Frequently asked questions about Depression

Depression is a very human vulnerability. People can sink into a depressed mood when their innate physical and emotional needs (see our well-being page) are not being adequately met, perhaps because of some setback or traumatic event, and they begin to worry about what has happened, or what might happen, and how they will cope.

Feelings of frustration, anger or anxiety, or guilt can become overwhelming but, instead of taking action to deal with the situation, which would bring the uncomfortable emotional arousal down, those of us prone to depression ruminate excessively about them only to exacerbate things more.

Every little thing we worry about and do not resolve in the day is translated into a bad dream the next night. So, worrying increases the amount of dreaming that we do. All the worries have to be worked through in extended and intense periods of dream activity, as the brain attempts to rebalance arousal levels (see my video presentation ‘Mood & Performance’). This upsets the balance between refreshing slow-wave, recuperative sleep and energy-burning dream sleep (known as REM sleep). When that happens, we soon start to wake up feeling tired and unmotivated. This makes us worry even more that ‘something is wrong with me’, and the cycle continues.

Exhaustion on waking and lack of motivation are features common to all depressed people. Because our normal sense that life is meaningful comes from the actions we take, life quickly comes to seem meaningless when our motivation levels are low. The natural delight we take in being alive and doing things drains away.

I work with the fundamental truth that people do not develop mental illness when their innate emotional needs are being met, healthily and in balance. Working with this organising idea I employ techniques from various therapies that have proven effective (interpersonal, cognitive behavioural, solution focused).

Because depression like any strong emotion, fogs our thinking, the emotional arousal must be lowered before anything further can be achieved. I have been trained in a range of ways to do this so that the depressed person can begin to think more clearly about the situation that is causing them to worry. When the person has calmed down, I will explain further what depression is and how it is caused. This in itself is hugely therapeutic for most people, since no one else is likely to have explained how and why the feelings arose and they were probably imagining that there was something deeply wrong with them.

I will actively look for past achievements, skills and good qualities and will give as much attention to them as the troublesome history. If it emerges that there is trauma underlying the depression, this will be resolved using the rewind technique

I will almost certainly use guided imagery to help the depressed person change their negative expectations into more positive, realistic and concrete ones, which will help them re-connect with previously enjoyed activities. In guided imagery, they get to rehearse in their imagination doing the things they need to be doing to make their lives work again. This helps them become more confident about using their own resources to take the actions necessary for starting to meet their emotional needs once more. Learning how to fulfil these innate needs resolves depression and provides the blueprint for quickly handling any relapses.

Usually, much progress is made in the first session but I will always want to see a person who has been deeply depressed a number of times, to make sure that progress is maintained and that the patient is continuing to take steps to change their expectations.
Most cases of postnatal depression can be treated very effectively in exactly the same way.

To be deeply depressed is just about the most awful feeling we can experience, apart from sheer terror. It can disable anyone. But the topic is surrounded by false ideas: Depression, as experienced by the vast majority of sufferers for example, is not a biological illness; neither is it 'anger turned inward'; it is not a 'chemical imbalance in the brain' and it is not usefully divided into 'clinical depression', 'post-natal depression' and ordinary 'depression'; and is not, in most cases, hard to come out of.

The term 'endogenous depression' may be used to describe a low mood that is purely the result of biological factors, such as a brain disorder or neurological dysfunction affecting serotonin, dopamine or other neurotransmitters. Such specific brain damage is very rare.

However, there can be a physical element to common depression. It is becoming increasingly apparent that depression may arise as a result of chronic inflammation in the body – chronic inflammation is caused by chronic stress, which brings us back to needs not being adequately met or difficulties/setbacks (physical or mental) not being addressed in ways that can enable needs to be met.

Note: Depressed or anxious people should be cautious about forms of counselling or psychotherapy that concentrates too much on the past, which encourages introspection or emotional arousal. Research shows this is often unintentionally harmful.

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