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The young girl seated across stared at me wide-eyed.  She was a student on full scholarship and had just started on her undergrad degree.  All through her high school years, she had looked forward to this time in her life.  But things had turned out very differently in the past few months.

Megan had always struggled with mild depression for the past few years but, now, she confessed, she could not get herself out of bed. An overwhelming sense of fatigue and despair seemed to engulf her and she found herself rapidly losing weight for no reason. Meeting with friends was too much effort and she took to isolating herself. She described her experience as “living under a dark, a dark cloud that never lifts.”

David, a doting dad of two, had recently separated from his wife of 10 years. The current health mandates with COVID-19 had restricted him from seeing his children as frequently as he would have liked.  Having to suddenly stay away from his two children had triggered a downward spiral. Of late, all he had wanted to do was watch TV.  Even choosing an interesting show was too much effort.  He just watched the same episodes of one show on repeat.

David knew that he was gaining weight from consuming too much sugar and fatty food but these indulgences made him feel better temporarily.  His friends advised him to “snap out of it and get on with life” but he didn’t seem to know how.  He found himself irritable and short tempered with friends and colleagues who offered help and, then, became self-critical for feeling this way.  “Its feels like torture,” he explained.

Recognizing the Problem: What is depression?

Depression is an illness, that may cause you to feel hopeless about the future, deeply sad, interfere with your ability to carry out activities of daily living and lose interest in things that you once enjoyed.  It is more common than you think and can equally affect anyone irrespective of gender, age, profession and social status.

It might help to understand that depression is not something you do to yourself!  It is a medical condition, caused by a chemical imbalance in the brain, that requires proper treatment and care. Individuals experience depression in different ways. Some symptoms may impact your body and others your mind.  But they are all extremely debilitating and negatively impact the quality of your life.

The causes of depression are extremely variable and intermingled.  It is quite possible that you might experience depression even if none of the causes listed below fit for you.  However, some common factors may include:

• Genetic vulnerability: You might be at a higher risk if you have a family history of mood disorders
• Early childhood trauma: Experts recognize that adverse childhood experiences (ACEs), such as being abused or neglected, are important risk factors for depression and other psychological disorders in later life.
• Drug and alcohol use: A history of drug or alcohol misuse increase risk of developing depression.
• Stressful life events: These may include isolating situations such as the current pandemic, a death in the family or a sudden life-altering illness.

Depression can be broken into categories depending on the severity of symptoms. Some people experience mild and temporary episodes, while others experience severe and ongoing depressive episodes. There are many different types and sub-types of depression.  It is important to consult your doctor for further evaluation and a correct diagnosis.

In general, if you experience five or more of the following symptoms that are persistent and do not go away on their own, consider seeking help right-away:

1. Feeling depressed most of the day, nearly every day
2. Loss of interest in most regular activities previously enjoyed
3. Significant weight loss even when not dieting or weight gain
4. Sleeping a lot or not being able to sleep, or experiencing both at different times
5. Slowed thinking or movement, feelings of restlessness or having slowed down
6. Fatigue or lack of energy on most days to carry out basic activities
7. Feelings of worthlessness or guilt
8. Loss of concentration or indecisiveness
9. Recurring thoughts of death or suicide

In men, symptoms may include high levels of irritability and aggression and tendency to use substances to alleviate the symptoms.  They may also experience reduced sexual desire.  In children and teens, depression can interfere with concentration and problem solving — capacities that are essential for daily functioning, leading to feelings of incompetence.  These changes are specifically more debilitating for high achievers, for whom these symptoms can fuel issues with low self-esteem and feelings of anxiety.

Choices for Healing

Living with depression is hard, no matter what symptoms you experience. The good news is that those who seek treatment often see improvements in symptoms in just a few weeks. Despite this, there is a lot of stigma associated with seeking help.  It is important to realize that depression can get worse without proper treatment and carry a significant risk to life.  Opting for help, earlier rather than later, can quickly restore the quality of your life.  There are several options you can chose from, although a combination of medication and psychotherapy is considered the most beneficial course of action.

Medication can range from antidepressants to sedatives or tranquilizers.  Each type of medication comes with its own benefits and risk factors (although benefits generally outweigh the risks).  Keep in mind that the medication may take from 3-6 weeks to kick in its effect, so keep up the schedule even if you don’t feel any different at first.  Consult your general practitioner or psychiatrist for a more detailed diagnosis and a prescription.

Psychotherapy may help address some of the underlying factors causing depression. Clinicians offer different types of modalities within psychotherapy, the most common being Cognitive Behavioural Therapy (CBT).  Above all, it is important to find a clinician with whom you feel a sense of comfort and connection.  If you do not feel ready to commence individual therapy, consider group therapy, where a clinician will work with a group of individuals and the focus is on psycho-education and skill building. Counsellors are bound by professional ethics and confidentiality is a top priority for most agencies, if that is an area of concern for you.  For further information on community resources in BC visit https://www.healthlinkbc.ca/health-topics/hw30709.

Bibliotherapy offers the option of staying informed about depression, how it develops and the treatment options which will help you feel more in control of your own healing journey and empower you to make informed decisions.  One of the best books on the topic is The Truth about Depression by Charles Whitfield, M.D.  But there are also many others with a similar focus that you might find helpful.

Self-care can improve symptoms of depressions by setting an intentional agenda to look after yourself.  Simple steps towards boosting the nutritional content of your food intake, drinking eight glasses of water or taking up a hobby can be the first steps you take towards healing. Physical activity of any sort can increase your body’s production of internal mood boosters called endorphins.  Simple breathing techniques, such as box-breathing and diaphragmatic breathing, also activate your body’s capacity to self-regulate and enhance mood.

Above all, please be aware that for some, just one form of help might work wonders but for others a combination of the above might bring results. If one form of treatment does not yield the results you seek, keep going until you find the right fit.  You have choices to enhance your recovery. Stay safe and well!

About the author

Audrey D’Souza, MA, RCC, is a trauma counsellor with Sources’ trauma counselling team.

References

American Psychiatric Association (2012). Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. Washington, DC: American Psychiatric Publishing

Beidel, D.C., Frueh, B.C. & Hersen, M. (2014). Adult Psychopathology and Diagnosis, 7th Edition, Hoboken, NJ: John Wiley & Sons, Inc.

Keitner, G.I., Ryan, C.E., Miller, I.W. & Zlotnick, C. (1997).  Psychosocial factors and the       long-term course of major depression.  Journal of Affective Disorders, 44(1), 57-67.

Kendlar, K.S. & Gardner, C.O. (2010). Dependent stressful life events and prior depressive       episodes in the prediction of major depression: The problem of causal inference in     psychiatric epidemiology. Archives of General Psychiatry, 67 (11), 1120-1127.

Whitfield, Charles. L. (2003). The Truth About Depression, Choices for Healing, Deerfield         Beach Florida: Health Communications.