Healthy Minds

Today The Gazette begins a series titled Healthy Minds Healthy Community, focussing on the issues of anxiety and depression. During May, which is Mental Health Month, we will be focussing on mental health and how working together as a community we can influence change and connect people to the right support. Counsellor, psychotherapist and clinical hypnotherapist Chris Roering has written a series of columns beginning with today’s ‘Depression – our unseen enemy’. Through a series of articles local people will be sharing their mental health stories. The columns and articles will culminate with an information night on Wednesday, May 29. The free information night will be held at the Warragul Country Club from 7pm to 9pm.

In this first column we look at the incidence of depression, how to tell if we might be depressed and the nature of depression.

Although depression is the subject of the four articles, anxiety is usually a major part of depression, so what follows applies in the main, to anxiety as well. (I am referring to what is known as a generalised anxiety disorder. It can manifest in Obsessive Compulsive Disorder, Panic Disorder, Post-traumatic Stress Disorder, Social, and other disorders.)

More than a decade ago, the World Health Organisation, (WHO) declared depression the fourth most significant cause of suffering and disability worldwide (behind heart disease, cancer and traffic accidents) and predicted that it would rise to become the second most debilitating human condition by the year 2020.

We reached that inglorious milestone in 2014! The WHO had to revise its forecasts, so two years ago, on March 30 2017, the WHO declared depression the leading cause of ill health and disability worldwide.

Rates of depression worldwide have risen by more than 18 per cent since 2005. The directorgeneral of the WHO, Margaret Chan said: ‘These new figures are a wake-up call for all countries to re-think their approaches to mental health and to treat it with the urgency it deserves.’

What does this mean for us? It tells us that depression is a pervasive and debilitating condition, growing world-wide. It suggests that most of the people who need help don’t receive it.

Depression will affect individuals, families and cultures in unpredictable ways and its growth is more likely to be socially transmitted than by other means. Australia has one of the highest rates of antidepressant use in the world – 10 per cent of Australians take them daily; use in children has increased proportionally. (May, 2016, in the Medical Journal of Australia (research by C. Davey & A. Chanen)

Is there a connection between anxiety and depression? Yes, a close one. If we feel anxious, we feel insecure. If we feel anxious and insecure, we usually have self-doubt (low self-esteem).

If we are anxious, insecure and have self-doubt, we are likely to become socially withdrawn and struggle with motivation. This could hardly make us happy - and so it’s easy to move into depression. (It is however possible to feel anxious without being depressed.) What about labels? Labels exacerbate depression! A diagnosis of depression can make us more depressed! The same applies to the label of anxiety. Anxiety and depression are a convenient way to label the result of collections of negative thoughts.

So, do anxiety and depression really exist? You can’t feel sad, angry, worried, or indeed any emotion without first having a thought. So, in a sense, anxiety and depression only exist if we see them as a label for our negative thoughts and not as an illness or disorder in themselves. It’s a good idea not to wear labels. It is all about our thoughts. Our thoughts are self-manifesting. If most of our thoughts are positive, we are unlikely to be depressed or anxious.

Am I depressed? How do we know if we are depressed? If we are, we might have some of these thought-based symptoms. Poor sleep patterns. If a child has a bad night, she/he will often be irritable, angry, tearful etc. Adults are not much different. The following are the sorts of thoughts that can deprive us of sleep: ‘If only’ thoughts or ‘must remember’ or ‘what if?’ thoughts etc.

Thoughts that cause us to have light sleep often with disturbing or excessively busy dreams, resulting in poor quality sleep, so that we wake up after 8 hours of sleep but still feel tired.

Thoughts (often inspired by poor planning) that cause us to get to bed late like: ‘I must just finish this before I go to bed.’

Thoughts that we might escape our thoughts by watching television in bed – a bad thing to do if we want quality sleep.

Self-sabotaging thoughts like: ‘I know I won’t be able to sleep tonight.’

Thoughts of regret like: ‘If only I had done this, or that….’ Anxiety. This is a strong thought-based feeling of apprehension, worry or unease. For instance:Over-thinking. Thoughts like: ’I wish my mind would shut up!’

Over-analysing. Thoughts like: ‘I should have done this or that’, or ‘I wonder what she meant when she said that.’

Overcrowded mind (too many thoughts) resulting in poor memory and concentration.

