Ask Alistair – Clinical Depression

regalistairdepression-2Dear Alistair,
I think I have clinical depression. Please tell me what the symptoms are and whether I can overcome it without medication.
Clinical depression, or Major Depressive Disorder, will affect around 20% of the population at some stage in their life. It prevents one from seeing the positive side of life, and can make one feel utterly alone.
For a diagnosis the majority of the following symptoms must be present most of the day nearly every day:
– Depressed mood (e.g., feeling sad or empty) or appearing tearful to others.
– Loss of interest or pleasure in most activities, including hobbies
– Change in appetite or a significant weight loss or weight gain
– Change in sleep patterns, i.e. insomnia or sleeping more than usual
– Fatigue or loss of energy
– Feelings of worthlessness or excessive or inappropriate guilt
– Diminished ability to think or concentrate, and a poor short-term memory
– Diminished ability to make decisions
– Recurrent thoughts of death or of committing suicide
Other relatively common symptoms include increased irritability, anger attacks/aggression, substance abuse, and risk-taking behaviour.
In terms of what causes clinical depression, ongoing stress usually plays an important role. This is because ongoing stress causes the stress hormone (cortisol) to continually circulate through one’s brain. This limits the availability of certain important brain chemicals (neurotransmitters) … which simply stops the brain from doing what it normally does, e.g. regulating one’s mood. Depression is, in other words, a physiological problem (just as are diabetes, high cholesterol, hypertension, etc.).
Those people who experience chronic stress and who then fall into major depression usually have a predisposition for depression which is caused by either a genetic vulnerability or a psychological vulnerability (which may be the result of unmet emotional needs during childhood and/or adolescence for example).
Hospital procedures, chronic health conditions, severe trauma and life changes / loss will cause many individuals to experience a depressed mood. This may turn into a major depressive episode for those who are vulnerable to depression.
I firmly believe that treatment for depression must involve all of the following “interventions”:
1. Psychotherapy or Talk Therapy – Scientific research indicates that talking with a psychologist is one of the best treatments for depression. Some people choose to be in therapy for a few weeks. Others choose to stay in therapy for many years.
2. Medicines for Depression – Anti-depressant medications are also usually crucial. If one antidepressant doesn’t work well, one’s doctor might try a different class of depression medicines, or change the dose. In general these drugs improve symptoms of depression by increasing the availability of the neurotransmitters in one’s brain.
3. Stress reduction training – As it is ongoing stress that tips most individuals into a major depressive episode, learning how to cope more effectively with stress is critical. Mindfulness-based training is one of the most beneficial options currently available.
4. Diet and Exercise – Diet and exercise are proving to be crucial for recovery. Cutting out refined carbohydrates, sugar & stimulants (e.g. caffeine) is critical. And as little as a 15 minute session of cardio-vascular exercise causes the release of endorphins which is very positive for brain functioning.