How to overcome depression
The word depression clearly has different understandings for different people, individuals may often refer to "feeling depressed" when feeling sad or low in their everyday lives. These moods are usually transitory and pass, however for some these feelings do not pass and have a severe impact interfering with their ever day lives, lasting weeks or months and even if they do go away, the feelings regularly return.
Depression also comes in many different forms including;
Although differing in symptoms and severity, all of these types of depression could be described as exhibiting an enduring and pervasive sense of negative well being, that effects individuals across a wide range of circumstances.
It has been estimated that worldwide some 300 million people some form of depression at least for some part of their lives (Source: P Gilbert, Overcoming Depression, 1997). Depression is also not as some might suggest a modern condition, being observed my Hypocrites as melancholia some 2,400 years ago. Furthermore, there is evidence, although we can’t ask them, that most if not all mammals, particularly those experiencing prolonged stress, can suffer depression, suggesting that depression is a natural response to external stressors.
In the recent past depression has become associated with chemical imbalances in the brain and indeed there is much evidence to support the link between depression and imbalances in the neurotransmitters, the chemicals involved in transmitting signals between neurons, in the brain. The result of this link is that depression has been commonly treated with synthetic chemicals, such as serotonin, that mimic the actions of these neurotransmitters. However as with all causal relationships, other than saying that there is a link, the direction of the link is unclear. It is just as probable that these chemical imbalances are caused by the negative patterns of thought as the imbalances causing the negative moods. In any event it is recognised that genetic or biological causes of these imbalances are probably rare and that in most cases the depression was originally triggered by an external event or situation.
Depression is usually diagnosed through the use of depression tests that rate a patients feelings with clinical depression being diagnosed if a certain number of feelings, that are signs of depression, are present over a certain period of time. According to the medical model a person can be only diagnosed as suffering from clinical depression if five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning and that at least one of the symptoms is either a depressed mood or loss of interest or pleasure.
These symptoms are:
Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood.
Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)
Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains.
Insomnia or hypersomnia nearly every day
Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
Fatigue or loss of energy nearly every day
Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)
Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)
Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
The above symptoms will also have to:
Cause significant distress or impairment in social, occupational, or other important areas of functioning.
Not be due to the direct physiological effects of a substance abuse, medication or another medical condition and
Not be better accounted for by bereavement.
For clinical diagnosis to be made the symptoms need to persist for longer than 2 months or be characterised by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.
Diagnosing clinical depression (or any other medical condition) is outside the ethical remit of any counsellor or psychologist, being the work of Doctors and Psychiatrists. Ethically any counsellor who suspects a client may be suffering from depression should, despite any of their own feelings on clinical diagnosis and the blanket prescription of medications, which whilst masking the symptoms of depression might actually make the psychological treatment of the underlying cause of the depression more difficult, should non-the-less, particularly if the client is expressing suicidal feelings, advise the client to seek a medical opinion from a suitably qualified medical practitioner.
However, the medical model of depression does pose some interesting dilemmas. It states that depression can be diagnosed only if the symptoms cannot be better attributed to bereavement. So, since grieving is a natural response, we can see that depression is simply an out-of-place natural response, furthermore, if bereavement can cause depression like symptoms , why not other kinds of loss such as loss of employment, loss of financial security, loss of independence, etc, etc. It would seem highly probable then, that at least for many people, depression may well be related to real life issues, that are beyond the control or coping strategies of the individual and that depression may well be a natural psychic defence, shutting down and protecting the individual from the stressor, rather than facing the situation. Treating a chemical imbalance that has been caused by environmental situations with drugs, without treating the emotional feelings towards whatever environmental conditions that underlie the depression would seem illogical. Although a counsellor, should NEVER suggest that a client should come off their medications, counselling would seem to have an important role alongside the medical treatment of depression, with of course the consent of the clients doctor. Indeed it is becoming increasingly common for counselling to be offered to patients with depression within doctor’s surgeries, or for doctors to advise their patients with depression to seek counselling, so that the underlying traumas can be addressed. In short it would be perfectly ethical for a counsellor to accept a client for treatment, who was already undergoing medical treatment, provided consent for the treatment had been provided by the clients doctor.
Therapy could help you to understand the cause and effect of depression and its self-defeating behaviours; how stress and anxiety effect your everyday life; relationships, past and present; your sense of grief and loss; and present day goals. This could lead therapy onto helping change your vision your future and to learn new ways of coping with further possible instances of depression. Therapy would guide you in learning to identify dangers and to adopt strategies for dealing with them. Coming to understand the origins of your negative thoughts you will be able to start to plan for a future where even if depression returns you will be able to recognise the symptoms and adopt the learned strategies to deal with them.
In order to overcome depression you will need to consider each of the following key steeps in order to aid recovery;
Seek help. Although you might have already seen a therapist, or be planning to see one, you will need to consider if you went of your own free will. It’s possible that you have been persuaded by your doctor or family pressure to seek therapy. For any therapy to be effective you will need to seek therapy for yourself, if you have not self-referred then you will need to focus around your own motivations for wanting therapy for depression.
Go steep by steep. It is important for you to progress at your own speed, dealing with particularly difficult issues as and when you are ready to deal with them.
Break the problems down into smaller ones. Many of your issues, such as those around your childhood, may seem difficult for you to deal with. Braking these down into particular, single incidences will help you to deal with each smaller incidence in turn.
Introduce new positive activities into your life. In thinking life is pointless you will possibly have given up doing the things you used to enjoy doing. Making an effort to start to do these again, or to take up new activities, possibly with your partner, should help to start to give you a new positive outlook on life.
Become more attentive and aware of your thinking. Start to recognise typical thoughts that go through your head when you are depressed.
Identifying your typical thinking styles. Learning to understand how you typically respond to situations, such as all-or-nothing thinking or discounting positive aspects of your life, will help you to start thinking differently.
Try writing down your thoughts. Keeping a diary of your thoughts will help you to recognise your patterns of thought.
Identifying key themes in your depression, such asa need for approval, shame, unhappy relationships, unrealistic ideals etc., Your diary and observations might help you identify these and give you the opportunity to spot and change these as they arise.
Learn to challenge your own thinking. By identifying the cause and effect of your negative thinking you can learn to use your rational conscious mind to challenging your negative thinking.
Start to change your negative thoughts. All of the above steeps will help you recognise and understand your negative thoughts them and to recognise any recurrences of these thoughts so that you can develop strategies for changing them into thoughts that are more beneficial to your well-being.
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