Chapter 1 explores the costs of depression in economic, social, and emotional terms. We describe what depression looks like in various people. Finally, we provide an overview of the best means for treating depression. In Chapter 2, we cover the difference between the various forms of depression. Furthermore, we explain the difference between grief and depression. Chapter 3 shows you how to find the motivation for taking charge of your own depression. And Chapter 4 tells you how to find and get professional help.
Part II: Seeing Things More Clearly: Cognitive Therapy
More studies support the value of thought therapy (cognitive therapy) for the treatment of depression than any other psychotherapy. Part II shows you how certain habitual ways of thinking can be a major contributor to depression. The chapters in this part combine to give you a large toolbox of techniques for changing these dark, distorted thoughts into realistic appraisals of yourself, your world, and your future. You can see that this transformation isn’t based on rationalisation or self-deception. Rather, you discover how to subject your thoughts to reasoned scrutiny based on logic and evidence.
Part III: Actively Combating Depression: Behaviour Therapy
When you feel overwhelmed by depression, you likely find yourself disengaging from everyday life. You start doing less and less as you put off tackling even slightly disagreeable tasks. Of greater concern, previously enjoyable activities seem dull, bland, and devoid of pleasure. Part III shows you how to short-circuit ‘do-nothingism’ and slowly regain confidence and joy. We give you a mental boost to get moving again through exercise and rediscovering healthy pleasures.
Part IV: Adjusting to Changing Relationships
Clinical trials of interpersonal therapy demonstrate the value of addressing the relationship side of depression. Depression has a way of disrupting relationships with friends, family, partners, and other loved ones. And relationship problems can worsen depression. Part IV extracts crucial elements from interpersonal therapy and provides additional ideas for handling relationship difficulties that can increase depression. We cover issues such as communicating in healthy ways and coping with loss and grief.
Part V: Full-Bodied Assault: Biological Therapies to Fight the Physical Foe
Pharmaceutical companies have invested billions of dollars into developing a wide range of antidepressant medications. We review these medications, from the earliest to the most recent, and give you important information regarding their effectiveness and side effects. We also give you some tools for helping make the decision as to whether or not medications make sense for you and your depression. Finally, we explore the role of herbs, supplements, and nutrition in alleviating depression and review a few alternative treatments for depression, such as light therapy.
Part VI: Life After Depression
We have every reason to believe that the information in the first five parts, perhaps in conjunction with professional help, will lift you out of your depression. But what do you do next? Part VI tells you how to deal with possible relapses in the future. We tell you how to reduce the likelihood of such slips and how to deal with them if they do occur. Next, we discuss a new approach called mindful acceptance that has recently been found to be very helpful for reducing depression relapse.
We then turn to the field of positive psychology for ideas on how to further enhance your life. We want you to feel better than good again, so we lay out strategies for enhancing your sense of well-being through a sense of purpose and connectedness.
Part VII: The Part of Tens
If you want quick ideas on how to deal with a low mood, you can find them here. Then we show you ten ways to help your kids if they get depressed. We conclude with ten ways to help a friend or partner overcome depression.
Icons Used in This Book
Throughout this book, we use icons in the margins to quickly point out different types of information. Here are the icons you’ll see and a few words about what they mean.
Helpful stories and case-studies about people we’ve known and worked with over the years.
This icon alerts you to an exercise you can use to hammer away at or discover more about your depression.
As the name of this icon implies, we don’t want you to forget the information that accompanies it.
This icon emphasises pieces of practical information or bits of insight that you can put to work.
This icon appears when you need to be careful or seek professional help.
This piece of art alerts you to information that you may find interesting, but skipping it won’t put you at a disadvantage in the battle against depression.
Where to Go from Here
Most books are written so that you have to start on page one and read straight through. But we wrote Overcoming Depression For Dummies so that you can use the detailed Table of Contents to pick and choose what you want to read based on your individual interests. Don’t worry too much about reading chapters and parts in any particular order. Read whatever chapters apply to your situation. However, we suggest that you at least skim Part I, because it contains a variety of fascinating facts as well as important ideas for getting started.
In addition, the more severe your depression, the more we urge you to start with Chapter 3 and continue with Part III. These chapters contain a variety of ways for overcoming the powerful inertia that keeps severely depressed people from taking action. After you read those chapters, feel free to continue picking and choosing what you want to read.
Part I
Discovering Depression and Designing Defences
In this part . . .
Discover the symptoms of depression and identify whether you or someone you care about may be depressed. We tell you about depression worldwide. And we explain the different forms of depression.
