Today is Time to Talk Day, so we asked Dr Hazel Harrison, creator of our brand new series called 'The Art of Listening', for tips on how to talk about mental health.
Depression is the most common mental health problem in the world, affecting more than 300 million people across the globe. According to the World Health Organisation it’s the leading cause of disability worldwide and its impact is continuing to increase over time.
What exactly is depression?
Depression is characterised by low mood and a loss of interest or pleasure, but it’s more than simply feeling down. Everyone’s experience of depression is different but hallmark symptoms include changes in appetite and sleep, feelings of hopelessness, irritability and lack of concentration. Many people with depression also have thoughts that life is not worth living.
Like all mental health issues, depression lies on a continuum, ranging from mild to severe. At the mild end of the spectrum, someone might feel low and notice some impact on their ability to live their life to the full, perhaps finding that they don’t get as much joy as usual or that everyday tasks are harder than they were before. At the more severe end, depression can make simple tasks like eating, drinking and washing oneself feel impossible and can lead to thoughts of suicide.
Depression commonly comes hand in hand with other issues - often with anxiety - and it can have a reciprocal relationship with relationship problems, overuse of drugs or alcohol and struggles at work. There are different types of depression, including seasonal affective disorder, postnatal depression and bipolar disorder, all of which have their own key signatures.
What causes depression?
There’s no one single cause of depression but it comes from a complex interaction between social, psychological and genetic or biological factors - a delicate interplay between nature and nurture. Scientists have isolated one particular gene that can put people at risk of developing depression but this gene only exerts its effect if the person experiences a stressful life event. Facing adverse life events such as trauma, loss and unemployment can increase the risk of developing depression but there is not always an obvious trigger.
What maintains depression?
Once depression sets in, it tends to maintain itself through a series of feedback loops. Aaron Beck, the founding father of cognitive therapy, described a “cognitive triad”, where a person with depression views themselves, other people and the world around them in negative terms. This leads them to misinterpret things through a negative lens, so failures are amplified, rejections seem more personal and the world generally seems like a gloomy and unforgiving place. Inevitably, people with depression tend to get stuck in cycles of negative thinking and rumination, which feed into low mood and impact their behaviour.
When people are depressed, they tend to withdraw from things that would otherwise make them happy. Because activities seem more effortful, people often pull away from hobbies, friendships and fun, and focus their diminished energy on the essential tasks. Or their negative belief system leads them to expect the worst, so they avoid any situation where they might “fail” and they convince themselves that people won’t want to spend time with them. It’s also easy to develop a mantra of, “I won’t enjoy it, so why bother”. The decrease in human connection and the lack of enjoyable activity means there’s a risk of living a life with limited opportunity for pleasure and so there’s nothing to break the cycle of negative mood.
How is depression treated?
In recent decades there have been promising advances in treatments for depression. Both medication and talking therapies have greatly evolved and many people completely recover from depression, or learn to manage it effectively. In the case of both medication and talking therapies, there are several approaches and it’s a case of finding out what works best for any given person.
One key approach with a strong evidence base is cognitive behavioural therapy (CBT). It usually begins with a focus on encouraging the person to reconnect with activities from which they’ve withdrawn, then moves on to target the negative thinking that’s so inherent in depression. Sometimes therapy will focus on changing underlying beliefs and rules that can put people at risk of depression, many of which are laid down in childhood and adolescence. Above all, a person will learn that there’s an explanation for their symptoms and challenge the common internal assumption that they’ve done something wrong.
And finally, what can we do?
At least 10% of us will experience an episode of depression in our lives and health economists predict that the rise of depression worldwide will continue. The key is to remember that it’s not permanent and there are plenty of effective treatments - the first step is to recognise any symptoms and endeavour to access help early.
If you think you might be depressed we’d recommend speaking to your doctor in the first instance. The Unmind platform contains resources to help with depression, along with a host of other mental health problems and has a built-in measurement tool to help make sense of any symptoms.