In everyday life, the word ‘depression’ may refer to many different things. The phenomenon becomes hard to understand as the word is used to describe both an emotion and a mental disorder. ‘Depression’ may refer to temporarily feeling bad as part of life’s normal disappointments, fatigue, melancholy and sadness. Normally these feelings help people change and develop, and no treatment is needed to handle these feelings.
Sometimes ‘depression’ can refer to a depressed state of mind, which can last for a few days or even months, but it does not involve other symptoms that would make life more difficult. Feeling temporarily bad, due to a disappointment in life, for example, or a depressed state of mind are not mental disorders; experiencing these feelings is not a sign of illness, nor are they treated as one.
The difference between grief and depression lies in the fact that grief usually has an object and a cause, such as loosing a job or someone close. Normally a person in mourning handles the feelings and memories concerning the loss inside their own head. Depression, however, rarely has one clear cause.
Depression as a mental disorder involves long-term lowering of mood, as well as other symptoms involving thoughts, feelings, behaviour and the entire body. Once depression is recognised, it can be efficiently treated.
Depression rarely has one single cause
The reasons for depression that needs treatment may vary. Usually depression is a combination of biological, psychological and social factors – there is rarely one obvious cause for depression. Genes, early living environment and events in life will affect how prone to depression the person will become.
For example, a particularly difficult childhood, such as being subjected to physical, mental or sexual abuse or abandonment, will increase the probability of depression. Depression may result when a person is faced with something extremely burdensome, painful or difficult.
Sometimes depression may be caused by a physical factor, such as dementia, hypothyroidism or Parkinson's disease. The side effects of certain medications, drugs or use of alcohol in general can cause depression in some people. Hormonal factors or the lack of bright light during the winter months may cause depression, as well.
Symptoms of depression
Depending on the severity of the symptoms, the depression may be specified as mild, moderate or severe. Typical symptoms of depression include:
A depressive mood involves feelings of melancholy, grief, numbness and irritability. The future seems bleak or insignificant. In addition, crying may increase a lot.
Loss of pleasure
Things that used to bring joy no longer feel pleasing or interesting. The joy of life has been lost.
A depressed person is overwhelmed by lack of initiative, inertia and fatigue, and he/she no longer seems to have the energy for even the smallest of things.
Loss of self-confidence or self-esteem
Thoughts about inferiority and worthlessness are common; the person no longer has confidence in his/her survival.
Unreasonable self-criticism or unfounded feelings of guilt
Feelings of guilt and deserving to be punished. Feelings of guilt often emerge in connection to situations the person has had no control over or where he/she had done nothing wrong.
Repeated thoughts of death or self-destruction or self-destructive behaviour
A depressed person may harbour thoughts of death and hopes of dying, as well as have suicidal thoughts.
Feelings of indecision or the inability to concentrate
The person is no longer able to concentrate or take action in matters that used to feel effortless.
Psychomotoric retardation or agitation
The person may either become paralysed or anxiously hyperactive.
A sleep disorder may present itself as difficulties in falling asleep, interrupted sleep and waking up during the early hours of the day, or it may present itself as hypersomnia.
Changes in appetite and body weight
The person may lose their appetite and lose weight, or their appetite may be increased and weight gained.
The symptoms of depression can be quite different from one person to another. Sometimes depression presents itself through vague physical pain and discomfort, making it difficult to detect. In addition, a person suffering from depression may find it difficult to describe his/her feelings to the people close to him/her or to the health care professionals. Instead of talking about depression, he/she may talk about personal relationships, sleeping problems, financial troubles or health problems.
The identification and treatment of depression have developed over the past decades. Today, depression and its identification are approached similarly to other illnesses. When treatment is sought and received in time, it will speed up recovery and prevent the depression from getting worse. However, persons suffering from depression often will not seek help until they feel they can no longer handle the symptoms. Read more about seeking treatment.
Sometimes the person needs to be very active in order to receive treatment. This is unfortunate as persons suffering from depression are often exhausted and taking even the smallest of steps in order to begin treatment may seem very difficult.
