Depression

This information was written with the intention of helping people who are  experiencing feelings of depression. It can be used as an aid in itself or to  bridge the gap between self-help, the assistance of friends and family and  professional services.

It was written because depression is a common experience and not a sign of  inadequacy or failure. University life has its stresses as well as having many  advantages. It is wrong to assume that exams, pressure of work, financial  worries or other practical problems are the only factors in causing stress for  students. High personal expectations, social expectations, difficulties in  living in a university environment affect all students, although not all will  become depressed.

Because it is so hard to admit to feeling depressed, particularly when others  around us seem to be enjoying themselves and well able to cope, we can feel  unjustified in seeking help. This is unfortunate because feelings of failure or  inadequacy can add to the downward spiral of depression and make it more  difficult to regain your confidence.

What is depression?

As with all human experience it is not easy to generalize and depression has  its degrees of severity from sadness, loss of interest in life to helplessness  and despair. However, at the time depression is being felt, most people who  experience it say that it is a completely here-and-now experience when all good  things are forgotten or can't be felt. Neither does the future hold out hope.  Isolation and a sense of being paralysed by a sinking mood can be  overwhelming.

People who are depressed characteristically experience many of the  following:

  • loss of interest and enjoyment in life;
  • a sense of worthlessness, loss of self-confidence;
  • loss of energy, concentration and motivation;
  • feeling useless, inadequate, helpless and bad;
  • feelings of emptiness and despair;
  • thoughts of suicide.

Some of the physical symptoms of depression can include:

  • Sleep disturbance (such as insomnia or wanting to sleep all the time or  nightmares)
  • Impairment of bodily functions, including:
  • a speeding of functions such as palpitations, diarrhoea, agitation (as a  result of accompanying anxiety)
  • slowed down functions such as constipation
  • slow thought processes, slow movements

These feelings and symptoms will go away or be significantly reduced when the  depression passes. It is crucial to try to hold on to the fact that depression  is temporary and short-lived in its intensity, that it is a natural response and  that help is available.

What causes depression?

People who experience depression usually wonder why they are depressed.  Friends and relatives also try to look for a reason in order to make sense of  what is happening. The search for an explanation or an answer is particularly  common. When reasons aren't obvious or seem insufficient to explain the  experience of depression some of the feelings associated with depression can  seem worse. It is usually more helpful to accept the feelings experienced in  depression than to search for the cause. Usually there is more than one reason  why any particular person becomes depressed but some of the following can play a  part in depression.

Distressing or traumatic events often give rise to a period of depression.  Normally these feelings about the event are eventually understood and we come to  terms with them after a period of time. Sometimes this does not seem to happen  and a deeper and more persistent depression sets in, from which it can feel  difficult to emerge.

Life circumstances at times of stress or around distressing events in our  lives can affect the way we are able to come out of the depression. For example,  if we are lonely, away from friends and family, have lots of pressures and  worries, then we may not cope as well, becoming more seriously depressed than we  might at other times.

Physical illness can often be accompanied or followed by depression,  especially when the illness is serious and painful. It is not uncommon after  glandular fever and bouts of 'flu. Depression around the time of childbirth and  afterwards can occur in women.

Personality may predispose some people to depression. Anyone can become  depressed under certain circumstances but some of us because of our early life  experiences or because of our individual vulnerabilities seem more prone to  depression.

Gender factors play a part in depression. Statistically women seem to get  depressed more than men. There are probably many factors involved in this,  including social and economic reasons. Men tend to be less likely than women to  admit their feelings, bottling them up or sometimes expressing them through  aggression or through drinking heavily. This means that there seem to be  gender-related forms of expression of feelings which are both expected and  acceptable in our society. This can lead to hesitation in seeking help.

Can I be helped by my friends and family?

It is difficult to generalize about how helpful friends and family can be to  someone who is feeling depressed. For some people they can be, perhaps,  literally a 'lifesaver', for others there may be a fear of not being understood  or burdening people, leading to an overwhelming feeling of isolation. For most  people the reality is probably somewhere in between. The support and care of  friends and family is very necessary and it is with social support that a  depressed person can begin to feel reconnected with others.

