Could you be depressed?
It may be difficult to tell: in studies even GPs only spot 50% of patients with depression (Mitchell, Vaze & Rao, 2009), though about 3% of people are depressed in any week, and 20% are depressed at some point in their lives. That’s where I can help. I’m a clinical psychologist in London who can effectively identify and treat depression.
As I explain below, depression is like being stuck in a hole. It’s a hole you can get stuck in at any stage of your life. Being in the hole can also lead to chemical changes in the brain, leading many to call depression a “mental illness”, even though it is more than that. My A to F Pathway to Depression describes how people end up in that hole and what symptoms they experience when they are in it.
Happily, there are solutions to depression – a number of them. I have integrated Cognitive Behavioural Therapy (CBT) with several other therapies to create a unique approach which I call Journeybuilding™ which allows me to tailor your treatment to your needs and so improve your chance of recovery. Read on to find out what I can do to help:
Depression is like being stuck in a hole
The word “depression” comes from the Latin for “pressing down”, a phrase which shows how depression feels like an external force that weighs you down or makes you feel lower than you should be. Imagine you’re stuck in a hole: Perhaps you fell in this hole by accident; perhaps something or someone put you in there. But now you feel ‘lower’ in some way than the people around you. It’s as though you’re alone in your hole and other people can’t reach you. You can’t see beyond the hole you’re in. You can’t get to the things you want in life. You’ve tried to get out of the hole but you keep slipping back. So you sit and ponder on what got you in and how to get out, or you pace restlessly. Frustrated by your predicament you become irritable, with angry outbursts. You feel sad and tearful. Eventually, fatigued by trying to escape, and starved of what you need, you weaken. You lose the energy to act. You think and move slowly. You sleep more to try and restore yourself, but your sleep is restless and unrefreshing. You become hopeless and collapse into apathy. Your mind becomes increasingly disconnected from the world beyond your reach, and starts to fill with unreal fantasies which seek to explain what happened or predict what will happen in the future. That’s how symptoms can make up the picture of depression. Where are the similarities with your own life? ^Top
Depression is a hole you can get stuck in at any stage of life
Just as people can suffer losses, or feel stuck in a hole at any age, so can people feel depressed at any age. But depression is often diagnosed from the mid-twenties, perhaps because younger people often have more hope or haven’t sought help. Many people rely on their natural human ability to recover from losses and avoid getting stuck in depression. However, at each stage of life a person can encounter obstacles which seem beyond their ability to overcome, so they do get stuck. These obstacles include:
- lacking a reliable person who loves them
- being excluded from peer-groups and high-status groups
- failing to achieve as much as their peers
- being trapped in an unrewarding role
- lacking a life of their own
- not liking who they are, or who they have to be
- not being part of something which is meaningful and bigger than them
I can identify where you’re stuck in life and help you to move on to the next stage. ^Top
Is Depression a Mental Illness?
Physical causes can create the psychological effects of depression. Illnesses like dementia, hypothyroidism, multiple sclerosis and stroke can cause physical changes in the brain which lead to biases in thinking, changes in our beliefs and concerns, and the expression of those changes as depressed behaviour. So there is a physiological process in depression which leads doctors to treat depression as a disease with psychiatric drugs that alter brain and body. The results with psychiatric drugs are mixed, so whilst the National Institute for Clinical Excellence recommends psychiatric medication, and studies show that it can add to psychotherapy, some researchers question whether psychiatric drugs are a placebo for patients who see depression as an illness.
Psychological causes can also create the physical effects of depression: Any event, including an illness, which robs us of things we value, can trigger changes in our beliefs, concerns and decisions, and their expression in our behaviour, which alter the hormones and neurotransmitters in our bodies. So there is a psychological process in depression which leads therapists to treat depression as a life problem. The results with therapy are also mixed, and it can be difficult for people to make changes in therapy when they feel so physically exhausted that they lack the energy to take action.