Treatment methods for depression
There rarely is one single cause for depression, thus there are various methods of treatment available. Normally depression is treated with drugs and psychotherapy at the same time. Depression can also be treated by providing someone to talk to; conversational help is usually offered by depression nurses (specially trained in depression treatment) at health care centres. Different kinds of groups are also helpful in the treatment of depression. Extreme cases may also require hospitalisation. Read more about recovery.
There are many different kinds of antidepressant medications, which can affect the biological causes behind depression. The official treatment recommendation for depression is based on a combination of psychotherapy and medication. Sometimes people suffering from depression can be so tired they do not have the energy to commit to psychotherapy or deal with the difficult life situation without medication.
Antidepressants are divided into tricyclic antidepressants, serotonin–norepinephrine reuptake inhibitors, selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors. The mechanism of action of the different groups of antidepressants varies slightly, because they affect the brain neurotransmitters in different ways.
The antidepressant groups are often referred to as the old and new generation antidepressants. Usually the new generation antidepressants have fewer side effects, such as tiredness and dry mouth. Nevertheless, the old generation antidepressants are better suited for some people suffering from depression. Read more about treating mental disorders with medication.
A patient suffering from depression will not feel the effects of the antidepressant medication right away; instead, their effect will gradually intensify within 2 to 8 weeks from the beginning of the treatment. The medication should not be interrupted, even if the medication may not seem to be working at first or the tiredness only seems to be getting worse.Insomnia is usually the first symptom of depression to be alleviated by the medication; it takes more time for the mood to improve.
If the prescribed medication does not seem to work, the doctor may replace it with another, change the dosage or include another drug in addition to that already being used. Some depressive states are better treated with psychotherapy than medication. Ideal treatment is usually a combination of psychotherapy and medication.
If the medication is working, it should be used between four to twelve months as prescribed by the doctor, even after the disappearance of the symptoms. Depression may recur if the treatment is discontinued too early. Treatment is always discontinued according to the doctor’s instructions; in order to minimise the symptoms caused by discontinuing the medication, the dosage is usually reduced gradually.
These symptoms may include headache, tiredness, sweating and irritability. The symptoms may occur when the body is readjusting to the discontinuation of medication. If the anxiety and depression continue or become worse after a month has elapsed since the ending of the treatment, it could be that the medication treatment was discontinued too early.
Some people suffering from depression should continue the medication treatment as so-called maintenance treatment long after the last depressive episode has ended. The medication should be continued for maintenance purposes especially if the depression has been severe, it involved self-destructive thoughts, there have been at least three severe depressive episodes, or if the person suffering from depression has significantly benefited from the medication. Prophylaxis, i.e. the treatment that is begun at the first appearance of depressive symptoms, may also prove useful if the person who has previously suffered from depression notices that a depressive episode is about to begin.
Psychotherapy has proven itself an effective treatment method for depression. Psychotherapy promotes recovery from depression for the following reasons:
- With psychotherapy, the person can learn to better identify his/her personal ways of thinking and will thus be able to change them. He/she begins to understand why he/she thinks in a certain way and how to lose the harmful thoughts.
- Understanding of the reasons for and backgrounds of depression may increase. At the same time, this creates the chance to deal with grief and difficult issues.
- The perception and interpretation of feelings may change. Awareness and understanding of personal feelings may develop. The patient will learn to interpret himself/herself in new ways.
- The ability to give new meanings to personal problems may develop.
- The ability to see one’s own life situation from a new point of view may develop.
- The changes in ways of thinking may result in changes in close relationships, at work and in studies.
- Psychotherapy may enhance the experience of active agency, i.e. of the person being able to influence his/her own life and the communities he/she belong to.
Making use of peer support and rehabilitation courses
Peer support refers to activities where people who have experienced roughly the same issues or people in the same life situation share their experiences with each other. Peer support is based on mutual equality, on being heard and understood, as well as on encounters and support. The central goal of peer support groups is to promote coping and recovery. Peer support groups often have counsellors who help the group to focus on the future.
