Depression

The Treatment of Depression

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The World Health Organization characterizes depression as one of the most disabling disorders in the world, affecting roughly one in five women and one in ten men at some point in their lifetime. Depression is the third most common reason for GP appointments. It is more than just feeling “down.” It is a serious illness caused by changes in brain chemistry.

Due to the rise of depression Psychologists have been researching depression and argue that factors contributing to depression include genetics, stress, grief, increased shame, changes in hormone levels, certain medical conditions, difficult life changes or circumstances and difficulties regulating emotions. Any of these factors alone or in combination can precipitate changes in brain chemistry that lead to depression’s many symptoms.

Symptoms of Depression

Depression has a variety of symptoms including:

    • Loss of interest in activities
    • Loss of energy
    • Difficulty concentrating
    • Hopelessness
    • Loss of appetite and weight or increase in appetite,
    • Self-criticism,
    • Withdrawal from people,
    • Poor memory
    • Suicidal thoughts/plans
    • Changes in sleep
    • Decrease in libido
    • Irritability

The impact of thinking on Depression
Individuals are vulnerable to depression when they get caught up in their thoughts and judge their experience. Certain ways you think can cause and maintain depression. Common thoughts include:

    • Mindreading: Jumping to conclusions about what others are thinking of you, for example, ‘They think I’m boring’’; ‘‘They will think I am a fool’’.
    • Fortune telling: Negative and pessimistic predictions about the future, for example: ‘I’ll never get over this’’; ‘I’ll be rejected’’; ‘‘I’ll make a fool of myself’’.
    • Catastrophizing: ‘Worst case’ thoughts and images that enter your mind, for example, concluding that something terrible will happen if you go out of your comfort zone, ‘‘Everything will go wrong’’.
    • All-or-nothing-thinking: Also called ‘black-or-white’ thinking, this refers to thinking in extreme terms like ‘I should do something perfectly or not bother at all’.
    • Shoulds: Rigid rules you place on yourself and others, examples include: ‘‘I should be able to….’’; ‘‘They should know what I am thinking’’; ‘I should get the approval of everyone’’,             ‘‘I should criticise myself for my failings’’; ‘‘I shouldn’t be depressed’’; ‘‘I shouldn’t cry’’.
    • Discounting the positives: Not seeing the positive and only focusing on the negative, for example, ‘‘That doesn’t count because anyone could do that’’
    • Self criticism/labelling: ‘‘I am a failure’’; ‘‘I am weak’’; ‘‘I am bad’’

Depression can be made even worse when you buy into your thoughts. This often leads to increased efforts to control, escape or investing large amounts of time getting caught up analysing our thoughts and trying to find unanswerable questions, also known as ruminating.

When engaging in unhelpful thoughts, people tend to engage in unhelpful behaviours that maintain depression, including:

    • Withdrawal from friends and family
    • Avoid activates that used to give you pleasure
    • Use of alcohol or drugs to numb feelings
    • Ruminate about the past and try to work out reasons for the way you feel
    • Stay in bed for large periods of the day, also known as ‘duvet diving’
    • Spend a lot of time on the internet or watching TV
    • Distracting behaviours
    • Isolation

The solutions of avoidance and escape can make you feel worse and more depressed.

Effective Treatments for Depression:  The body responsible for producing guidelines for treatment is the National Institute of Health and Clinical Excellence (NICE), which is highly regarded throughout the world. The guidelines can be downloaded from their website www.nice.org.uk. These guidelines are based on scientific evidence.

The following are all recommended approaches for the treatment of depression in adolescents or adults:

• For mild depression, the national guidelines recommend six to eight sessions of counselling over a period of ten to twelve weeks.

• Cognitive Behaviour Therapy (CBT) has proven effective in the treatment of depression. CBT involves thought challenging – moving away from unhelpful thoughts to rational thoughts and activity scheduling to aid moving out of the depression cycle. CBT has been found to be as effective as anti-depressant medication. It is directive, active and collaborative in its approach. Homework is set in between sessions to generalise the skills.

• Behavioural Activation (BA) has proven effective as it targets unhelpful behaviours. It does not challenge thoughts but rather gives you skills to ‘defuse’ from unhelpful thoughts.

• Mindfulness Based Cognitive Therapy (MBCT) has strong evidence based for re-current depression. It has been endorsed by NICE for 3 or more episodes of depression. Results have shown that MBCT is more effective than maintenance doses of antidepressants in preventing relapse and can also reduce the severity of symptoms. MBCT is delivered in a group format over the course of 8 weeks.

If you feel depression is affecting you, or if you would like to find out further information about this topic, contact the practice for a confidential appointment.

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