Depression Prevention Tips

Depression explained Depression is a common experience. We have all felt 'depressed' about a friend's cold shoulder, misunderstandings in our marriage, tussles with teenage children - sometimes we feel 'down' for no reason at all.

However, depression can become an illnesswhen:

  • The mood state is severe;

  • It lasts for 2 weeks or more; and

  • It interferes with our ability to function at home or at work.

Signs of a depressed mood include:

  • Lowered self-esteem (or self-worth)

  • Change in sleep patterns, that is, insomnia or broken sleep

  • Changes in appetite or weight

  • Less ability to control emotions such as pessimism, anger, guilt, irritability and anxiety

  • Varying emotions throughout the day, for example, feeling worse in the morning and better as the day progresses

  • Reduced capacity to experience pleasure: you can't enjoy what's happening now, nor look forward to anything with pleasure. Hobbies and interests drop off.

  • Reduced pain tolerance: you are less able to tolerate aches and pains and may have a host of new ailments

  • Changed sex drive: absent or reduced

  • Poor concentration and memory: some people are so impaired that they think that they are going demented

  • Reduced motivation: it doesn't seem worth the effort to do anything, things seem meaningless

  • Lowered energy levels.

If you have such feelings and they persist for most of every day for two weeks or longer, and interfere with your ability to manage at home and at work, then you might benefit from getting an assessment by a skilled professional.

Having one or other of these features, by themselves, is unlikely to indicate depression, however there could be other causes which may warrant medical assessment.

If you are feeling suicidal it is very important to seek immediate help, preferably by a mental health practitioner.

psychological treatment


  • Cognitive Behavior Therapy (CBT)

  • Interpersonal Therapy (IPT)

  • Psychotherapies

  • Counseling

  • Narrative Therapy

CBT, IPT, psychotherapy and counselling all provide either an alternative to medication or work alongside medication. As always, a thorough assessment of the person is needed in order to decide on the best set of approaches.

Cognitive Behaviour Therapy (CBT) People suffering from depression - particularly 'non-melancholic depression' - will often have an ongoing negative view about themselves and the world around them. This negative way of thinking is often not confined to depression, but is an ongoing part of how the person thinks about life. Many or all of their experiences are distorted through a negative filter and their thinking patterns become so entrenched that they don't even notice the errors of judgement caused by thinking irrationally.

Cognitive behaviour therapy aims to show people how their thinking affects their mood and to teach them to think in a less negative way about life and themselves. It is based on the understanding that thinking negatively is a habit, and, like any other bad habit, it can be broken.

CBT is conducted by trained therapists either in one-on-one therapy sessions or in small groups. People are trained to look logically at the evidence for their negative thoughts, and to adjust the way they view the world around them. The therapist will provide 'homework' for between sessions. Between 6-10 sessions can be required but the number will vary from person to person.

CBT can be very beneficial for some individuals who have depression but there will be others for whom it is irrelevant.

Interpersonal Therapy (IPT) The causes of depression, or our vulnerabilities to developing depression, can often be traced to aspects of social functioning (work, relationships, social roles) and personality .

Therefore, the underlying assumption with interpersonal therapy is that depression and interpersonal problems are interrelated.

The goal of interpersonal therapy is to help the person understand how these factors are operating in the person's current life situation to lead them to become depressed and put them at risk to future depression.

The therapy occurs in three main phases:

  • an evaluation of the patient's history

  • an exploration of the patient's interpersonal problem area and a contract for treatment

  • recognition and consolidation by the patient of what has been learnt and developing ways of identifying and countering depressive symptoms in the future.

Usually 12-16 sessions of IPT will be required.

Psychotherapies Psychotherapy is an extended treatment (months to years) in which a relationship is built up between the therapist and the patient. The relationship is then used to explore aspects of the person's past in great depth and to show how these have led to the current depression. Understanding this link between past and present - insight - is thought to resolve the depression and make the person less vulnerable to becoming depressed again.