Several parties organise rehabilitation for mental health patients in collaboration with KELA. For example, the rehabilitation unit of the SOS Crisis Centre also organises rehabilitation courses and peer support groups. Additional information on rehabilitation can be obtained, for example, from the Finnish Central Association for Mental Health.
Depression is a common mental disorder
Depression causes disability
Depression is a serious public health problem. Alongside musculoskeletal disorders, it is the biggest reason for disability retirement in Finland. Depression as a mental disorder is now better recognised than before, resulting in a significant statistical increase in the number of people suffering from depression.
However, generalisation about depression cannot be explained unambiguously. For example, it is possible that the stress and uncertainty of the modern work life, as well as the performance-based way of life, consume so much energy that the ability of those suffering from depression to function normally is lower than before, therefore resulting in increased disability caused by depression.
Depression involves the risk of suicide
It is very common for a person suffering from depression to have self-destructive thoughts. Hopes of dying and suicidal thoughts express the person's will to get out of an extremely tormenting state brought on by severe depression. However, the hopelessness and pain caused by depression are not permanent. Depression can be treated effectively and in a way that promotes recovery.
People who have recovered from depression often say they feel like life makes sense again, even though nothing in it made sense during the height of the depression. The longer and more serious the depression, the higher the risk of suicide. This is why treatment must always be sought in time. Suicidal talks of a depressed friend or family member should always be taken seriously and he/she should be encouraged to seek professional help. Read more about suicide.
Depression may recur
Depression has a tendency to recur. The more serious the depression and the higher the number of previous depressive episodes, the higher the probability of recurrence. Early identification and treatment of depression is the best way to prevent new depressive episodes.
When someone close you is depressed
Depressed persons often do not have the energy to maintain personal relationships and they may isolate themselves from the rest of the world. However, close relationships and the social network are extremely important to them: depressed people need support and help from the people closest to them in order to prevent the depression and isolation from getting worse.
Depression in a loved one can be energy consuming
Depression in a person close to us is difficult: feelings of loneliness and helplessness, as well as concern over the person who is depressed can be a very heavy burden to bear. When someone close to us is depressed, it often creates mixed and difficult feelings. Relatives and friends should remember that they do not have to, nor should they, go along with the moods of the depressed person. Similarly, they do not need to react or try to find a solution to every manifestation of anxiety made by the depressed person.
The most important thing is to remember to tell the other person that he/she is important. Sometimes simply knowing that someone really cares helps the person who is depressed. One should keep in mind that the actual treatment of depression should be left to health care professionals. However, it is often the task of family and friends to maintain the hopes of depressed persons: to remind them that they are getting the help they need and that it is possible to overcome depression.
Family and friends must take care of their own well-being and coping
Family and friends should always remember to take care of their own well-being. An exhausted person will not have the energy to support someone else. That is why it is so important to try and live your own life, go out, continue hobbies as normal, or do whatever makes you happy even if someone close to you is depressed. Enjoying life is not forbidden.
One should keep in mind that the depressed person certainly does not want to see people close to him/her exhausted; in fact, he/she may even be afraid of being too heavy a burden. Maintaining personal well-being does not take anything away from the person who is depressed; instead, it forms mutual resources. Support and peer activities are available for the families and friends of people suffering from depression. Sometimes it feels good to discuss what has happened together with people in the same situation.
Depression and adolescence
During adolescence, people develop fast physically, psychologically and socially. Adolescence is an important period in terms of the development of mental health. Depression-like symptoms may appear as early as childhood, manifesting themselves as restlessness, self-effacement and behavioural disorders. However, the probability of depressive episodes is dramatically increased during puberty and shortly thereafter. Puberty is characterised by intense feelings, occasional melancholy and sadness. Depression can be distinguished from these mood changes involved in the turmoil of puberty.
Unlike adults, the most obvious symptoms of depression in young people are irritability or anger instead of the actual feeling of depression. Nevertheless, adolescents also experience the same feelings as depressed adults, such as losing interest in things they used to find interesting. Depression in adolescents becomes especially concerting when their behaviour changes dramatically when compared to their previous behaviour.
