How to recognise the signs of depression

Depression is not just a difficult condition to endure, it’s a risk factor for everything from heart disease to dementia and substance abuse – and the South African Depression and Anxiety Group (SADAG) reports that it results in at least 23 suicides here a day. 

Depression can affect people of all ages, cultures and walks of life, creeping up and darkening their lives, cutting them off from others and turning them in on themselves. It comes in different forms, but these are the most common:

Major Depression

Also known as clinical depression, this is an all-consuming dark mood. You have no energy and lose interest in activities you once enjoyed. You feel sad, worthless, hopeless and guilty, and can have trouble sleeping or sleep all the time, and changes in appetite or weight. Concentration is difficult, and you struggle to function normally. You withdraw from others, personal hygiene often slides, and your thoughts can turn to suicide. Major depression is a medical condition linked to lowered levels of the brain chemical serotonin and sufferers often have a family history of depression. But environmental factors can be triggers, including job, relationship, financial and physical health stresses. "Depression is the end result of many factors," says Gauteng clinical psychologist Dr Colinda Linde. "Burnout, existential crisis (experiencing a lack of meaning), feeling helpless with no way out, isolated and misunderstood."

Persistent Depressive Disorder (PDD)

Sometimes called dysthymia, chronic depression or high-functioning depression, this is low mood that lasts for at least two years, but is not as intense as with major depression. You are able to function daily, but feel down and joyless for much of the time. "The feelings can persist secretly for many painful years," says Durban counselling psychologist Dr Akashni Maharaj. "They can become difficult to manage if the individual is faced with challenging contexts along the way. It can also become debilitating at times." Most worryingly, with PDD you’re at risk of having an episode of major depression, she says. A major depression episode may last as little as two weeks – the trouble is, someone with PDD often lives in constant fear of another episode. 

Bipolar Disorder

Once called manic depression, this is a group of brain disorders marked by extreme mood swings. In the high or manic phase, you can experience a sudden burst of physical and mental activity, with racing thoughts, rapid speech, grandiose delusions, increased sexual drive, impulsiveness, irritability, aggressiveness, and socially inappropriate, wild, reckless behaviour. In the low or depressive phase, there are usually feelings of sadness, hopelessness, lack of motivation, indecisiveness, worthlessness and guilt. You can have emotional outbursts, changes in your sleep and appetite, chronic fatigue, anxiety –and thoughts of suicide.

Seasonal Affective Disorder (SAD)

This form of depression, sometimes known as the ‘winter blues’, comes as days grow shorter and darker in winter, especially in places where it rains or blows, such as parts of the Cape. SAD is associated with changes in your body’s natural daily rhythms, and is triggered by lack of sunlight, which influences the functioning of chemical messengers such as serotonin and melatonin. Symptoms include low mood, lethargy, changed eating patterns, increased appetite and weight gain. 

Premenstrual Dysphoric Disorder (PMDD)

PMDD is a severe form of premenstrual syndrome (PMS), with extreme moodiness, irritability or anger, low mood, difficulty concentrating, lack of interest in activities you usually enjoy, increased appetite, insomnia or sleepiness, and feeling overwhelmed or out of control.

Perinatal Depression

Also known as postpartum depression, this sets in after childbirth and lasts longer than the two weeks of common ‘baby blues’, which include mood swings, crying, feeling anxious and overwhelmed, and having difficulty concentrating and sleeping. Postpartum depression is far more serious. You have severe depressed mood or mood swings, intense irritability and anger and cry excessively. You can have difficulty bonding with your baby, fear that you’re not a good mother, and feel inadequate, worthless, ashamed, guilty and hopeless, with thoughts of harming yourself or your baby.

Alarming as all this is, many people accept the signs of depression as ‘normal’ and force themselves to soldier on, or escape destructively into drink, drugs or excessive behaviours, from over-working to over-eating, exercising compulsively, or self-medicating on over-the-counter sedatives and painkillers. What you should be doing is getting professional help, as soon as possible. ‘People need to know that depression is a real and treatable condition,’ says SADAG founder Zane Wilson.

See your health professional as soon as possible, to first rule out physical problems. They can recommend a psychologist or psychiatrist if you need one, who may prescribe medication. ‘Modern antidepressants have minimal side-effects when taken as directed,’ says SADAG operations manager Cassey Chambers. Research suggests that cognitive behavioural therapy (CBT), combined with medication, is the most effective treatment for depression. CBT focuses on the connection between how you think and feel. It helps you examine the thought patterns you’ve developed over time, and adjust them to be more rational and balanced. 

‘CBT is based on research, so the techniques can target specific aspects of depression and shift them,’ says Dr Linde. ‘For example, using behavioural activation you identify specific goals every week, and take small actions toward them every day. The cognitive side of CBT focuses on the negative thoughts and beliefs that keep the depression going, like the belief that nothing can change and that there’s nothing that can be done to shift things.’

In severe cases, especially if you are suicidal, a short course of electro-shock therapy (ECT) may be prescribed. Today only millivolts are briefly administered, and it can be done in outpatients. It may sound scary, especially as we’ve seen it portrayed in movies, but nowadays it’s much gentler and can make the difference when nothing else is lifting the depression. 

But sometimes, smaller steps are all that’s necessary. Just talking to other people can make you feel better, as can eating a balanced diet. Nutritional deficiencies, smoking, excessive drinking and lack of exercise can interfere with your blood chemicals. Simply exercising for 20-30 minutes a day can help relieve stress and boost feel-good endorphins, and some studies suggest that for mild to moderate depression, it may be as effective as antidepressants.

If you recognise the symptoms listed above, seek professional help. They can’t be snapped out of or ignored, and left unaddressed, have the ability to devastate lives. 

• For advice and support contact SADAG on 0800 21 22 23, sms 31393 or visit www.sadag.org

Also read: The importance of seeking help for mental health issueshttps://clicks.co.za/health/article-view/the-importance-of-seeking-help-for-mental-health-issues

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