depression

the melancholia illness

the first thing to understand about depression is that it is an illness with onset, course and resolution phases, during which your functioning is demonstrably different and impaired from normal.

It is not the same as being generally unhappy and dissatisfied with life and the world or transiently saddened by events or life pressures. While adverse life-events may play a role in causing a depressive episode, not all mood-lowering reactions can be classed as depression and may indeed be perfectly appropriate and normal for the circumstances.

So what are the symptoms?

  • persistently low mood, sadness, hopelessness, often worse in the mornings
  • sleep disturbance with characteristic early morning waking
  • loss of appetite and significant loss of weight
  • lethargy, feeling and appearing slowed up; or conversley, being agitated
  • inabilty to enjoy previously pleasurable activities
  • feelings of life not being worth living; suicidal thoughts
  • difficulty concentrating
  • in severe cases, delusions of poverty or guilt; or catatonic stupor

What causes it?

There's no single cause - but adverse or traumatic life events, stress, etc. may lead to depression or it can arise seemingly out of the blue, with no apparent outside cause. Some people are more vulnerable, eg women, or those with a family history of it; but it is a very common in all walks of life.

There is a definite biological basis for the condition, whether brought on by life events or not - and it is at the nerve cell level in key areas of the brain that control mood that things go awry. Certain chemicals called neurotransmitters (serotonin and noradrenaline) in the cells are disturbed and under-functioning. This is where anti-depressant medication comes in, to correct the neurotransmitter function again. 

How can it be treated?

There are two main types of treatment - anti-depressant medication and Cognitive Behavioural Therapy (CBT). Both are effective, although CBT may not work in severe cases because the patient is too ill to make use of it. In those cases, anti-depressants will be required firstly to get you to the point where you can engage in CBT.

Please see the about my treatment section for more detail about the specific treatments.
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