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QUESTIONS & ANSWERS ABOUT DEPRESSION

Below are answers to the most frequently asked questions about depression and its treatments.  These have been put together by Dr Catherine Delin, a registered (SA) psychologist and member of the Australian Psychological Society (APS).

Dr Delin holds honorary positions at two South Australian universities, has a qualification in health education and a PhD in psychology.   She has a very strong background in research within psychology, has taught and supervised students for more than 2 decades, and has a long standing interest in the efficacy of different therapies.

We are in good hands here!



 
 
How do I know if I have depression?   What are its symptoms?
It is often said that depression is the common cold of our mental and emotional life, that is, we will all experience occasional bouts of it from time to time.    Certainly everyone feels 'down' or 'blue' sometimes, and it is true that depression as an illness is being diagnosed far more often these days than ever before.    Nevertheless, it's important to understand that just feeling a bit miserable for a day or two is not the same as suffering from depression.  We also need to realise that we can be suffering from depression without feeling particularly miserable.

Depression causes three different kinds of symptoms - in our thinking, our feeling and our bodily experience, as well as our behaviour.

  • Our thinking - we are likely to brood about things, to be forgetful, and unable to concentrate or solve problems, and we might begin to wonder whether our life is worthwhile.
  • Our experiences - we might cry easily and feel very sad, feel listless and unable to enjoy our usual activities, and lose our sense of humour.
  • Our behaviour - we can become restless and unable to sleep, or we might sleep too much, we might eat too much or not enough; as well, we might be impatient and grumpy, or we might hide away and not see anyone or even answer the phone.

If you have had depression before, you will probably recognise that it is happening to you again, although sometimes we get lots of vague aches and pains, or catch colds and other infections easily, and this is actually a sign that we are in a depressed state. So rather than feeling down, we just feel ill.  If the doctor can find no reason for your illness, then it might be that you are depressed (although it's a good idea to seek a second medical opinion if your life is badly affected by your symptoms).

Psychologists can use a paper-and-pencil test to find out whether you are depressed or not.  One that is often used is the Beck Depression Inventory.  It asks questions about your thoughts, feelings and behaviour, and the more questions on which you have a high score, the more depressed you are.  However, it's not necessary to take such a test.  A doctor or psychologist will be able to diagnose your depression by talking to you, and even noticing such things as how slowly you move and speak, whether you make eye-contact when speaking, and even whether you have washed and dressed smartly.

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What should I do if I'm depressed?

If you think you might be depressed, and your problems are really interfering with your life, the best thing to do is to find a general practitioner whom you trust, and confide in him or her.   Ask your doctor about the possibility of seeing a mental health professional such as a psychiatrist or a psychologist.

If you prefer not to go to the doctor, asking friends and family for support, exercising (if you can), eating and sleeping as well as you can, or taking a break from work might help.

Ultimately, however, you might either have to accept living a less happy life or accept that some form of professional intervention is necessary.

Remember that depression is an illness. Lots of people have it, and having it doesn't mean you are weak or have failed in some way. If you would seek help for any other illness, why not seek help for your depression?

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What should I do if I have suicidal thoughts?

Thinking about suicide is not in itself dangerous.  In fact, the idea of suicide has crossed the minds of most people at some time or another.

However, if you think about suicide a great deal of the time, or if you think about it as an escape from the problems in your life, you should recognise that you are depressed. Then you must decide whether to take action about your depression.  If you do seek professional help, be sure to tell the practitioner that you have been thinking about suicide, even if they don't ask about it.

If you have gone one step further and are developing an actual plan for how you will kill yourself you must get help IMMEDIATELY.
 Tell someone you trust.  Tell them you are serious.   Or...

  • anywhere in Australia, phone Lifeline on 13 11 14.
  • walk in to the Casualty or Emergency section of a major hospital.
  • go to your general practitioner.
  • if you have already seen a mental health professional such as a counsellor contact him or her.
There are also sites on the Web which offer support.
depressioNet.com.au has Help In Your Area which lists some Australian health care professionals.
Or you can go to a search engine and do a search using the word 'suicide'.

