Tim Talks: The Black Cloud

A note from Tine: Welcome to another edition of Tim Talks! For those who are new to Beautyholics Anonymous, Tim Talks is a new series on the blog where my husband, Tim, will be sharing his knowledge to help raise mental health awareness. Tim is a psychiatrist who works in metro Melbourne. His area of interest is child, adolescent and youth psychiatry.

Today’s topic is one that’s close to my heart. It’s something I want to bring awareness to and why Tim and I started the Tim Talks segment on BA. It’s a lot more serious than my usual content but I hope this answers some questions you may have on depression. Please note that this article does not constitute medical advice and if you need more information, please consult your local GP.

Tim Talks - The Black Cloud

© Coley Christine

I picked the title ‘the black cloud’ as it is a very apt descriptor of how depression feels like, where a looming sense of gloom and apathy is present all the time. There is mounting evidence to indicate that depression will be the leading cause of disability in the not so distant future, surpassing even medical conditions such as cardiovascular diseases. With initiatives such as Beyond Blue and the Black Dog Institute promoting more awareness about depression, I am hopeful that sufferers and supports can better understand and manage this debilitating disorder.

In this blog post, I will focus on defining depression and also the psychological approaches to managing depression.

Sadness vs Depression, how can one tell?

This is a pertinent distinction to discuss, as the fear is that one can over-medicalise normal experiences and emotions as symptoms of a disorder. Depression usually presents with other associated symptoms such as decreased interests in pursuits or activities ie anhedonia (the inability to experience pleasure from activities usually found enjoyable, e.g. exercise, hobbies, etc), sleep and appetite disturbances, depressive cognition linked to feeling hopeless and helpless, as well as significant impacts on their ability to maintain relationships and employment or educational pursuits.

In severe forms of depression, they are very slowed in their thoughts, gesture and movements, a term called psychomotor retardation. This can also accompany thoughts of suicide. A general rule of thumb is that if the above symptoms are present for more than 2 weeks, it is termed a depressive episode.

Can’t depressed people just get on with it?

This is a common misconception and one that surfaces a lot in my discussions with carers of depressed people. Some seem to be of the view that by just persuading the sufferer to get back into what they were accustomed to doing, it would help resolve their difficulties. Some even go to the extent of saying that depressed people are just lazy or are trying to gain sympathy through their predicament.

There is a strong biological basis to depression, and there is increasing evidence to suggest that sufferers have altered functions in their cognitive ability, which means that they are more likely to find completing tasks and new learning very challenging. This tends to reinforce their inadequacies and feelings of worthlessness. What tends to be helpful is for their supports to be slowly and gradually encouraging them to tackle small achievements and validate their successes to improve their self-confidence.

If I am depressed, do I need to get professional help?

This really depends on the severity of the depressive symptoms being experienced, as well as whether there are concerns around the emergence of suicidal thoughts. I strongly believe that an inquisitive and concerned approach is helpful particularly if you have noticed some social withdrawal or work or relational difficulties with your friend or peer or family member. If someone is experiencing suicidal thoughts frequently, do find out if they have made any plans or have set their affairs in order, as that is an indication that urgent help and possibly in-patient psychiatric treatment might be warranted. It is helpful to find out what the local psychiatric triage number is, as you can call them or access Lifeline to get advise on how to help support the depressed individual.

Another thing that is important to be mindful about is that sufferers who experience severe symptoms may feel that they are a burden onto others and may not actively seek help. They may even refuse any treatment offered. Contacting emergency services will allow police and ambulance personnel to assess the situation, and the police have the authority to transfer someone to the nearest emergency department for further assessment of their mental wellbeing.

What are the things that will help someone through depression?

Support and giving depressed sufferers the opportunity to talk about their difficulties and offering positive encouragement is always a good start. Help them to understand that they are not alone in this battle, and that the majority of sufferers improve if they are actively involved in managing it. Maintaining regular exercise and social contacts is also not to be underestimated.

Avoid excess use of alcohol, as alcohol can further worsen depression. It can be too overwhelming to face the myriad of stressors all at the same time, breaking it down into workable tasks that you can fit into a day will be more manageable.

What is CBT?

CBT is short for cognitive behavioural therapy. It is an approach of psychological treatment that has been shown to be effective in treating many disorders such as depression and anxiety. Generally a psychologist, psychiatrist or health professionals trained in CBT can provide this form of treatment in the community setting. The duration can range from 8 to 16 sessions on average.

