Depression
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What is Depression?
Depression is a mood disorder that is brought on by overly negative inferences, interpretations and irrational beliefs about ourselves, others or/and the events in our life.
Why do we get depressed?
Dysfunctional thinking is largely what causes depression. According to Cognitive theory, we do not get disturbed just because we encounter a negative event, we need to interpret and/or evaluate that situation in a very negative and distorted manner in order to feel depressed. Therefore, events are considered the ones triggering the irrational beliefs we may hold, while those irrational beliefs are in fact the ones causing the depression.
There other TRIGGERS why a person may feel depressed such as having a physical illness, biological changes, the loss a significant person, a break-up or separation, poor health, etc.
If events caused directly depression, then everyone would get depressed about the same things and their distress would be identical from one individual to another. In reality, people get unhealthily disturbed and depressed only when they have a number of irrational beliefs about the event/s. Rational Emotive Behavioural therapy can be quite effective to identify and modify those types of beliefs. Sometimes, it is just not possible to make a positive change to something that happened in the past. Therefore, when we cannot do anything about changing what is triggering our depression, we still can learn to change our beliefs about the event and by doing so, we will feel more in control and coping better. However, sometimes we can change the situation by just behaving differently, when this is the case REBT, would focus on developing the necessary coping mechanisms or social skills.
Depression can also be more than the problem itself, a consequence of some other problem. Normally, people suffering from panic attacks feel so limited and for so long that eventually, they develop depression. So, anxiety can be one of the main causes of depression. Guilt and shame are also very common triggers of depression, for example if you feel guilty and cannot know how to accept yourself and your mistakes, you may feel depressed too. Sometimes, when this is what happens, we assess what we need to work on first.
In summary, What Rational Emotive Behavioural therapy does is to identify that combination of inferences, interpretations, irrational beliefs and dysfunctional personal rules causing the depression. Once identified, client and therapist work towards challenging those beliefs in order to find a more realistic, functional way of thinking.
Just "thinking positively" is not going to decrease depression in any lasting way. Though depressed people do not engage in a great deal of positive thinking, it is not just the absence of positive thoughts but the frequency of negative thoughts and the dysfunctional patterns of thinking that perpetuate depressed mood. Advice to "think positively!" or to engage in "positive affirmations" like "I'm a good person" often does not work. Positive thinking alone will not alleviate depression. Saying "I'm doing a great job" will not work when for the majority of the day, your automatic thoughts are self-critical and hopeless. Therefore, even though you are telling yourself positive things, you still believe negative things.
DSM IV Criteria for Major Depressive Episode
- At least one of the following three abnormal moods which significantly
interfered with the person's life:
- Abnormal depressed mood most of the day, nearly every day, for at least 2 weeks.
- Abnormal loss of all interest and pleasure most of the day, nearly every day, for at least 2 weeks.
- If 18 or younger, abnormal irritable mood most of the day, nearly every day, for at least 2 weeks.
- At least five of the following symptoms have been present during the
same 2 week depressed period.
- Abnormal depressed mood (or irritable mood if a child or adolescent) [as defined in criterion A].
- Abnormal loss of all interest and pleasure [as defined in criterion A2].
- Appetite or weight disturbance, either:
- Abnormal weight loss (when not dieting) or decrease in appetite.
- Abnormal weight gain or increase in appetite.
- Sleep disturbance, either abnormal insomnia or abnormal hypersomnia.
- Activity disturbance, either abnormal agitation or abnormal slowing (observable by others).
- Abnormal fatigue or loss of energy.
- Abnormal self-reproach or inappropriate guilt.
- Abnormal poor concentration or indecisiveness.
- Abnormal morbid thoughts of death (not just fear of dying) or suicide.
- The symptoms are not due to a mood-incongruent psychosis.
- There has never been a Manic Episode, a Mixed Episode, or a Hippomanic Episode.
- The symptoms are not due to physical illness, alcohol, medication, or street drugs.
- The symptoms are not due to normal bereavement.
Associated Features and Comorbidity
- Anxiety:
- 80 to 90% of individuals with Major Depressive Disorder also have anxiety symptoms (e.g., anxiety, obsessive preoccupations, panic attacks, phobias, and excessive health concerns).
- Separation anxiety may be prominent in children.
- About one third of individuals with Major Depressive Disorder also have a full-blown anxiety disorder (usually either Panic Disorder, Obsessive-Compulsive Disorder, or Social Phobia).
- Anxiety in a person with major depression leads to a poorer response to treatment, poorer social and work function, greater likelihood of chronicity and an increased risk of suicidal behaviour.
- Eating Disorders:
- Individuals with Anorexia Nervosa and Bulimia Nervosa often develop Major Depressive Disorder.
- Psychosis:
- Mood congruent delusions or hallucinations may accompany severe Major Depressive Disorder.
- Substance Abuse:
- The combination of Major Depressive Disorder and substance abuse is common (especially Alcohol and Cocaine).
- Alcohol or street drugs are often mistakenly used as a remedy for depression. However, this abuse of alcohol or street drugs actually worsens Major Depressive Disorder.
- Depression may also be a consequence of drug or alcohol withdrawal and is commonly seen after cocaine and amphetamine use.
- Medical Illness:
- 25% of individuals with severe, chronic medical illness (e.g., diabetes, myocardial infarction, carcinomas, stroke) develop depression.
- About 5% of individuals initially diagnosed as having Major Depressive Disorder subsequently are found to have another medical illness which was the cause of their depression.
- Medical conditions often causing depression are:
- Endocrine disorders: hypothyroidism, hyperparathyroidism, Cushing's disease, and diabetes mellitus.
- Neurological disorders: multiple sclerosis, Parkinson's disease, migraine, various forms of epilepsy, encephalitis, brain tumours.
- Medications: many medications can cause depression, especially antihypertensive agents such as calcium channel blockers, beta blockers, analgesics and some anti-migraine medications.
If you want to read more about depression and how to identify and modify your dysfunctional beliefs, click on this link: "Coping with Depression" (Beck & Greenberg).
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Last Modified: 7 June 2008
Copyright ©2008 Silvia Buet
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