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Module 1
Overview of Depression

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What is Depression?

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Depressive Symptoms Worksheet

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What Causes Depression

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Psychotherapy for Depression

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Module Summary

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About the Modules

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Module 1: Overview of Depression

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Back from theWhat 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 fromother 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 canbecome 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 depressedpeople 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.

MoodDepression 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 witheven 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 morningand relatively better in the afternoon. This is called ‘diurnal variation,’ which often accompanies a more severetype 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 theirself-esteem and self-confidence become very low. They dwell on how bad they feel, how the world is terrible, andon how hopeless everything is.

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PhysicalSome 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 thanusual 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 anddissatisfied with their family, and other close, relationships. They may feel shy and anxious when they are withother people, especially in a group. They may feel lonely and isolated, yet at the same time, are unwilling or unableto 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 yoursymptoms 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?”CCI

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Back from theDepressive 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 ofsymptoms 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?

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Cognitive/Affective

Module 1: Overview of Depression

BehaviouralPage 4

Back from theWhat 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 todeveloping depression. However, one may inherit an increased vulnerability to the illness, but not necessarily theillness itself. Although many people may inherit the vulnerability, a great many of them may never suffer adepressive illness.
Hormones
Research has found that there are some hormonal changes that occur in depression. The brain goes throughsome 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 forsome of the symptoms of depression. Medication treatment can be effective in treating theseconditions.
Brain Chemicals (Neurotransmitters)
Nerve cells in the brain communicate to each otherby 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 ofneurotransmitters results in reduced communication between the nerve cells and accounts for the typicalsymptoms 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 orrelationship, 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 theirexams, getting a particular job, earning a certain amount of profit from a business venture, orC
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Back from thefinding a life partner. If for some reason they are not able to achieve those goals, they might believe that they havefailed somehow, and it is this sense of failure that can sometimes bring on, or increase, depression.
StressAn accumulation of stressful life events can also bring on depression. Stressful events include situations such asunemployment, financial worries, serious difficulties with spouses, parents or children, physical illness, and majorchanges in life circumstances.

Conclusion
While we cannot do much about the genes we have inherited, there are a number of things we can do toovercome 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, thereare 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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Back from thePsychotherapy 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-basedtreatment” or “evidence-supported therapy.” These words refer to a particular type of treatment or therapy thathas 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 andchanging 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 intherapy.

Behaviour Therapy
Depressed people tend to feel lethargic and unmotivated. They often stay at home and avoid going out andinteracting 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. Somebehavioural 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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Back from theModule Summary
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About 20% of the population experience major depression, which is adisorder of mood
The symptoms of depression include low mood, a tendency to thinkvery negative thoughts, low energy, lack of motivation, a tendency tosleep 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, andneurotransmitters, and psychological factors include thinking styles,
issues concerning loss, and stressful life events
There are a number of treatments for depression – medicaltreatments 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 thebehavioural 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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Back from theAbout The Modules
BACKGROUNDThis module was created in the early 2000s by Clinical Psychologists at the Centre for ClinicalInterventions, under the supervision of the Centre’s Founding Director, Paula Nathan.
The concepts and strategies in these modules have been developed from evidence based psychologicalpractice, primarily Cognitive-Behaviour Therapy (CBT). CBT for depression and anxiety is based on theapproach 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 (3rded.) 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 psychiatricproblems: 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: Centrefor Clinical Interventions

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