Good relationships with parents and friends contribute to the recovery of a depressed adolescent
Girls are more likely to get depressed than boys, or at least depression in girls is more likely to be diagnosed. Social support is extremely important to a depressed adolescent. Good relationships with friends and parents promote recovery. Many young people suffering from depression also suffer from another problem at the same time. These problems are most likely to be substance abuse problems, attention deficit and behavioural disorders, as well as eating and anxiety disorders. There are efficient treatments available for all these problems.
Seek help for a depressed adolescent.
Depression and the elderly
Changes in health and life situations brought on by old age may put a strain on mental health. The increased need for assistance, dependency on other people, and coping with grief and loss are demanding to mental resources. Depression in old age is often concerned with losing friends and family members, as well as the deterioration of personal physical health. Loneliness can also be very taxing to the mental health of many seniors.
Depression in elderly people may easily go unnoticed
Depression in old age easily goes unnoticed as many of the symptoms of depression, such as sleep disorders, fatigue and loss of appetite, are often considered as natural changes coming with old age. On the other hand, the condition of apparently demented seniors may have been significantly improved once the depression has been identified and treated. Isolation, vague pains, delusions and memory disorders in the elderly may be signs of depression, as well as of other illnesses. Depression in the elderly may be hard to identify if the depressed person attempts to sugarcoat his/her condition as a result of personal negative images and fears concerning mental disorders.
The birth of a child results in emotionality
Most mothers become more emotional after childbirth, to some extent at least. Emotionality is often characterised by crying, mood swings, irritability, and problems with sleep and appetite. The baby may feel strange and the mother may not feel as she would like. Often the love for the baby develops little by little. Unrealistic expectations and stories of infancy automatically being the most wonderful time of a mother’s life can result in strong feelings of guilt.
Postpartum emotionality is perfectly normal; it is brought on by the changes in life caused by having a baby, the birth experience, and the hormonal changes caused by birth. More than anything, a mother experiencing postpartum emotionality needs understanding and support from people close to her and from health care professionals.
The prognosis for postpartum depression is good
Actual postpartum depression is a condition that requires treatment. There is a thin line between emotionality and depression, and sometimes the depression develops slowly. Postpartum depression develops within one year from the delivery. Its symptoms are similar to other depressive episodes. However, in addition to exhaustion, lack of initiative and anxiety, the mother may have obsessive thoughts and fears concerning the baby and the baby's care; for example, the mother may think she may harm the baby.
These fears are very rarely justified, but it is always important to seek help for postpartum depression. Postpartum depression often involves unfounded feelings of guilt, which, at first, may prevent the mother from seeking help. The mother may start to think that she cannot tell about her depression to anyone, because everyone expects her to be happy about the baby. However, postpartum depression is a mental disorder which has nothing to do with how much the mother loves her baby. The prognosis for postpartum depression is good.
Physical illness and depression
A severe physical illness can put one’s mind to test, as well. Cancer, for example, increases the risk of depression. There are various support groups for people with different illnesses (for example Syöpäjärjestöt (Cancer Society of Finland) or Reumaliitto (Rheumatism Association). People can contact these groups when they feel down over their illness or when they simply need peer support.
Severe physical illnesses affect the mood; the changed situation in life and different kinds of fears brought on by the illness put a strain on the mental health of an individual. Sometimes these changes may cause so much stress that they lead to depression. Thus, the depression should also be treated.
Proper treatment of physical illnesses will prevent depression from developing: sufficient information on the illness and its treatment, availability of medical personnel and the smoothness of treatment in general are extremely important to the mental health of the patient.
Seasonal affective disorder
In case depression mostly occurs during wintertime, it may be a case of seasonal affective disorder. During the dark months of the year, a considerable number of Finns feel the need to sleep late, become easily irritated, are constantly tired, crave for something sweet to eat and gain weight. For a small number of people, these symptoms become so strong, they must be interpreted as seasonal affective disorder. Seasonal affective disorder involves anxiety, hopelessness and self-destructive thoughts.
