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Everyone feels down from time to time but for most people this soon passes. Depression, is different because the low mood persists beyond a few days. The severity of the mood disorder ranges from mild to moderate or severe, when it may be designated a clinical depression and require treatment. A significant proportion of people experience a major depressive episode at some time in their lives. For some people, such episodes return from time to time. Unfortunately, depression is still a condition that suffers from stigma, which causes people a sense of shame or failure leading to delay in seeking much needed help.

A combination of physical, emotional and mental symptoms
Symptoms of depression encompass emotions, physical states and thought processes. A person may feel deeply unhappy and pessimistic. They may lose interest in things while motivation and desire drain away. Despair and hopelessness may be so severe that they have thoughts of suicide or self-harm. They may also experience tension and anxiety, becoming prone to irritability, tearfulness and become easily frustrated. At the same time they may feel their body slow down, overcome by a lack of energy, with the sense that everything takes additional effort. Headaches and bodily pain may feature. Weight gain as a result of overeating or weight loss due to loss of appetite are possible. Interest in sex or other activities may fade. Thinking tends to become repetitively negative. Unproductive rumination is common and may occur during the night as sleep is disturbed. Concentration and decision making are usually adversely affected and memory may be also. Overall the person may feel trapped by the combination of symptoms, unable to pull themselves out of the emotional trough into which they have fallen.

The causes of depression
There is no single cause of depression and, while there are inevitably characteristics in common, not everyone’s experience is exactly the same. Current thinking is that depression is caused by a number of factors, either singly or in combination. Some people become depressed through years of suppressing their own personality to please others. Depression sometimes appears in different generations in the same family suggesting a genetic predisposition. The onset of major ailments or serious injury, as well as in pregnancy, after giving birth or during menopause may result in depression.

Some depressive episodes are triggered in response to traumatic or painful events, some of which may have happened much earlier in life. Although it is perfectly natural to feel sad at the death of a loved one and grief generally loses its intensity over time, some people find that depression takes hold. Other kinds of loss may also be triggers, including the loss of a job, financial security, social status or ability. Retirement may result in depression if a person feels they are no longer of use or social relevance.

Depression sometimes results from burnout. A person in a stressfully demanding job may try to keep going, ignoring the mental and physical alarm bells going off out fear of failure or a sense of shame at perceived weakness. They may have internalised an expectation of invincibility or have their sights set on perfection and infallibility.

Solutions become problems
How people set about alleviating the feelings and symptoms of depression often makes matters worse. For instance, due to the knock to their sense of self-worth, they may isolate and, in some cases, withdraw from almost all social interaction. As there is no outlet for the self-perpetuating negativity, detachment from supportive social networks tends to lead to a worsening of symptoms. Another faulty coping mechanism is in turning to mood-altering substances. While these may offer quick relief, any beneficial effect is short lived and the risk of depression increased. That risk grows if the substance use develops into dependence or addiction. Given their direct (toxic) effect on the brain, drugs such as alcohol or benzodiazepines are implicated in the onset of depression, while for others, such as cocaine and heroin, depression may be more due the harms inflicted by the associated lifestyle. Depression can though, feature in withdrawal from substances of addiction.

People may turn to food to comfort or soothe themselves but, as result, may consume too many calories and become overweight and even more depressed as a consequence. A similar process can be seen where people resort to mood-altering behaviours with addictive potential. For instance, compulsive sexual activity often results in a depressive reaction.

Assessment and Treatment
It is often the case that someone close to an individual like a family member or colleague notices changes in demeanour and behaviour before the person suffering from depression comes to the realisation. It is important for this person to sensitively express their view as it may well be what finally leads to the person accepting the need for help.

Once they do reach out and access treatment, a thorough assessment will be necessary to explore the history of the illness and to identify possible contributing or complicating factors. In cases where a dual diagnosis is reached (depression and substance use disorder co-exist), the treatment plan will be designed to address both conditions.

In cases of mild depression, time may be the simple healer. Increasingly, exercise has been found to alleviate mild depressive symptoms. It doesn’t have to mean intensive workouts. Frequent walks in a natural environment may be quite sufficient. Some kind of talking therapy or counselling and/or a self-help group may well prove helpful. For those people with Seasonal Affective Disorder (SAD), light therapy will be considered.

If the depression is moderate or severe, other interventions may be called for, such as anti-depressant medication. This is most effective when combined with a talking therapy like Cognitive Behavioural Therapy (CBT) which helps change negative interactions of thinking, feeling and behaviour. In cases where a problematic relationship is implicated in the depression, Interpersonal Therapy (IPT) may be called for. Admission to a private luxury treatment facility equipped to administer detoxification and with high levels of psychiatric and psychological support may be the appropriate and safest choice. The time and space can be provided for the person to come to an understanding of their condition and, with the right support, to learn ways of helping themselves. The spiritually uplifting environment will make an important contribution to a positive outcome.