“Look into the depths of your own soul and learn first to know yourself, then you will understand why this illness was bound to come upon you and perhaps you will henceforth avoid falling ill” (Freud cited in Tishkowski, 2005).
Depression
What is depression?
Depression is a mental health condition affecting our thinking, energy, emotions and behaviour.
How common is depression?
Estimates of incidence of depression in our population vary from 1 in 20 (HSE 2008; HSE 2012) to as high as 1 in 10 or 450,000 people at any one time in Ireland (AWARE 2015). Experiencing depression equates to far more than just having a bad day. Rates of depression in women are twice as high as they are in men partly due to hormonal factors, particularly when it comes to premenstrual syndrome (PMS), premenstrual dysphoric disorder (PMDD), postpartum depression, and perimenopausal depression.
What are the most common signs of depression?
Depression can present through a combination of the following symptoms:
- Feelings of sadness, helplessness and hopelessness. A bleak outlook—nothing will ever get better and there’s nothing you can do to improve your situation.
- Loss of interest in daily activities. No interest in former hobbies, pastimes, social activities, or sex. You’ve lost your ability to feel joy and pleasure.
- Appetite or weight changes. Significant weight loss or weight gain—a change of more than 5% of body weight in a month.
- Sleep changes. Either insomnia, especially waking in the early hours of the morning, or oversleeping (also known as hypersomnia).
- Anger or irritability. Feeling agitated, restless, or even violent. Your tolerance level is low, your temper short, and everything and everyone gets on your nerves.
- Loss of energy. Feeling fatigued, sluggish, and physically drained. Your whole body may feel heavy, and even small tasks are exhausting or take longer to complete.
- Self-loathing. Strong feelings of worthlessness or guilt. You harshly criticise yourself for perceived faults and mistakes.
- Reckless behaviour. You engage in escapist behaviour such as substance abuse, compulsive gambling, reckless driving, or dangerous sports.
- Concentration problems. Trouble focusing, making decisions, or remembering things.
- Unexplained aches and pains. An increase in physical complaints such as headaches, back pain, aching muscles, and stomach pain.
What causes depression?
Depression can occur as a result of the break-up of a relationship, genetic predisposition, loss of a job, bereavement, or there may be no obvious cause.
What are the different levels of depression?
Mild depression
A person with mild depression typically experiences tiredness, some early morning wakening, indecision, poor concentration and loss of confidence. It is important to note here that the person will not necessarily feel depressed.
Moderate depression
Individuals will present as depressed to other individuals. Most of the aforementioned symptoms characterise this form of depression. Typically these factors include a combination of: feelings of sadness, anxiety or boredom, low energy, tiredness or fatigue, under or over sleeping, poor concentration ability, loss of interest in hobbies, family or social life, low self-esteem, some suicidal thoughts, and physical pains with no physical basis.
Severe depression
Beyond the symptoms of moderate depression, a person’s judgement is impaired in a severe depression. Extremely negative and pessimistic views of their own self-worth and future prospects will be evident, interspersed with strong suicidal thoughts or intent.
Someone suffering a severe depressive episode may have delusions or false beliefs (e.g. that they are evil, wicked, bankrupt or terminally ill) or may suffer from hallucinations (hearing voices or having visions) with similar themes. If delusions or hallucinations are present, this depression is referred to as a psychotic depression.
Specific types of depression are reactive, unipolar, bi-polar, seasonal affective disorder (SAD) and postnatal depression (McKeon et al 2000, pp.7-11).
What is bipolar disorder?
Formerly known as manic depression, this illness manifests with contrasting mood swings between periods of depression versus periods of elation for about 1 in every 100 of the population, although 15% of these individuals may only ever experience a single bipolar episode in their lives (HSE 2008; HSE 2012). Symptoms of the depressed phase are the same as those of unipolar depression already described above such as apathy, despair, lethargy and self-deprecating perspectives.
What are the symptoms of elation or mania?
- Feeling elated, enthusiastic, excited, angry, irritable or depressed
- Increased energy, ‘never felt as well’, over-talkative or over-active
- Reduced need for sleep and marked difficulty in getting off to sleep
- Racing thoughts, ‘pressure in the head’, indecision, jumping from one topic to another
- Poor concentration levels
- Increased interest in pleasurable activities, new adventures, sex, alcohol, street drugs, religion, music or art
- Excessive and unrealistic belief in one’s ability, or having grandiose plans
- Being unaware of the physical symptoms of illness
- Feelings of invincibility, impulsive and reckless risk-taking
- Feeling suicidal during episodes of extreme anger or distress
If five or more of these symptoms are present for more than two weeks, it may be a manic episode so it is advisable to seek professional medical advice.
What causes bipolar disorder?
Genetic factors are believed to be of major significance in the causation of bipolar disorder.
