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What is Depression

Depression (major depressive disorder) is a common and serious medical illness that negatively affects how you feel, the way you think, and how you act. Fortunately, it is also treatable. Depression causes feelings of sadness and/or a loss of interest in activities you once enjoyed. It can lead to a variety of emotional and physical problems and can decrease your ability to function at work and at home.


If you think you’re suffering from depression, the first thing to do is talk to someone. The most important thing is to deal with the problem. Please don’t ignore the depression or hope it goes away.  If you visit a counselor or doctor,  they can advise on the best treatment for you.


Depression Is Different from Sadness or Grief/Bereavement


The death of a loved one, the loss of a job, or the ending of a relationship are difficult experiences for a person to endure. It is normal for feelings of sadness or grief to develop in response to such situations. Those experiencing loss often might describe themselves as being “depressed.”

But being sad is not the same as having depression. The grieving process is natural and unique to each individual and shares some of the same features of depression. Both grief and depression may involve intense sadness and withdrawal from usual activities. They are also different in important ways:

In grief, painful feelings come in waves, often intermixed with positive memories of the deceased.

In major depression, mood and/or interest (pleasure) are decreased for most of the two weeks.

In grief, self-esteem is usually maintained. In major depression, feelings of worthlessness and self-loathing are common.

In grief, thoughts of death may surface when thinking of or fantasizing about “joining” the deceased loved one. In major depression, thoughts are focused on ending one’s life due to feeling worthless or undeserving of living or being unable to cope with the pain of depression.

Grief and depression can co-exist for some people, the death of a loved one, losing a job, or being a victim of a physical assault or a major disaster can lead to depression. When grief and depression co-occur, the grief is more severe and lasts longer than grief without depression.


Risk Factors for Depression


Depression can affect anyone—even a person who appears to live in relatively ideal circumstances.


Several factors can play a role in depression:


Biochemistry: Differences in certain chemicals in the brain may contribute to symptoms of depression.


Genetics: Depression can run in families. For example, if one identical twin has depression, the other has a 70 percent chance of having the illness sometime in life.


Personality: People with low self-esteem, who are easily overwhelmed by stress, or who are generally pessimistic appear to be more likely to experience depression.


Environmental factors: Continuous exposure to violence, neglect, abuse or poverty may make some people more vulnerable to depression.

How do I know if I have depression?



  1.  Feeling sad or down a lot of the time, even when there’s no reason

  2. Feelings of despair that you can’t escape

  3. A lack of feeling or emotion. You don’t feel anything and have lost the ability to feel happy

  4. Feeling exhausted and lacking energy all the time

  5. Continuous and long mood swings, when you change from feeling happy to despairing, sorrowful or angry, and irritable

  6.  The things that used to give you enjoyment or make you happy leave you feeling numb or uninterested

  7. Feeling that you don’t want to talk to family or friends

  8. Difficulty concentrating or losing interest in your work

  9. Putting on or losing a lot of weight

  10. Different sleep patterns. You might not be able to fall asleep or you can’t get up in the morning

  11. Some people suffer from postnatal depression after having a baby

  12.  Feeling guilty as if doing something terrible or feeling worthless as a person

  13.  Feeling so bad that you think it would be a relief to die or hurt yourself


Here are some of the symptoms:



Hopeless outlook


Major depression is a mood disorder that affects the way you feel about life in general. Having a hopeless or helpless outlook on your life is the most common symptom of depression.


Other feelings may be worthlessness, self-hate, or inappropriate guilt. Common, recurring thoughts of depression may be vocalized as, “It’s all my fault,” or “What’s the point?”


Lost interest


Depression can take the pleasure or enjoyment out of the things you love. A loss of interest or withdrawal from activities that you once looked forward to — sports, hobbies, or going out with friends — is yet another tell-tale sign of major depression.


Another area where you may lose interest is sex. Symptoms of major depression include a decreased sex drive and even impotence.



Increased fatigue and sleep problems


Part of the reason you might stop doing things you enjoy is that you feel very tired. Depression often comes with a lack of energy and an overwhelming feeling of fatigue, which can be among the most debilitating symptoms of depression. This could lead to excessive sleeping.


Depression is also linked with insomnia, as one might lead to the other and vice versa. They can also make each other worse. The lack of quality, restful sleep can also lead to anxiety.




While depression hasn’t been shown to cause anxiety, the two conditions often occur together. Symptoms of anxiety can include:


  •     nervousness, restlessness, or feeling tense

  •     feelings of danger, panic, or dread

  •     rapid heart rate

  •     rapid breathing

  •     increased or heavy sweating

  •     trembling or muscle twitching

  •     trouble focusing or thinking clearly about anything other than the thing you’re worried about



Changes in appetite and weight


Weight and appetite can fluctuate for people with depression. This experience may be different for each person. Some people will have an increased appetite and gain weight, while others won’t be hungry and will lose weight.

One indication of whether dietary changes are related to depression is if they’re intentional or not. If they’re not, it may mean that they’re caused by depression.


Uncontrollable emotions


One minute it’s an outburst of anger. The next you’re crying uncontrollably. Nothing outside of you prompted the change, but your emotions are up and down at a moment’s notice. Depression can cause mood swings.

Looking at death


People who die by suicide usually show symptoms first. Often people will talk about it or make a first attempt before succeeding in ending their life. If you think someone is at immediate risk of self-harm or hurting another person:

  •     Call your local emergency number.

  •     Stay with the person until help arrives.

  •     Remove any guns, knives, medications, or other things that may cause harm.

  •     Listen, but don’t judge, argue, threaten, or yell.

How does affect me?