The early stages of the treatment focus on education about depression, with an emphasis also on teaching depressed individuals the importance of behavioural activation. This entails supporting them to have a more structured day where they have opportunities to pursue enjoyable activities as well as to monitor their physical activity levels, mood and sleep patterns (through a journal).

Usually many people can have anxiety symptoms co-existing with depression, the principles of anxiety management such as breathing exercises and progressive muscle relaxation are practised so that sufferers can learn to cope better when they are overwhelmed with anxiety. The cognitive refers to cognitive restructuring, which is the attempt to help sufferers examine their thought processes and challenge its veracity. This targets the distorted negative thinking patterns that depressed sufferers commonly have.

I hope that has provided some clarity around depression and some of the psychological treatments available. I have also put some links to some of the resources from the various organisations discussed above.

Until next time, I wish you all good mental health.

Lifeline Tel: 13 11 14
MoodGYM Training Program: An online free CBT program which can be a good starting point for people to find out abit more about CBT. Registration is required to use this service.

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4 comments… add one
  1. Isabel

    I used to refer to my depression as “the black hole in my head” and those who’ve suffered from it would probably have similar descriptions. The biggest problem I had then was feeling misunderstood and it’s so apt that you emphasize that awareness about depression is important.

    Even though I have a stable, loving family, I felt that they did realise that I had a problem with depression but were at their wits end as to how to deal with me. I don’t blame them. It’s not something that is easy to empathize unless you’ve been in that same dark place. I was fortunate that I found an online community that offered help in terms of understanding depression and also a forum for sufferers to give one another support. In being there, I was very conscious about that it could do as much harm as it could do good because when I’m not in a good place, being in that forum could actually exacerbate my condition. I learned that I had to be selfish and only went on that forum when I knew the discussions there would not trigger the danger buttons. And when I felt better, I tried to lend support to others who might need some help getting over a rut. That place was a life saver as I felt understood when I was there. Sadly, it has since shut down.

    It takes tremendous will to get one’s self out of the dark hole. With reference to a previous Tim Talk’s post, I also had problems with insomnia but was very reluctant to go on meds. Eventually it got so bad I asked my doctor for a prescription but I had to be disciplined in only consuming it when my insomnia was at its worst. To become hooked on drugs was the last thing I wanted or needed. And the after-effects of the sleeping meds were not pleasing to say the least. It felt like I walked around with cotton wool in my head all day. I was also very conscious about weaning myself off it as soon as I was able to establish some sort of sleep pattern.

    Thanks for creating more awareness about depression. It’s something close to my heart and I share my experience with it in the hope that it might offer someone else out there the encouragement that it is possible to beat the beast. Keep believing that there is light at the end of the tunnel even if you can’t see it.

    1. Tine

      Tim: Hi Isabel, thanks for being so open in sharing about your personal struggles with depression. What you have raised about group or forum support is quite important; it can be an added stressor especially if you are trying to help fellow sufferers whilst battling depression, and so prioritizing your individual mental health needs is a very helpful strategy.

      Pertaining to sleeping medications, it may be worth a discussion with your GP about looking into melatonin if that has not been explored before. It is a naturally occurring hormone that is useful in facilitating sleep and also in shifting your body clock in instances of shift work/ jet-lag. A lot of the other sleeping medications can usually leave you feeling quite groggy when you wake, and with extended use (usually beyond two weeks) can pose added issue of tolerance to it.
      Let’s keep up these conversations so that there is increasing awareness about mental health.

  2. Hilary

    Thank you for this. Whilst its getting more acceptable to talk about depression, especially over here in Australia compared to my original home land of the UK where things are a bit more reserved, its still seen as a ‘pull yourself together’ thing and something people don’t want to talk about. The more we do talk about it, the less this gets and the stigma gets reduced, which can add a layer to it being an issue.

    There was an AMAZING show on at the Adelaide Fringe and just closed in Melbourne (sorry, should have told you earlier!) called ‘Fake it til you Make it’ by Bryony Kimmings dealing with specifically Male Depression it was completely and utterly amazing! If anyone gets a chance to see it ever, I very very much recommend it (it has funny bits as well as dark bits).

    Thank you.

    1. Tine

      Tim: Hi Hilary, it sounds like a great show (and it just closed early this month, shucks), I’ll be on the watch-out for ‘Fake it’ if it does a re-run.
      I think that when some people have a limited understanding of depression, they can make generalised misguided assumptions about it, and I hope we can dispel more of the myths or stigma to depression with these discussions. Just like any other medical condition, it warrants our attention and urgency in helping and supporting those in such predicament.

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