Depression

Chris Irons

• Publisher: Bloomsbury Academic
• Year: 2014
• ISBN:
  9781350312449
• Edition: 1
• Topic: Psicologia
• Subtopic: Psicologia clinica

It has been estimated that depression may affect 12-18% of people at some point during their lifetime. This accessible introduction covers the causes, symptoms, diagnosis and treatment of clinical depression, and is engaging reading for anyone wishing to understand this complex mental health problem.

Chapter 1

Introduction

At times, everyone feels low in mood, down in the dumps, unhappy or sad. In fact, these occasions are likely to be common for many of us, and can last a matter of minutes, hours, or sometimes, a day or two. At these times, if people ask how we are, we might even say ‘I’m depressed’. These types of feelings could arise without any particular trigger – the type of ‘getting out of the wrong side of the bed’ day – or may follow a period of difficulty or stress, such as a having a lot on at work or following an argument with a friend. Indeed, it is very normal to experience changes in mood when difficult things happen to us, such as the break-up of a relationship or loss of job. Whilst these feelings are unpleasant, they are not the type that that we will be focusing on in this book.

When you speak to someone who is suffering from depression, they will tell you that it is very different from the type of low feelings described above. They are likely to tell you about feeling persistently low in mood, over weeks, months or even years. They will describe how it is difficult or impossible to get any pleasure or enjoyment out of things in the way they used to – as if looking at life through grey tinted spectacles. They may also describe a whole variety of other difficulties, including low energy, a lack of motivation, problems concentrating and many others (which we will explore later).

What is having depression like?

Depression is a very unpleasant experience and can affect many aspects of our day-to-day experience.

Motivation

Motivation – an organising and driving force towards a particular goal – is often impacted in a significant way during a depression. We can feel slowed down, lacking in energy and ‘not bothered’ to do anything. Things that we would normally do without thinking, like having a shower, getting dressed and eating breakfast, can suddenly become unimportant or overwhelming. Daily life can feel like an uphill battle, and people sometimes describe that they feel like they have a heavy weight on their shoulders or like they are walking through treacle, making each step or action difficult.

Emotions

Our emotions change in depression in two common ways – we experience a decrease in positive emotions and an increase in negative, unpleasant emotions. This combination is key. Anhedonia – derived from a Greek word meaning ‘without pleasure’ – is a core feature of life when depressed. Things that previously brought a joy and happiness, such as seeing friends, watching a film or playing football, now feel like they will be unfulfilling or unlikely to give us pleasure. As we will explore later, there can be problems here in both the anticipation of an activity (e.g. ‘there’s no point in trying, I won’t enjoy it’) and the actual engagement in the activity (‘it’s not enjoyable like it used to be’).

Alongside a reduction in positive emotions, depression is also associated with an increase in negative emotions and feelings. For many depressed people, anxiety increases alongside depression, and things can feel threatening, scary or anxiety provoking in a way that they didn’t used to be. In fact, over 50% of people diagnosed with depression will also meet diagnostic criteria for an anxiety disorder at the same time (Kessler et al., 2003). Anger may be another emotion that increases with depression; we may feel more irritable, frustrated and resentful, and take this out on people around us. We might even have intense feelings of rage and hatred that are difficult to express. Alongside these emotions, we may also experience an increase in sadness, shame and guilt, all of which can continue to feed our depressed feelings.

It is also worth mentioning here that there are some depressions in which people describe feeling numb or unemotional. This is often referred to as ‘blunted’ emotions, and here, both positive and negative emotions feel dulled; hence when a person would normally expect to feel excited or sad, they would experience minimal feelings or simply an absence of feelings.

Thoughts

A number of important changes occur in our thinking when we are depressed. The first relates to the content of our thoughts (the words or phrases that tend to go through our minds). When depressed, our thinking turns more negative, and in particular, many become self-critical, blaming themselves for feeling the way they do or focusing on perceived flaws about themselves. We may begin to dislike ourselves, feel that we are no good and inferior, and compare ourselves with others (and their lives) in a more negative way (known as negative social comparison).

Alongside the content of our thoughts changing, the process of our thinking can also change. For some people, this involves feeling that thoughts are slowed down, jumbled or fleeting. For other people, thinking becomes preoccupied and fixed on particular things, for example, how much of a failure they feel. Commonly in depression, we ruminate more (focusing on things that have happened in the past) or overly focus on the future in an unhelpful way (for example, by engaging in worry). This is often linked to feeling hopeless or the future being bleak.

