Tag: Depression

What you must know about depression

What do you know about depression?

Big red question mark with little which character of a man leaning against it

Before you go any further, count on your fingers the things you know about depression. Got it? Okay, keep that in mind. Let’s see if we can add to your knowledge here.

Trigger warning; the topics covered in this article may trigger emotional responses and you may wish to stop reading now.

So, what is depression?

Coloured image of man sitting on the floor, knees up and head leaning on his knees. Does he know what depression is?
Depression in men – Image by Holger Langmaier at Pixabay

Depression is a long lasting low mood disorder that affects your thoughts, feelings and behaviours. It can also affect your ability to feel pleasure, even in the things you used to enjoy. It can can render you unable to do everyday things and eliminate any interest in regular activities. And sometimes you may feel as if life isn’t worth living.

The NHS stipulates that depression is more than just a feeling of being unhappy or fed up for a few days. If you suffer from lasting feelings of unhappiness and hopelessness, and you are feeling tearful or you are loosing interest in everyday activities, make sure to take the depression self-assessment on their website.

Depression is a genuine health condition, it’s real and it has real soul-destroying symptoms. You can’t just ‘get over it’ or ‘snap out of it’, as some might suggest, and it’s most certainly not a sign of weakness.

Who does depression affect?

It can affect anybody, and it can also impact hugely on the depressed person’s family, carers or friends. Depression knows no boundaries and cuts across religion, faith, class, creed, race, gender, or age. Take a look at the following statistics, which have been borrowed from MHFA England:

  • Depression is one of the leading causes of disability worldwide and a major contributor to suicide and coronary heart disease
  • 24% of women and 13% of men in England are diagnosed with depression in their lifetime
  • Depression often co-occurs with other mental health issues and substance abuse
  • Depression occurs in 2.1% of young people aged 5-19

Do you know what causes depression?

Well, the jury’s out on this one. There is no one cause fits all with depression and there’s lots of different theories. However, as with lots of mental health disorders, a variety of factors could be involved, such as:

There are happy hormones such as dopamine, serotonin and endorphins, but also stress hormones that can trigger depression
Hormones might trigger depression
  • Life events such as loss (death, divorce, seperation), redundancy, loss of job status, loss of income, or loss of home appear to have a role to play in depression
  • Biological differences. People with depression seem to have physical changes in their brains.
  • Genetic/inherited traits. Depression is more common in people with blood relatives who also have it. But once again, it’s unclear and we can wonder — is it nature or nurture? Researchers are still trying to identify the genes involved in causing depression.
  • Brain chemistry. Neurotransmitters are naturally occurring brain chemicals that likely play a role in depression.
  • Hormones. Changes in the body’s balance of hormones may be involved in triggering depression. These changes might occur during pregnancy or in the weeks or months after the birth (postpartum) and from pre-menstrual tension, the menopause or thyroid problems, or any one of a number of other conditions. See your GP; to rule out any other causes.
  • Low socio-economic status such as income, education, occupation, social class, or wealth and location/environment might also be the cause of depression.

How do people with depression think?

Educate yourself about depression, it will help to keep you motivated.
Changes in sleeping pattern may be a symptom of depression

Depression affects different people in different ways, and some describe it as feelings of sadness, loss, or anger. I’ve had all those feelings, and the thought of ending my life was/is never far away. But because I didn’t want to leave my sons with that legacy, I thought of how I could make it look like an accident. What if I run my car off the road? What if I fall in front of that lorry hurtling down the road on my way to work?

Obviously I can’t speak for others who’ve struggled with suicidal thoughts, but I’ve listened to many patients who’ve survived the experience. I now understand we had many things in common. One of which was that we didn’t want to die, it was that we couldn’t bear the pain, and if things were better we would choose to live. But there’s always impulsivity, or a perhaps window of opportunity arises and some people take it.

So, if you’re having thoughts of dying by suicide, please talk to someone urgently. Also, if you know someone who’s depressed and suicidal, please speak out. Ask them if they are having these thoughts — and soon.

If you’ve had a combination of the symptoms (below) for at least two weeks or more, and for most of the day, nearly every day, you might be depressed.

