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.
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.