Unit 5 Understanding Depression

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Unit 5 Understanding Depression

About this unit

In this unit learners will gain an understanding of depression and the causes of the condition. They will develop an appreciation of what depression feels like and the symptoms that may be experienced. Learners will gain an understanding of ways in which depression can be managed and treated and will also gain an understanding of the roles and needs of family and friends.

Learning Outcome 1

The learner will:

Understand the term ‘depression’

The learner can:

1.1 Define the term ‘depression’

1.2 Differentiate between feeling low and clinical depression.

1.1 Defining Depression

Depression can range from changes to our mood (feeling low at times), to severe clinical depression. For most people a period of depressed mood is set off by a series of life events that have been upsetting – there are reasons that we can identify that have caused our changed outlook on life. Although this can be difficult to cope with at the time under normal circumstances we tend to gradually pick ourselves up and find hope and interest in our lives again.

1.2 The difference between low mood and Depression

Within all of our lives we will also experience normal ‘ups and downs’, but will take these in our stride and usually accept this as part of normal daily life.

With clinical depression there is often a change in the chemistry of the brain, which requires medical treatment to be managed effectively. When feelings of hopelessness are frequent, or do not pass, and the despair that a person feels is impacting negatively on their life and achievements, they are said to be suffering from clinical depression. There are 3 core symptoms that help to diagnose depression. These are low mood, lack of energy and a lack of interest in activities. These are usually present on most days, for a period of at least 2 weeks, for depression to be diagnosed.

Depression can affect men or women from all walks of life and of all ages. It is twice as common in women as men and will affect up to 40% of people (4 out of every 10) at some point in their lives (BUPA 2002). It can occur as a one off response to a life crisis, be ongoing for a longer period of time, or may recur in episodes (or ‘bouts’) after the first occasion.

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Learning Outcome 2

The learner will:

Understand the possible causes of

depression. The learner can:

2.1 Describe three possible causes of depression

2.1 Possible causes of Depression

There may be many reasons why we experience depression and every person who has experienced depression will have a different story to tell. Many theories have been suggested about things that can contribute to our risk of depression. Many people who have experienced depression feel they are unsure about what caused it for them. It may be a single event or a build up of many minor issues.

In previous units we have already looked at the ways that stress and anxiety can escalate and affect our ability to cope. If we feel there are great demands on our time and we are taken for granted by others this can affect our mood and outlook. It may be that we need to look at our lives and make some time for ourselves to improve our feelings of self-worth.

Abraham Maslow (1959) developed a theory called ‘The Hierarchy of Needs’. This suggested that all humans have basic needs in life in order to feel satisfied. He imagined these needs to be arranged like a ladder (or sometimes you will see his theory drawn as a pyramid with different levels). The most basic needs were at the bottom of the ladder and higher needs at the top level. The top level was the need to become all that we are capable of. Maslow felt that if needs at the bottom of the ladder were not achieved this would stop the person from moving on to higher needs. If we experience ongoing illness we may not achieve our potential because basic needs, such as stability, socialising and feelings of security are absent in our lives. In depression many of the basic needs are not met and so we may feel unhappy and unfulfilled in our lives.

Hormonal changes can affect women at different points in their life – within each monthly cycle of menstruation the hormone changes can affect mood, at menopause or after having a baby. Depression after a baby is known as post- natal depression and we will look at this in more detail in the next unit.

Activity 31 in your Activities and Self-Assessment Workbook relates to

the section above

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Some people have mood changes throughout the seasons of the year, feeling positive and happy in warm summer months, but depressed during cold, dark autumn and winter days. It is now known that the lack of sunlight in winter months can affect the mood and this is known as Seasonal Affective Disorder (SAD).

Poor physical health or ongoing illness can lead to increased risk of depression. If the person has been isolated and inactive for a long time due to ill health it is easy to become negative about life. If abilities have also been lost due to illness we may become depressed because we are so unhappy about our loss of independence. Poor diet, lack of exercise and drug or alcohol abuse can also contribute to depressive symptoms.

