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Back from the Bluez

Module 1

Overview of Depression

What is Depression? 2
Depressive Symptoms Worksheet 4
What Causes Depression 5
Psychotherapy for Depression 7
Module Summary 8
About the Modules 9

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What is Depression?
Many people experiencing the symptoms of depression might begin to wonder if there is something really wrong
with them. One typical fear is that they might be going crazy. Unfortunately, the reactions and comments from
other people such as, “Just get yourself together!” are not very helpful.

Although you might feel alone in your struggle against depressive moods, the reality is that many people
experience these moods from time to time, or even regularly. In fact, it is estimated that 1 in every 4 persons
experience significantly depressed mood at some time in their life.

Depression can affect any kind of person at any stage of their life. You may be an introvert or an extrovert,
socially active or shy, youthful or elderly, male or female, wealthy or poor. Whatever your distinction, you can
become depressed. That means that any person you know is fair game. So remember, you are not alone.

Depression is a word used in everyday language to describe a number of feelings, including sadness, frustration,
disappointment and sometimes lethargy. However, in clinical practice, the term "Depression" or "Major
Depression" differs from these everyday 'down' periods in three main ways:

• Major Depression is more intense

• Major Depression lasts longer (two weeks or more)
• Major Depression significantly interferes with effective day-to-day functioning

In this information package, the word depression is referring to Major Depression or clinical depression.

Depression as a Syndrome
A syndrome is a collection of events, behaviours, or feelings that often, but not always, go together. The
depression syndrome is a collection of feelings and behaviours that have been found to characterise depressed
people as a group. You may find that you experience all or some of these feelings and behaviours. There are many
individual differences to the number of symptoms and the extent to which different symptoms are experienced.
These symptoms are described in this next section.

Mood
Depression is considered to be a disorder of mood. Individuals who are depressed, describe low mood that has
persisted for longer than two weeks. In mild forms of depression, individuals may not feel bad all day but still
describe a dismal outlook and a sense of gloom. Their mood may lift with a positive experience, but fall again with
even a minor disappointment. In severe depression, a low mood could persist throughout the day, failing to lift
even when pleasant things occur. The low mood may fluctuate during the day – it may be worse in the morning
and relatively better in the afternoon. This is called ‘diurnal variation,’ which often accompanies a more severe
type of depression.
In addition to sadness, other moods common to depression are:
• anxiety
• guilt
• worthlessness and inadequacy

Thinking
Individuals who are depressed think in certain ways. They tend to see themselves in a negative light. Often their
self-esteem and self-confidence become very low. They dwell on how bad they feel, how the world is terrible, and
on how hopeless everything is.

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Physical
Some people experience physical symptoms of depression.

· Sleep patterns could change. Some people may experience difficulty falling asleep. Some may wake
during the night and find it difficult to go back to sleep, or wake up early in the morning. Others
may find themselves sleeping more and have difficulty staying awake
· Appetite may decline and weight loss occur, or some people may find themselves eating more than
usual and thus gain weight
· Sexual interest may decline
· Energy levels may fall, as does motivation to carry out everyday activities. Depressed individuals
may stop doing the things they used to enjoy because they feel unmotivated or lethargic

Interacting with Other People

Many depressed people express concern about their personal relationships. They may become unhappy and
dissatisfied with their family, and other close, relationships. They may feel shy and anxious when they are with
other people, especially in a group. They may feel lonely and isolated, yet at the same time, are unwilling or unable
to reach out to others, even when they have the opportunities for doing so.

What about you?

What symptoms of depression do you experience?
Turn to the next page for the Depression Symptoms Worksheet and write them down. To help you identify your
symptoms of depression, ask yourself:

“How does my life change when I’m depressed?”

“What have I noticed about what I do or don’t do when I’m depressed?”
“How does my view of myself, others, and the future change when I’m depressed?”
“What do other people notice about me when I’m depressed?”

