Depression and accompanying suicide are a huge national health problem.
What we now know is that depression is very common; it is estimated that 20.8% of the population will develop depression in the course of their lifetime (5).
However, for young people it is worse. In a May 2016 Guardian article, former Australian of the Year, Professor Patrick McGorry, said that in Australia mental illness contributed to about 50% of the poor health experienced by young people.
Again in the Guardian (9 June 2016), Professor McGorry noted that “suicide rates have become a king tide, more than double the road toll”.
While occasional suicidal thoughts are common for those experiencing depression, daily ideation is a serious warning sign, and help should be sought immediately*.
To put this in perspective, Professory McGorry also said there were 12 000 deaths each year due to suicide and medical illnesses related to mental illness. By contrast, 3 000 people died each year from breast cancer and 4 000 from bowel cancer.
What You Need to Know: The Causes of Depression
Acute (or reactive) depression is the depression that results from reaction to a bad life experience. If we have a bad life experience it can change the way we think about things, or our cognitive style. So for example, if someone was to fail to get the job that they had studied and worked so hard for, future job prospects may begin to look bleak.
Chronic depression is the term given to depression that has an earlier age of onset. With this type of depression, people often report that they have been depressed as long as they can remember. Memories of being depressed in adolescence are common. The cause is usually found in childhood upbringing and the course of treatment for chronic depression is longer. However the way we appraise ourselves, our world, and the future are not the only things that can make us depressed.
Depression can result from factors other than negative self appraisals. No matter how supportive our thinking is, there are circumstances that can be depressing, because they carry an ongoing burden of suffering – for example, two or more chronic illnesses at the same time, or chronic pain. Psychological strategies are very important in copying with these demanding circumstances in order to prevent depression.
In addition depression can be caused by interpersonal conflict, or when people stop doing the very things that made life worth living.
Depression is also frequently co-morbid or accompanies other psychological difficulties, such as anxiety disorders, addictions, and eating disorders.
A common question is whether therapy or medication is the preferred treatment option, or perhaps a combination of both. Studies show that the increment in efficacy of both together to be either zero or modest (2), except for inpatients with depression who benefit more (9). However consumers prefer therapy (4) as they connect their depression to life circumstances.
Therapy is effective because, at a basic level, a depressed mood is caused by our thoughts. Aaron Beck, the creator of CBT, discovered that depression was caused by a negative view of self, and a bleak view of the world that surrounds us (job prospects, friends/relationships, living situation) and a bleak view of our future (1).
So if we can change our thoughts (called cognitive restructuring in CBT), we can change our mood. This process works very well.
Medication has benefits in that it is faster acting than therapy, usually taking less than 14 days for the effect to be felt – so it is good in crisis situations. However studies of cognitive behavioural therapy (CBT) show that it is just as effective as medication with non-bipolar depression.
The hope with medication is that when the patient feels better, s/he will will see life in a more positive light, but unfortunately that does not happen in the majority of cases. Studies report high relapse rates of 66 to 80% (3) after discontinuation of medication; consequently, many medical professionals favour long-term drug maintenance.
The advantage with therapy is that it gets to the cause of the problem, and therefore relapse is less likely when treatment is discontinued.
For acute or reactive depression, CBT is very effective, as is MBCT to prevent relapse.
For those who are carrying significant burdens (such as chronic illness or pain), psychological strategies are vital.
In the case of people who have for some reason or other stopped doing the things they used to love, a therapy called Behaviour Activation is effective.
For interpersonal conflict there is IPT (Interpersonal Psychotherapy); while in the case of chronic depression that may trace its origin to childhood, Schema Therapy can be beneficial. This is because it takes into account the effects of abandonment, mistrust, abuse, neglect, emotional deprivation, being made to feel defective or inadequate,and other critical factors that may have been experienced.
(The exception is Bipolar Disorder, where the first line treatment is medication, as this illness is seen as primarily as an imbalance in neurological biochemistry. However adjunct psychological therapies are recommended, because bipolar episodes can be triggered by interpersonal conflict, irregular sleep-wake patterns and psychological stressors.)
In only a small percentage of cases (12-20%), do people relapse after therapy (7), an indicator of the efficacy of psychological strategies in the treatment of depression.
The fact that a person has had depression once, does mean that s/he may be more vulnerable to a future episode (6). A specialist therapy has been specifically designed to prevent relapse called mindfulness-based relapse cognitive therapy or MBCT (8). It is worth noting however, that if a person is depressed, mindfulness will make the depression worse, so this therapy is introduced only after treatment has been completed. It is designed as an effective early warning system of possible relapse.
Author: Paul Carver, B Sc, M Sc, PG Dip Health Psych.
Paul Carver is a Psychologist with a very wide range of experience, focused on bringing the very best evidence-based treatments to his clients. He is experienced in the use of CBT, Behavioural Activation, Schema Therapy including use of the YSQ (a sizeable questionnaire that is very helpful in revealing early childhood patterns and beliefs), IPT and MBCT for depression, as well as adjunct therapy for Bipolar Disorder, and chronic illness management.
To arrange an appointment with Brisbane Psychologist Paul Carver at Vision Psychology Mt Gravatt, freecall 1800 877 924 or you can book online.
* 24 HOUR SUICIDE HELPLINES:
- Lifeline Telephone Crisis Support: 13 11 14
- Salvation Army (state wide) Crisis Counselling Service: 1300 363 622
- Beck, A.T. (1967) Depression; Causes and treatment. Philadelphia:University of Pennsylvania Press.
- Biggs, M. M., & Rush, A. J. (1999). Cognitive and behavioral therapies alone or combined with antidepressant medication in the treatment of depression. In D. S. Janowsky (Ed.), Psychotherapy indications and outcomes (pp121-172). Washington D.C. American Psychiatric Press. .
- Bowers, W.A. (1990). Treatment of depressed in-patients. Cognitive therapy plus medication, relaxation plus medication, and medication alone. Br J Psychiatry;156:73-8.
- Hall, Lynn H.; Robertson, Malcolm H. (1998). Undergraduate ratings of the acceptability of single and combined treatments for depression: A comparative analysis. Professional Psychology: Research and Practice, 29(3), 269-272.
- Kessler, R.C., Berg;und, P., Demler, O., Jin, R., Merikangas, K.R., & Walters E.E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 62(6):593-602
- Scott, J. (2000). New evidence in the treatment of chronic depression. New England Journal of Medicine, 342,1518-1520
- Simons A.D., Murphy G.E., Levine J.L., & Wetzel R.D. (1986). Cognitive therapy and pharmacotherapy for depression. Sustained improvement over one year. Arch Gen Psychiatry. 43(1):43-8
- Teasdale J.D., Segal Z., Williams J.M. (1995). How does cognitive therapy prevent depressive relapse and why should attentional control (mindfulness) training help? Behavior Research and Therapy. 33(1):25-39
- Wright, J.H. (1996) Inpatient cognitive therapy. In E.M. Salkovkis (Ed.), Frontiers of cognitive therapy (pp208-225). New York, Guilford Press.