Learning Outcome 3

The learner will:

Understand what depression feels like. The

learner can:

3.1 Describe what depression feels like.

3.1 What does Depression feel like?

Perhaps the clearest feature of depression is low or sad mood. Each person may have varying symptoms and these may be present in degrees of severity, but may include:

□ Changes to appetite. Some people lose interest in food, others find that

they over-eat

□ Trouble sleeping, waking early in the morning, or sleeping more than

usual

□ Feeling unhappy most of the time

□ Negative thoughts about being useless or worthless, feeling guilty

or blaming ourselves for things that are not necessarily our doing

□ Feeling unusually emotional or tearful, or maybe detached or numb

□ Difficulty in concentrating, decision making or remembering things

□ Being less active and feeling that energy levels are low

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□ Gaining no pleasure from usually enjoyable activities, company of

others, or happy events

□ Feeling unusually anxious about mixing with others

□ Lack of libido and a reduced desire in sexual activity

□ Frequent aches and pains and general health concerns

□ Despairing that things will never get better

□ May lead to thoughts of ‘not wanting to wake up tomorrow’ or even

actively wanting to end our lives

□ Around 10% of patients with major depression will attempt to commit

suicide. Although this is worrying, active measures are being taken,

nationally, to recognise depression early and to support effective

treatment to reduce suicide rates.

□ The UK suicide rate was 11.6 deaths per 100,000 population in 2012,

but there are significant differences in suicide rates between men and

women. Male suicide rates were more than three times higher at 18.2

male deaths compared with 5.2 female deaths per 100,000

population. (office of national statistics 2014)


the section above

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Learning Outcome 4

The learner will:

Understand how a person with psychotic depression may be affected.

The learner can:

4.1 Describe three factors specifically associated with psychotic depression.

4.1 Psychotic Depression

Is a severe form of depression, often with suicidal ideation and symptoms of delusions and hallucinations The person does not recognise that they are ill.

Factors associated with Psychotic Depression

The onset of psychotic depression is spontaneous. It tends to occur with no identifiable cause. There is a loss of insight as the person is unable to recognize they are ill. Hallucinations and delusions may be present, these may include:

□ Delusions of guilt

□ Delusions of unworthiness

□ Delusions of poverty

□ Delusions in relation to bodily changes.

Admission to hospital is very likely.


the section above

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Learning Outcome 5

The learner will:

Understand how depression affects the individual, their life and their friends and family.

The learner can:

5.1 Describe five examples of how depression may affect the individual and their life.

5.2 Describe how a person’s depression may affect their friends and family.

5.1 Effects of Depression

Once we begin to experience symptoms of depression we may distance ourselves from others and stop enjoying our usual activities. If we are not active we have a chance to reflect on our own thoughts more readily, and if we are not happy these thoughts can be quite negative. We may incorrectly believe that we are not well liked, or that we have no direction in our lives, or any number of other negative thoughts and feelings. If we are not mixing with others we are not facing any challenge to these negative thoughts. We can continue to believe these negative thoughts we are having and this can make our feelings of depression worsen.

We can become ‘trapped’ in a cycle of feelings, thoughts and behaviours as a result. This has a negative affect on our motivation to do things, and this can make us increasingly depressed. To break this cycle helps us to start recovering from symptoms of depression.

NEGATIVE

THOUGHTS

‘I can’t be bothered’

‘There’s no point’

CHANGES TO

BEHAVIOUR

Becoming less

motivated and less

active than usual.

Choosing to avoid

people or

situations and

becoming isolated

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Other effects:

□ Unable to cope with the activities of daily living e.g. personal hygiene,

personal appearance, housework, childcare etc.

□ Adverse effects on relationships with family and friends – may cause tensions with partners and other close family members

□ Effect on children – may suffer neglect or emotional distress; or they may become carers

□ Loss of libido – affects intimate relationships

□ Unusual or excessive anxiety or worries about loved ones

□ Signs of alcohol or drugs misuse

□ Difficulty forming and maintaining relationships

□ Isolation and loneliness.

