Depression                                                               

From the Author’s notes:

Like many disorders depression can be an endless loop, and freedom from it relies upon a direction away from this loop, using self-management to keep us from falling back in.

'A persons' mental health is their own creation, voluntarily only they can change it.'

Many of us will employ this self-management sub-consciously, as a natural function of avoiding distress. In its simplest form, we may just have a glass or two of wine if we are feeling a bit down, but it may need to be far more complex than this, with substantial changes in lifestyle - and become a lifelong battle. There is no proven inheritance link to depression, but there could be genes passed on that make us more prone to it.

'Feelings are not facts - they are interpretations.'

It may at first be difficult to identify in itself, so it would be wise to look at some of the symptoms we may experience during depression. One in five of us will suffer, and to be diagnosed we are likely to have both mind and body dysfunction for a few weeks at least. It is six times more common in the six months following a traumatic event, (death of parents or partners, loss of job etc). Symptoms may include low mood, anxiety, feeling jittery, panic attacks, emotional numbness, very slow thinking and reasoning, clumsiness, concentration and memory lapses (motor neurone retardation due to ineffective communication between nerve cells), cynicism, bitterness, poor sleep, (such as waking in the early hours and being unable to fall asleep again, as if the night has been compressed into three hours or so), appetite irregularities and changes, poor sex drive, and in more severe cases, delusions (false beliefs), hallucinations (unreal perceptions), self punishment and even suicidal tendencies. Sixty per-cent of suicides are due to depression, so it is wise to ensure the numbers of support organisations, the Samaritans, G.P.'s etc. are readily available to those who have expressed thoughts on it. Even if no obvious mental or physical symptoms appear, dramatic changes in behaviour may be occurring.

Research found that chemical changes in neurotransmitters (brain functioning), meant that dopamine, seratonin & noradrenaline are in short supply during depression. Anti-depressant drugs aim to replace these chemicals, which may have been reduced by the action of stress, so it is not unreasonable to expect depression following a hectic spell at home or work etc. Cortisol production, a hormone released from the pituitary gland, is also erratic. Illnesses that affect hormone production, such as thyroid disorders, adrenal gland malfunction, glandular fever etc, are often followed by depression, and the use of other drugs, typically anti-epilepsy drugs, steroids and diuretics can also play an adverse part. Seasonal affective disorder (SAD), is caused by lack of daylight, where under-production of melatonin occurs from the pineal gland.

Theories behind the use of drugs for treatment:
Many of the drugs prescribed by professionals work by preventing neurotransmitters being re-absorbed by the cells that release them. These include Tricyclics, SSRI's (Seratonin specific re-uptake inhibiters, such as Prozac), MAOI's (which stop neurotransmitters being broken down by Monoamine Oxidase, but require careful dietary control to reduce side effects on blood pressure etc), Lithium or Carbamazepine (use of Lithium requires very careful monitoring using blood tests). Also efficient is the use of ECT (Electro-convulsive therapy), in suitable patients. It causes very mild fits under anaesthetic and has been shown to be both quick and effective.

Let us take a look at some more physical causes of depression, such as those that may occur after the birth of children or during the menopause. The most serious form of post- natal depression is known as puerperal psychosis, which is a form of manic depression with wild swings of mood from euphoria to despair. Once again, the fact that this disorder may run in families has prompted research into genetic influences. Blood samples are currently being taken to assist research. Apart from the personal distress felt by sufferers, babies under three have been shown to respond adversely when communication with the mother is disrupted. The child’s emotional state can be negatively affected by unresponsive interactions from the caregiver. Because post-natal depression leads to less quality time spent with the child (time is taken up with the sufferers own situation), children receive less ‘positive effect’ from their interactions. In addition, the parents view is that the infant has become difficult and demanding, and reacts negatively whenever they communicate, and that they are having to put in more effort than should be necessary. Looking at depression as a whole, women are twice as likely to be diagnosed than men, (for various reasons), and again, it is thought that chemical imbalance is largely to blame, and this occurs naturally in women. Fluctuations in Progesterone and Oestrogen occur during the menopause; production will be affected by hysterectomy and sterilisation; and half of women go through the 'baby blues' following childbirth. At this time hormone levels during pregnancy return dramatically back to normal, and at 2-52 weeks mild depression is common. Unless we are naturally very tolerant, such chemical changes may be enough to 'tip the scales' and cause instability in us.
Some other things that make us more susceptible include personality (especially those that could be described as dogmatic, hide their feelings, are obsess ional, have little control of their destiny, easily become anxious, have low self esteem, expect high standards or are perfectionists), family upbringing etc, but depression is certainly no respecter of class.
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If we are nervous, tensed, frightened etc, it must be remembered that this is not only occurring within our mind, but also within other internal organs, possibly the whole body. This can lead to dangerous physical conditions in time, if a remedy is not sought. The entire chemical balance of the body becomes disrupted, an effect that may be temporarily relieved by prescribed medication or use of substances such as drink and tobacco etc. It is quite common for physical symptoms to manifest themselves - real or unreal, identifiable or not. The body may find that physical symptoms become its only escape from this relentless loop.
For some, the devastating feeling that is experienced is described as an overbearing black cloud, or a deep dark pit from which escape becomes more and more desperate. This describes the feeling of helplessness at the height of its destructive effect on us, and there will be many less traumatic but nevertheless significant signs that will have occurred beforehand.