Part of what happens when people experience depression is a disconnection  with other people and perhaps from their own ability to feel. Getting back in  touch with one's feelings can be frightening and confusing but it can also be  exciting and life-giving. It may help the depressed person and their friends and  family to recognise that there may be mood swings and a shifting around of ways  of behaving as someone emerges from depression.

How can I help myself?

You are the most important person in your own life and some of the ways in  which you can begin to help yourself are listed below.

It is important to accept that coming out of depression can take time. A  healing process is needed. Being free from depression does not mean having  trouble-free or achieving total happiness. All people have problems from time to  time. It is part of life.

Don't bottle things up. Try to tell people about how you feel or about what  has happened if you have experienced a major upset in your life. For most  people, in the long run, re-living painful experiences several times with an  empathic listener will help. Crying and expressing other painful feelings are  all part of the healing process.

Recognise how many obstacles you place in your own way. Don't play what  Dorothy Rowe calls the "Yes, but ….."game. This can prevent you from doing  things that might help, from trying new things and from looking at things in a  different way.

Treat yourself kindly. Depressed people do not have a caring, nurturing  approach to themselves. Depression is one of the most punishing experiences a  person can undergo. It is very important to remind (and forgive) yourself that  you are suffering from depression and take steps to look after yourself. This  will have different meanings for individuals but can include:

  • resisting the temptation to drown your sorrows (in drink, drugs or food)
  • taking rest periods (even if you don't want to sleep), breaks, holidays, a  change of scene etc.
  • taking up old hobbies or trying out a new experience which has the potential  to give you pleasure
  • caring for your body through exercise, pampering yourself etc.
  • Find ways of discovering a peaceful place for yourself. It is essential for  the healing process to allow your natural resources to play their part. Many  people find relaxation helps them to get relief and peace away from their  tensions. Others use meditation or yoga, aromatherapy or therapeutic massage.  Music can help a great deal. It is necessary to stop struggling, take a risk,  trust yourself and let go in order to experience the calmness and peacefulness  that evades you.

If your depression is such that you cannot even contemplate any of the above  and that the only thing you can think of is that you are unable to go on without  seeking professional help, this in itself might be the most important decision  towards helping yourself that you can take.

Depression is a very common experience and you are not unusual in the  suffering you are experiencing. Help is available through a number of sources  (see page 8), although relief might not be immediate.

Ask yourself how many times you said "Yes, but ……" to the above.

Dorothy Rowe, in her book 'Depression: The Way Out of your Prison' reminds us  that,

"A journey of a thousand miles starts under one's feet."

What organised help is available to me?

People differ in the forms of help they find acceptable or suitable. It is  important to find the approach that best suits your needs. Some people want to  get through their depression without using medication, others find they need to  use this form of help at least for a while. Many people approach their GP when  they experience depression but this does not mean that their GP will  automatically prescribe anti-depressants. Nowadays, the GP is quite likely to  suggest a form of counselling or psychotherapy.

Talking things through with a counsellor or psychotherapist who is trained to  listen and understand can bring tremendous relief. It may be that powerful  feelings will need to be experienced in a period of counselling with painful  experiences being talked about, relationships explored and difficulties  confronted. Counsellors and psychotherapists are able to recognise that this can  be a very difficult process to go through particularly for someone who is  severely depressed.

Anti-depressants may be prescribed by a GP if someone is severely depressed  or when the depression goes on for a long time. Anti-depressants don't begin  working as soon as you start taking them. It may be necessary to wait two to  four weeks. Your doctor will advise you on this and also on the possible  consequences of stopping them suddenly. There may be some side-effects with  anti-depressants and your GP can tell you what to expect.

Psychiatric help. A few people do not recover from depression without more  specialised help and are likely to be referred to a psychiatrist. The  psychiatrist may offer or refer you to more specialised treatment which can  range from psychotherapy, different medication or (rarely)hospital  admission.