It’s in your mind and your body…
So the truth is that depression has two sides, physical and psychological, which are inextricably linked, like brain and mind, or computer hardware and computer software. The danger for treatment lies in leaving one side out: A person who sees depression as just a physical illness can’t take responsibility for it or make changes in thought and action to break the cycle of depression. A person who sees depression as just a psychological problem can’t get help for their body and brain to fight the physical effects of depression. So it’s good to mix treatments for the physical effects of depression (such as medication, dietary changes and exercise) with treatments for the psychological effects (such as changing thoughts, behaviour and relationships).
The physical and psychological factors in depression feed each other in a vicious cycle: We see the physical effects of depression which only make us feel more depressed. As we feel more depressed, so we tend to act in ways which weaken our bodies. ^Top
The A to F Pathway to Depression
Here’s the pathway to depression. See if you can make the connections from A to F in your life or the life of someone close to you. That’s their unique Pathway to Depression:
Antecedent events… trigger depression, and are about having to do without love, support, success, or rewards from something or someone important.
Beliefs & Biases…develop as a result of the events above, and may include regrets for the past, disappointment with the present, pessimism about the future, believing oneself to be worthless or a failure, and finding others unhelpful.
Challenges & Concerns…arise from your beliefs about how those events prevent you meeting your needs. These concerns include greater sadness, sensitivity, irritability, self-pity, guilt, shame, self-blame, and loneliness. People also feel lower in mood, appetite, libido, motivation, strength, energy, pleasure and quality of sleep.
Decisions & Defences…are your mind’s ineffective attempts to deal with your concerns. They include nightmares, being caught up in brooding and rumination, feeling indecisive, ineffective, or helpless, and having fantasies of dying or committing suicide.
Expressions & Effects… are the outward signs of your unhappiness, including oversleeping, drowsiness, inattentiveness, tension, slowness in speech and action, overeating, agitation, restlessness, crying, and aggressive outbursts.
Follow-ons… are the knock-on effects of depression, including impotence, headaches, menstrual problems, weight loss or weight gain, memory problems, and social withdrawal. Unfortunately, these often become new Antecedents in the vicious cycle of depression. ^Top
Solutions for Depression
Fortunately there are good reasons for hope. Just as there are many ways into the hole of depression there are many ways out. In general, when you get out of depression depends on: how deep a hole you’re in, when conditions around you change, what help you get, what skills you learn, what direction you head in…and whether you keep going even when you don’t feel like it!
Depression may be something you can get out of on your own: about 45% of people do recover eventually without treatment. On the other hand 55% of people don’t, and most who recover will find themselves back in depression again. Fortunately, on the journey to recovery, you can get a guide. Having a therapist helps: after 15 sessions of the average therapy about 60% of people in studies are completely out of depression. In other words, a depressed person is better off after the average course of therapy than 86% of people who go it alone.
I aim to improve on average therapy, by helping you to change direction at each stage of the A to F Depression Pathway, so you return your normal level of happiness. Also, since people get into different holes at each stage of life’s journey, I find ways out which suit the stage you’re at in life. Thirdly, depression is something which connects the physical, the psychological and the social so I look for solutions at each of those levels. Fourthly, depression can encompass your experience, your thoughts and your philosophy of life, so I help you get more comfortable with each of those perspectives. I aim for a complete and integrated solution.
Nonetheless, even after a successful course of the average therapy, in studies about 75% fall back into depression at some point. So to stay out of depression, you’ll need to find extra skills and make extra progress beyond simple recovery. You’ll need to get to a whole higher level of functioning. Mindfulness meditation is one skill I can help you learn: it can halve the chances of you falling back into depression. And I can help you build a vision of your life as a meaningful path where you can enjoy the journey as well as get to valued destinations and meet your needs. That way you can get as far away as possible from the place you were at when you got stuck in depression.
How successful am I? Read what some of my clients say about me here. If you’re feeling depressed contact me using the form on the right to learn how I may able to help you.