Understanding Depression

To start to deal with depression one must understand it.

Firstly we need to recognise that depression is a coward.  It will creep up on us when we least expect it and do its best to ruin our day, week, month or life.  It has some very sophisticated tricks that fool us into believing that it is our only future and that ignoring it, challenging it, or treating it is futile.

Depression is also a thief.  It will try to rob us of our confidence, dignity, friends, sense of humour and, if left unchecked, life.

Depression often presents in waves, coming and going.  A depressive episode can last from hours to days, weeks, sometimes months.  Triggered for any or no reason, one of the frustrating elements is simply not knowing.  Even a moderate trigger can lead to a full blown depressive episode for no apparent reason.  There are few if any warning signs, an episode can come at any time.

No two episodes are the same and no two people experience depression in the same way.  There are some consistent themes that are directly associated with a depressive episode which may include any, or all of the following, in no particular order:

  • Emotional withdrawal and shutdown.
  • Sense of emptiness.
  • Feelings of failure, worthlessness being desperately sad.
  • Irresponsible behaviours, often financial.
  • Anger and destructive outbursts.
  • Acute fatigue.
  • Loss of interest in everything.
  • Comfort eating, or loss of appetite.
  • Insomnia.
  • Confusion, memory issues and inability to concentrate.

Although predominantly a mental illness, depression can have notable physiological presentations often similar to having strained every muscle in the body.

There are two other significant factors closely associated with Depression:

Anxiety and Self Harm.  Anxiety is often the companion term associated with Depression however although linked, presents individual symptoms equally as powerful and destructive in their own right.  It is often anxiety that causes persistent insomnia and disturbed sleep patterns.

Self harm is similarly closely associated with Depression while exhibiting its own particular characteristics.  The harm may not necessarily be physical and often presents in social exclusion of family and friends, alienating colleagues and creating an environment unconsciously designed to cause dislocation from potential support structures.  At its most extreme self harm is physical and may include burning, scratching and cutting of skin, bruising and other forms of self mutilation. The most pernicious form of self harm however is the taking of one’s own life. This may escalate with frightening rapidity over such a short period of time that no warning signs are immediately present prior to the suicide.

Many view suicide as a means of removing what they see to be a terminal and irreconcilable pain, or protecting those they love from “having to live with me like this”.

The most commonly problematic feature of depression however is that it is generally a completely hidden illness.  Consequently it will either go unnoticed or be seen as a change in a person that is simply uncharacteristically unsocial, yet unquestioned.

“Snapping out of it” or “cheering up” is as unlikely as expecting someone with a broken leg to run for a bus.  Similarly saying “I know how you feel” isn’t helpful.

Because depression can be completely disabling we need to treat it in the same way we would a physical injury; with patience and sensitivity, without judgement and realising that each presentation, like a physical fracture, is unique to that person.  

For some, medication will be helpful, for others less so.  In general, structured talking therapy is thought to be highly effective and sometimes people just need to be reassured that they’re not going mad.  Internet and Facebook can be a mixed bag – the hashtags such as #itsOkNotToBeOk and graphical memes can be supportive however it is often the case that “Social Media” exhibits it’s most unsocial characteristics – making a depressive episode more intense.

The only thing depression could claim to be a positive attribute is that it’s an Equal Opportunity Illness.  It doesn’t discriminate and has no prejudices – it will offer itself equally to all.