Am I depressed - or is it something else?

Our moods naturally vary over time and from day to day. Everyone gets down sometimes. We may say that we are 'down', 'fed up', or 'feeling under the weather'; we may get disheartened about something that happens or when things don't go the way we would have liked. Although people often say 'I'm depressed' to mean these things, this would not usually be what is called clinical depression but is simply part of the normal ups and downs of life. Some people naturally experience frequent mood changes, while others have a relatively stable equilibrium.

Similarly, if we suffer a major loss, we readily understand that it is normal to grieve. Although some of the emotions we feel when we are bereaved appear similar to depression, grieving is a natural and ultimately healing process. Sometimes, though, past losses which were not fully mourned at the time may later resurface and present as depression much later.

So, what is depression?

Put simply, the distinction between feeling 'down' and being depressed is one of both degree and duration; i.e. low mood becomes problematic when it is frequent, persistent and begins to affect our work, relationships, social activities and self-esteem. Depression includes a persistent low mood and loss of interest or pleasure in life - it also commonly involves:

• a change in eating, weight and/or sleep patterns
• reduced energy levels and reduced physical activity
• impaired concentration
• negative thoughts and beliefs about self, others and the world
• avoiding other people and withdrawing.
• feelings of worthlessness or hopelessness
• loss of interest, enthusiasm and enjoyment
• reduced sex drive
• feeling irritable and short-tempered, or tearful
• being unable to continue as usual with work and interests, maybe because you feel listless, or 'can't be bothered', or things feel pointless
• the future may seem bleak or hopeless, or feel that it just not worth going on, or think about suicide.

Please note that we may feel some of the above for reasons other than depression, or even several together for a brief while, without this being of major concern. Someone who is depressed will experience a number of these changes persisting for quite some time.

Nonetheless, depression is very common - it affects people of all ages and backgrounds and is one of the most common reasons for people seeking help from counsellors or doctors.

Why do people get depressed?

Often depression is a response to events or circumstances that are felt to be deeply troublesome or distressing, or which seem to threaten our personal identity. Usually these circumstances seem too hard or even impossible to change. There can be a sense of powerlessness, hopelessness and an all-pervasive gloom.

However, sometimes people seem to get depressed for no obvious reason. In these cases, it may be that something that hurt deeply some time ago (even years ago) begins to surface now. Although this is perplexing and just as distressing, this process is not uncommon. Sometimes, though, the onset of depression seems to be caused by nothing in particular and can be the result of chemical or hormonal changes affecting our body.

It is understandable to feel down for a while after something upsetting has happened, like the end of a relationship or feeling disappointed that you have not done as well as you would have liked. Usually this disappointment passes with time, and people find that they can come to terms with what has happened and start to look forward to the future in a more positive way. However, if the low mood is frequent or persists, or seems so severe that it affects your ability to function normally, it is time to seek out some help.

Negative thinking

When people are depressed they usually find themselves thinking very negative thoughts about themselves and the world; typically these thoughts are felt to be absolutely true and that there is no way of things ever changing. However, studies have shown that when people are no longer depressed they go back to seeing things in a more positive and balanced way.

Negative thoughts affect the way people feel, therefore frequently perceiving things in a very negative way will exacerbate feelings of depression. Negative thoughts are usually -

• about yourself:
  • nobody likes me; I'm worthless; I'm unlovable
  • I am doing really badly at work
  • I'm a failure; I will be criticised; I will be rejected
  • I am a fraud - I should not be here
  • nobody will ever want to have a relationship with me
• about your situation:
  • Where I live is a horrible place
  • I will never be able to do all the work
  • I don't fit in; I'm different; I will always be alone
  • I have nothing in common with anyone who works here
• and/or about the future:
  • it's hopeless; I won't be able to cope
  • things will never get any better
  • I am always going to feel like this

Situations which people describe as making them vulnerable to becoming depressed include -

• feeling lonely and thinking that nobody cares
• finding work difficult and fearing criticism, ridicule or rejection
• thinking that they are a failure, or don't fit in.

