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Depression

“This music is so depressing”, “He looks so depressed”, “This shift is so slow it’s depressing”. Carelessly overused, inaccurate, and at times, belittling, the term ‘depression’ leads to confusion when we are going through real distress, and are trying to figure out what to do about it.

Depression is a medical illness.  The disease affects the brain, which in turn can affect the rest of the body. Depression can affect anyone, regardless of age, income, race or gender. Fifteen percent of adults in North America will have suffered from depression at some point in their lifetimes.

Everyone feels down from time to time. However, with depression, these feelings are more severe and occur nearly every day for two weeks or more.

Depression may be caused by one thing or a combination of factors including biological, psychological and environmental – like feelings linked to social or family life.

Below we will try to explain what depression can look like, feel like, or how it can express itself in a person. Although; it should be kept in mind when reading this list that people experience depression at different intensities and on many levels.

Depression is a severe medical condition and should be diagnosed by professionals. The information listed here does not replace getting proper help and guidance from your doctor.

Emotional Symptoms

How does depression feel? What are signs that I might be depressed?

  • Feeling sad, empty, hopeless, or numb
  • Feeling restless, irritable, or anxious
  • Difficulty concentrating or making decisions
  • Less interest or participation in activities normally enjoyed
  • Feeling guilty or worthless
  • Repeated thoughts of death or suicide

Physical Symptoms

Depression isn’t always just a mental thought, it can show up as a real physical issue that might seem to be something else entirely.

  • Low energy and feeling tired all the time
  • Changes in appetite or weight (eating more or less)
  • Sleeping more or less, just not wanting to get out of bed or insomnia
  • Increased use of drugs or alcohol, typically to “black out” levels
  • Self-destructive behavior, loss of control, or uncontrolled rage, usually out of nowhere and without any real just cause
  • May include headaches, aches, pains, digestive problems, dizziness or lightheadedness

Environmental Factors

Depression can often be triggered by very stressful life events, such as:

  • The death of a loved one, a move, a divorce or breakup, financial difficulties or job loss
  • Social isolation or loneliness, which can come from bullying, abusive relationships. etc
  • Periods of relationship conflict, whether personal, work or home
  • Demanding work or a stressful workplace
  • Health issues, especially when the health issue is ongoing

Biological Factors

Primary theories suggest that depression is caused by an imbalance of naturally occurring substances called neurotransmitters in the brain and spinal cord.

Serotonin and norepinephrine are two neurotransmitters in the brain that appear to be involved in the symptoms of depression.

Types of Depression

Just as there are many different signs and symptoms of depression, there are different types, usually categorized into four groups:

Stress-related depression may be caused by sudden stress or a significant event like a breakup, losing a job, bad grades, or the death of a loved one. This is a fairly obvious type of depression to spot – a major life crisis spins a person into a “bad time”. Typical treatments include talk therapies and possible antidepressants, depending on the severity of the episode. Stress-related depression can lead to more severe forms of depression.

Seasonal depression (seasonal affective disorder, or SAD) tends to come around the same time each year, usually in the fall or winter, when there is less sun and the days are shorter. Western British Columbians suffer from SAD quite frequently, and to different intensities. Seasonal depression has many of the same signs as depression like feeling down, tired, short-tempered, craving sweets and starches, headaches, and having problems sleeping. Treatments range from upping your vitamin D dosage and broad-spectrum lighting to medication.

Chronic depression (dysthymia) is not a severe type of depression, but symptoms can stay with you for a long time and affect your daily life. Without treatment, chronic depression can lead to major depression. Many people with chronic depression suffer from major depression at least once in their lives. A lot of chronic depression is treated with low-dose antidepressants, talk therapies and mental exercises.

Major depression is a severe form that can lead to problems at home, school, and work. It can keep you from being able to study, sleep, and find joy in things like sports, music, friendship, and sex. While some people only suffer from major depression once in their life, others suffer from it many times. Major depression needs professional help, be it therapy, medication or both.

Bipolar disorder (manic-depression) can involve extreme changes in mood. May change from feeling depressed to feeling very active or talkative to feeling “normal.” Sometimes this can look like someone on a sugar high; hyper, chatty, seemingly very happy, then crashing hard and being very low, or even angry for no reason.

Treatment Options

Cognitive behaviour therapy (CBT) – helps you identify and challenge the negative thinking patterns and irrational beliefs.

Exposure therapy – encourages you to confront your fears and anxieties in a safe, controlled environment. By gradual exposure to the feared object or situation, either in your imagination or in reality, you gain a greater sense of control, and as you face your fear without being harmed, your anxiety will diminish.

Cognitive-behavioural therapy and exposure therapy are types of behavioural therapy, meaning they focus on behaviour rather than the underlying psychological conflicts or issues from the past.

