depression or anxiety, please consult a qualified professional as soon as possible and they will take you through different options for treatment. There is strength in seeking help and power in taking action.

For Bionic Reading, copy this webpage’s URL or text and paste it here.

I am not a qualified medical or mental health professional, but depression and anxiety have accompanied me since childhood. In the coming posts, we’ll be exploring common themes from my own study and life experience.

The scope of this and the following posts on mental health will be limited to depression, anxiety, and self-harm as these are my fields of knowledge.

These are huge topics. I will try to break them down into the most relevant information and provide links for further study if you would like to do a deeper dive into it.

Overcoming depression and anxiety takes time, effort, and understanding. There is no simple, quick fix, but believing it is possible is the first step. For now, let’s focus on understanding it. Then we can work on making incremental improvements to our lives and helping others.

Depression

In this part, we will talk about different types of depression, causes, symptoms, signs of depression in others, treatments, and my personal experience. In a later section, ‘Triggers and Tools’, we will look at strategies to help.

Depression is complicated and everyone’s experience is different. It can be brief or long, light or heavy, or somewhere in between. As you’ll see below, there are many types and many causes.

Types of depression

Major Depression, Major Depressive Disorder (MDD), or Unipolar Depression is characterized by symptoms experienced most of the day, nearly every day, for episodes of at least two weeks, and can be experienced as recurrent episodes throughout life. It is often described in terms of mild, moderate, or severe.

The different types of MDD are:

Seasonal Affective Disorder (SAD) – related to particular seasons where sunlight is diminished

Atypical Depression (mood reactivity) – where mood improves when something positive happens

Bipolar Disorder (previously known as Manic Depression) –alternating between episodes of depression and extremely elevated energy

Psychotic Depression – characterised by false fixed beliefs (delusions) or hearing or seeing things that others can’t hear or see (hallucinations)

Postpartum (or Postnatal) Depression –feeling disconnected from a new baby after giving birth or experiencing fears that they could hurt the child

Premenstrual Dysphoric Disorder – occuring during the second half of the menstrual cycle

Situational Depression or Adjustment Disorder – triggered by a significant life-changing event

Disruptive Mood Dysregulation Disorder – affects children and adolescents aged 6-18 and is characterised by irritability which can result in severe and frequent temper outbursts which are out of proportion to the situation and not consistent with the child’s developmental age

Persistent Depressive Disorder (PDD, previously known as Dysthymia) – chronic depression, usually milder with an episode lingering for a long period of time (can be years)

Quoted and adapted from https://www.psycom.net/depression
& https://www.psychiatry.org/patients-families/depression/what-is-depression

When I talk about depression, I’m talking about PDD, as this is my field of knowledge and experience. Moving forward, when I use terms like ‘depression’ & ‘depressed’, you can assume I’m talking about PDD.

This is a simplified and condensed introduction to depression. For a deeper dive, please check out the links throughout and at the end of this post, or read any of my previous writings on the subject.

Causes of depression

There are various possible causes of depression including:

Brain structure or chemistry

Chemical imbalance (serotonin)

Family history of depression

Genes

History of other disorders

Stressful or major life events (including positive ones)

Hormone changes (menstrual cycles, pregnancy, giving birth)

Physical conditions (e.g. chronic pain or headaches)

Certain medications

Personality (low self-esteem, easily overwhelmed by stress, generally pessimistic)

Environment (exposure to violence, neglect, abuse, poverty)

Quoted and adapted from https://www.psycom.net/depression
& https://www.psychiatry.org/patients-families/depression/what-is-depression

Symptoms of depression

According to the American Psychiatric Association (APA)’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5, the authority for psychiatric diagnoses), a diagnosis of depression can be made if the following applies:

The individual must be experiencing five or more symptoms during the same 2-week period and at least one of the symptoms should be either (1) depressed mood or (2) loss of interest or pleasure.

Depressed mood most of the day, nearly every day.

Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.

Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.

A slowing down of thought and a reduction of physical movement (observable by others, not merely subjective feelings of restlessness or being slowed down).

