What is clinical depression and how to understand it?

To understand clinical depression, we need to answer the following five questions: What is it? What causes it, what are the types, what does it feel like and how to get help? Dr Imren Sterno, lead consultant clinical psychologist, at AXA Health, explores each question and offers an insight into a topic that can affect anyone.

What is clinical depression?

Everyone has experienced ‘the blues’ or perhaps feeling low on a Sunday evening as work is around the corner. Feeling low and having ‘off moments’ is natural, as life can be challenging, and difficult experiences are inevitable.

We are not designed to be happy all the time, as we are human, have different emotions and need to allow ourselves to experience difficult feelings to help get through life’s turbulent journey.

However, when these feelings tip into:

• a feeling that won’t shift,
• a sense that nothing is going well,
• negativity taking over,
• and you feel you cannot live your life in a way that you wish,

this is when you may be starting to have signs of clinical depression.

Clinical depression or major depression (terms used to formally diagnosis depressive disorder), is classified as a mood disorder, and it is associated with a disruption to everyday life and prevents a person from living their life in the ‘normal’ way.

It has a negative impact on how they think, feel and behave. It can also have an impact on energy levels and physical health.

What causes depression?

Everyone and anyone can get depression, regardless of age, gender, or ethnicity. There is no one single cause and it can be different for different individuals.

What current research tells us is that for some, it can be a combination of factors, and for others it can be an adverse life event that triggers an episode or a build-up of multiple adverse life events that led to a depressive episode.

Evidence from National Institute for Health and Excellence¹ states the following factors can attribute to a depressive episode:

• Life events (such as a divorce, a loss, crisis, job loss, bullying, experiencing violence, witnessing a tragedy, difficult family dynamics, rejection from a community)
• Childhood experiences (such as abuse, neglect, sexual abuse or domestic violence, unsettled family life, bullying, witnessing, or experiencing any trauma)
• Recreational drugs
• Family history of mental illness
• Other diagnosed mental disorders
• Physical health problems
• Styles of thinking (this involves negative thoughts and a tendency to evaluate oneself or one’s life in a negative manner and developing a negative pattern of thinking, which impacts on how we feel and behave), making some more susceptible to depression if they have negative patterns of thinking.

Types of depression?

Depressive symptoms can also be the result of other conditions, as there are different types of clinical depression.

Below is a summary of the most common:

Persistent depressive disorder (PDD): PDD is continuous depression that lasts for 2 years or more. It is also referred to as dysthymia or chronic depression.

Seasonal affective disorder (SAD): This has become more common in our everyday language. SAD is depression that occurs at specific time of year, or during a particular season where the weather changes and is darker and days are shorter.

>Read more on SAD and what it is.

Antenatal depression: This is depression that occurs while you are pregnant. It is sometimes called prenatal depression. Please refer to Postnatal and antenatal depression - Mind for more information.

Postnatal depression (PND): This is depression that occurs in the first year after having a baby. This can include affecting fathers and partners. Please refer to Postnatal and antenatal depression - Mind for more information.

Premenstrual dysphoric disorder (PMDD): This is a hormone-related disorder that affects your body but also how you feel. Please refer to Royal College of Nursing for more information.

What does depression feel like?

Depression is often difficult to describe, for some it can feel intense and overwhelming and for others it is completely debilitating.

Clinical depression prevents individuals from living their life in a way they wish and changes the way an individual can engage in the world. Some of my patients have described feeling ‘darkness around them’ or ‘hollow and empty inside’.

Often this is coupled with experiencing no pleasure or joy in life and the belief that nothing will bring them joy again. There is also a strong sense of hopelessness and feelings of failure and worthlessness. It causes individuals to question themselves, and struggle to concentrate or make decisions.

It can also impact on physical health and a lack of energy or always feeling tired but not being able to sleep or feel rested. It can also cause headaches, reduced appetite, and feeling nauseous.

How to get help?

There are lots of self-help resources online, Mind in particular have some useful tips and insights on their website: Treatments - Mind.

The first step is to go to your GP and discuss your symptoms and what you are experiencing. If this feels overwhelming to do alone, seek support from a friend or loved one, who can go with you and offer some guidance.

Once you have been to your GP, they may refer you to have an appointment with a mental health professional, such as a psychiatrist or refer you to a clinical psychologist.

There are different outcomes that you can expect after seeing a mental health professional, for example:

• they may offer you a formal diagnosis,
• put you on a waiting list for talking therapy
• or offer you medication.

Often the type of talking therapy that you are offered if you suffer from clinical depression is Cognitive Behavioural Therapy (CBT), which is a type of talking therapy that help you address the ‘here and now problems,’ and teaches you strategies to manage your symptoms better.

>Read more on CBT

Regarding medication, you may be offered antidepressants, which work by helping mood regulation in the brain.

The best thing you can do if you are struggling is reach out, seek help from a friend or loved one and then a medical professional. The quicker you get access to help the better your recovery.

References

1. Depression in adults: treatment and management – NICE