How to help yourself

There are some things you can try which have been shown to help lift a depressed mood. These involve changing your behaviour and challenging your negative thoughts.

Changing behaviour

People who are depressed often stop doing pleasurable activities which would make them feel better in the short term, for example they may stop going out, opt out of regular activity, or stop going to see friends. Encourage yourself to start doing things again - activity can lift your mood and you may well find that you can do things better than you imagine. If you usually enjoy going to the cinema or swimming, for example, try these things to start with. Any activity will be helpful, but enjoyable activities and physical exercise/sport are particularly effective.

• Break tasks down into steps or manageable 'chunks' and tackle these one at a time. Although it may not seem so to you, you will probably be able to do things just as well as when you are not depressed
• Start with easier tasks and then progress to more difficult ones: this will help you to regain your confidence
• Be realistic and allow yourself more time to do fewer things
• Allow yourself to feel pleasure at what you have achieved and reward yourself for each achievement
• It is very important to spend time with people who are supportive. Isolating yourself increases depression, while social support helps lift a low mood
• Find people with whom you can be honest about how you are feeling, and with whom you do not have to put on any pretence - but don't take up all their time.

Changing negative thoughts

As already stated, there is a link between negative thoughts and emotional disturbance which can make us vulnerable to depression.

If you are not aware of any specific negative thoughts and are confused about why you are depressed, you may find it helpful to talk with someone. A trained counsellor can help you understand the depression and find the most effective and appropriate ways of dealing with what you are experiencing. There are different ways of challenging your thoughts. One way is to use a structured cognitive behavioural approach (such as described briefly here) which involves:

• becoming more aware of your negative thoughts
• recognising that your appraisal of situations may be biased or distorted due to depression
• learning how to challenge your own negative thoughts and beliefs so that they become more balanced.

Do not automatically believe your negative thoughts no matter how strong they feel at the time. By considering other explanations, your 'worst possible' conclusion will be seen as only one of a number of possible explanations for your situation. This allows you to consider each explanation and see which is most likely to be true, or to try to collect 'evidence' which will help you test the different explanations.

If you feel it is appropriate, try talking to other people to help you get a balanced perspective on which are the most likely explanations.

Medication

Modern antidepressant medication is thought not to be chemically addictive. Usually it takes two to three weeks before having any beneficial effect and it is typically prescribed for at least six months.

If there are difficult circumstances contributing to your depression, medication won't cure them - but it may help you to rediscover your natural abilities and coping strategies to address these issues.

If you feel medication may be an appropriate way forward, you will need to speak to your doctor. Be as open as you can about how you feel and your circumstances, so that you can decide together on the best course of action. Do not be afraid to ask questions about any medication suggested and what to expect while you are taking it.

Your doctor is likely to arrange to see you regularly if you are prescribed an anti-depressant. Be sure to go back yourself if you feel the medication makes you feel worse or if it seems to be having no effect. Also, it is important that you only change or stop taking the medication after talking to your doctor, as stopping suddenly can sometimes cause people difficulties.

When to seek further help

• If your low mood and negative thoughts persist or are so strong that you feel powerless to do anything about them
• If you have nobody to confide in who can help you look at why you are feeling depressed
• If your low mood is interfering with your life, work or relationships
• If you experience feelings of hopelessness or feel suicidal.

Where to seek help

• Ring NHS Direct for advice
• Talk to your doctor who can discuss the range of treatments available to you, including medication
• Come to the Occupational Health Counselling Service to talk to one of the counsellors.although you may not be able to see someone straight away.
• If you feel really desperate and despairing out of normal working hours, telephone your doctor's practice (a message will give you an emergency number) and a doctor and you will be able to speak with a doctor
• Telephone the Samaritans

Some books that might be helpful

• The Feeling Good Handbook, David Burns (Penguin, 2004)
• Mind over Mood, Padesky & Greenberger (Guilford, 1995)
• Depression - the way out of your pain, Dorothy Rowe (Routledge, 2003)