Depression: How to detect and defeat it

Annie, 36, lives with her husband and two children. What she lives can hardly be called life. Most of the day, she is in a state of fear and anxiety. Fear of nothing in particular, but fear nevertheless. She is often tense, wearing a strained and haggard look. At times, she finds herself crying without knowing why. The smile or the laughter of her children makes no great impact on her. At night, she is restless, a victim of insomnia. “It's horrible. It's scary. I'm desperate, I can't take it anymore,” she confided in me. “I'm never in the mood for anything. I can't do things. I don't go anywhere. I don't want to see anyone. I live just lying down, even though I cannot sleep. I just lie there thinking about my problems over and over. Food disgusts me. I've lost 5 kilos in the last few weeks. Sometimes I think that it would be best to just finish with this nightmare.”

Annie is a victim of depression, the most common of all mental disorders and health complaints. Worldwide, as many as 400 million people suffer from depression at any given time, with prevalence estimates ranging from 12 percent to 14 percent of the population.1 The common symptoms of depression are a low mood, loss of interest or pleasure, feelings of guilt, low self-worth, disturbed sleep, lack of appetite, low energy, and poor concentration. At its worst depression can lead to suicide, a tragic fatality associated with the loss of about 850,000 lives each year.2

While such a picture is worrisome, what's worse is that two-thirds of people suffering from depression do not seek treatment, since more than 80 percent of those with clinical depression significantly improve their lives with treatment.

Types of depression

Researchers have suggested different theoretical subtypes of depression.3 They are:

1. Major depression is a condition in which one feels depressed all the time, has no interest in anything, and suffers from loss of appetite, insomnia, anxiety, fatigue, doubts, and suicidal tendencies.

2. Dysthymic disorder is a more prolonged depression (about a minimum of two years for adults, one year for children and adolescents), with similar symptoms as those for major depression, but with less intensity.

3. Bipolar depression is a condition characterized by the presence of major depressive and maniacal episodes. It is an abnormal state of mind, expansive or irritable, that can last for a week, with delusions of greatness, absence of sleep, speaking more than usual, scattered thoughts, activism, and psychomotor agitation.

4. Cyclothymia is similar to the bipolar disorder, but of longer duration and less intensity.

Am I depressive?

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A decalogue for anti-depression

Two basic ways to combat depression are psychotherapy and pharmacological therapy. For the latter, one should be evaluated by a psychiatrist, who will prescribe appropriate treatment. The most effective psychotherapy is cognitive-behavioral–to enable patients to acquire new abilities in their way of perceiving, understanding, and reacting to difficulties they experience with a view to reducing the gravity and duration of the condition. Among the various ways to achieve this, I would like to suggest 10 steps–what I have termed “A Decalogue for Anti-depression.”4

1. Intentionally fight pessimistic thoughts. The most important negative thoughts are known as the “Negative Cognitive Triads” These are: (1) negative thoughts and feelings about oneself; (2) the tendency to interpret the environment in a negative way; and (3) viewing the future in a pessimistic way. For example, Annie was convinced that she was a bad mother and a disastrous wife. She thought that her husband didn't love her anymore and that he would surely leave her. She also thought that what had happened to her mother would happen to her as well (her mother died depressive).

How does one fight these thoughts? Two steps will help. First, detect and discover the negative thoughts. Second, confront them with evidences of reality.

We asked Annie to write down her negative situations in a notebook with four columns. The first three columns were for her description of the event, what she thought and felt according to the situation, and what type of evidence she possessed. She was to write in the last column a positive thought that could replace the negative one. For example, one day she came across a friend who failed to greet her—an event that triggered negative thoughts. Here's what she wrote down:

Situation

My friend walked right past without greeting me.

What I think and feel.

I think she's mad at me. That produced fear and rejection.

Evidence

The serious and disagreeable face gesture.

Alternative thought

It could be that she's not mad at me, instead worried about something more personal.

2. Break the negative ideas circuit. Annie thought that her husband will get tired of her and would abandon her. So she would retract and adopt a disdainful attitude toward him. “If he's going to leave me, why should I worry about him?” she would say. “Did you hear what he said when he came in? That I will not get better again, like my mother. What he wants is to get rid of me.” Such thoughts may provoke a negative response from her husband, which in turn would reinforce her feelings of rejection and future abandonment. Annie was trapped in a vicious circle that was dragging her down in the depressive pool.

How does one change these negative ideas? One way is to confront such thoughts with the real situation. In reality, Annie's husband Omar loved her very much, and was doing everything he could to make her recovery possible. Annie knew that she should preserve her marriage and family, and that she should be more loving and caring. Confronting the negative and reinforcing the positive, Annie could break out of the vicious cycle of negative thoughts without underestimating or devaluing the potential of the positive in her. When the attitudes change, everything changes.

3. Avoid “absolute” thoughts, the all-or-none kind. “Omar will never again love me like before.” “Everything always comes out bad.” Such thoughts and attitudes are typical of depressive patients. The tendency is to judge the experiences, situations, people, and themselves by only two categories of good or bad, always or never, saint or sinner, etc. To change that way of thinking, the most effective method is to introduce nuances in the reasoning with a slant toward the optimistic side. For example, Annie understood that she retained the love of her husband, even though it was true that he found himself a bit tired. She learned to say: “I'm going to come out ahead, with God's help.” “There are things that I do that come out bad, but there are others that I do well.”

