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July 11, 2016

Tackling Depression

Reuel S. Amdur

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Understanding depression. That was the topic of a lecture at Ottawa's Royal Ottawa Hospital on September 17. Presenting were three psychologists, Kelsey Collimore, Andrew Jacobs, and Michelle Todd.

They began with a definition.  It is a psychological disorder characterized by low mood or a decline of interest or pleasure.  Similar affect could be experienced in coming out of surgery, but depression is persistent.  While depression may be unipolar or bipolar, this lecture addressed unipolar depression.

Depression may be a reaction to life experiences.  On the other hand, it can also occur for no apparent reason.  In some cases, it may persist all the time.

We can look at depression in terms of mood or cognition (thought) symptoms.  The mood may be persistent sadness, loss of interest in things, in pleasure, and in motivation; a feeling of emptiness; anxiety; feeling of guilt; and irritability.  From a cognitive perspective, the experience may be one of hopelessness and helplessness.  Self-esteem is low, with feelings of worthlessness.  Suicidal ideation and behavior may be present.  Memory may be problematic, and the mind may ruminate, preoccupied with repetitive negative thinking.  It becomes difficult to concentrate, and the person becomes indecisive.  The general outlook is one of pessimism.

Depression can also be examined in terms of physical symptoms and behavior.  Physically, there is fatigue and low energy, increase or decrease in appetite and weight, disturbance of sleep patterns, aches and pains, decreased sex drive, and agitation or slowing down.  In terms of behavior, we may see withdrawal and difficulty in relating to others.  Excessive crying may be present.  Sleeping may also be excessive or problematic, and the person might become isolated.  Escape and avoidance may be characteristic, and the person may even be suicidal.

What causes depression?  Consider any one or more of the biological, psychological, and social factors.  12.6% of Canadians will experience a depressive disorder in a lifetime, 5.4% in the last 12 months.  It is estimated that by 2020 the worldwide frequency of depression will be second only to coronary disorders. 

Depression takes a wide toll, on the person, the family, and society.  The societal impact is felt in the impairment of functioning in the person’s role and the use of health and social services.  There is a financial impact because of the cost of treatment and decline of productivity, absenteeism and presentism.  Presentism involves showing up to work when sick and producing at a substandard rate.  Physical health is also negatively affected by depression.

The depressed person may be stuck in a reinforcing cycle of thought, mood, behavior, physical state, and back to thought.  However, there are points of possible intervention.  Thus, activity may improve mood and increase motivation, over time and with effort.  Or at a minimum activity may at least break the cycle by keeping the depression from getting worse.

A depressed outlook may overgeneralize mistakes, leading the person to feel that he cannot get things right, resulting in his giving up.  An internal dialogue may make this pattern persistent, without intention or awareness.  “We tend to treat our thoughts as true and act accordingly,” said Dr. Todd.  The sociologist W.I. Thomas put it this way: “If men define situations as real, they are real in their consequences.”  It is not the situation but how one interprets it that determines how one feels.  If we want to change how we feel, we might start with our thoughts.  Alternatively, we might start with exercise.

Rumination, recycling negative thought, can be part of depression.  But we can interfere with the rumination.

Depression is not just individual.  It can characterize relationships.  Thus, it can involve interpersonal conflict avoidance, excess reassurance-seeking, negative feedback-seeking, and self-obstruction.  When a person fails to be adequately assertive, there is a loss of relationship and roles, a losing of social contact and of positive interaction with others, a shrinking of the support system. 

When a depressed person feels insecure in himself and his relationships, there is a tendency to seek reassurance.  This becomes wearing, and others may withdraw. The person seeks even harder, and thus the cycle continues and tightens.  The person may also seek negative feedback and may even set up obstacles for himself, lowering expectations.

So what can be done about depression?  In dealing with the cycle, it is not necessary to attack all at once at all points in order to bring about change.  For example, activity may be the entry point.

Treatment may be psychological, pharmacological, or both.  The speakers said that both seem to be more or less equally effective, but often treatment combines the two approaches.  Electro-convulsive therapy may be used in cases that are more resistive.

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