Defeating depression’s no walkover. Many obstacles block the path. We identify these blocks and show how you can get past them. In this part, we also provide an overview of the various treatments for depression, and reveal how to obtain the best possible help.
Chapter 1
Understanding and Overcoming Depression
In This Chapter
Looking at depression
Understanding what causes depression
Figuring out the price
Treating depression
Life after depression
Depression can feel like being locked away in a prison. Feeling frightened, alone, miserable, and powerless, you can find yourself withdrawing into a shell. Hope, faith, relationships, work, play, and creative pursuits – the very paths to recovery all seem meaningless and impossible. Like a cruel punishment, depression imprisons the body, mind, and soul.
Though depression may feel isolating and inescapable, we have a set of keys for unlocking the prison door. You may find that the first key you try works, but usually the door is double locked, and opening it needs a combination of keys. We’re here to help, and have a pretty impressive bunch of keys for you to try out, taking you from darkness into the light.
In this chapter, we explain the difference between sadness and depression. Next, we show you how to recognise depression across a range of different people. We work out the costs of depression in terms of health, productivity, and relationships and tell you about the treatment options for depression. And finally, we offer you a glimpse of your new life, beyond depression.
Understanding Your Level of Well-Being
But if there was a magic cure for depression, would that be the whole answer? Surprisingly not. Increasingly, we are becoming aware that people who all score zero on a traditional depression rating scale, (i.e. no depression) can nonetheless be in hugely differing emotional states, from just ticking over, to achieving real fulfilment, satisfaction, and happiness. If we see happiness and depression as opposite ends of one continuum, then moods can go beyond depression. We can use just one questionnaire not only to rate presence or absence of depression, but also life satisfaction/well-being. Professor Stephen Joseph and his colleague
s developed a very useful self-report questionnaire which builds on this idea to assess the spectrum of well-being, which is shown below. Take a few minutes to complete the questionnaire if you wish to understand your level of well-being.
A number of statements that people have made to describe how they feel are given in Table 1-1. Please read each one and tick the box which best describes how frequently you felt that way in the past seven days, including today. Some statements describe positive feelings and some describe negative feelings. You may have experienced both positive and negative feelings at different times during the past seven days.
To work out your score, use the following scoring key to turn your answers into numbers.
For items 2, 4, and 5: Never = 0, rarely = 1, sometimes = 2, often = 3.
For items 1, 3, and 6: Never =3, rarely = 2, sometimes = 1, often = 0.
Now, using the scoring key above, add scores on all 6 items to give a total score, with a possible range of 0 to 18. Most people score between 11 and 13. Higher scores indicate greater happiness. As scores decrease, however, happiness fades into unhappiness, which fades into depression. Research estimates that scores below nine are increasingly indicative of depressive states. If you scored very low on the questionnaire, it is possible that you are suffering from what psychologists call clinical depression. Of course, one short questionnaire can’t give us all the answers – that would take a full assessment from a psychologist – but it may be useful in giving you a sense of where you lie on the spectrum of well-being.
Importantly, what this questionnaire shows is that it’s not just helping people manage their depression that’s important, but also finding ways to increase their happiness.
A key theme throughout this book is that we all can be overwhelmed, and experience depression, if sufficient powerful events occur simultaneously, testing coping skills to the limit – and then beyond. The level of misery, can feel unprecedented. It can take an inordinate effort to admit to the problem and accept help. But if you choose to self-disclose, we trust you’ll be amazed by the level of support, and reciprocal revelations.
Feeling Blue, or Depressed?
‘For better, for worse; for richer, for poorer; in sickness and in health, ‘til death do us part . . .’ You may recognise these words from a certain ceremony, dating way back in time. They sum up the inevitability of life’s ups and downs, and it’s ultimately inescapable end. Even if nothing goes seriously wrong, everyone, sooner or later, is going to die. Expecting to live a life without times of sadness, despair, or grief is unrealistic. But experiencing sorrow makes you truly appreciate life’s blessings.
Misfortune and loss can cause sadness and grief, but they don’t have to lead to depression. The difference is that sadness and grief lessen in intensity as time passes, while depression often does not (see Chapter 2 for more information about grief and types of depression). Misfortune and loss may feel pretty overwhelming at the time they occur. But time does eventually heal.
Unlike periods of sadness, depression involves deep despair, misery, guilt, and loss of self-esteem. People suffering from depression feel hopeless, helpless, and blame themselves not only for this, but also for just about everything else that goes wrong. Depression disrupts the body’s rhythms, often disturbing sleep, appetite, concentration, energy, sexual activity, and enjoyment. The net result is that depression seriously reduces your ability to love, laugh, work, and play.