Symptoms of depression:

  • changes in eating patterns – either loss of, or increased appetite, weight gain or loss (when not dieting)
  • changes in your regular sleeping pattern like sleeping too much, too little, not at all, or waking regularly in the early hours of the morning
  • tiredness, fatigue or lack of energy where you can’t even do the little things
  • loss of interest in things like sex or activities you used to enjoy
  • unexplained physical problems, such as constant headaches, neck or back pain
  • feeling tearful, sad, empty, worthless or hopeless
  • feelings of self-loathing, self-blame, guilt, or fixating on past failures
  • having angry outbursts, being irritable or getting frustrated, even over little things
  • feeling anxious, agitated or restless and find yourself pacing or fidgeting
  • feeling lethargic, slowed down thinking, speaking or body movements
  • trouble concentrating, thinking, remembering, or making decisions
  • frequent negative and intrusive thoughts or recurrent thoughts of death, suicidal thoughts, suicide attempts, writing suicide letters – if this is you, please seek immediate support, from your GP in the first instance. You can also find a list of useful mental health contact numbers here.

Remember

This list above is not exhaustive and you may have other symptoms. If you are experiencing the above symptoms regularly, please speak to your GP or another mental health professional. If you’re reluctant to seek treatment, talk to someone you trust, like a loved one, a friend or faith leader. Recognizing that you’re depressed is essential to getting the right help. The earlier you receive support and attention, the better the outcome.

What helps with depression

Did you know full recovery from depression is a possibility?
You can make a full recovery from depression

I deliberately wrote ‘helps’ because currently, that’s all we have. There isn’t a cure as such. But the good news is, that with the right treatment and support, most people with depression can make a full recovery. Depression affects millions of people worldwide, and there are varying treatment options available. These might be anything from lifestyle changes, talking therapy to medication.

Prescription drugs and the treatment of depression

If you are suffering from depression, your doctor may choose to prescribe antidepressants. Antidepressants are medications used to treat depression. There are a variety of medications that can be used to treat depression. These antidepressants all work to take away or reduce the symptoms.

Antidepressants are classified into different types depending on their structure and the way that they work.

Seven types of antidepressant drugs:

  • Monoamine oxidase inhibitors (MAOIs)
  • Norepinephrine and dopamine reuptake inhibitors (NDRIs)
  • Selective serotonin reuptake inhibitors (SSRIs)
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs)
  • Serotonin antagonist and reuptake inhibitors (SARIs)
  • Tricyclic antidepressants (TCAs) and tetracyclic antidepressants (TeCAs)
  • Miscellaneous antidepressants.

Popular medicine for depression

The most popular medicine used in the treatment of depression are the serotonin reuptake inhibitors (SSRIs).

Popular SSRI’s include names such as Prozac (fluoxetine), Luvox (fluvoxamine), Paxil (paroxetine) and Lexapro (escitalopram).

Names of miscellaneous antidepressants are Wellbutrin (bupropion) – also used in the treatment of nicotine addiction – Trintellix (vortioxetine) and Spravato (esketamine).

Never take antidepressant prescription drugs without a prescription from a licensed psychiatrist or mental health care doctor.

Did you previously know :

  • that depression is one of the leading causes of disability worldwide?
  • and a major contributor to suicide and coronary heart disease?
  • the huge array of possible causes?
  • what causes depression?
  • that anyone can be affected by depression?
  • it can be treated successfully and people with depression can make a full recovery?

Over to you

What do you think?
Clipart.com

Okay my lovelies, for those of you who are not mental health professionals, did you learn anything new? For those of you ‘in the know’, have I missed something/anything? What are your experiences of depression? Maybe you have some tips to cope with depression? I’m looking forward to your comments, suggestions or questions.

In the meantime, you might find the following posts interesting:

Related: The best depression blogs of the year (1). Depression, anger and narcissistic vulnerability from the perspective of a depressed patient (2).

What on earth is smiling depression?

I’ve heard it called many things, but “Smiling Depression”? Come on, it can’t be real. Or can it?

Have you ever heard of smiling depression?

Coloured female with psychotic depression smiling at the psychiatrist
Is this smiling depression? Image by Unsplash.com

No, me neither. I came across it while researching for a completely unrelated post. I was actually trying to find the words to describe a mental health professional’s fake smile. However, the more I read about smiling depression, the more it resonated with me, and I thought it might interest you.

