Published on Friday, 22 February 2008 13:37 | | 
Depression may be the world's most common mental health problem but, as Diane Southam explains, it's one of the most misunderstood
You're depressed because you didn't get that job? No, you're not depressed, you're disappointed. You reckon your girlfriend's been suffering from depression since her dog was put down? Sorry, but she hasn't, she's been grieving. Your best mate's told you he's depressed you can't make his 30th? Don't you believe it, he's pissed off and sad, and so, no doubt, are you. Your holiday's over, and work and winter are looming? Hang on, what you're feeling isn't depression, it's a touch of good old-fashioned melancholy.
We can usually snap out of these negative feelings by taking some positive action such as applying for another job, booking next years' holiday or even taking up Salsa dancing. And if we try processing the feelings instead of running away from them we can usually gain a bit of self-knowledge at the same time. Real depression is something altogether quite different.
Real depression is usually defined as reactive or clinical. Reactive depression is triggered by something in our environment – like having a long-term illness or a severe financial problem. It will usually lift once you recover your health or the financial problem gets sorted. But with the black dog of clinical depression, the triggers aren't so obvious.
Some mental health practitioners claim that if you have a parent who suffers from severe depression you're eight times more likely to experience depression yourself, but others argue that there's no genetic link whatsoever. Low levels of serotonin in the brain – the
chemical that lifts mood – is believed by some to cause depression, while others insist that low serotonin is the result, not the cause of depression. What most healthcare professionals do, however, agree upon are the symptoms: low mood, irritability, lack of energy, loss of confidence, sleep disorder, eating disorder, loss of libido, feelings of worthlessness or guilt, lack of energy, loss of ability to socialise, suicidal thoughts.
Opinions also differ on how best to treat depression. Some advise the use of anti-depressants – also known as SSRI's (Selective Serotonin Re-uptake Inhibitors) that boost serotonin levels; others claim that the talking therapies such as counselling, psychotherapy and cognitive behavioural therapy are more effective. A good number of mental health practitioners advocate a combination of both.
In my experience as a therapist, anti-depressants don't cure the root cause of a problem, but they can help to lift mood. A woman suffering from depression triggered through staying in an abusive relationship might find medication makes her feel better, and even helps her to overcome the inertia that's keeping her there, but with a talking therapy she would gain insight into why she got into the relationship in the first place. The likelihood being that if she doesn't find out, pretty soon she'll end up being unconsciously drawn to another abusive partner.
Whether we're depressed or not it's important to acknowledge all our feelings – however acceptable or unacceptable we think they are – because our feelings are all interconnected. By suppressing so-called negative feelings such as anger or lust we can end up suppressing positive feelings, too, like excitement and joy. Being cut off from many of our feelings is a symptom of depression.
One of the most common root causes of depression I've come across in my work is suppressed or unexpressed anger. Usually due to reasons of upbringing or education, some people have been led to believe it's 'bad' to feel anger and if they do, it means that they themselves are 'bad' and hence unlovable. But what happens when someone like this feels a murderous rage towards a person who has hurt them deeply – which, let's face it, most of us have done at some point in our lives? They swallow it. The rage metamorphoses into depression – which in its worst form is a kind of self-murder that can result in self-harm or suicide.
So if you think you're experiencing a real depression, please seek professional help. And if you're just feeling a bit blue, before you go around labelling yourself as depressed, get to know yourself better by working out and processing whatever it is you're really feeling.
Further information:
Shoot the Damn Dog – A Memoir of Depression by Sally Brampton (Bloomsbury 2008)
Depression UK (A self-help charity, previously known as Depressives Anonymous)
MIND - 0845 7660 163
(Aims to remove stigma attached to mental health issues)
BBC Newsnight interview with ex-Norwegian Prime Minister and depression sufferer Kjell Magne Bondevik