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What is depression?

Everyone feels low at some point in their lives, but depression can be distinguished from this ‘everyday’ low mood by its intensity and its duration. When someone is depressed, they cannot see any end in sight for their feeling of hopelessness and this feeling can go on for weeks, months or even years if left unattended to. The other significant thing about depression is the damaging effect it normally has on someone’s ability to function.

The following list includes some of the features of depression that many people who have suffered from it experience:

  • Loss of interest in life and things that used to interest them

  • Feeling unhappy and miserable virtually all the time

  • Restlessness, agitation and/or irritabbility

  • Difficulty making decisions

  • Poor concentration

  • Feelings of uselessness and inadequacy

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Risk factors for depression

Explore the risk factors surrounding depression

Many of the most important risk factors for depression are to do with relationships with other people.

Poverty

Socioeconomic factors are also thought to be important in increasing the risk of becoming depressed. Poverty is particularly important because it can reduce the opportunities people have to support their social network, for example, by making it difficult for them to travel to visit friends and relatives.

Poverty is also known to be a risk factor for physical ill-health, which, in turn, increases the risk of depression. Those living in poverty are also known to be at higher risk of crime and are more likely to live in environments that can feel unsafe, all of which can increase the stress associated with depression and also high levels of anxiety.

Social isolation

Social isolation is also a key risk factor, mainly because it brings with it particular stresses and deprives people of the types of support that can reduce the risk of becoming depressed. It is important to note that 48% of people aged over 75 years live alone (Age Concern 2005).

Physical ill-health

Physical ill-health - particularly chronic pain and disability - are all risk factors too. Intuitively, it makes sense that being in constant pain or finding it difficult to perform ‘simple’ tasks can, in themselves, be depressing experiences. This is partly because each of these factors can affect someone’s ability to join in social activities.

Bereavement

Bereavement is a very common cause or trigger for depression, particularly for older people. The strain that caring for someone can cause, the conflict and disagreements that can arise between individuals, and loss in a general sense, are all factors that can increase the likelihood of someone experiencing depression.

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Protective factors

Focusing on the risk factors that can make people vulnerable to depression can mean that their strengths and resilience are too easily underestimated or even overlooked completely.

The reality is that there are a number of ‘protective factors’ that help to prevent people from becoming depressed. The likelihood or not of developing depression depends on each individual’s circumstances and their own unique balance between risk and resilience, which, of course, also varies over time. (Godfrey et al 2005)

Self-esteem

Some individuals have high levels of self-esteem and self-confidence, which make it less likely they will experience depression in later life. These are also factors that might well have protected them from becoming depressed when younger.

Strong social network

Those individuals who sustain a strong social network based on interdependence with others are also less likely to develop depression. Being involved in social activities - especially those that may be valued by others - and having a sense of belonging all act as a buffer against the stresses and strains of life that can literally make life depressing.

Sense of belonging

Those who have a strong sense of belonging to their locality and are attached to the places they live in are also thought to be less vulnerable to depression, even in the face of losses such as bereavement.

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Recognising and treating depression

One of the most important issues relating to the diagnosis and treatment of depression in older people is that fact that it is often overlooked or its significance underestimated. Many older people themselves do not necessarily recognise depression as an illness and some may even consider it a ‘normal’ part of the ageing process. It is therefore less likely that they will raise it with their GP or anyone else.

Some professionals fall foul of some of the negative stereotyping of old age themselves and mistake the signs and symptoms of depression for normal ageing.

Some professionals may also find it awkward to discuss emotions and feelings with patients for fear of causing offence or through personal embarrassment. They therefore might never enquire deeply enough to uncover the extent of the depressed feelings that someone may be experiencing.

Some professionals may also find it awkward to discuss emotions and feelings with patients for fear of causing offence or through personal embarrassment. They thereby might never enquire deeply enough to uncover the extent of the depressed feelings that someone may be experiencing.

It is important to recognise that depression is not normal and early recognition, diagnosis and treatment of it is essential to preventing unnecessary suffering. Treatments can include not only drugs such as antidepressants but also counseling and building social networks to reduce the impact of social isolation (Source Moriarty 2005). Treatments can also include alternative or complementary therapies such as acupuncture.

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Recognising and treating depression

Read the transcript of Deborah talking about some of the difficulties she has faced with depression. As you read note from the list of difficulties below the 3 that she mentions. When you have finished click on NEXT to check your answers.

  • No energy
  • No end in sight
  • Social isolation
  • Increased forgetfulness
  • Feeling afraid and anxious all the time
  • No understanding of what depression is

“The worst thing about depression, when I had it at least, was the feeling that I was completely cut off from other people. Even when I did see anyone, like when my daughter came to visit, it would never feel completely real somehow. I would never feel we really made contact. So I began to feel that there was no point in seeing other people at all. I stopped going out and when I had to go out, like to do some shopping, I avoided people and avoided talking to anyone.

Then other people, shopkeepers and so on, start to think you’re just a miserable old woman, so they stop trying to be friendly, which is even more depressing. And so it goes on and on, a horrible, vicious circle.

But if I had to say what the worse thing about depression was for me, it was the lack of energy. Doing anything, anything at all, even little bits of housework, felt like swimming through treacle. Looking back, I can hardly believe the hours and hours I would spend just sitting there in that old armchair doing nothing. And to make everything even worse, it never, ever felt as though there was an end in sight. After all, why should there be? I never understood how or why it started, so how could I know when it would end, if it would ever?

It just felt as though my life had come to a natural end but that my body was struggling on somehow. I really did start to believe that growing old was just very, very depressing and that feeling this way must be almost normal.”

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Recognising and treating depression

You should have selected the following three items from the list of difficulties Deborah mentions:

  1. Social Isolation
  2. No understanding of what depression is
  3. No Energy