Depression

Depression is one of the most common reasons that bring people to seek counselling and psychotherapy. However, the term 'Depression' does not convey a singular experience but rather it accounts for a variety of mood states, some of which differ significantly from one another, both in their quality and severity. Depression can involve feelings of intense sadness and desolation, or can be experienced as an emotional "flatness" and emptiness. It can be felt as an acute and alarming experience, or as a numbing of the mind, body and spirit. The degree of depression can vary from mild to moderate or severe, and can last for a short or long period of time. Mild depression is a common experience that many people experience at some point. However, some cases of depression can become severe or chronic, and are much more debilitating.

Signs of depression
If you are depressed you may experience some or all of the following symptoms. Some people may experience most of the symptoms, while others will have just a few. The same person may experience different sets of symptoms at different times. The severity of the symptoms may also be different and may vary over time.

• Sadness, anxiety, or 'empty' feelings
• Sadness, anxiety, or 'empty' feelings
• Decreased energy, fatigue, being 'slowed down'
• Loss of interest or pleasure in people, activities and hobbies that were once enjoyed
• Change in sleep patterns, that is, insomnia, oversleeping, or very early waking.
• Loss of weight or appetite, or overeating and weight gain
• Feelings of hopelessness (‘this will never end’) and pessimism
• Feelings of helplessness (‘nothing I do helps’), guilt, and worthlessness
• Lowered self-esteem or self-worth
• Less ability to control emotions such as anger, guilt, irritability and anxiety
• Varying emotions throughout the day, for example feeling worse in the morning and better as the day progresses
• Reduced motivation: it doesn't seem worth the effort to do anything, things seem meaningless
• Feeling trapped and fantasising about escape 
• Thoughts of death, suicide, or suicide attempts
• Difficulty concentrating, making decisions, or remembering
• Restlessness, irritability or excessive crying
• Chronic aches and pains or physical problems that do not respond to treatment
• Changed sex drive
• Nothing is worth looking forward to, future seems bleak

Postnatal depression

Depression associated with childbirth affects as much as 7 to 20 percent of new mothers. When less severe depressive moods and distress are taken into account, the statistics are considerably higher. It is now acknowledged that such depression often starts at any time from the early stages of pregnancy. If such depressive experience during pregnancy - termed ‘Antenatal Depression’ - goes untreated, it may evolve into a serious postnatal depression.

Traditionally society has portrayed pregnancy and childbirth as blissful and tranquil experiences with a natural expectation that the bonds between mother, child and father will “kick in” when the baby is born.  The characteristic experiences of loss and confusion that coexist with the joys of parenthood are absent from such romanticised views.

Against these prevailing myths, all too often women experience depressive moods, anxiety and helplessness during a period which is expected according to society to be the happiest of their lives. Paradoxically, these expectations also contribute to women’s sense of guilt and shame over their feelings, which propel them to further silence their pain and sense of inner chaos. The mechanism is then set in place for a depressive vicious cycle to escalate.

If new motherhood is compounded with depression the results are debilitating for the entire family, with serious short and long term cognitive, emotional and social ramifications for the child.

Depression associated with childbirth is not a different condition from other depressive moods or syndromes (although it is often characterised with both depressive and anxious experiences). However, in the context of motherhood women tend to hide their depression in the hope that it will ‘ride itself out’ - a tendency that all too often results in an under-treated, escalating and potentially serious condition.

The following increase a woman’s risk of developing postnatal depression: depression or anxiety during pregnancy, a moderate depressive mood known as ‘maternity blues’, lack of adequate social support, life events and stressors, past history of depression or anxiety, being a single mother, unsatisfactory marital relationship; socioeconomic status, unplanned pregnancy, miscarriages and abortions, complications during pregnancy or labour.

Women who experience postnatal depression often describe themselves as having few or all of the following:

• Feeling anxious, confused and fearful
• Caught up in uncontrollable worries about the baby, others or the future
• Questioning their readiness and competence at mothering
• Worry that they will not love their baby or feel they already do not
• Feeling estranged from their pregnancy, baby and family
• See themselves as hopeless and helpless
• Feeling isolated from their partner, family and friends
• Lacking concentration, motivation and energy
• Having sleeping difficulties that are not associated with baby’s sleep cycle
• Feeling overwhelmed by day to day activities and demands
• Afraid that they are ‘losing their mind’ and are helpless to shake it away
• Blaming themselves for being depressed and attributing their situation to personal defectiveness

Anxiety and Panic

Depression is very commonly accompanied by another mood state – anxiety. When depression is accompanied by anxiety, the anxiety tends to exacerbate the depressive mood and symptoms. Anxiety also commonly presents as a separate disorder, without depression (termed Generalised Anxiety Disorder). However, very frequently an initial anxiety disorder may develop into, and then get further complicated by, depression.
 
Anxiety disorders are the most common of emotional disorders. Anxiety differs from “normal” feelings of tenseness. It is a severe and ongoing tension that seriously interferes with the person’s daily functioning and quality of life. People with generalised anxiety worry constantly and feel helpless to control their worries.

Untreated anxiety can impel the person into avoiding situations that are perceived by him as triggering his anxiety, for example a person may be pushed by his anxiety to avoid engaging with or talking to people, leaving his house, looking for a job, or sitting an exam. He may have problems sleeping, may suffer muscle aches and feel shaky and headachy. People with anxiety disorders can be irritable and often have problems concentrating and working effectively. They are likely to suffer from depression, and they also may abuse alcohol and other drugs in an effort to gain relief from their sufferings.

The symptoms of anxiety include:

• Overwhelming feelings of fear (that may escalate into panic)
• Uncontrollable thoughts and excessive ‘what if…’worries
• Recurring nightmares
• Sleep difficulties
• Physical symptoms such as feeling sick to your stomach, "butterflies" in your stomach, heart pounding, startling easily, and muscle tension

A common type of Anxiety Disorder is Panic Disorder. The core symptom of panic disorder is the panic attack, an overwhelming combination of physical and psychological distress.

During a panic attack several of these symptoms occur in combination:

• Pounding heart or chest pain
• Sweating, trembling, shaking
• Shortness of breath, sensation of choking
• Nausea or abdominal pain
• Dizziness or light-headedness
• Feeling unreal or disconnected
• Fear of losing control, "going crazy," or dying
• Numbness
• Chills or hot flashes
• Because symptoms are so severe, many people with panic disorder believe they are having a heart attack or other life-threatening illness.

Anxiety disorders respond well to two types of treatment: psychotherapy and medications. Depending on the individual case, these treatments can be given alone or in combination.