Are there any medical reasons why I should address depression?
Depression can also have serious implications for general health, as another symptom is over-stimulation of the adrenal glands resulting in over-production of glucocortisol. This increases the likelihood of heart attacks and osteoporosis and weakens the immune system making the sufferer more prone to infection and disease (Barry, 2010). People with major depression often also suffer from anxiety disorders, substance abuse, eating disorders and borderline personality disorder.
So how can counselling help with depression?
I am sometimes asked if the work that I do with clients will cure their depression. The term ‘cure’ is not a phrase that I am particularly fond of in a therapeutic environment because it carries connotations that individuals will have something done to them! Such an approach would be in opposition to the purpose of therapy, which is to allow the individual to take back control of what they are in control of and to let go of or accept the things we cannot control.
I therefore work with clients to help them manage their depression and to establish long term patterns that can work for them rather than against them. We already know that depression is a mental health condition affecting our thinking, energy, emotions and behaviour. Given that CBT effectively addresses dysfunctional or negative patterns of thoughts, feelings, and actions, resulting in undesirable physical symptoms, this scientific and evidence-based talk therapy is considered as the gold standard treatment for depression. Therefore CBT can be used alone or in combination with anti-depressant medication (Thase et al., 1997; NICE 2009 cited in Westbrook et al., 2013, p.263). Your GP can advise you about medications and I will help you to address depression using an integrative CBT approach.
Have you prior experience of working with clients with depression?
Yes I have worked extensively with clients whose depression has ranged from mild to severe in various settings since 2010. This experience has encompassed working privately on a 1 to 1 basis with individuals and facilitating large AWARE support groups in a number of community locations. I was also tasked with training new facilitators to offer support, information and education around depression and anxiety in Waterford, Cork, Kilkenny and Dublin.
Furthermore I held the anchor role as a weekly support group facilitator for inpatients in the Dept. of Psychiatry in University Hospital Waterford from 2011 to 2013 where I continue to deliver regular informational talks. Additional encounters with individuals whose lives are adversely impacted by depression and anxiety occurred during my 5 years with the Samaritans, as a bereavement support worker in family ministry, and within my ongoing work as a counsellor in a family resource centre.
It is possible to come through depression, and early recognition and ongoing support are key to a positive outcome. I generally recommend that clients without a previous diagnosis of depression visit their GP as the first port of call. You can then contact me and we can proceed at a pace that is right for you.
Depression
What is depression?
Depression is a mental health condition affecting our thinking, energy, emotions and behaviour.
How common is depression?
Estimates of incidence of depression in our population vary from 1 in 20 (HSE 2008; HSE 2012) to as high as 1 in 10 or 450,000 people at any one time in Ireland (AWARE 2015). Experiencing depression equates to far more than just having a bad day. Rates of depression in women are twice as high as they are in men partly due to hormonal factors, particularly when it comes to premenstrual syndrome (PMS), premenstrual dysphoric disorder (PMDD), postpartum depression, and perimenopausal depression.
What are the most common signs of depression?
Depression can present through a combination of the following symptoms:
- Feelings of sadness, helplessness and hopelessness. A bleak outlook—nothing will ever get better and there’s nothing you can do to improve your situation.
- Loss of interest in daily activities. No interest in former hobbies, pastimes, social activities, or sex. You’ve lost your ability to feel joy and pleasure.
- Appetite or weight changes. Significant weight loss or weight gain—a change of more than 5% of body weight in a month.
- Sleep changes. Either insomnia, especially waking in the early hours of the morning, or oversleeping (also known as hypersomnia).
- Anger or irritability. Feeling agitated, restless, or even violent. Your tolerance level is low, your temper short, and everything and everyone gets on your nerves.
- Loss of energy. Feeling fatigued, sluggish, and physically drained. Your whole body may feel heavy, and even small tasks are exhausting or take longer to complete.
- Self-loathing. Strong feelings of worthlessness or guilt. You harshly criticise yourself for perceived faults and mistakes.
- Reckless behaviour. You engage in escapist behaviour such as substance abuse, compulsive gambling, reckless driving, or dangerous sports.
- Concentration problems. Trouble focusing, making decisions, or remembering things.
- Unexplained aches and pains. An increase in physical complaints such as headaches, back pain, aching muscles, and stomach pain.
What causes depression?
Depression can occur as a result of the break-up of a relationship, genetic predisposition, loss of a job, bereavement, or there may be no obvious cause.
What are the different levels of depression?
Mild depression
A person with mild depression typically experiences tiredness, some early morning wakening, indecision, poor concentration and loss of confidence. It is important to note here that the person will not necessarily feel depressed.