5.2 Effects on family and friends

□ It is very upsetting to see someone you care about appear to change so much, with no apparent interest in the world or anything in it (including you at times)

□ You may often feel helpless. You may feel bewildered and resentful that this has happened to someone you care about

□ You may feel annoyed with the person because you are at a loss as to how to help them. Depression can cause someone’s moods to change so that you feel you don’t know the person as well as you used to. You might feel like giving up trying to reassure someone, especially if they do not seem to be trying to help themselves any more

□ If your relative or friend is severely depressed you may find yourself doing things on their behalf such as cleaning or cooking, maybe even encouraging them to dress in the morning. You may worry about how they will cope in your absence and about the risk of their contemplating suicide

□ This is a lot to bear on your own and you may need support and advice. If possible get others to help you and share the load

□ You may choose to talk to your GP about your concerns or discuss your own feelings with relatives and friends. You may also be able to get in contact with a local support group for people in your situation.

Activity 34a and 34b in your Activities and Self-Assessment Workbook

relates to the section above

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Learning Outcome 6

The learner will:

Understand the demands of daily life that may contribute towards maintaining depression.

The learner can:

6.1 Describe the demands of daily life that may contribute towards

maintaining depression.

6.1 The impacts of life’s demands on Depression

Everyday life has a number of demands. Most of the time these will seem manageable, whilst at others, they may be overwhelming. Life’s demands may contribute to a depressive episode or worsen, or exaggerate, symptoms, therefore, maintaining an existing depression. Demands may include:

□ Relationships – especially if there are tensions or breakdown;

divorce; insecurity; lack of support

□ Caring responsibilities

□ Occupational problems – frustration; conflict; low status; work stress

□ Domestic responsibilities – cooking, cleaning, shopping etc.

□ Financial pressures – bills, debts etc.

□ Illness and disability of self or loved ones

□ Expectations of self or others

□ Unemployment

□ Home problems – overcrowding; poor conditions

□ Bereavement


the section above

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Learning Outcome 7

The learner will:

Understand how depression can be managed and know some of the resources available to support the individual experiencing depression.

The learner can:

7.1 Describe local resources and treatments that would be available to

an individual experiencing depression.

7.2 Identify the resources and treatment required to manage a person with psychotic depression.

7.1 Managing Depression

Because depression includes feelings of hopelessness it can be difficult to make a start in managing depression when it is experienced. It is a big step to recognise and accept that things can be done to help, and that not everything is hopeless.

Sometimes it is helpful to know what was happening to the person when they began to feel depressed. This can help the person to work out why a particular event affected them so negatively and to review their thinking about what happened.

It may not always be possible to pinpoint what triggered an episode of depression. The important issue is for the person to accept that they may need support, and to find ways that help them to challenge their depressive feelings.

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Getting Help

Helping yourself:

□ In recent years the importance of exercise in managing depression has been researched and shown to be beneficial. Many GP surgeries can now refer patients to a local Gymnasium or Health Club and subsidise sessions in the effort to combat depression. It is now known that the brain chemicals that are suppressed in depression can be boosted by exercise, and that this lifts the mood of the patient. Even regular walking or swimming helps to boost these chemicals, known as endorphins. Activity breaks the cycle of negative thoughts, feelings and behaviours which can trap us in depression

□ Starting the day with a confident outlook can actually have the effect of making us feel more positive and less depressed. It may be a struggle at first, and even feel a little false, but it can contribute to us feeling better about ourselves. Positive thinking breaks the cycle of negative thoughts, feelings and behaviours of depression

□ Speaking to a friend or relative who enjoys our company can help to remind us that others do care about us and that we are valued. This can lift our mood, which also breaks the cycle of negative thoughts, feelings and behaviours associated with depression

