While we all feel sad, moody or low from time to time, some people experience these feelings intensely, for long periods of time (weeks, months or even years) and sometimes without any apparent reason. Depression is more than just a low mood – it's a serious condition that affects your physical and mental health.
We don’t know exactly what causes depression, however a number of things are often linked to its development. Depression usually results from a combination of recent events and other longer-term or personal factors, rather than one immediate issue or event.
Research suggests that continuing difficulties like unemployment, living in an abusive or uncaring relationship, long-term isolation or loneliness, prolonged work stress– are more likely to cause depression than recent life stresses. However, recent events (such as losing your job) or a combination of events can ‘trigger' depression if you’re already at risk because of previous negative experiences .
Therapeutic treatments (also known as talking therapies) can help you change your thinking patterns and improve your coping skills so you're better equipped to deal with life's stresses and conflicts. As well as supporting your recovery, counselling can also help you stay well by identifying and changing unhelpful thoughts and behaviour.
There are several types of effective psychological treatments for depression as well as different delivery options. Some people prefer to work one on one with a professional, while others get more out of a group environment. A growing number of online programmes, or e-therapies, are also available.
You may be depressed if, for more than two weeks, you've felt sad, down or miserable most of the time, or have lost interest or pleasure in usual activities, and have also experienced several of the signs and symptoms across at least three of the categories below.
It’s important to remember that we all experience some of these symptoms from time to time, and it may not necessarily mean you're depressed. Equally, not everyone who is experiencing depression will have all of these symptoms.
Anxiety is more than just feeling stressed or worried. While stress and anxious feelings are a common response to a situation where we feel under pressure, they usually pass once the stressful situation has passed, or ‘stressor’ is removed. Anxiety is when these anxious feelings don't go away – when they're ongoing and happen without any particular reason or cause. It’s a serious condition that makes it hard to cope with daily life. For someone experiencing anxiety, these feelings aren't easily controlled.
On average, one in four people – one in three women and one in ﬁve men – will experience anxiety at some stage in their life. Anxiety is common, but the sooner you get support, the more likely you will recover.
Staying well is about finding a balance that works for you, but there are some general principles that most people find useful. These include reducing and managing your stress levels, maintaining a healthy lifestyle, reducing or eliminating alcohol and drugs, and taking action early if you start experiencing symptoms of anxiety or depression. It's also important to deal with any setbacks and keep trying.
Family and friends can play an important role by providing practical and emotional support such as being there to listen. Listening is very powerful. Would you like to enlist Andrew as a professional counsellor to aid your journey?
Others don't get me
..... actually - if I don't start today - that's another day wasted of my life.
Why I feel it’s important to tell my clients the data pharmaceutical companies won’t
Dave was glaring ferociously at me. He wasn't angry with me personally, you understand, but for the moment I was a stand-in for the doctor he was telling me about:
"He told me that if I didn't take antidepressants, I would be depressed for ever! What do you think, Mark? I've taken antidepressants before. They've never made me feel any better, and I always get side effects. Should I go back to taking them?"
You might sometimes get this. I do. Clients wanting you to tell them whether they should consume these pharmaceutical products or not.
I always emphasize that, of course, it's entirely up to them. Doctors can't make them take these products, and I can't tell them that they mustn't take these products.
Part of being adult is making choices for yourself, of course. But when it comes to making important choices about potentially changing your brain chemistry (you can't get much more important that that!), you really need some hard facts to inform your choice.
If I am pressed on the matter, I give out the following facts. And if your clients ask about these products, you can pass on these facts too.
1. Antidepressants can be harmful
Many people are injured by the medical products they use. From anxiety and sleep disorders to sexual dysfunction and suicidal ideation, all antidepressant products carry a risk of side effects. It's amazing - and terrifying - how often doctors don't even discuss the potential for harm with their patients.
It's possible, and even probable, for some side effects to be discounted as symptoms of the depression rather than effects of the medication. Doctors are subjected to some of the most sophisticated marketing you'll find anywhere on the planet. And they are not necessarily pharmacological experts who understand exactly how every drug they prescribe works.
Although medical drugs unquestionably do save many lives, and improve the quality of many more, it's important to remember that there is a huge, if not always acknowledged, financial incentive for drugs companies to develop medications that have to be taken 'for life'. When you stop taking a drug (because you're better, hurrah!), the manufacturer makes no more money out of you.
But make no mistake, drugs can be dangerous and side effects are not as rare as some people (are led to?) believe.
Medicinal drug-induced deaths are now the fourth cause of death in medical settings. The idea that medical drugs are unequivocally good for us is, excuse the pun, dead in the water. 
2. The premise of antidepressant usage is unproven
Drug companies currently spend around three billion pounds a year promoting the notion that depression is a purely biological illness that can be effectively treated only by (in many cases) long term usage of their products.
