The word depression is a much misused term. When people are feeling a little sad, moody or down for a short period they often say they are depressed. But in reality they are really just having an “off” day or week and their mood will lift shortly.
However, clinical depression is different, explains Dr Stephen Critchlow, a psychiatrist who will give a free talk on “Coping with depression” tonight (Thursday ) at the Clayton Hotel, Ballybrit at 8pm.
“With serious depression people are feeling low and down almost all the time for at least two weeks with a complete loss of enjoyment of life. Usually, they are not sleeping well, they may be waking up early, are often losing weight and have a poor appetite. Their energy and drive are diminished and their concentration is affected.”
They are often agitated or irritable too and may be indecisive, he says. “They really are not able to cope well with life. They often want to be by themselves and sometimes there is a sense of hopelessness, like ‘What is life all about?’ ‘Has it any value?’ Guilt is often present, either real or imagined, and their thoughts are negative with feelings of low self worth. “What’s the point?” people might say to themselves or others. Life may become unbearable and suicidal thoughts or actions can follow.”
However, he is keen to stress that not everybody who commits suicide is depressed. Some such deaths may occur because the people involved are “lost or broken” after a relationship has ended, for instance.
Depression is a serious problem in Ireland, according to Dr Critchlow, a retired consultant psychiatrist who trained in England and worked as a doctor at both the then Regional and Merlin Park hospitals from 1979 to 1983.
At any one time around 300,000 people in this country will be depressed - about seven per cent of the population, he says. Some will have an isolated episode while others have an ongoing susceptibility to the condition but with help can cope satisfactorily. Some mainly experience this low mood disorder during winter. Around one in 10 people have “highs” as well as lows and are often referred to as bipolar.
About twice as many women as men are affected by depression, both young and old.
“Women at home with a young child, for example, may be struggling and feel trapped, particularly if their partners are not available. Women working outside the home tend to do better.”
What causes depression? There is some evidence that the condition tends to run in families but how strong this genetic factor is is difficult to say.
It can be rooted in events which occurred early in life, explains Dr Critchlow. “There are two types of things going on - events early in life which affected us and things going on more recently [in our adult lives]. The kind of parenting we had can be important, if our parents were absent or unavailable or uninvolved or very critical there will be remaining effects. Abuse, whether physical or sexual, will carry its toll, too.
“But not everyone with these problems gets depressed. So what else is going on? Life events in the recent past affect us, also. These are often, although not always, related to some kind of loss. Losses of partner, spouse, job, finances, health or role all have their effect either singly or in combination. Persistent anxiety or experience of severe trauma can deeply affect us. Periods of rapid change can throw us - too much happening too quickly, such as moving house [in combination with other change]. Drugs and alcohol can make a situation worse and tip a person ‘over the edge’. Sometimes, we [doctors] have to be honest and say we do not know why a particular person has become depressed. We do live in a bit of a crazy world where bad things happen to good people.”
Dr Critchlow outlines while anybody at any age can get depressed the young and the elderly tend to be most affected. Young people, particularly if they are living away from home and are alone or isolated, are vulnerable as are older people because of the losses they may have experienced, such as that of a partner, health, their role in life (they may no longer feel valued ) and loneliness. Being unemployed, single, divorced (marriage tends to be protective ) or having financial difficulties has a part to play, also.
People often try to cover up the fact that they feel depressed. “Men tend to mask it a bit more, they may drink heavily.
There still tends to be a stigma associated with the disorder but not so much in Ireland, says the psychiatrist who previously worked at Holywell Hospital in Antrim before taking early retirement in 2006.
“This would be more the case in Africa or the East. But you do see it here, too. I found older people complained of this, that and the other rather than depression. Sometimes, in the elderly we find people with depression can present with memory problems. Some people come to you too complaining of feeling exhausted, having no energy. They did not realise they were not sleeping well because of the depression.”
When someone is “seriously depressed” medical review is important, says the psychiatrist. “Few people actually need to be hospitalised. It is important to exclude possible underlying illness. The depth of the depression should be assessed as well as the support available for that person and the best treatment option. Sometimes hospital may be necessary if the risk of suicide is deemed high, health is seriously at risk or the person is incapable of managing alone.
“If you are low and down for two weeks and you are not eating or sleeping well this will take you down, you will tend to get worse. You see from time to time people coming into hospital who live alone. They are not caring for themselves, they are not washing or eating. Sometimes people develop strange beliefs, ‘I’m no good. The devil is in me,’ because they are so low. They begin to imagine things, they might say ‘I’m the worst person in the world’. If they made a slight mistake in their income tax 20 years ago they will recall it and blow this incident out of proportion.”
Well meaning friends and family often give the wrong advice telling people with depression to “pull themselves together”, he says. “But they are not able, they need help. Sometimes you find people don’t make allowances for someone who is ill, instead they blame them for the way they are.
“Just listening and being available for a depressed person is important. Be alert and do not be afraid to ask about suicidal thoughts. Encouraging exercise, a normal diet and a daily routine can be helpful.”
Doctors treating people with depression may recommend antidepressants with perhaps other medication to help patients sleep, he says. “There are many different antidepressants that work well. They help to correct chemical imbalances in the brain resulting from depression. They usually begin to work within around two weeks and treatment is usually for at least six months. They are not addictive.
“Doctors will usually advise on work and family issues. They may recommend specific ‘Talking Treatments’ such as cognitive behaviour therapy (CBT ) which helps people examine their thoughts and behaviour can be very helpful. Sometimes people are thinking very negatively. Interpersonal therapy helps the person resolve difficult relationships. Family and marital therapy have their place. Bereavement counselling can be very valuable. When and how to give these treatments needs careful assessment.”
There are a number of ways in which people can reduce their chances of becoming depressed, explains Dr Critchlow. While we cannot avoid all that life “tosses at us” we can try to steer clear of certain situations which would make us vulnerable. Having a stable marriage, remaining in employment, getting enough sleep, avoiding isolation, especially if your mood is low, talking through your problems with other people, having a healthy diet and exercising regularly are all protective measures.
Dr Critchlow, who has been a spiritual leader for many years, believes a spiritual dimension is important in understanding and coping with mental illness. Referring to a study by Dublin based consultant psychiatrist Professor Patricia Casey entitled “The psychosocial benefits of religious practice” he says this reveals that rates of depression and suicide are reduced among those who practise their religion.
“In several ways having a spiritual dimension in their lives can help people with depression. It gives them a sense of life having a purpose, ie, ‘I’m not just here for myself, I’m here to love God and my neighbour.’Also, there is a sense of forgiveness being real, if I’ve done something wrong I can be forgiven. (Sometimes I’ve met people with depression where there’s been real guilt. One guy cheated on his wife and felt terrible. ) You’ve got a Christian environment for support, also.”
He offers the following helpful resources:-
Aware helpline 1890 303 302
On line depression clinic (www.irishhealth.com/clin/depression/aware.html )
The Samaritans 1850 60 90 90
The psycho-social benefits of religious practise by Professor Patricia Casey (www.religiouspractice.ie )
The Bible. Dr Critchlow recommends starting with the Gospel of John and King David’s Psalms (eg, 23, 27, 40, 56 ). “Read the Psalms (6, 38, 51 and 32 especially ) and see how low King David became. But he never lost hope and found God was there for him.”