Other sources of help

The Counselling Service is very able to help with drug and alcohol related  problems. We work in a non-judgemental way to help you achieve the goals you  have set yourself. As you will see from our confidentiality statement we do not  normally inform anyone of any illegal activity we hear about in counselling. The  only exception to this rule is when there is a clear and immediate risk to  someone's life.

Other specialist help can be obtained through your own GP, via Student Health  or by contacting one of the national support and information services:

Alcoholics Anonymous Information Line
01904 644 026/7/8/9

Alcohol Concern Information Line
0207 928 7377

Drinkline
0800 9178282

How can I help someone else?

People are different in the way that they respond to attempts to help and in  what they find helpful. These are general approaches that have been found to be  helpful but the suggestions are by no means definitive:

  • Spend time with them even if the person isn't able to say very much about  how they are feeling. Depressed people find it very hard to express feelings and  may not know why they are depressed;
  • Accept what the person says about themselves even if this is not the full  picture as you see it;
  • Resist putting pressure on them by giving too much advice or by probing too  hard. It is often the case that depressed people have thought a lot about what  they could 'do' about their problems but aren't ready or able to do anything  about them at that time;
  • Avoid trying to cheer up depressed people. This doesn't mean you can't offer to go to places with them, or offer reassurance. It can be very helpful for  depressed people to have time away from their depressing situations but this is  unlikely to effect a lasting change of mood and it is important not to take this  as a personal slight;
  • Be consistent. It can be hard to stay close to someone who is depressed but  your friendship is likely to be more valuable than you think. Depressed people  can feel insecure and unworthy of friendship.
  • Caring for yourself

It is important to take care of yourself and not get overwhelmed by someone  else's depression. This isn't easy to do and often why people steer clear of  people who are depressed. It won't help if you get depressed too.

  • Be clear and firm about your own boundaries. Offers to support 'any time -  day or night' are unrealistic and not helpful to anyone.
  • If you are getting too affected by the situation, limit the help you can  offer, eg part of an evening, then some time on another day. Stick to the time  you have agreed.
  • Talk to someone else about the situation to help you offload and get some  support.
  • When other help is needed

Know your limits. If what the person tells you (eg about suicidal feelings)  is more than you can cope with, take this seriously, tell the person as gently  as you can and suggest they seek outside help. Your ongoing support will still  be very valuable. You might need to be patient for a while and offer  encouragement and support until the person is ready to seek help.

Dragging someone to the GP or the Counselling Service is unlikely to be  helpful and is more likely to reflect your exasperation or wish to make things  better than the depressed person's motivation to seek help.

There are cases (although rare and difficult to distinguish) when a person is  feeling so entirely lacking in hope that they are unable to seek help and could  put themselves at serious risk. It might be at this point that someone will need  to act on their behalf. It is not possible to be clear about if and when this  might be necessary. On the whole, people have a tremendous capacity to survive,  particularly when they receive help and understanding.

Unhelpful advice to depressed people

This mainly involves trying to impose your views and values on to the  depressed person such as:

“Pull yourself together and get on with it.”

“I always find busying myself with work helpful.”

“Don’t let them get you down. I wouldn’t stand for it ……!” 

“I don’t  believe in taking anti-depressants.”

“I wouldn’t go to a counsellor. I’d rather solve my problems myself.”

“Everybody gets depressed. Don’t worry about it.”

“There’s always someone else worse off than you.”

This information was written with reference and thanks to:

Dorothy Rowe: Depression:. The Way out of Your Prison 
Routledge Kegan  Paul. 1983

Depression. Royal College of Psychiatrists. 1992

The Blues. University Counselling Service, The University of Cambridge

Conference proceedings: Depression, its diagnosis, its diversity and  treatment. St George's Hospital Mental Health Library. 1994

Professor Pam James, Liverpool John Moores University

Carys Wyn-Jones, formerly Accommodation and Welfare Advisor, The University  of Liverpool

Dr Fergus McMillan, formerly of the Student Health Service, The University of  Liverpool