Moderate depression
Individuals will present as depressed to other individuals. Most of the aforementioned symptoms characterise this form of depression. Typically these factors include a combination of: feelings of sadness, anxiety or boredom, low energy, tiredness or fatigue, under or over sleeping, poor concentration ability, loss of interest in hobbies, family or social life, low self-esteem, some suicidal thoughts, and physical pains with no physical basis.
Severe depression
Beyond the symptoms of moderate depression, a person’s judgement is impaired in a severe depression. Extremely negative and pessimistic views of their own self-worth and future prospects will be evident, interspersed with strong suicidal thoughts or intent.
Someone suffering a severe depressive episode may have delusions or false beliefs (e.g. that they are evil, wicked, bankrupt or terminally ill) or may suffer from hallucinations (hearing voices or having visions) with similar themes. If delusions or hallucinations are present, this depression is referred to as a psychotic depression.
Specific types of depression are reactive, unipolar, bi-polar, seasonal affective disorder (SAD) and postnatal depression (McKeon et al 2000, pp.7-11).
What is bipolar disorder?
Formerly known as manic depression, this illness manifests with contrasting mood swings between periods of depression versus periods of elation for about 1 in every 100 of the population, although 15% of these individuals may only ever experience a single bipolar episode in their lives (HSE 2008; HSE 2012). Symptoms of the depressed phase are the same as those of unipolar depression already described above such as apathy, despair, lethargy and self-deprecating perspectives.
What are the symptoms of elation or mania?
- Feeling elated, enthusiastic, excited, angry, irritable or depressed
- Increased energy, ‘never felt as well’, over-talkative or over-active
- Reduced need for sleep and marked difficulty in getting off to sleep
- Racing thoughts, ‘pressure in the head’, indecision, jumping from one topic to another
- Poor concentration levels
- Increased interest in pleasurable activities, new adventures, sex, alcohol, street drugs, religion, music or art
- Excessive and unrealistic belief in one’s ability, or having grandiose plans
- Being unaware of the physical symptoms of illness
- Feelings of invincibility, impulsive and reckless risk-taking
- Feeling suicidal during episodes of extreme anger or distress
If five or more of these symptoms are present for more than two weeks, it may be a manic episode so it is advisable to seek professional medical advice.
What causes bipolar disorder?
Genetic factors are believed to be of major significance in the causation of bipolar disorder.
Are there any medical reasons why I should address depression?
Depression can also have serious implications for general health, as another symptom is over-stimulation of the adrenal glands resulting in over-production of glucocortisol. This increases the likelihood of heart attacks and osteoporosis and weakens the immune system making the sufferer more prone to infection and disease (Barry, 2010). People with major depression often also suffer from anxiety disorders, substance abuse, eating disorders and borderline personality disorder.
So how can counselling help with depression?
I am sometimes asked if the work that I do with clients will cure their depression. The term ‘cure’ is not a phrase that I am particularly fond of in a therapeutic environment because it carries connotations that individuals will have something done to them! Such an approach would be in opposition to the purpose of therapy, which is to allow the individual to take back control of what they are in control of and to let go of or accept the things we cannot control.
I therefore work with clients to help them manage their depression and to establish long term patterns that can work for them rather than against them. We already know that depression is a mental health condition affecting our thinking, energy, emotions and behaviour. Given that CBT effectively addresses dysfunctional or negative patterns of thoughts, feelings, and actions, resulting in undesirable physical symptoms, this scientific and evidence-based talk therapy is considered as the gold standard treatment for depression. Therefore CBT can be used alone or in combination with anti-depressant medication (Thase et al., 1997; NICE 2009 cited in Westbrook et al., 2013, p.263). Your GP can advise you about medications and I will help you to address depression using an integrative CBT approach.
Have you prior experience of working with clients with depression?
Yes I have worked extensively with clients whose depression has ranged from mild to severe in various settings since 2010. This experience has encompassed working privately on a 1 to 1 basis with individuals and facilitating large AWARE support groups in a number of community locations. I was also tasked with training new facilitators to offer support, information and education around depression and anxiety in Waterford, Cork, Kilkenny and Dublin.
Furthermore I held the anchor role as a weekly support group facilitator for inpatients in the Dept. of Psychiatry in University Hospital Waterford from 2011 to 2013 where I continue to deliver regular informational talks. Additional encounters with individuals whose lives are adversely impacted by depression and anxiety occurred during my 5 years with the Samaritans, as a bereavement support worker in family ministry, and within my ongoing work as a counsellor in a family resource centre.
It is possible to come through depression, and early recognition and ongoing support are key to a positive outcome. I generally recommend that clients without a previous diagnosis of depression visit their GP as the first port of call. You can then contact me and we can proceed at a pace that is right for you.
“Look into the depths of your own soul and learn first to know yourself, then you will understand why this illness was bound to come upon you and perhaps you will henceforth avoid falling ill” (Freud cited in Tishkowski, 2005).