Remember that however bad you feel (and we DO know how bad that can be) you are not alone, and realise that if you hurt yourself, you will have the injury or other effect to deal with as well as your depression.

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What is bipolar disorder?

An older term for bipolar disorder was 'manic-depression'.

People who suffer from this disorder sometimes enter a state of mania or excitement. They might swing between the extremes of deep depression and wild mania or they might not experience depression at all.

In the manic phase of their illness, sufferers become very unrealistic about what they can do. They might even think that they are some very important person, or that they can do such things as flying or walking on water, depending on how severe the bi-polar depression is.

They might spend money recklessly as if there were no future. Their thoughts will race and they may seem agitated or over-excited. They might take very little sleep and talk constantly. They might begin lots of new projects but leave much work unfinished.

On the other hand, they might actually be very productive in this phase. In fact, many people who suffer from this disorder stop taking their medication because it evens out their moods and they like being 'high'. While ultimately their health would suffer from going at such a pace, the illness is only a problem if the ability to work or carry out their normal daily and social activities is impaired.

If there is interference in their normal functioning, it's a sure sign that professional help should be sought.

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What is the difference between psychologists and psychiatrists?

In Australia, psychiatrists study for a medical degree before moving on to psychiatry which is an additional course of study and practice. They can therefore prescribe drugs as well as offering 'talking therapy'.

A clinical psychologist studies for at least 6 years, learning about various aspects of human behaviour, emotions and thought processes, but has no formal knowledge of drug treatments and is not allowed to prescribe drugs.

The APS have prepared some further information on the difference between psychiatrists and psychologists.

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Is there any difference between clinical psychologists and counselling psychologists?

This is a difficult question, and the answer might be different depending upon which state you live in.

In South Australia, for example, psychologists are not able to use the term 'clinical psychologist' as a specialisation title even if they have a Masters degree in clinical psychology, although this is not true for all states.

The important issue is whether the psychologist has undertaken a course of study (generally at least 6 years of study) which is accredited by the Australian Psychological Society.

A psychologist who uses the title 'counselling psychologist' has probably done a course with a strong emphasis on counselling skills as such, whereas a 'clinical psychologist', while knowing these skills, may have more expertise in such areas as test administration and interpretation, and cognitive-behavioural therapy (CBT).

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Is there more than one type of 'talking' therapy available for depression?

There are numerous kinds of 'talking' therapy available for depression. In her 1999 article 'Changing conscious experience - Comparing clinical approaches, practice and outcomes' (published in the British Journal of Psychology, volume 90, page 587 on), Jane Henry comprehensively lists the psychological therapies that are available. At least a dozen of these involve talking between therapist and patient, but with different emphasis depending upon the orientation of the therapist. Generally speaking, the nature of the therapy offered by a professional will reflect their ideas about the underlying causes of depression.

For example, psychodynamic and psychoanalytic therapists who believe that unresolved conflicts or issues from earlier in life contribute to our depression, and it therefore makes sense to examine our childhood for problems. Or, if the therapist believes that our depression is largely caused by the faulty way that we handle life's problems, our coping strategies, they may help us to learn some better ways to cope. In the same way, a therapist might believe that the depression lies in our 'self-talk', the habitual things that we say to ourselves ("I'm worthless", "Nobody likes me", "Things always go wrong for me"). In that case, they will work with us to change our way of thinking - for "things always go wrong for me", we might learn to substitute "Life isn't fair, and some things have gone wrong for me in the past, but I can't predict the future when no-one knows what will happen for me".

In relation to psychodynamic types of therapy, you may find that the therapist speaks very little during the session, but waits for you to speak, even if you say nothing. From time to time they might give an interpretation of what you have said, some way of understanding what is happening with you. On the other hand, those who use therapies based in other traditions may talk quite a lot, even instruct you in different things to do and give you 'homework' assignments.