□ Doing an activity that we enjoy, such as gardening or reading can be a positive step. Many activities fall by the wayside when we feel depressed, and starting to pick these activities up can boost confidence and enjoyment in life

□ We may choose to meet other people who have experienced similar feelings at a support group. This can give us a chance to talk openly about how we feel with someone else who understands

□ Getting adequate sleep and eating a healthy diet can help us to be healthier and can influence the chemical balance in our bodies

□ Resist the temptation to drown your sorrows with a drink. Alcohol has a depressant effect on the body and actually makes depression. symptoms worse

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Possible Treatment and Local Resources

□ Physical symptoms of depression can resemble those of other conditions and need to be checked out. Your GP will probably be the person to treat you for depression. Only with severe symptoms will you be referred to a Psychiatrist or Specialist Mental Health Service

□ A course of anti-depressant drugs may be prescribed by your GP. These are not tranquillisers and they are not addictive. They work on chemicals in the brain to lighten your mood to allow you to cope more effectively. They will also help to restore sleep pattern and appetite.

Most anti-depressants take 2-4 weeks before they have any effect so it is important not to give up too quickly if you don’t feel better straight away. Your doctor may suggest that you keep taking them for up to 6 months after you feel better as this is proven to prevent depression symptoms returning

□ Many people wish to take alternatives to drug treatment, such as counselling, therapy or self-help. Your doctor will be able to advise you of other sources of help available in your area.

□ There may be local groups or organisations which may give advice and assistance, or provide counselling or therapies. National organisations such as MIND and The Samaritans may be able to provide help locally.

Family and Friends - Your Role

□ As a relative or friend you can help by being patient and understanding, by showing a real interest in the person themselves, not just in their problems. You can show your concern by listening sympathetically, and being prepared to spend time with them

□ Your role may be to encourage your relative or friend to talk about their feelings rather than bottle things up. This can take a lot of time, going over the same things again and again, but try to be patient.

□ Family and friends can also help by challenging the depressed person’s negative ways of thinking, and their preoccupation with their problems. If someone feels, for instance, they are never any good at anything; you can help by pointing out situations or tasks they have handled successfully. Doing things together which they can succeed at may help, too

□ Someone who is depressed is likely to need a lot of prompting and encouragement to seek help. You can be of assistance by finding out about local support groups and possibly by accompanying that person to the group or to a GP appointment.



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7.2 Managing Psychotic Depression

Psychotic depression will require admission to hospital. This may be voluntary or compulsory under a section of the Mental Health Act 1983.

The first priority is the person’s safety and continuous nursing observation is necessary.

Other measures may include anti-psychotic medication and electroconvulsive therapy (ECT) when a person’s life is at risk (e.g. due to suicidal intent or dehydration due to refusal to eat or drink).

The Future

Recovering from depression can take a long time and many people worry they will never fully recover. We should not forget that someone who has been deeply depressed and has got over it will still experience ‘good’ and ‘bad’ days just like everyone else and we should remember not to be too sensitive to these normal moods.

Learning to relax and to manage the stress that builds up can be enormously important when recovering from depression. It can also help prevent depression recurring in the future. There are now many relaxation and yoga classes in local community centres (your public library should be able to give you details). There are also many books, CD’s, Mp3’s and tapes that help you to learn simple relaxation techniques at home.

Joining a self-help group can be helpful if we find it hard to motivate ourselves to do things on our own. It can provide support while we are depressed and help build up our confidence in recovery. After depression has lifted, it can be important to learn to recognise early warning signs that it may be returning. A group can also be very useful in this respect.

Depression can be a disabling illness and can be hard to overcome. With appropriate support we can look at our life and consider how to change things to improve our physical and mental health. Although at the time we may feel completely overwhelmed by depression, people do recover and go on to gain positive changes in their lives as a result of a difficult experience.

Now go to your Activities/Self-Assessment Workbook and answer the self-assessment questions for Unit 5. Following review with your tutor, you should then complete the activities for Unit 5.



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Unit 5 Understanding Depression