Living with Depression

Samar Hafeez

Clinical Psychologist and Counsellor

Bangalore, India 

Almost everyone feels down from time to time; getting a bad grade, having an argument with a dear one, not achieving a positive appraisal at work, disagreements with siblings and many other life instances that pose a demand or pressure on you can make you feel sad. 

Most times, these negative thoughts and feelings last for a couple of days and fade away. They usually don’t seem to disrupt or extensively impair your day-to-day activities, and most of us feel fine after we have had a healthy constructive conversation or a good laugh with a family member, colleague or friend. 

However, if you suffer from depression, these negative thoughts and feelings seem to be leeched onto you, sucking the fun out of your life. The negativity does not seem to improve or subside and may carry on for months perhaps years and definitely causes significant distress or impairment in social, occupational and other important areas of functioning.

Depression is more than just sadness; it has been called the world’s number one public mental health problem. Some people experience a few symptoms and some experience many. 

The severity of symptoms also vary in individuals over time. Some of these signs and symptoms include feeling a markedly diminished interest or pleasure in almost all activities, feeling gloomy, guilty, melancholic, worthless and hopelessness most of the day, almost everyday; negative thinking, significant weight loss when not dieting or weight gain (i.e. a change of more than 5% of body weight in a month), decreased or increased appetite, insomnia (sleeplessness) or hypersomnia (excessive sleepiness) nearly every day, psychomotor agitation or retardation (i.e. restlessness or sluggishness), inability to concentrate, recurrent thoughts of death and suicidal ideations, or suicide attempts.

The presence of five or more of the above symptoms over a 2-week period and representing a negative change from previous functioning will indicate the onset of this mental condition.

Depression is a heterogeneous problem which has numerous risk factors including a combination of genetic, environmental and psychosocial factors. It can appear at any age, but the likelihood of onset in adolescence is a lot higher.

Major life changes, trauma, sexual abuse, chronic stress and substance abuse, pregnancy, chronic physical illnesses like cancer, stroke and diabetes can be among causes. For many individuals, life influences and “how” they interpret it appears to be the most important cause. In this article, we will be mainly looking into the cognitive reactions related to depression.

 

You feel the way you think

Depression is an illness that mostly results from thoughts that are distorted subsequently in some way and every bad feeling is the result of negative thinking. Illogical pessimistic attitudes play a central role in the development and continuation of all depressive symptoms. 

Over 30 years of research confirms that people with depression tend to have more negative thoughts leading to being depressed. These thoughts are the most frequently overlooked symptoms of depression. These cognitions contain the key to relief and are therefore the most important symptom.

Emotions and actions result entirely from the way you interpret things. It is an obvious neurological fact that before you can experience any event, you must process it with your mind and give it a meaning, before you can feel or react to it.

The following is list of some cognitive distortions (ways in which our mind convinces us of something that is not really true) that form the basis of our depressive state:

1. All-or-nothing thinking: In this cognitive distortion, we see things in black or white categories. For instance, if your performance falls short of perfect, you see yourself as a total failure. There is no middle ground in this type of thinking
   
2. Overgeneralisation: In this mind trap, you see a single negative event as a never ending pattern of defeat
   
3. Mental filter: You pick out a single negative detail about an issue or situation and dwell on it
   
4. Disqualifying the positive: You don’t believe in positive experiences and insist that they “don’t count” for some reason or the other
   
5. Jumping to conclusions: Without definite facts that convincingly support ones conclusion, you jump to negative conclusions
   
6. Magnification (catastrophising) and minimisation: Also called “binocular trick” because you are either exaggerating things or belittling them. It usually occurs when you look into your own imperfections and mistakes and exaggerate their importance and minimise your good points 
   
7. Emotional reasoning: You assume that if you are feeling negative, then that must be the way things are: “I feel it, therefore it must be true.” One usual side-effect of emotional reasoning is procrastination
   
8. “Should” statements: You try to motivate yourself by telling yourself you should be doing something, but overtime these statements can cause you to feel pressured and demotivated
   
9. Labelling and mislabelling: This is a more serious form of overgeneralisation. When making a mistake, you attach a negative label to yourself, such as feeling like “a loser”. This is similar when someone else upsets or annoys you and then you attach a negative label to them
   
10. Personalisation: This is when you start to blame yourself for everything and take responsibility of others’ mistakes and failures, when there is no absolute need to

Treatments

For milder forms of depression, I would request the reader to mindfully and thoughtfully identify their thoughts and respective feelings and reactions. Jot down these thoughts in a diary, using a “triple column technique”. In the left column, write down the negative thoughts that drift in your mind; in the middle column, identify your distortions and in the right hand column, write down more realistic interpretations or rational responses to the specific distortions.

This daily written exercise will accelerate your personal growth and shall hopefully provide some substantial emotional relief.

Also try practicing meditation, which in the best form would be spiritual closeness to God Almighty through offering the daily prayers (Salat) with sincerity and hope. Spiritually inclined individuals forgive and forget any negative or cruel event quickly, thereby saving themselves from chronic stress, which can be one of the causes of depression.

It is very important and crucial that you practice positive self-talk daily and surround yourself with people who encourage and motivate you.

Keeping a gratitude journal or a record of all positive, rewarding and pleasant experiences of life can help. Reading or recalling it every night before going to bed can increase thankfulness and joy.

Including moderate exercises at least six days a week has a great positive and beneficial affect in mental health. Exploring nature and getting some fresh air often can feel rewarding. Do what you like to do more often and try to get more sunshine as production of vitamin D in the body reduces depressive symptoms.

Do not isolate yourself for long periods and do activities that make you feel better.

When depression is moderate to severe, it can be crippling and can seize your ability to think and reason clearly. In these cases I would recommend you see a mental healthcare professional for an entire mental status examination as soon as possible. 

Fortunately, you don’t have to live with depression; you can always show it a way out. Even the most severe cases are treatable with help from medications and psychotherapy.

If you know anyone with depression, please offer emotional support which involves patience, understanding, affection, empathy and encouragement. Engage the depressed person in conversation and listen carefully. Invite him or her for walks or outings. Do not ignore signs of depressions; if a person engages in any suicidal ideations or attempts, immediately seek help on behalf of that person.

The most crucial thing is to offer hope! This eradicates almost every existing problem.

(Please always consult a doctor or specialist to diagnose health conditions and follow the advised plan of a qualified doctor.)