Portfolio of Hope

1. What is depression?

Depression is a mood disorder that presents itself as a persistent feeling of sadness, for weeks or months as opposed to days, and a loss of interest in activities that were previously enjoyed.

2. What is the difference between ‘feeling low’ and being ‘clinically depressed?’

Low mood generally refers to feelings of sadness that last for a relatively short period of time (days/weeks as opposed to months.) These feelings of sadness that underpin what it means to ‘feel low’ usually dissipate when the issues that have triggered the negative feelings are resolved (e.g., work pressures, financial worries, poor health etc.) In contrast, depression is a long-term illness. It is not just ‘feeling sad for a few days’, it is a serious mental illness that can remain present for months, despite any initial ‘triggers’ having seemingly been overcome. As such, depression cannot be treated in the usual ways one is encouraged to pursue when they are feeling ‘a bit sad’ (eating healthier, exercising more, getting enough sleep etc.), instead professional help is usually needed, whereby the individual suffering with depression seeks therapy (CBT) and, if deemed appropriate, medication (anti-depressants), to aid them on their ‘road to recovery.’

3. What are the factors associated with psychotic depression?

Psychotic depression is a subtype of major depression. It occurs when depression overlaps with psychosis, presenting itself as prolonged sadness combined with the presence of hallucinations (e.g., hearing voices) and delusions (e.g., intense feelings of worthlessness.)

Aside from experiencing hallucinations and delusions, other common symptoms of psychotic depression include feelings of agitation and anxiety, difficulty sleeping (insomnia), hypochondria, intellectual impairment, and, in some cases, physical immobility. People with psychotic depression also have an increased risk of experiencing suicidal thoughts.

Although the exact cause is unknown, psychotic depression is commonly seen in individuals who have experienced some form of adversity in their childhood. To treat it in the most effective way possible, a combined approach should be taken, consisting of medication (antipsychotics and antidepressants), psychological therapies, and social support.

4. What are the possible causes of depression?

Whilst the source of depression cannot be deemed as being the same for everyone, since mental illness is certainly no ‘one size fits all’ situation, there are some common causes that can affect many people. One such cause can be seen as being childhood experiences. Someone who has had a challenging upbringing, possibly having been subject to trauma of some type, is at an increased risk of developing mental illness’ such as depression. Examples of what a ‘challenging’ upbringing might refer to, is abuse, whether that be physical, sexual, or emotional, as well as neglect, grief, traumatic events, and/or an unstable family situation. Such events can have a major impact on one’s self-esteem and ability to deal with difficult emotions and situations. This can lead to one developing depression later in life.

Another potential cause of depression is the presence of physical health problems. Someone with a chronic or life-threatening illness that has a significant effect on their day-to-day life can have a major impact on their mood, which can subsequently lead to depression arising.

Having mentioned two causes of depression that are largely uncontrollable, there are also some causes that are controllable. Substance abuse, diet, sleep, and exercise being some of those causes.

A final cause of depression that I will mention here is genetic inheritance. Although it has not been scientifically proven that there any specific genes for depression, research has highlighted how someone who has a close family member with depression is more likely to experience depression themselves. This however might not be due to biological factors, but because of ‘learned behaviour’ (that meaning one mirrors the negative coping mechanisms they witnessed growing up.)

5. What feelings might an individual who is experiencing depression have?

The feelings associated with depression are wide-ranging, however there are a series of common symptoms that many people with the diagnosis report having.

As the very definition of depression is a persistent feeling of sadness, it is unsurprising that one of the feelings those with depression will experience is just that, sadness. This sadness may present itself visibly in people who are tearful, however symptoms may also be invisible to the eye, such as feelings of restlessness and agitation.

Other feelings that people might experience relate to their self-esteem and can lead to them perceiving themselves in a negative way, experiencing feelings of guilt and/or a sense of worthlessness which in turn can damage their self-confidence.

People might also feel ‘empty’ and ‘numb’, finding themselves unable to gain pleasure from the things they used to enjoy. Feeling so hopeless and full of despair can result in many people with depression struggling with suicidal thoughts.

6. How can depression affect those diagnosed and their overall quality of life?

In the same way that the symptoms and causes of depression differ massively from person to person, so do its effects on different people.

In some cases, depression might impact only the individual’s sense of self-esteem, causing them to lack in confidence, whereas in others, it can also have an impact on their relationships, their work, and their overall health, amongst many other things. 