What about the lady in the picture (right)? Is this a real smile or is it covering something else? Would you be able to tell the difference?

I remember several occasions, being depressed and so angry with my now ex, and having to put a bright face on for my sons’ birthday parties. Once the soggy streamers were binned, the guests had gone on their merry way and the boys were comatose, my mood immediately plummeted down to my little size three’s. I bet most of you have had something like this occur?

Depressive Disorders

The most common and typical form of depression is the depressive episode, but there are other subtypes of major depressive disorder. When the depressive episode recurs we speak of recurrent depressive disorder. Then there is Dysthymia which is characterized by milder severity of depressive symptomatology compared to depressive episodes or recurrent depressive disorder. We have manic depressive disorder, atypical depression and psychotic depression, and last but not least seasonal affective disorder. And then, of course, there is smiling depression.

Think about someone with depression for a few moments

Typical example of seasonal depression. Crying and blowing nose.
Sad and crying —Image by dlpng.com

Did you imagine someone who always looks miserable, down or sad? Someone who’s sat in their pj’s, wrapped in a duvet, crying on the sofa all day? Someone who can’t be bothered to attend to their hygiene needs or their scraggy bed hair? You might have thought any of that.

However, and unfortunately, some people with what’s known as smiling depression don’t have those obvious symptoms of depression. They often come across as happy, upbeat, and look cheerful or even on top of the world, on the outside. Yet, they might feel dreadful, like they’re just treading water, sad, hopeless or worthless on the inside.

So, what is smiling depression?

Severely depressed subject hides face behind cardboard while struggling with feelings of sadness.
Struggling with sadness Image by Pixabay.com

According to Medical News Today, smiling depression is a term doctors use to describe when a person masks their depression behind a smile.

While smiling depression isn’t a technical term that psychologists use, it’s definitely possible to be depressed and to successfully mask your symptoms. Also, though it’s not a clinical diagnosis, trust me, smiling depression is real. Surprisingly, it affects more people than you might think.

Likewise, people living with smiling depression are in all probability, perfectionists, high achievers and very successful. Their mood is likely to worsen considerably if they don’t meet their own impossibly high standards.

What are the risks of having smiling depression?

.Despite the worldwide prevalence of mental ill health, it’s still really difficult for some people to open up and ask for help. Furthermore, current research shows that harmful stereotypes about mental illness often prevent people from seeking treatment or speaking out at all (Olivia Singh, Insider, 2020).

Sadly, these people who can’t or don’t talk about their feelings might be more vulnerable to suicidal ideation. And because spotting the signs of smiling depression isn’t easy, it can be missed.

People with a major depression sometimes feel suicidal but many don’t have the energy to act on these thoughts. But someone with smiling depression might have the energy and motivation to follow through (T.J. Legg, Insider, 2018)

Who might have smiling depression?

Quote saying Sometimes the prettiest smiles hide the deepest secrets
Quote of the day

Absolutely anyone! It could be someone you know who, when you greet them, they smile brightly and engage in conversation.

It might be a family member who when you call, they sound chipper and tell you everything’s going well. How about that annoying colleague who’s always, always cheerful, who brings in homemade goodies for everyone and tells you how wonderful life is?

Despite how they appear or sound, you might want to watch and listen just that little bit closer. You could notice that the lips smile but there are no creases around the eyes, or that their smile fades too quickly. Maybe their body is tense or their shoulders are up round their ears. And you could get the “Oh, yes, I’m fine.” with a great big hearty grin but would you be smiling if you just felt fine?

Someone with smiling depression might sound ecstatic but does it sound over the top, cos we quite often overcompensate for feeling down by trying too hard? Listen for the heavy huff or puff at the end of their sentences which may be incongruent with their cheerful quips. Pay attention if they’re less interested in spending time together or they don’t communicate as much as they used to, despite what they tell you.

Do I have smiling depression?

Alcoholism is a common mental illness among subjects with chronic depression
Image by mgg-vitchakorn at Unsplash.com

It’s possible? Only yesterday we were visiting friends for a bbq and all morning I felt absolutely awful, almost to the point of cancelling. Even throughout the drive there I was having suicidal ideation.