Fatigue or loss of energy nearly every day.

Feelings of worthlessness or excessive or inappropriate guilt nearly every day.

Diminished ability to think or concentrate, or indecisiveness, nearly every day.

Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

To receive a diagnosis of depression, these symptoms must cause the individual clinically significant distress or impairment in social, occupational, or other important areas of functioning. The symptoms must also not be a result of substance abuse or another medical condition.
Quoted and adapted from
https://www.psycom.net/depression/major-depressive-disorder/dsm-5-depression-criteria

Regarding suicide, if you need help right now, go here: https://www.opencounseling.com/suicide-hotlines or https://findahelpline.com/i/iasp

If this is not an emergency, consider reading my previous post, ‘Suicide’.

Other symptoms linked to depression include:

Regular trouble sleeping or oversleeping

Negative headspace (e.g. irritability, frustration, pessimism, worry)

Physical aches and pains (e.g. headaches, stomachaches or neck tension)

Increase in purposeless activity (e.g. inability to sit still, pacing, handwringing)

Loss of libido

Changes to menstrual cycle

Memory problems

Quoted and adapted from
https://www.psycom.net/depression
https://www.psychiatry.org/patients-families/depression/what-is-depression, https://www.nhs.uk/mental-health/conditions/clinical-depression/symptoms/ &
https://www.spring.org.uk/2021/06/signs-of-depression.php

Signs of depression in others

Here’s what to look for if you’re concerned about someone else:

Any of the symptoms listed previously

Regular trouble sleeping or oversleeping

Poor self-care (e.g. appearance, hygiene, empty fridge/cupboard)

Little joy in receiving visitors

Social withdrawal

Not completing work/tasks

Regular lateness or absence from work or school

Use of alcohol and other drugs

Negative comments (especially about themself)

Talking or joking about suicide

Treatments for depression

Medication

Psychotherapy

Cognitive Behavioural Therapy (CBT) – helps recognise and understand thought patterns, develop coping skills

Electroconvulsive Therapy (ECT)

Self-help

Lifestyle changes

Quoted and adapted from
https://www.nhs.uk/mental-health/advice-for-life-situations-and-events/how-to-help-someone-with-depression/ &
https://www.beyondblue.org.au/the-facts/depression/signs-and-symptoms

We will look at ways to help yourself and others later on in ‘Triggers & Tools’.

My experience of depression

Here, I’ll describe my personal experience of depression.

For me depression has shown up in different ways over the course of my life. I see it like background noise in the everyday. Sometimes the background noise comes to the foreground. Sometimes it gets so loud it becomes distracting, and sometimes you forget it is there.

I also see depression as an invisible lens that shapes how I see the world. Like seeing the world through shades of only one colour – hence the name of my blog: ‘Monochrome Glasses’.

It is so much more than just sadness. Sadness can be a part of it, but it can sometimes show up as seemingly random physical symptoms and emotions such as anger or apathy. For me, the defining factor has been a seemingly unending physical and mental exhaustion.

I’ve learnt and am still learning how to live with it. I am optimistic now, but I wasn’t always. At the end of 2021, I began to believe that a life without depression is possible, but I still err on the side of caution, well aware that without the right systems and protection it can creep (or explode) back on the scene. However, that knowledge is empowering because I have developed and continue to develop tools to deal with it.

Depression has been a defining factor in shaping the course of my life. This is due to the way it affects my thoughts and behaviours which we’ll explore in later posts. If I had not lived with depression, I would be a very different person for sure, but I have and it has forced me to become more resilient, stronger and more compassionate. Now I’m determined to turn what was my biggest weakness into my biggest strength!

What strategies have helped you or a loved one cope with depression?

References & Further Reading

Emergency phone numbers and helplines

Find a Helpline

https://findahelpline.com/i/iasp

Open Counseling

https://www.opencounseling.com/suicide-hotlines

Learning about depression

American Psychiatric Association (APA)

https://www.psychiatry.org/patients-families/depression/what-is-depression

Anxiety and Depression Association of America

https://adaa.org/understanding-anxiety/depression