Behaviour

Our behaviour can also change significantly in depression. Typically, people describe finding it difficult to get going, to have energy to do things, and often, there are reductions in the amount of things they do. They may find it difficult to get out of bed or engage in basic daily activities, such as showering, cleaning teeth, getting dressed or eating. As a result of these changes, but also in addition to them, people may withdraw from social interactions and become more isolated. When around others, people with depression can act in non-assertive or submissive ways, for example agreeing that they are wrong, even when they feel they are right.

How common is depression?

Depression is a very common condition. It is estimated that between 12 and 18% of people will develop depression sometime in their lifetime, and it may well be that these are conservative estimates. The World Health Organization (WHO) has estimated that at least 350 million people worldwide are currently depressed (http://www.who.int/mediacentre/factsheetsfs369/en/). They also suggest that by 2020, depression will be the second most burdensome health disorder (following cardiovascular problems) in leading to disability-adjusted life years (DALYs – a measure of the amount of time someone suffers with a particular illness or disorder in their life). But it doesn’t just stop there, as the WHO estimates that by 2030, depression will be the leading cause of DALYs worldwide. The apparent increasing commonality of depression is explored further in Box 1.1.

Box 1.1 The depressed generation: Are levels of depression increasing?

The World Health Organization (WHO), a United Nations organisation concerned with international healthcare, suggests that increasing levels of depression mean that by 2030, depression will affect more people than any other health issue. A number of studies have suggested that there are increasing levels of depression (prevalence rates). Moreover, there seems to be an increasing public and media awareness of depression as an illness, including greater publicity of well-known people, like actors, sportsmen and musicians, who have experienced depression.

Even though there is a popular perception that rates are increasing, is this backed up by scrutiny of the figures? Well, the research literature on this is quite mixed. For example, in a large study of 42,000 Americans, Compton et al. (2006) found a doubling of the prevalence rates of depression between 1991–1992 (3.3% of the population) and 2001–2002 (7.06% of the population). However, a number of other studies have reported no change. For example, in a study measuring depression prevalence in Canada between 1952 and 1992, Murphy et al. (2000) found that there were no significant changes during this 40-year period. In another study, Hawthorne et al. (2008) looked at rates of depression in Australia between 1998 and 2004. Although they found a slight increase in rates (0.6%), this was not statistically significant.

So, how are these two different findings – the WHO prediction of depression becoming the most burdensome illness by 2030, and recent studies showing no change in prevalence rates of depression – possible? There appear to be a number of factors related to this discrepancy:

How rates of depression are measured – for example, whether this is via self-report questionnaire, semi-structured interview or professional diagnosis – as these can all lead to different rates being reported.

Whether studies follow people over a set period of time, working out how many become depressed during that period, versus asking people to recall whether they have been depressed in the past. There are major concerns about the accuracy of peoples’ memory when looking back on symptoms in the past, and this may distort the figures in studies that have used this methodology.

Rates of depression might be increasing in some countries (i.e. developing countries) but staying stable in developed countries. This would then skew findings depending on what countries are included in any study.

Although the use of illness ‘burden’ by the WHO is a helpful concept indicating how much a person’s life is impacted by depression, it does not as such show how prevalent depression is, or that it is increasing in prevalence.

Whilst depression will become the most burdensome illness by 2030, this may in part be due to the reducing burden of other health problems (due to better treatments, e.g. cardiovascular problems).

We will explore in later chapters about whether there are some people who are more likely to become depressed. However, the reality is that anyone can become depressed. Although stigma may still remain, there is now much greater awareness and appreciation of this condition and its consequences. In fact, many well-known people, including Royalty (Queen Victoria, Princess Diana), Politicians (Winston Churchill, Abraham Lincoln), Sportsmen and women (Frank Bruno, Marcus Trescothick, Dame Kelly Holmes), Musicians (Robbie Williams, Bey...

Table of contents

• Cover
• Title page
• Copyright
• Contents
• List of Figures
• Note from Series Editors
• Reading Guide
• Acknowledgements
• 1. Introduction
• 2. Depression: Diagnosis and Classification
• 3. Biological Explanations
• 4. Psychological Explanations
• 5. Social and Environmental Explanations
• 6. Evolutionary Approaches
• 7. Biological and Physiological Treatments
• 8. Psychological Interventions
• 9. Social Interventions
• Glossary
• References
• Index