Depression is a mood disorder making you feel profoundly sad, without joy, despondent, and unable to experience pleasure. Depression appears in a variety of forms, with varying symptoms. We describe these types of depression in Chapter 2, but all of them involve a very low mood or diminished sense of pleasure.
The Many Faces of Depression
Depression can affect anyone regardless of race, social class, or status. Symptoms include deep sadness, loss of energy, loss of interests, low self-esteem, feelings of guilt, and changes in appetite and sleep. These symptoms are experienced by both men and women, young and old. However, the symptoms of a depressed toddler may be different to those of a depressed 80-year-old.
In Chapter 2, we explore the various types of depression. Here, we show you how to identify depression in different people at different life stages.
Young and depressed
Depression can affect children of any age, from preschool through to young adulthood. Experts agree that the rates of depression in young people have gone up enormously. The rates are probably underreported because children aren’t usually able to identify that they’re suffering from depression, and parents and professionals often fail to recognise the problem. Parents are sometimes reluctant to accept that their children are depressed. Children can often be unaware of their feelings, or not have the words to describe what they are experiencing. They rarely spontaneously tell others what is happening to them. Instead, they may show changes in their behaviour, appetite, and sleep.
Marilyn’s mother brings several big bags of fun-sized party treats into school on the morning of her daughter’s eighth birthday, and asks the teacher to give them out to the children. The teacher promises to do this and to lead the class in singing ‘Happy Birthday’ just before break.
At the end of the day, Marilyn’s teacher approaches her mother and says, ‘I’m worried about Marilyn. We all sang ‘Happy Birthday’ to her just before break, and all the other children were so excited when I gave out all those lovely chocolate bars. But Marilyn hardly even smiled, and she spent break and lunchtime on her own in the quiet area. In fact, I often see her alone in the playground. She’s become much quieter this term and seems less and less interested in the lessons, too. And she doesn’t take part the way she used to. Is something the matter?’
When children are depressed, they lose interest in activities that they previously enjoyed. If you ask them if they’re sad, they may not be able to put their feelings into words. However, children may show signs of depression, such as low energy or motivation, sleep problems, appetite changes, irritability, low self-esteem, and self-criticism. They may feel unloved, pessimistic, or even hopeless about the future. In fact, depressed children experience more anxiety and physical symptoms than do depressed adults.
Watch children at play for subtle signs of depression. Depressed children may frequently include themes of death or loss into their play. All children’s play includes such themes on occasion, but these subjects show up more often in young people who are depressed. You may need to observe children over a period of time because their moods change. They may not seem depressed all the time, (unlike adults with depression). Their moods may go up or down throughout the day. Consult a professional if you have any doubts.
Children, depression, and obesity
The BBC reported in 2008 that one in ten 6-year-olds is obese, and that the total number of obese children has doubled since 1982. On present trends half of all children in England by 2020 are going to be obese. But is this just harmless puppy fat or something more serious? Obese children are more at risk than their thinner counterparts in experiencing depression, low self-esteem, and other mental health conditions. What researchers don’t yet know is how the two conditions connect: does depression in children cause obesity, or does obesity cause the depression? Whatever the answer to this question, the findings that depressed children can develop obesity highlights the importance of addressing depression when it occurs. See Chapter 11 for more information on the relationship between food and mood.
Grandparents: Grumpy or depressed?
Some people view old age as inevitably depressing. They assume that the older you get, the greater the deteterioration in quality of life. Of course it’s true that the longer you live, the more opportunity you have of experiencing negative as well as positive events. And certain illnesses, aches, pains, and disabilities do become more likely with increasing age, as do losses of family, friends, and social support. Therefore, some sadness is to be expected.
Nonetheless, depress
ion is absolutely not an inevitable consequence of old age. Most symptoms of depression in the elderly are identical to those in people of all ages. However, the elderly are more likely to focus on the physical, and talk about their aches and pains rather than their feelings of despair. Furthermore, elderly people commonly express regret and remorse about past events in their lives.
Depression interferes with memory. If you notice increased memory problems in Grandpa or Grandma, you likely suspect the worst-case scenario – Alzheimer’s disease, otherwise known as dementia. However, these memory problems can often be the result of depression.
And depression in the elderly increases the chances of death. Yet, if you ask elderly people whether they are feeling depressed, they may not recognise their feelings, or may even ridicule the idea. But by denying depression, the older person may not receive the treatment he or she needs.
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