Dialectical behaviour therapy (DBT) This approach works towards helping people increase their emotional and cognitive regulation by learning and assessing what triggers them, and how to apply specific coping methods to avoid undesired reactions. DBT combines standard cognitive behavioural techniques for emotion regulation and reality-testing with concepts of distress tolerance, acceptance, and mindful awareness.

Electroconvulsive Therapy (ECT) For very severe, persistent depression. Not shock therapy but rather very low-level electrical pulses. It is often effective and has few side effects.

Eye movement desensitization and reprocessing (EMDR) is a form of psychotherapy in which the person being treated is asked to recall distressing images while generating one type of bilateral sensory input, such as side-to-side eye movements or hand tapping. Unlike CBT with a trauma focus, EMDR does not involve (a) detailed descriptions of the event, (b) direct challenging of beliefs, (c) extended exposure or (d) homework.

Selective serotonin re-uptake inhibitors (SSRIs) – block the reabsorption (re-uptake) of serotonin in the brain, making more serotonin available.

Tricyclic Antidepressants – This seems to stop neurotransmitters from binding with specific receptors on the nerves. Because the norepinephrine and serotonin refuse to bind to the receptors, they seem to build up in the areas between the nerve cells. As a result, the neurotransmitter levels rise.

Monoamine oxidase inhibitors (MAOIs) – Monoamine oxidase is a natural enzyme that breaks down serotonin, epinephrine, and dopamine. MAOIs block the effects of this enzyme. As a result, the levels of those neurotransmitters might get a boost.

Mixed Re-uptake AntidepressantsDual inhibition of serotonin and norepinephrine re-uptake can offer advantages over other antidepressant drugs by treating a wider range of symptoms.

Nutraceuticals or “medical food” is a prescription strength form of folate, also known as one of the essential B vitamins, B9.

Natural Drugs – CBD, Mushrooms.

It is important to discuss all symptoms you may have with your doctor to get the most appropriate therapy!

Questions to Ask Medical Professionals

What is causing my depression? Is it another health problem or medication?

Which treatments are right for me (medication, counselling, or both)? Why?

What medication side effects should I look out for?

If I notice side effects, who should I contact, you or someone else in your office?

Are there any foods, alcohol, or medications that I shouldn’t take while I’m on this medication?

How long will it take before I start feeling better?

How long do I need to take this medication and/or be in therapy?

What if this doesn’t work? What’s next?

Will my insurance pay for it? How much will I have to pay?

What if I can’t pay for the medication? Are there any free as samples from the company that makes it?

Should I think about experimental treatments or clinical trials?

Is there anything else I can do to feel better?.

How do I talk about my depression with other people?

Should I talk to my advisor or my boss about it?

What should I do if I start to feel suicidal?

Resources

Crisis Services Canada
Canadian Mental Health Association
E-Mental Health
Find a Therapist

Regional Support Services

British Columbia

BC Crisis Centre & Mental Health Support 
310-6789
1-800-SUICIDE (784-2443)
#211

Reduced Cost Counselling Options in Vancouver

Crisis Intervention & Suicide Prevention Centre of BC
Vancouver Coastal Region: 604-872-3311
Sunshine Coast/Sea-to-Sky: 1-866-661-3311

BC Interior Crisis Line Network 
(Serving all BC Interior Region)
1-888-353-CARE (2273)

Crisis Prevention, Intervention 
& Information Centre for Northern BC
(Serves all of Northern BC)
250-563-1214 
1-888-562-1214

Vancouver Island Crisis Society
1-888-494-3888

North Island Crisis & Counselling Centre Society
250-949-6033

Alberta

Distress Centre
1-403-266-HELP

Mental Health Helpline
1-877-303-2642

Distress Line of Southwestern Alberta 
(Serving Chinook health region)
1-888-787-2880
(403) 327-7905

The Support Network Distress Line
(Serving Edmonton and surrounding areas)
1-800-232-7288

Manitoba

Klinic Crisis Line
1-888-322-3019

Crisis Stabilization Unit
(Serving Winnipeg Health Region)
204-940-3633

Mental Health Crisis Service
(Serving Central Regional Health Authority)
1-888-310-4593

Saskatchewan

Saskatoon Crisis Intervention Service
306-933-6200

Saskatchewan HealthLine
#811 or 1-877-800-0002
306-766-6600

Ontario

Connex Ontario
1-866-531-2600

Good2Talk
1-866-925-5454

District and Crisis Ontario Helplines 
416-486-2242

Gerstein Crisis Centre
416-929-5200

Mental Health Crisis Line
Ottawa: 613-722-6914
Greater Ottawa area: 1-866-996-0991

New Brunswick

Chimo Helpline
1-800-667-5005
Fredericton area: 450-HELP (4357)

Yukon

Yukon Crisis Line
403-668-9111

USA

Mental Health America
1-800-273-8255
Text ‘MHA’ to 741741

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