Taking control when depression strikes
By psychologist Angie Willcocks
Depression is one of the most common of all mental health problems (anxiety is the other). It's talked about more than ever before and yet, probably in part because of the nature of the illness, we know that there are many people out there with undiagnosed and untreated depression.
Depression can follow a disappointing or difficult occurrence in life (such as a job loss, relationship breakdown or health crisis) or can appear 'out of the blue'. Some people experience episodes of depression throughout their life, and others have one episode only.
Depression is more than just low mood. Depression is feeling low or sad for at least two weeks, with other symptoms as well. Symptoms are of depression are:
- Feeling sad or miserable most or all of the time
- Losing interest and/or pleasure in things you would usually be interested in or gain pleasure from
Sometimes some of the following can also occur:
- Appetite changes
- Sleep disturbance
- Feeling slowed down or lethargic in your body
- Feeling excessively restless or agitated
- Feeling guilty or worthless
- Difficulties concentrating or focussing on the task at hand
- Difficulties with decision making, even for small decisions
- Frequent or recurrent thoughts of death and dying (your own or other people's)
- Feeling as though people are being unusually critical or unfriendly
The good news is that depression is treatable. The treatment of choice for depression is psychological counselling (usually focussing on the depressed person's thinking style) and anti-depressant medication if needed.
In my experience, many people are worried or sceptical about taking anti-depressant medication. Some people worry that they will become addicted to the anti-depressant, some worry that the medication will change their personality and others still worry about the other people finding out that they are on 'happy pills'.
The decision whether or not to take medication is, of course, a personal one - often made after much soul-searching. When I first started out as a psychologist, I was young and idealistic and quite against the use of anti-depressant medication, thinking it was unnecessary and over-prescribed. I still think that it may be a little over-prescribed by busy GPs, but I have come to see that anti-depressant medication has a very important role in recovery from depression for many people. I now recommend that my clients see their GP or talk to a psychiatrist about starting medication if any of the following are happening:
- Early waking. This refers to waking up in the early hours of the morning (from about 2am to 5am) without apparent reason. Early waking is a classic symptom of depression and one that can spiral out of control if left untreated. Lack of sleep can obviously contribute to poor daytime coping and lying awake in the early hours of the morning just allows too much time for depressed style thinking.
- Not attending work or study or doing what needs to be done (looking after children, cooking dinner) because you "can’t be bothered" or it all seems way too hard.
- Recurrent thoughts that just don't seem to go away even when you try to distract yourself from them. These thoughts might be about something bad that has happened or they might be about dying or other morbid things. When these thoughts are too prominent or repetitive they can take away focus and make concentrating on more productive things very difficult.
Medication would be expected to help in all of the above symptoms in a way that counselling cannot. Also, anti-depressant medication can help people care enough about life to bother to come along to treatment to learn new ways of looking at things.
Ideally, anti-depressant medication should be taken while you are having some psychological counselling aimed at identifying and dealing with negative patterns of thinking and behaving. I think of the medication as crutches that can help make a recovery easier, and psychological assistance as the physio that happens alongside. Like physio sessions, psychological sessions are not always fun, but they do build up strength and skills that make for a more thorough recovery.
I am very aware that psychologists are not always accessible for people working remotely or working on a FIFO roster. In these circumstances, websites like beyondblue or moodgym can be useful, as can some of the 'self help' work books available. While these resources (no matter how well written they are) are not as good as face-to-face counselling with a psychologist, in my opinion they are better then doing nothing at all or taking medication without learning any new skills.
Here are some useful books if you can't get to a psychologist:
- Cognitive behavioural workbook for depression, by William Knaus
- The mindful way through depression, by Williams, Teasdale and Segal
- The Happiness Trap, by Russ Harris
It's also a good idea to invest in some relaxation or visualisation CDs (and then to actually do these … at least three times a week)
I lend a CD by Russ Harris to many of my clients. It's called Mindfulness Skills Vol 1 and is available at www.actmindfully.com.au.
To read other columns written by Angie Willcocks during her six years with Mining Family Matters, please click here. And remember that we offer a free email Q&A service with our psychologists, so just click here to ask a question about relationships, parenting or your career. All advice on Mining Family Matters is for general information only and should never be regarded as a substitute for professional health services or crisis services. To talk with a trained volunteer telephone counsellor at any time of the day or night, call Lifeline on 13 11 14. To contact the info line at beyondblue: national depression initiative, phone 1300 22 4636.