4. Don't punish or criticize yourself. Another tendency of the depressive person is to be permanently judging or evaluating his or her own actions, emphasizing personal defects and errors. They tend to ignore their virtues and dwell on their weaknesses. This attitude of self-depreciation disables and destroys, whereas the recognition of virtues helps the action and constructs a new future.

5. Take away the tyranny of the “I should.” When “I should” is allowed to grow, it becomes a permanent tyrant, making excessive demands. Instead of “should,” learn to adopt the attitude of “I would prefer.” The former is a tyrannical demand, a failure of which leads to low self-worth and eventually to depression. The latter is an aspiration, a goal to reach at your own pace. If there is a time when duties need to be more flexible, it is when you are depressed.

6. Avoid unpleasant and stressful situations. Like attending funerals, for example. Such events add to the stress of an individual, particularly one with a tendency toward depression.

7. Recognize your value and virtues. Recognizing one's own capabilities and personal value is part of the road to well being.

8. Learn to enjoy and obtain satisfaction from what you do. Depression results from a failure to enjoy the beauty and the blessings of life. Benjamin Franklin said it well: “The rich man is not he who has it all, but the one who enjoys what he has.” Learning to recognize the good and the beautiful around us is a transcendent jump to the discovery of the happiness of living.

9. Promote hope. Hopelessness is an essential component of depression.5 Hopelessness correlates closely with depression, depressive symptoms, and suicidal tendencies.6 Research on depression treatment indicates that reducing hopelessness is an important predictor of successful outcomes, particularly during the first few weeks of therapy.7

How does one fight hopelessness? Developing trust in God, building self-confidence, stimulating personal resources, and mobilizing mental and spiritual strengths create a hopeful atmosphere. Hope is to believe that there is always a way out, that the future will bring better things. That is why we asked Annie, “What will you do after you overcome depression? How will the next day be?” Planning for a future and planning to live with her children, she was able to envision a happy life. Little by little, she saw meaning in life, and light began to dawn. “Never has a night beaten the dawn, and never has a problem beaten hope.”

10. Trust in God. Religious involvement is an important variable that has received attention in recent literature on depression. Several high profile studies8 indicate that certain aspects of religiousness (e.g., public religious involvement, intrinsic religious motivation) may be inversely related to depressive symptoms. That is, the greater the religious involvement, the fewer the symptoms of depression.

Mario Pereyra (Ph.D., Universidad de Córdoba, Argentina) is a clinical psychologist in private practice. He is also a teacher and researcher at Universidad de Montemorelos, Mexico. He is the author of many articles and several books, including ¡Sea feliz! Cómo vencer la depresión y controlar la ansiedad (Publicaciones de la Universidad de Montemorelos, 2005), co-authored with Carlos Mussi, from which this article has been adapted. Dr. Pereyra's email address: pereyram@um.edu.mx.

REFERENCES

  1. World Health Organization (2006). Depression What is depression?
    http://www.who.int/mental_health/management/depression/definition/en/.
  2. Ibid.
  3. S. R. H. Beach and N. Amir, “Is Depression Taxonic, Dimensional, or Both?” Journal of Abnormal Psychology 112 (2003), pp. 228–236.
  4. M. Pereyra y C. Mussi, ¡Sea feliz! Cómo vencer la depresión y controlar la ansiedad (Montemorelos, Mexico: Publicaciones de la Universidad de Montemorelos, 2005).
  5. W. Kuyken, “Cognitive Therapy Outcome: The Effects of Hopelessness in a Naturalistic Outcome Study,” Behaviour Research and Therapy 42 (2004), pp. 631–646.
  6. M. A. Young, L. F. Fogg, W. Scheftner, J. Fawcett, H. Akiskal, and J. Maser, “Stable Trait Components of Hopelessness: Baseline and Sensitivity to Depression,” Journal of Abnormal Psychology 105 (1996), pp.155–165.
  7. L. P. Riso and C. F. Newman, “Cognitive Therapy for Chronic Depression,” Journal of Clinical Psychology 59 (2003), pp. 817–831.
  8. For example, A. W. Braam, P. van den Eeden, M. J. Prince, A. T. F. Beekman, S. L. Kivelae, B. A. Lawlor, et al., “Religion as a Cross-Cultural Determinant of Depression in Elderly Europeans: Results from the EURODEP collaboration,” Psychological Medicine 31 (2001): 803–814.

FOR FURTHER READING

American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 4th ed., DSM-IV (Washington, D.C., text revision, 2000).

D. G. Blazer, R.C. Kessler, K.A. McGonagle, and M. S. Swartz, “The Prevalence and Distribution of Major Depression in a National Community Sample: The National Comorbidity Survey,” American Journal of Psychiatry, 151 (1994), pp. 979–986.

P. Saz, and M. E. Dewey, “Depression, Depressive Symptoms and Mortality in Persons Aged 65 and Over Living in the Community: A Systematic Review of the Literature,” International Journal of Geriatric Psychiatry, 16 (2001), pp. 622–630.

T. B. Smith, M. E. McCullough, and J. Poll, “Religiousness and Depression: Evidence for a Main Effect and the Moderating Influence of Stressful Life Events,” Psychological Bulletin, 129:4 (2003), pp. 614–636.