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Depressive Symptoms
Worksheet
Depressive symptoms can be grouped into 3 possible categories. Some symptoms are of the physiological type,
which are those that are have something to do with physical sensations or your physical body, for example:
insomnia, poor appetite, or low energy levels. Some symptoms are of the cognitive (thoughts) and affective
(emotions) type, such as: thoughts of suicide, hopelessness, feeling sad, and crying. The third category of
symptoms is to do with how you act and behave, for example: staying in bed, not going out, avoiding people.

What do YOU experience, when you are depressed?

Somatic/Physiological Cognitive/Affective Behavioural

insomnia, poor appetite, or low energy levels hopelessness, feeling sad, and crying. staying in bed, not going out

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What causes Depression?

It is important to understand that depression is not caused by one thing, but probably by a combination of factors
interacting with one another. These factors can be grouped into two broad categories – biology and psychology.
Many biological and psychological factors interact in depression, although precisely which specific factors interact
may differ from person to person.

Biological Factors
The biological factors that might have some effect on depression include: genes, hormones, and brain chemicals.

Genetic Factors
Depression often runs in families, which suggests that individuals may inherit genes that make them vulnerable to
developing depression. However, one may inherit an increased vulnerability to the illness, but not necessarily the
illness itself. Although many people may inherit the vulnerability, a great many of them may never suffer a
depressive illness.

Hormones
Research has found that there are some hormonal changes that occur in depression. The brain goes through
some changes before and during a depressive episode, and certain parts of the brain are affected.
This might result in an over- or under-production of some hormones, which may account for
some of the symptoms of depression. Medication treatment can be effective in treating these
conditions.

Brain Chemicals (Neurotransmitters)

Nerve cells in the brain communicate to each other
by specific chemical substances called neurotransmitters. It is believed that during depression, there is reduced
activity of one or more of these neurotransmitter systems, and this disturbs certain areas of the brain that
regulate functions such as sleep, appetite, sexual drive, and perhaps mood. The reduced level of
neurotransmitters results in reduced communication between the nerve cells and accounts for the typical
symptoms of depression. Many antidepressant drugs increase the neurotransmitters in the brain.

Psychological Factors
Thinking
Many thinking patterns are associated with depression. These thinking patterns include:
• overstressing the negative
• taking the responsibility for bad events but not for good events
• having inflexible rules about how one should behave
• thinking that you know what others are thinking and that they are thinking badly of you

Loss
Sometimes people experience events where loss occurs, and this can bring on depression. The experience of loss
may include the loss of a loved one through bereavement or separation, loss of a job, loss of a friendship or
relationship, loss of a promotion, loss of face, loss of support, etc.

Sense of Failure
Some people may stake their happiness on achieving particular goals, such as getting ‘As’ on their
exams, getting a particular job, earning a certain amount of profit from a business venture, or

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finding a life partner. If for some reason they are not able to achieve those goals, they might believe that they have
failed somehow, and it is this sense of failure that can sometimes bring on, or increase, depression.

Stress
An accumulation of stressful life events can also bring on depression. Stressful events include situations such as
unemployment, financial worries, serious difficulties with spouses, parents or children, physical illness, and major
changes in life circumstances.

Conclusion
While we cannot do much about the genes we have inherited, there are a number of things we can do to
overcome depression, or to prevent us from becoming depressed. Your doctor may have suggested medication,
especially in a severe depression. While taking medication can be of assistance in overcoming depression, there
are other things you can do that will help overcome and prevent depression. The next few pages present
information about some options for the psychological treatment of depression.

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Psychotherapy for Depression

Depression can be treated with medical treatments such as antidepressant medication or electroconvulsive
therapy, and psychotherapy. Please see your medical doctor or psychiatrist for more information about medical
treatments as this will not be discussed in this information package.

We’re now going to talk briefly about two psychological therapies that have been proven to be effective most of
the time. You might have come across words such as “best practice” “evidence-based practice,” “evidence-based
treatment” or “evidence-supported therapy.” These words refer to a particular type of treatment or therapy that
has been evaluated and has proven to be effective. For the treatment of depression, the evidence-supported
therapies include cognitive therapy and behaviour therapy.