Those seeking help will often be advised to go for a full medical check up first, in order to rule out conditions such as an under active thyroid, or any other that may cause a change in the body’s’ chemical balance. Doctors may advise self-hypnosis, relaxation techniques, and counselling or psycho- therapy in addition to or instead of drug treatments. Tampering with the bodies' chemical balance by removing or adding drugs or hormones is clearly unwise, and if there are any adjustments needed, it is best left to an expert. As an example of how easy it is to disrupt this balance, it has recently been suggested that people with naturally low levels of cholesterol may actually cause depression if they go on a diet. If depression has been long term, the possibility of resultant physical illness may also need to be treated, as well as the depression itself.
Understandably, time pressed  G.P.'s have difficulty in identifying if symptoms are a cause of, or result of, depression, and even if they are certain that the patient is physically well, may have extreme difficulty reassuring them. At this point, it would seem prudent to send the patient for professional counselling or therapy.

Apart from chemical imbalance, which may be present from natural causes, and not as a result of us tampering with it; the effect of traumatic experiences, including those of childhood, which may be locked away in our subconscious, may need intensive examination and therapy. These effects are often described as circumstantial depression, while chemical effects are described as clinical depression. In some very difficult cases both may be present, and this is a terrible cross to bear, not just for the victim, but also for their partners and family. Depression tends to be a very personal experience, and any permanent cure can only be managed from within.
Those that seek counselling for depression may typically express a lack of will to get up in the morning, try to keep away from or be unable to face the world, and may at times even lose the will to live. The helplessness and negativity are key features of depression, and if you can identify that your thoughts often run along these lines, it may be one of many ways to confirm the diagnosis. It is wise to inform others close to you if you have depression, for at least they may be a little more supportive and considerate if they know what is going on. It may also lighten the burden on you if you can share it with others, and they will be able to offer different viewpoints, which though not providing miracle cures, may at least help you up one rung on the ladder of recovery.

'When we focus on ourselves, we lose our personality, when we focus on others, we gain it.'

For family that are offering support, their unconditional love will be needed, and it would be unwise for them to voluntarily join in with the distress and anguish that this condition inflicts. They will need to take on a management role and be supportive as and when required, unless the sufferer is in danger of causing personal injury.

In many cases the personal nature of this condition mean that victims turn away from nearest family - who often bear the brunt of the frustration they feel - and if need be call organisations such as the Samaritans for help. This should not be discouraged or be taken as a rebuke.

Psychological causes can sometimes be traced back prior to the age of six, when the effect of our parents is most felt. If we are not taught by both word and example, are not shown affection or interest, parents are absent from important events etc, they are all felt as forms of deprivation for the child, and can cause lasting ill effects. The lack of 'self worth' that these situations may cause is later seen as poor self-esteem, not to be confused with confidence, which is more akin to daring than self worth. Being bullied or being continually told we are stupid, thick, etc. can become the background to how we evaluate ourselves and seriously hinder our development of self-esteem and identity. If we do not receive the love and attention we felt was needed, the likely result is insecurity, despair, fear, rejection and anger. The most unsafe of these is anger, because it is likely to be more noticeable and receive swift punishment. When attention on this becomes focused, we may suppress anger at this stage and not have the other feelings answered either. Later on, the suppression of anger may surface in the form of grudges or 'a chip on the shoulder'.

'Every act rewards itself, how many acts have you in the bank? Is it the good bank or the evil bank? Would you want to receive evil with interest ?!'

Dependency on the parent, caused by never allowing a child to stand on its own feet, and continually making all their decisions for them, may cause that child to rely on 'props' later in life. These 'props' can of course take many forms, and can be difficult to identify as coming from dependency. The adult may unwittingly chose a partner that matches the parent, but still be unhappy.

'Find yourself and the right person will find you - otherwise who will they know and love?'