In addition to various other treatment methods, seasonal affective disorder may be treated with light therapy, i.e. by using an efficient bright light luminaire. Exercise, and outdoor activities in particular, often have a positive effect on the mood. Fitness training is definitely worth trying when fighting back seasonal affective disorder.
Recovering from depression
Depression is the most common mental disorder in Finland and is therefore discussed separately in this section. Each year, thousands of Finns return to work or studies after recovering from a depression that required treatment. The speed of recovery from depression varies from one person to another and various things affect recovery. The following factors, for example, may promote recovery from depression and other mental disorders or problems. Read more about recovery in general.
General optimism towards life
It is difficult for depressed people to feel optimistic about the future; after all, the symptoms of depression include feelings of unhappiness, melancholy and lack of prospects. However, it has been stated that those depressed individuals who deliberately tried to maintain a positive attitude and believe in their own coping also recovered faster.
Learning to lose negative thoughts
When the depression is diagnosed for the first time, the person suffering from the disorder has often experienced one or more traumatic events in his/her life, such as divorce, rejection or loss of employment. However, research shows that the significance of these difficult life experiences is lessened during later depressive episodes. Instead, it would seem that depression is more likely to recur as a result of negative thoughts and images.
This is a sort of a vicious circle. As melancholy sets in, the thoughts of the person become more dark and melancholic: "I’m good for nothing, I wonder what everyone is thinking when I’m like this, I usually fail...” These negative thoughts, in turn, cause the person to see himself/herself and his/her surroundings in an ever more pessimistic light.
Most people get past this kind of worrying and dwelling on things but negative thinking is more common and permanent for people suffering from depression. People suffering from repeated depressive episodes should learn different ways of controlling their thoughts. It is important to realise when your thoughts begin to circle around negative things and to understand that such thoughts do not promote personal well-being.
Similar awareness of personal thoughts is necessary, not only in depression, but in many other mental disorders, as well. Recovering from, for example, bulimia or other eating disorders, becomes easier when the patient is aware of the issues and thoughts that may trigger binge eating or unhealthy dieting. With bipolar affective disorder, it is particularly important to learn how to anticipate the symptoms of mania.
Writing and other helpful activities
Writing helps in analysing difficult experiences, thoughts and feelings, thus increasing self-understanding. Some people who have recovered from depression say that only by writing and reading their own texts they began to understand the reasons behind their illness.
Writing a diary is perhaps the most common way to unload and understand the anxiety the person is feeling, but many people also write poems or stories. Tukinet allows you to write about your experiences to a trained support person or share your feelings in group discussions. The operation of Tukinet is mainly based on counselling, i.e. you will have your own support person, with whom you can reflect on your own situation through writing. In addition to writing, painting, playing and listening to music may promote the understanding of personal feelings and thereby recovery at times.
Exercise increases the secretion of pleasure-producing hormones in the brain, thus alleviating depression and anxiety in particular. Severely depressed people find it hard to find the energy even for a short walk outside. That is why simply eventually getting up and going out can make the patient feel good. When thinking about doing some exercise, it should be remembered that even little exercise is better than no exercise. In addition to depression and anxiety, exercise also helps alleviate nervousness and tension.
Support of family and friends
The support of families and friends has been found to have a major impact on recovery. For example, a person suffering from depression often easily becomes isolated, and the fatigue involved in depression may make it difficult to leave home. Therefore a simple visit to town or cooking together with friends can already cheer up the person. Naturally, rest should not be forgotten. You cannot make depression disappear by telling the depressed person to cheer up.
However, withdrawal from social relationships does not promote recovery. However, not everyone has family or friends and others find it too difficult to talk about the disorder. Therefore mental health patients must think for themselves what would promote their personal recovery.
Finding significant things and life meaningful
Many people suffering from depression have said that they noticed they had started to recover when, after a long time, small things felt good again. Although people usually find the things that they find meaningful and important by chance, they can also consciously look for them. You should do things you think might make you feel good or that used to feel good. Even small moments of joy are sometimes steps towards recovery.