Counselling Counselling encompasses a broad set of approaches and goals that are essentially aimed at helping an individual with problem solving - solving long-standing problems in the family or at work; or solving sudden major problems (crisis counselling).

Narrative Therapy Narrative Therapy is a form of counselling based on understanding the 'stories' that people use to describe their lives. The therapist listens to how people describe their problems as stories and helps the person to consider how the stories may restrict them from overcoming their present difficulties. It sees problems as being separate from people and assists the individual to recognise the range of skills, beliefs and abilities that they already have (but may not recognise) and that they can apply to the problems in their lives.

Narrative Therapy differs from many therapies in that it puts a major emphasis on identifying people's strengths, particularly as they have mastered situations in the past and therefore seeks to build on their resilience rather than focus on their negatives.
physical treatment


The main physical treatments for depression comprise

  • Drug treatments

  • Electroconvulsive therapy

A third physical treatment with as yet narrow application is

  • Transcranial magnetic stimulation.

Drug Treatments There are three groups of drugs most likely to be used for depression:

  • Antidepressants

  • Tranquillisers

  • Anti-manic drugs or mood stabilisers

Antidepressants
  • There is a large number of antidepressants - they have a role in many types of depression and vary in their effectiveness across the more biological depressive conditions.

  • Selective Serotonin Reuptake Inhibitors (SSRIs), Tricyclics (TCAs) and Irreversible Monoamine Oxidase Inhibitors (MAOIs) are three common classes of antidepressants. They each work in different ways and have different applications.

  • At the Institute we believe that they are not, however, equally effective and that it is necessary to find the right antidepressant for each person.

  • If the first antidepressant does not work, it is sensible to move to a different kind of antidepressant. For the biological depressive disorders, more broad action antidepressants are usually more effective.

  • A well-informed health provider should be able to use their assessment of the type of depression, its likely causes and their understanding of the person to identify the medication most likely to benefit.

Finally, being able to decide not to use medication is important too.

Tranquillisers These medications are usually called 'minor' or 'major' tranquillisers.

  • Minor tranquillisers (typically benzodiazepines) are not helpful in depression; they are addictive and can make the depression worse.

  • Major tranquillisers are very useful in people with a psychotic depression and in melancholia where the person is not being helped by other medications.

'Anti-manic' drugs or 'mood stabilisers' These drugs are of great importance in bipolar disorder.

  • Their use in treating mania makes them 'anti-manic', while their ability to reduce the severity and frequency of mood swings makes them 'mood stabilisers'.

  • Lithium, valproate and carbamazepine are the most common.

It is important to remember that the anti-depressants and mood stabilisers are often necessary both to treat the depression that is occurring now, and to make a relapse in the future less likely. So people sometimes need to continue taking medication for some time after they are better.

Electroconvulsive Therapy (ECT) Because of its controversial past many people feel the need to think carefully before having ECT or allowing it to be given to relatives.

Clinicians at the Institute firmly believe that ECT has a small but important role in treatment, particularly in cases of

  • Psychotic depression

  • Severe melancholia where there is a high risk of suicide or the patient is too ill to eat, drink or take medications

  • Life-threatening mania

  • Severe post-natal depression.

While there are some short-term side-effects, ECT is a relatively safe and, because an anaesthetic is used, not too unpleasant.

Transcranial magnetic stimulation (TMS) A possible alternative to ECT is transcranial magnetic stimulation (TMS).

Transcranial magnetic stimulation is a procedure used by neurologists, both as a treatment and as diagnostic procedure. A coil is held next to the patient's head and a magnetic field created to stimulate relevant parts of the brain. Unlike ECT, there is no need for a general anaesthetic nor is a convulsion induced.

In our view, the evidence in favour of this treatment is not yet in, but it is a major area of research at the Institute and elsewhere. If TMS is shown to be as effective as ECT this would be a distinct advance in the treatment of many mood disorders. No clear evidence about its utility is expected for a number of years.