Emotional symptoms of stress include:

  • Becoming easily agitated, frustrated, and moody

  • Feeling overwhelmed, as if you are losing control or need to take control

  • Having a hard time relaxing and quieting your mind

  • Feeling bad about yourself (low self-esteem), and feeling lonely, worthless, and depressed

  • Avoiding others

Physical symptoms of stress include:

Cognitive symptoms of stress include:

  • Constant worrying

  • Racing thoughts

  • Forgetfulness and disorganization

  • Inability to focus

  • Poor judgment

  • Being pessimistic or seeing only the negative side

Behavioral symptoms of stress include:

  • Changes in appetite -- either not eating or eating too much

  • Procrastinating and avoiding responsibilities

  • More use of alcohol, drugs, or cigarettes

  • Having more nervous behaviors, such as nail biting, fidgeting, and pacing

How Is Depression Treated?


Depression is among the most treatable mental disorders. Between 80% and 90% percent of people with depression eventually respond well to treatment. Almost all patients gain some relief from their symptoms.


Before a diagnosis or treatment, a health professional should conduct a thorough diagnostic evaluation, including an interview and a physical examination. In some cases, a blood test might be done to make sure the depression is not due to a medical condition like a thyroid problem or a vitamin deficiency (reversing the medical cause would alleviate the depression-like symptoms). The evaluation will identify specific symptoms and explore medical and family histories as well as cultural and environmental factors with the goal of arriving at a diagnosis and planning a course of action.



Psychotherapy / Counselling therapy


Psychotherapy, or “talk therapy,” is sometimes used alone for the treatment of mild depression; for moderate to severe depression, psychotherapy is often used along with antidepressant medications. Cognitive behavioral therapy (CBT) has been found to be effective in treating depression. CBT is a form of therapy focused on problem-solving in the present. CBT helps a person recognize distorted/negative thinking with the goal of changing thoughts and behaviors to respond to challenges in a more positive manner.


Psychotherapy may involve only the individual, but it can include others. For example, family or couples therapy can help address issues within these close relationships. Group therapy brings people with similar illnesses together in a supportive environment, and can assist the participant to learn how others cope in similar situations.


Depending on the severity of the depression, treatment can take a few weeks or much longer. In many cases, significant improvement can be made in 16 to 20 sessions.


Self-help and Coping


There are a number of things people can do to help reduce the symptoms of depression. For many people, regular exercise helps create a positive feeling and improves mood. Getting enough quality sleep on a regular basis, eating a healthy diet, and avoiding alcohol (a depressant) can also help reduce symptoms of depression.


Depression is a real illness and help is available. With proper diagnosis and treatment, the vast majority of people with depression will overcome it. If you are experiencing symptoms of depression, the first step is to see the Counsellor, GP, or psychiatrist. Talk about your concerns and request a thorough evaluation. This is a start to addressing your mental health needs.

Advantages of cognitive behavioral therapy in depression

1. It is used to reduce symptoms of depression as an independent treatment

2. It is used to modify the underlying schemas or beliefs that maintain the depression

3. It can be used to address various psychosocial problems, for example, marital discord, and job stress which can contribute to the     symptoms

4. Reduce the chances of recurrence

5. Increase the adherence to recommended medical treatment


The use of cognitive behavioral therapy according to the severity of depression

Type of depression                        First-line                                Adjunctive                                    Number of  sessions


Mild                                          BCT or Meditation                BCT or Meditation                        8-12

Moderate                                 BCT or Meditation                BCT or Meditation                        8-16

Severe                                      Medication or/

                                                 and Somatic treatment                   CBT                                       16 – more

Chronic depression                BCT or Meditation                  BCT or Meditation                       16-more      

and recurrent depression                                                                                                              and booster

                                                                                                                                                         sessions up  

                                                                                                                                                         to 1-2years     



Overview of cognitive behavioral therapy for depression



1. Mutually agreed on problem definition by therapist and client

2. Goal settings

3. Explaining and familiarizing the client with five area model of CBT

4. Improving awareness and understanding of one’s cognitive activity and behavior

5. Modification of thoughts and behavior - using principles of Socratic dialogue, guided discovery, and behavioral       

    experiments/exposure exercise

6. Application and consolidation of new skills and strategies in therapy sessions and homework sessions to generalize it across 


7. Relapse prevention

8. End of the therapy

Cognitive theory conceptualizes that people are not influenced by the events but rather by the view they take of the events. It essentially means that individual differences in the maladaptive thinking process and negative appraisal of life events lead to the development of dysfunctional cognitive reactions. This cognitive dysfunction is in turn responsible for the rest of the symptoms in the affective and behavioral domains.

Counseling for Depression


What causes depression?


There are a lot of different causes of depression. These include:


  • A build-up of stress and anxiety from being bullied, working too hard, or family situations

  • Alcohol and drug abuse cause depression

  • Grief or serious life changes, such as when someone dies, you become sick, lose your job or have an accident

  • Depression runs in families and you might inherit the genes that make it more likely to have depression. However, if a family member suffers from depression, it doesn’t mean that you will as well

  • Whatever the reason for depression, remember that it’s never your fault. Depression is a common health problem, just like high blood pressure, diabetes, or a heart condition



If you think you’re suffering from depression, the first thing to do is talk to someone. The most important thing is to deal with the problem. Don’t ignore the depression or hope it goes away on its own.


Being unhappy isn’t the same as being depressed. Depression is a term often used loosely to describe how we feel after a bad week at work or when we’re going through a breakup. But major depressive disorder — a type of depression — is much more complicated. There are specific symptoms that determine whether it’s depression or the sadness we all sometimes experience in life.


Determining if persistent, unshakable dark feelings are a result of depression can be the first step toward healing and recovery. Read through these warning signs to see if it’s time for you to see a mental health professional.

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