By negatively affecting relationships, depression can in turn lead to the break down of said relationships, potentially resulting in one becoming isolated at a time when they need support more than ever. Depending on who the relationship is with, it can also affect their employability. If they become irritable with their employer, employees, or customers (having not explained their depression in advance), they might find themselves jobless, likely resulting in their depression worsening.

According to the world health organisation, depression is the second most common reason for disability in the world, it is therefore fair to make the bold statement that ‘depression can lead to the onset of chronic illnesses.’ This is because it can lead to increased blood pressure, putting an increased strain on one’s heart as a result of intense and prolonged stress.

7. How does an individual’s depression affect others?

Depression does not just affect the people diagnosed with the illness, but it can also affect their friends and family.

As loved ones often take on a ‘caregiver’ role, they are likely to feel hopeless/powerless for being unable to help their loved one to recover by ‘fixing’ the ‘problem.’ They may also experience feelings of guilt if they believe that they might have been to ‘blame’ for their loved one’s depression. The negative feelings that people close to someone with depression are exposed to puts them at an increased risk of becoming ill themselves. They might suffer from psychological distress, a direct consequence of burnout and exhaustion triggered by their depression.

Depression can also result in relationship difficulties. If someone’s irritability and subsequent social withdrawal, both symptoms of their depression, is misinterpreted as being directed specifically at their partner, this might lead to conflict arising, putting the future of their relationship in danger.

8. How may the demands of daily life contribute towards depression?

Often the stresses of everyday life have the biggest impact on people’s mental health, contributing towards the development of depression. This is true even more so in today’s society, whereby we are always on the look out for more. We crave improvement constantly, never settling for where we are, but forever striving to do better and be better. This means that we do not appreciate what we have when we have it. As such, we put ourselves under immense stress trying to accomplish more. This can contribute towards depression, since we undervalue ourselves and therefore experience a lack of fulfilment and sense of not being ‘good enough’, a result of our low self-esteem.

9. What treatment is available to individuals experiencing depression?

• CBT: CBT is centered around changing your thoughts so that, in turn, you are better equipped to manage your problems. ‘How can it change my thoughts?’, you may wonder. Well, CBT is proven to effectively improve peoples states of mind by, in simplistic terms, ‘rewiring’ their brain. This is achieved via therapy sessions either once every week or once every two weeks, with sessions, on average, lasting 30-60 minutes. The recommended course of CBT is different for everyone. Depending on individual circumstances, courses can range from just 5 sessions to 25 sessions.

• Family Therapy: As depression is a condition that effects not just the individual with the diagnosis, but their family and friends too, family therapy is often highly recommended. Family therapy usually explores; what your condition is and how it might progress in the future, and what treatment is available to you. By ensuring that everyone has the basic information regarding the condition, families can act as a support network. Family therapy also equips families with the knowledge they need to recognise the best ways to support their loved one, helping them to understand how they can better help to manage any future depressive episodes they may witness.

• Antidepressants: Usually taken alongside some form of talking therapy such as CBT, antidepressants are prescribed to people with a diagnosis of depression to help minimise their symptoms. Doses differ depending on individual cases, with the lowest dose being 20mg, and the highest being 200mg.

10. What resources can be used to help a person with psychotic depression?

• Crisis Plan: Crisis plans should be something that everyone struggling with their mental health has, regardless of the specifics of their illness. By encouraging people to think about what support they might want in the future should they become unwell, they will be better equipped to deal with such situations, should they arise. It can be helpful to create a crisis plan with family and/or friends present, so that they too can be made aware of what support would be most effective in their loved one’s time of need.

• Mood Tracker: Mood trackers/diaries are extremely useful for helping individuals to identify common patterns that may serve to trigger psychotic episodes. They help people to think about things they might have otherwise overlooked, such as recent life events, as well as their mood, sleep, and diet. Keeping a diary can also help people to recognise early warning signs that suggest psychotic depression is ‘on the horizon.’ A diary can therefore not only help the individual living with psychotic depression, but also their loved ones. Having a tool in which they can identify triggers, early warning signs and symptoms can help them to help their loved one identify when they are becoming unwell, therefore acting as a form of early intervention, something that will benefit everyone.

• Mind: Mind offers a series of activities, guided learning, and wellbeing sessions, with their aim being to support people to feel connected, learn more about themselves, and discover how they can take care of their emotional wellbeing and mental health in a productive rather than destructive way.