Marcy is 36 and works as a graphic designer for an advertising firm. Marcy had been in a relationship with Tim for seven years but they broke up six months ago and she is struggling to carry on as normal. She has lived in the town for two years, after moving here when Tim got a promotion at work.
Since the breakup Marcy has been feeling devastated and worthless. She struggles to get the motivation to go to work and has had a lot of time off sick. She thinks her manager wants to get rid of her.
Marcy wakes often during the night and can't get back to sleep. At these times she finds her mind going over all the things that have gone wrong in her life. She feels completely hopeless about her prospects for the future and doubts that she will ever have another relationship or will ever have a family. She is angry at herself for “being so stupid” and following Tim to this new town.
She used to be an active person, but now Marcy stays indoors most weekends, and doesn’t bother to eat or wash unless she has to. She has stopped contacting her friends and doesn’t get much enjoyment out of the things that used to matter to her.
What is depression?
We all feel low sometimes - sadness and suffering are a normal part of life. It is normal to feel sad if we get bad news, or if we lose something or someone. Low mood can become depression if it carries on for longer than normal, and if it starts to affect you in other ways:
- Feeling low for most of the day
- Not being interested in things that used to interest you
- Change in appetite - significant weight loss, or weight gain
- Change in sleep - not being able to sleep, or sleeping too much
- Feeling worthless or guilty
What causes depression?
Many people are vulnerable to depression but can stay healthy. Sometimes a 'trigger' comes along which throws us off balance and can lead to depression. This can be anything, but might include losing something or someone important to you, thinking or feeling that we are losing something, or a milestone event such as an anniversary. Things that might make someone vulnerable to depression are:
- Events in childhood which have shaped how the person thinks about themself, the world, and their future
- Lower levels of social support (fewer good, supportive people around them)
- Major life events (e.g. separation, divorce, death, but also positive events such as births)
- Lots of life events or losses in quick succession (this can overwhelm our normal abilities to cope)
(Once I've got depression) what keeps it going?
Whatever has caused an episode of depression there are a lot of things in the 'here and now' that can act to keep it going:
- Unhelpful thinking - Any time we become more emotional (e.g. anxious, depressed) our thinking can become biased which means that we may start to see the ourselves, the world, or our future in unhelpful ways
- Unhelpful behaving - When we feel low it is common to stop doing things we used to because we think they won't be any fun. Or we might cope in other unhelpful ways, such as sleeping too much, or self-medicating with drugs or alcohol.
- Unintended consequences of the ways we choose to act
Common assumptions in depression
We all have core beliefs and assumptions - about ourselves, the world, other people, and our future. In depression it is common for these to be more fixed or more extreme. Some common assumptions in depression are:
- "Unless I succeed in all areas I am worthless"
- "If I disagree (give my own opinion) I won't be liked"
- "I should be happy all the time"
- "I can't be happy unless I am loved"
- "Good things happen to good people. Nothing good is happening to me so I must be bad"
Do you see yourself in any of these?
What can I do to protect myself from depression?
If we know that we are vulnerable to depression there are things that we can do to mitigate against the worst effects:
- Social support is one of the biggest protective factors against depression. Having a friend to talk to, or a group we feel a part of, can make all the difference. Could you rekindle old friendships, or try to make new ones?
- Having a routine, such as work, helps to keep our sleeping pattern regular which can help to prevent depression
- Regular exercise is important in preventing depression. When we feel healthier and more active we are more likely to take pleasure in life
What can I do to overcome depression?
From a CBT point of view, feeling depressed is maintained (kept going) by unhelpful thinking and unhelpful behaviour in the here-and-now. Because these two things keep depression going it is necessary to make changes to how we think and what we do in order to overcome it.
1. Allow more positive things to happen to you
When we become depressed it is common to avoid things. We often do this for the best of intentions - such as to try to avoid a bad feeling - but avoiding comes with a consequence. One extremely successful treatment for depression helps you to overcome depression-related changes in activity and is called behavioural activation
2. Overcome unhelpful thinking
Biased thinking in depression is reversible.
3. Identify and challenge unhelpful core beliefs
Relationships and experiences early in our lives set us up with 'core beliefs' about ourselves, the world, other people, and our future. Beliefs are opinions, not facts, and it can be helpful to update unhelpful beliefs.
Use this to find out what your typical patterns of unhelpful thinking are
Begin to collect details of your negative automatic thoughts
Record your activity and monitor how you feel