Depression often arises from the terrible conflict of being trained into dependence, yet yearning for independence. Often the guilt of under-achievement, fostered by parents that expect too much of us, may turn into depression, but this is a 'false guilt' and should not be confused with the guilt of doing wrong. A Pastor would tell you that these are guilt’s which the Lord would never condemn, as apposed to the true guilt of wrongdoing. By the way, it is important to note that for many, there are distinctions that can be learned from the Bible which lead us on the right path, when, as so often happens with depression, we lose direction. There is also a difference between guilt and shame - guilt provides a positive result from wrongdoing, i.e. we will try to do better next time - whereas shame is a negative result of being someone who does wrong and does not possess self control. Such positive / negative conditions, which can be extremely difficult for those with depression to visualise, often hold the key to recovery.

'Anything the mind can believe, the mind can achieve.'

The dangers of negative thinking during depression cannot be over-emphasised. One negative thought tends to support the previous one, and it is a cycle that must be broken. It is well documented that negative deductions take more mental effort to understand than positive ones. To this extent negative thoughts are bound to remain in our memory, because of the effort we have applied in creating them. It is even possible to forget the last time we had a positive thought, because it was so simple. Any way that you can break into the loop and produce positive thinking and actions is critical to recovery. Our perception of events, such as whether the glass is half empty or half full, will determine our reactions. We cannot proceed from an event to a negative response without having first perceived the event as harmful. Although it can be difficult to realise that perception of events is always a positive / negative seesaw, always picture the seesaw in your mind and remember which side you are jumping on. Some events, and some criticisms of us, will be quite balanced, so we must not push them to the negative side of the seesaw all the time, and thereby sustain an imbalanced view.
The release of suppressed emotions may also be an important part of recovery, sufferers may wish to tell their Pastor, their husband or wife, their physician or therapist, use various methods of uncovering hidden emotions, such as hypnotherapy etc, or dissipate the harmful effects of these emotions into correctly channelled exercise, sport, work etc. Above all, we must not keep quiet, but search out the cause of these emotions and uncover them. If it is likely that repression has come from a parent or elderly relative, then act with speed, for it will be very difficult to eradicate once they have departed this world. It may take intense courage to face all the people involved and have things out in the open, but at last you will be released from the burden of responsibility and rid yourself of the shackles that prevent your freedom, and lastly - be able to forgive.

Summary:
Sufferers should try at all costs to break into the loop of negative thought and emotions that characterise depression. Fortunately, none of us are too old or young, too fat or thin, too sad or lonely or too poor to learn. Something can be done. Choose any of the things in this list that you feel capable of, and slowly work your way through them and back to health. After the first one, you have the freedom to chose which order is best for you.
1. Have a medical check to determine if there is a possible physical cause. Do not rule out the temporary use of prescribed drugs to help you, or professional help if it is offered.
2. Release suppressed emotions, especially from childhood, uncover and bring them to the surface by any means, and rid yourself of all grudges. Release yourself from the burden of carrying these emotions, but don't try to get even - just forgive.
3. Shy away from negative thoughts, you've already built a mountain of them - try to redress the balance by building a mountain of positive thoughts. Start with something small and achievable, but valuable as a foundation stone to build on. This may be a moral issue, for example.
4. Take up some physical exercise no matter how mundane it may seem, since this will promote the chemicals produced by the body that help our well-being, as well as taking your mind off things and breaking a cycle of continuous reflection.
5. If you find it difficult to think positive and then act, try doing it the other way round - in the words of Dr. Stanley Jones, ' It is sometimes easier to act yourself into a new way of thinking, than to think yourself into a new way of acting'. There will be many untackled jobs around, so just do a simple one; it probably won't be too painful. Although you may be thinking 'what's the point?', the point is you shouldn't be thinking - you're doing it the other way round, remember? Even if you only manage a really small thing, it is still an accomplishment, and is a building block for your self-esteem and recovery.
6. Try to do something to help others on a routine basis - once a week, once a day if possible - these will also be accomplishments, and act as building blocks for your self esteem and competence.

'Your subconscious is your hidden boss - impress him with your new skills and hard work, and he will give you a rise - in spirits.'

Some useful numbers:
Compassionate Friends (bereavement) 0117 9539639. Cruse (bereavement) 0181 332 7227.  Depressives Anonymous (East Yorks) 01482 860619. Manic Depression Fellowship 0181 974 6550.  Depression Alliance 0171 633 9929. Mind Infoline: 0345 660163. Saneline (2-12p.m.) 0345 678000.
Association for Post-Natal Illness 0171 386 0868. Samaritans 0345 909090.
Useful books: Depression & how to survive it, Spike Milligan and Anthony Clare (Ebury Press 1993)
A consumers guide to therapy, Lindsay Knight (Fontana-Collins 1995)
Anxiety and depression, a practical guide to recovery, Robert Priest (Vermillion 1996)