Cognitive Therapy
The aim of cognitive therapy is to help individuals realise that they can influence their mood by identifying and
changing their thoughts and beliefs. When people are depressed, they often think very negative thoughts about
themselves, their lives, and their future. This further worsens their mood. Cognitive therapy focuses on
discovering and challenging unhelpful assumptions and beliefs, and developing helpful and balanced thoughts.
Cognitive therapy is also structured, time-limited, and focused on the ‘here-and-now.‘ This form of treatment for
depression has been proven to be effective when individuals are able to acquire the skills that are being taught in
therapy.

Behaviour Therapy
Depressed people tend to feel lethargic and unmotivated. They often stay at home and avoid going out and
interacting with people. As such, they may miss out on opportunities that help lift their mood. Behaviour therapy
aims to identify and change aspects of behaviour that may perpetuate or worsen the depression. Some
behavioural strategies include: goal setting, activity scheduling, social skills training, and structured problem solving.

In Summary …
These two therapies have been shown to be effective most of the time. Often, a combination of these therapies
are offered for people who experience depression. This information package focuses on providing information on
the cognitive and behavioural aspects of depression, which includes suggested strategies for how you could better
manage your mood.

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Module Summary
• About 20% of the population experience major depression, which is a
disorder of mood
• The symptoms of depression include low mood, a tendency to think
very negative thoughts, low energy, lack of motivation, a tendency to
sleep more, and an avoidance of social activities
• Depression is not caused by one thing, but the interaction of
biological and psychological factors
• Biological factors include genes (family history), hormones, and
neurotransmitters, and psychological factors include thinking styles,
issues concerning loss, and stressful life events
• There are a number of treatments for depression – medical
treatments and psychological treatments
• The more common and effective psychological treatments include
cognitive therapy and behaviour therapy, or a combination of both

Stay Tuned...
In the next module, we will discuss the
behavioural aspects of depression that might
maintain or perpetuate low mood. We will
also discuss strategies and ways of overcoming
these difficulties.

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About The Modules
BACKGROUND
This module was created in the early 2000s by Clinical Psychologists at the Centre for Clinical
Interventions, under the supervision of the Centre’s Founding Director, Paula Nathan.
The concepts and strategies in these modules have been developed from evidence based psychological
practice, primarily Cognitive-Behaviour Therapy (CBT). CBT for depression and anxiety is based on the
approach that depression and anxiety are the result of problematic cognitions (thoughts) and behaviours.

REFERENCES
These are some of the professional references used to create the modules in this information package.

Beck, A. T., Rush, A. J. , Shaw, B. F., Emery, G. (1979). Cognitive Therapy of Depression. New York: The
Guildford Press.

Beck, J.S. (1995) Cognitive therapy: Basics and beyond. New York: The Guilford Press

Barlow, D.H. (2001). Clinical handbook of psychological disorders: A step-by-step treatment manual (3rd
ed.) New York: The Guilford Press

Clark, M.D. & Fairburn, C.C. (1997) Science and practice of cognitive behaviour therapy. Oxford:
Oxford University Press

Dobson, K.S., & Craig, K.A. (1998) Empirically supported therapies: Best practice in professional
psychology. Thousand Oaks: Sage

Hawton, K., Salkovskis, P.M., Kirk, J., & Clark, D.M. (1989) Cognitive behaviour therapy for psychiatric
problems: A practical guide. Oxford: Oxford University Press

Nathan, P.E. & Gorman, J.M. (2002) (Eds.) A guide to treatments that work (2nd ed.) New York: Oxford
University Press.

“BACK FROM THE BLUEZ”

This module forms part of:

Nathan, P., Rees, C., Lim, L., & Correia, H. (2003). Back from the Bluez. Perth, Western Australia: Centre
for Clinical Interventions

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