Yet as soon as I walked in the door and saw my friends I was all smiles and hugs (okay, I get the social distancing thing). The afternoon was terrific, with scintillating conversation, food that was amazingly different and cold sparkling wine to wash it all down with.

Then crash, and without warning, my mood nosedived. I felt it immediately I put my first foot out the door, amidst the goodbyes and more hugs. Then I cried silent tear all the way home and I remain low, tearful and hopeless today as I type. I know this particular bout of my persistent depressive disorder is situational and reactive so hopefully it will pass, soon.

Final thoughts

I know that we can’t all be happy every minute of every day, it’s almost impossible, but it’s certainly not normal to feel blue or sad all the time either. It feels excruciatingly exhausting and it’s where I am right now. It’s taken around seven hours to write this post, reread and edit lol.

Over to you

Large red question mark with white character of a man leaning against it
Clipart.com

What do you think about the term smiling depression. Is it just another elaborate term dreamt up by our silver-spooned or pretentious psychologists? Do you think maybe you or someone you know is experiencing smiling depression? I look forward to reading your comments and will answer any questions.

You might want to read about depression, 10 thinking errors of depression here. Or a guest post about a fellow blogger’s depression and anxiety here.

Related: Data-driven subtypes of major depressive disorder (1). The dangers of smiling depression (2). Let’s talk depression (3).

10 thinking errors of depression that could be ruining your life

Aaron T Beck – Aaronbeckcentre.org

Lets just get all the blurb out of the way — you can skip it if you want and just scroll down a few paragraphs to the thinking errors (cognitive distortions).

In 1972, psychiatrist, psychoanalyst, and cognitive therapy scholar Aaron T. Beck, who focussed his attention mainly on depression, published his book Depression: Causes and Treatment.(1)

The cognitive approach believes that mental illness stems from faulty cognitions about others, our world and us. This faulty thinking may be through cognitive deficiencies or cognitive distortions (processing information inaccurately). During his work, Beck developed a list of “errors” (cognitive distortions) in thinking that he proposed could maintain depression.

Cognitive deficit is an inclusive term used to describe impairment – when a person has trouble remembering, learning new things, concentrating, or making decisions that affect their everyday life i.e. dementia. (Outside the scope of this post).

Cognitive distortions are exaggerated or irrational thoughts that cause individuals to perceive reality inaccurately. Whilst Beck laid the groundwork for the study of these distortions, his student David Burns (2) continued research on the topic and further developed the cognitive distortions to a list of ten.

The cognitive distortions listed below are categories of automatic thinking, and are to be distinguished from logical fallacies:

Smartecovery.org
  1. All-or-Nothing Thinking: You see things in black-or-white. If a situation falls short of perfect, you see it as a total failure. When you ate a big spoonful of ice cream, you told yourself, “I’ve really blown my diet now.” This thought upset you so much that you finished the entire tub!
  2. Over generalisation: You see a single negative event, such as a romantic rejection or a career reversal, as a never-ending pattern of defeat by using words such as “always” or “never” when you think about it. A depressed salesman became terribly upset when he noticed bird poo on the windshield of his car. He told himself, “Just my luck! Birds are always crapping on my car!” Of course the don’t always crap on his car.
  3. Mental Filter: You pick out a single negative detail and dwell on it exclusively, so that your vision of all reality becomes darkened, like the drop of ink that discolors a beaker of water. Example: You receive many positive comments about your presentation to a group of associates at work, but one of them says something mildly critical. You obsess about his reaction for days and ignore all the positive feedback.
  4. Discounting the Positive: You reject positive experiences by insisting they “don’t count.” If you do a good job, you may tell yourself that it wasn’t good enough or that anyone could have done as well. Discounting the positive takes the joy out of life and makes you feel inadequate and unrewarded.
  5. Jumping to Conclusions: You interpret things negatively when there are no facts to support your conclusion. Your partner’s late coming in from work and you think, “Oh no. He must have had an accident.”
    Mind Reading: Without checking it out, you arbitrarily conclude that someone is reacting negatively towards you. Your friend passes you on the other side of the road and you think,”Huh, she’s ignoring me!” She might not have seen you or she might be fretting over her own worries.
    Fortune-telling: You predict that things will turn out badly. Before a test you may tell yourself, “I’m really going to blow it. What if I flunk?” If you’re
    depressed you may tell yourself, “I’ll never get better.”
  6. Magnification: You exaggerate the importance of your problems and shortcomings, “Look at the size of my nose.” or you minimise the importance of your desirable qualities. This is also called the “binocular trick.”
  7. Emotional Reasoning: You assume that your negative emotions necessarily reflect the way things really are: “I feel terrified about going on airplanes. It must be very dangerous to fly.” Or “I feel guilty. I must be a rotten person.” Or “I feel angry. This proves I’m being treated unfairly.” Or “I feel so inferior. This means I’m a second-rate person.” Or “I feel hopeless. I must really be hopeless.” Just because you feel like crap, it doesn’t mean that you are.
  8. “Should statements”: You tell yourself that things should be the way you hoped or expected them to be. After playing a difficult piece on the piano, a gifted pianist told herself, “I shouldn’t have made so many mistakes.” This made her feel so disgusted that she quit practicing for several days. “Musts,” “oughts” and “have tos” are similar offenders. “Should statements” that are directed against yourself lead to guilt and frustration. Should statements that are directed against other people or the world in general lead to anger and frustration: “He shouldn’t be so stubborn and argumentative.” Many people try to motivate themselves with should and shouldn’ts, as if they were delinquents who had to be punished before they could be expected to do anything. “I shouldn’t eat that doughnut.” This usually doesn’t work because all these should and musts make you feel rebellious and you get the urge to do just the opposite.
  9. Labeling: Labeling is an extreme form of all-or-nothing thinking. Instead of saying “I made a mistake,” you attach a negative label to yourself: “I’m a loser.” You might also label yourself “a fool” or “a failure” or “a jerk.” Labeling is quite irrational because you are not the same as what you do. Human beings exist, but “fools,” “losers,” and “jerks” do not. These labels are just useless abstractions that lead to anger, anxiety, frustration, and low self-esteem. You may also label others. When someone does something that rubs you the wrong way, you may tell yourself: “He’s an S.O.B.” Then you feel that the problem is with that person’s “character” or “essence” instead of with their thinking or behavior. You see them as totally bad. This makes you feel hostile and hopeless about improving things and leaves little room for constructive communication.
  10. Personalisation and blame: Personalisation occurs when you hold yourself personally responsible for an event that isn’t entirely under your control. When a woman received a note that her child was having difficulties at school, she told herself, “This shows what a bad mother I am,” instead of trying to pinpoint the cause of the problem so that she could be helpful to her child. When another woman’s husband beat her, she told herself, “If only I were better in bed, he wouldn’t beat me.” Personalisation leads to guilt, shame, and feelings of inadequacy. Some people do the opposite. They blame other people or their circumstances for their problems, and they overlook ways that they might be contributing to the problem: “The reason my marriage is so lousy is because my spouse is totally unreasonable.” Blame usually doesn’t work very well because other people will resent being scapegoated and they will just toss the blame right back in your lap. It’s like the game of hot potato – no one wants to get stuck with it.
Oplexcareers.com

Cognitive therapy (CT) is a type of psychotherapy developed by Beck based on the cognitive model. This states that thoughts, feelings and behavior are all connected, and that individuals can move toward overcoming difficulties and meeting their goals by: identifying and changing unhelpful or inaccurate thinking, problematic behavior, and distressing emotional responses.

This involves the individual working collaboratively with a therapist to develop skills for testing and modifying beliefs, identifying distorted thinking, relating to others in different ways, and changing behaviors

My next post will look at ways of restructuring some of these unhelpful distortions.

I know I’ve had all of these thought distortions at some point in my life? Have you had any? Which ones?

  1. Beck, Aaron T. (1972). Depression; Causes and Treatment. Philadelphia: University of Pennsylvania Press.
  2. Burns D. (1989). The Feeling Good Handbook. Harper-Collins Publishers. New York.

If you are interested in learning more about this book, you can find it on Amazon (I have no affiliation with Amazon) with over 1,400 reviews to help you evaluate its effectiveness.

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