A depressed mood is characterized by a significantly lowered mood and a loss of interest or pleasure. Experiencing a depressed mood from time to time (particularly in response to negative external events) is a common and normal experience. This is to be distinguished from a major depressive episode, which is characterized by the presence of either:
- A markedly depressed mood, most of the day, nearly every day;
- A markedly diminished interest or enjoyment in all, or almost all, usual activities, most of the day, nearly every day;
persisting for at least a two week period; along with the presence of at least four of the following symptoms:
- Disturbed appetite (a decrease or increase in appetite, resulting in significant loss or gain in weight);
- Disturbed sleep (insomnia or sleeping too much);
- Psychomotor agitation or retardation;
- A lack of energy, tiredness, fatigue;
- Difficulty with thinking clearly and sustaining focus and concentration, associated with difficulty making decisions and not remembering things;
- Feelings of worthlessness and/or excessive guilt;
- Ideas or acts of self-harm or suicide;
- Reduced self-esteem and self-confidence;
- Decreased libido.
However, a lot of people who will experience depression may not fulfil the requirements for a diagnosis of major depression. As depression can be experienced in many different ways. It can build gradually, or it can come on suddenly. It can vary in its severity, as well as vary in the symptoms experienced and the effect that it has on the person.
For some individuals, their general functioning will be as normal (i.e., sleep, appetite, energy, concentration and memory), while their mood may be flat (often with feelings of emptiness). Others may predominantly experience a lack of energy, motivation, interest and enjoyment.
Dysthymia is a milder and more chronic form of depression, where a person can suffer a depressed mood for years, even perhaps for much of his or her life without knowing it. Some individuals could almost be regarded as having a depressive personality style.
Regardless of the form and/or severity of the depression, individuals usually seek treatment when the experience is distressing to them or bothering them in some way; or it sufficiently interferes with their everyday functioning (i.e., personal, work, or social functioning) and/or their quality of life.
For some individuals, anti-depressant medication will be the first line of treatment (particularly for those with severe depression). Anti-depressant medication can provide significant assistance when the depressed individual is distressed or particularly troubled by the depressed mood; and/or when the individual’s functioning is significantly affected.
In most cases, depending on the type and the nature of the depression, Cognitive Behaviour Therapy (CBT) is an essential initial therapeutic approach to the treatment of depression. As the individual is feeling down and negative, his or her thinking and behaviour will be negative. Cognitive therapy helps individuals to identify and correct their distorted and negatively biased thinking. Behaviour therapy helps to identify and change aspects of behaviour that may be playing a part in maintaining the depression, or that may even be making the depression worse. Some individuals may also benefit from being shown relaxation techniques and/or meditation. Once learned, cognitive-behavioural strategies can be applied again if/when the individual has any further difficulty with depression, or they can be applied regularly to minimize the re-occurrence of depression.
Where an individual has experienced recurrent episodes of depression, or has experienced chronic depression (as in the case of dysthymia), I often suggest or recommend a treatment approach comprising the initial use of CBT, until the person is better managing his or her mood, to be then followed by the use of psychodynamic psychotherapy. As such individuals will often have low self-esteem and a lack of sense of self, and will have personality traits that undermine their self-esteem and leave them susceptible to depression (and other disorders) … such as a tendency for self-criticism and ‘being hard on oneself’.