The first thing I tell my clients is that there is no evidence, despite the billions spent on marketing the idea, that clinical depression is caused through 'faulty biology' or 'bad genes'. 
I tell them depression is not like Type 1 Diabetes, although some doctors have been encouraged to use that analogy. I might also add that all trials of these antidepressants are conducted by the drug companies themselves, and these trials are not currently independently assessed, so they can (and do, therefore) choose not to publish studies that show only a weak or no advantage of their products over placebo. 
3. No antidepressant is more or less effective than any other
Despite nearly forty years of development, no single antidepressant has been shown to be any more efficacious than any other. So the newer SSRIs are not more effective or less effective than the older style Tricyclic (TCAs) or Monoamine oxidase inhibitors (MAOIs) of old. [5) The newer ones don't work any better, although some people believe they are less toxic. However, there is evidence that switching between antidepressants to find the one that works best for the individual produces better outcomes overall. 
4. Dosage makes no difference to outcome
Sometimes clients tell me their doctor wants them to increase their dosage. In such cases, I generally suggest that if they feel they have to take these products, a lower dosage is always better than higher dosage.
Why? Because it's been found that higher dosage antidepressants (taking into account the placebo effect of knowing you are on a more powerful course) make no difference to outcome.
I always advise they consume these drugs at lower dosages because toxicity will be less and side effects should be weaker on the lower dosage. It's a myth that a person will get better quicker if they are on a higher dosage of antidepressant - but it's a dangerous myth.
5. Effective psychotherapy is better at preventing relapse than drugs
You might also tell your client that effective psychotherapy also changes the way the brain works, but in a good way and without side effects. And research has found that, because it teaches skills that can be used for life, it is much better at preventing relapse into depression than antidepressants. 
You could also mention that a common withdrawal symptom of coming off antidepressants is feeling low. This is because the brain is trying to adjust to life without the drug. This withdrawal symptom is often not recognized for what it is, and is instead interpreted as an indication that the person needs to go back to taking the drug, because they are still 'depressed underneath'.
So it's worth waiting for the withdrawal symptoms to subside before any decision is made regarding further consumption of these drugs.
I might add that I am not in the business of telling others that they must or mustn't take these drugs. I also say that if they do take them, I will still gladly help them psychotherapeutically, although that might not be as ideal as seeing them 'clean'.
Some psychotherapists might consider it none of their business to comment on whether their clients do or don't take psychotropic drugs. But considering the numbers of patients who are injured or at risk of being injured taking these products, I think we have a duty to at least provide a counterbalanced view if asked.
In the end, Dave didn't take any more antidepressants. He decided they weren't for him. He got better anyway.
(1) See also: Barbara Starfield, MD, Is US Health Really the Best in the World?
(2) See: Antonuccio, David O.; Danton, William G.; DeNelsky, Garland Y. "Psychotherapy versus medication for depression: Challenging the conventional wisdom with data." Professional Psychology: Research and Practice, Vol 26(6), Dec 1995, 574-585. A meta-analysis of over 100,000 pieces of research into the causes, consequences, and best treatments for clinical depression, conducted from 1978-1993.
(3) At least 90 studies have been done to discover what happens when monoamine levels are reduced in people. A meta-analysis of this research was conducted at the University of Amsterdam. It found that there is no evidence that lowered serotonin acts as a depressant. Ruhé HG, Mason NS, Schene AH. Mood is indirectly related to serotonin, norepinephrine and dopamine levels in humans: a meta-analysis of monoamine depletion studies.Molecular Psychiatry. 2007 Apr;12(4):331-59.
(4) Irving Kirsch, PhD. The Emperors New Drugs: Exploding the Antidepressant Myth. Bodley Head (2009).
(5) See also: The Case Against Anti-depressants.
(6) See: Kirsch, I., & Moncrieff, J. (July 2007). "Clinical trials and the response rate illusion". Contemporary Clinical Trials 28 (4): 348-51.doi:10.1016/j.cct.2006.10.012. PMID17182286. And also see: Kirsch, Irving; Sapirstein, Guy. Listening to Prozac but Hearing Placebo: A Meta-Analysis of Antidepressant Medication.Prevention & Treatment, Vol 1(2), Jun 1998.
(7) See: Equal on average does not mean equal for everyone. And see also the referenced article: K Kroenke et al.Similar effectiveness of paroxetine, fluoxetine and sertraline in primary care. JAMA 2001 286: 2947-2995.
(8) Antonuccio, David O.; Danton, William G.; DeNelsky, Garland Y. "Psychotherapy versus medication for depression: Challenging the conventional wisdom with data."
(9) Nierenberg AA, Petersen TJ, Alpert JE. Prevention of relapse and recurrence in depression: the role of long-term pharmacotherapy and psychotherapy. Journal of Clinical Psychiatry. 2003;64 Suppl 15:13-7.
(10) For example, see Antidepressants linked to thicker arteries.
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