Another approach, which may be used as part of any therapy, is called 'reflective listening', and the professionals who use it might subscribe to a model called 'humanism'. The therapist seems to say back to you what you just said. This is not as simple-minded as it sounds as it actually enables you to explore your feelings more thoroughly. So, for example, if you ramble for a while jumping from one problem to another, by listening closely the therapist may determine that the predominant feeling you are experiencing is confusion. When they say, "You feel confused and unsure of a direction to take", you might then say, "It's true that I don't know which way to go, but I mainly feel sad". And so it goes on.

In practice, many professionals these days use what's called an 'eclectic' approach, using the most helpful aspects of several different types of therapy. Of course, there are other types of 'talking' therapy, too, like couples therapy, co-counselling, and family therapy, and these might be applicable if one of the people is depressed. Then there are some more unusual approaches, like primal therapy, psychodrama, neurolinguistic programming and so on. Your therapist will probably advertise the fact if they adhere to one particular, different, model.

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If I am depressed, will I need shock therapy (electric convulsive therapy)? What is ECT?

ECT can be an effective therapy for very severe depression, but it would probably only be considered if your depression is severe enough for you to need hospitalisation and/or other treatment options aren't able to treat your symptoms effectively. The treatment involves administering, under anaesthetic, a series of electric shocks to the brain at intervals over a few weeks. Many complain of memory loss following ECT.

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Will I have to lie on a couch and talk about my childhood?

It is very unlikely, in Australia, that you will be asked to lie on a couch for your 'talking therapy'. You will probably sit in a chair facing your counsellor who may or may not sit behind a desk. Patients lie on a couch when they are undergoing psychoanalysis which is rather unusual in Australia, but more common in the US, Britain and Europe. Depending on the kind of therapy you may or may not be asked to talk about your childhood. If there are issues from your childhood that you find distressing, you might want to mention that to your therapist.

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Are researchers investigating treatments for depression?

There is a huge ongoing research effort into treatments for depression including drug treatment and psychotherapy's. We have some research available on depressioNet in our research section and if you are aware of any other reputable research, please let us know.

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How can I recognise danger signs for suicide in another person?

It's a dangerous myth that people who talk about suicide won't actually do it. Paradoxically, people often undertake the act of suicide shortly after they begin to improve a little - they now have the ability to go through a relevant series of actions. Look out for signs such as acting rather more cheerfully, making a new will or tidying up business affairs, giving away possessions. Journalist Celine Reindhardt conveys something of the inner world of suicide in her article "Crime: Attempted Suicide"

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What treatments are available for depression?

There are several different treatments which are suitable for depression and these are often used in combination. Firstly, there is 'talking therapy'. Secondly, depression is often treated with anti-depressant drugs. Thirdly, there are various self-help therapies. For example, regular exercise can make quite a difference because it generates endorphin's, the body's own 'feel-good' chemicals. Strategies like eating a balanced diet and getting enough rest might not directly help, but if you neglect these areas, your depression could be worsened.

There are lots of other things you can do as well, either alone or working in conjunction with your professional helper. For example, some argue that depression is anger turned inwards - that you're really angry with someone or some situation but are not expressing it - and that you will feel better if you identify and express your anger. Exercise is, in itself, a good way to use up all those anger chemicals, but you can also use a punching bag, or hit a soft inflatable toy. Or you can write a letter (that you won't post) to the person who you feel has wronged you explaining how you feel. Of course, your anger is very often quite appropriate, as when you have been abused or cheated or hurt, and in these cases using your anger to motivate you into taking control of a situation can be very therapeutic.

On the other hand, some argue that thinking and writing about what's making you unhappy increases your depressed feelings. Research suggests that if there is some major trauma or life event underlying your depression, writing about it can help. On the other hand, writing about your daily hassles might just serve to magnify them.

Don't forget all those little things you can do for yourself, too, that can help you to feel a little bit better. Why not treat yourself to a massage, some new clothes, a new piece of software, your favourite music, whatever you know you have enjoyed when you were not depressed.

It's important to keep as active as you can. Although you may feel like withdrawing from friends and family, it's best to keep in contact with them if you can.

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Your feedback and input will be greatly appreciated.

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