Thoughts of indecision like: ‘I can’t make up my mind.’

Controlling thoughts like: ‘People will think I’m stupid:’ (imagining that we can control what people are thinking about us).

‘What ifs?’ Thoughts that create scenarios about the future - which we can’t possibly know. ‘What if she did this? He would then do that and then this would happen.’ (Because it’s a ‘what if?’ thought, it has no evidence - and yet we allow these unsubstantiated thoughts to control us.)

Thoughts of extreme fear or being totally overwhelmed by stress, resulting in panic attacks.

Thoughts giving rise to a fear of not being able to control something which is beyond our control like: ‘I hate flying as I always think the plane will crash.’ Thoughts causing irritability and anger This is especially towards those who are close to us (partner, family etc.). These are usually the ‘fight’ responses to anxiety. For instance:An innocent comment can trigger a thought leading to an instant anger outburst or irritation. These outbursts seem beyond our control.

Oversensitivity often results in irritability and anger – for instance when a person has a thought that their self-esteem is being threatened or their ability challenged. (People with low selfesteem often fiercely guard what’s left of it.)

Thoughts which give rise to a feeling of anger at the loss or withdrawal of approval. (An example might be a partner falling out of love for us, or a boss demoting us.)

Angry thoughts arising from the frustration of not being able to control someone or something - not realising that the only person we can actually control is ourselves! (An example of this is road rage.) Thoughts causing low motivation This is to do things for ourselves, rather than for others(e.g. exercise ). For instance: Thoughts

of procrastination that make us struggle to get things done, like: ‘It doesn’t really have to be done now, I’ll get around to it later, but I first want to do this…’.

Thoughts arising from poor self-esteem like: ‘I’m not capable. It’s all too hard.’

Thoughts arising from poor sleep or tiredness like: ‘I just can’t do that today.’

Thoughts of futility like: ‘What’s the point? If I do it, it won’t make any difference.’

Negative thoughts of futility-based self-doubt like: ‘Even if I try to do my work/study, I have fallen so far behind I’ll never be able to catch up.’ . Lowered mood These are thoughts that can make us feel sad, miserable, overwhelmed and trapped. These thoughts are inward looking. (People who look outward are usually not depressed!) For instance: Thoughts of in adequacy like: ‘I’m a failure .' Thoughts of disconnection. ’No one understands what it’s like. No one cares.’ Thoughts of guilt. 'It’s all my fault.’ Thoughts involving negative judgements like: ‘Only bad things happen to me.'

Self-destructive thoughts like: 'I’m worthless. This will never end.’

Misguided thoughts of escape that can lead to addiction like: ‘I need a drink. I need a hit. Alcohol relaxes me.’ (Alcohol and drugs are a significant cause of anxiety and depression.)

Dangerous (dysthymic) thoughts of escape like: ’Life’s not worth living. People would be better off without me.' Thoughts causing low self-esteem. Judging ourselves by what we imagine others think about us, because we don’t know who we are. For instance:Thoughts

of needing approval. We all like approval, but these thoughts are more like a craving and often result in putting the needs of others way ahead of our own needs, thus extracting approval or praise. (This is just a band-aid as it doesn’t last, and we continue to need more outside approval.)

Thoughts of low self-value like: ‘My opinion doesn’t matter. I’m not good at anything.’

Destructive, self-analytical thoughts like: ‘I’m ugly.’ ‘I’m fat.’ (The latter is often a cause of anorexia nervosa.)

Thoughts of self-doubt like: ‘I’ll never be able to do that.’ 'Nothing good ever happens to me.'

Thoughts causing social withdrawal from close family and friends

This is often the flight response to anxiety - not keeping up with others or going out.. For instance: Thoughts

of in security like: ‘It’s safer staying at home.’

Thoughts of self-deprecation like: ‘I’m too fat to go out - people notice.’

Inertia induced thoughts resulting in not being able to do usually enjoyable activities. ‘I just can’t be bothered.’

Thoughts of wanting to be alone with our depression like: ‘I’m going to wrap myself up in my warm blanket of depression where I feel secure.’

Thoughts involving a fear of change: ‘I know my depression; it’s too scary to think about what life would be like without it.)

Low libido - is a symptom of depression, exacerbated by anti-depressants. Freeze This is when, instead of expressing our emotions, we push them down. We now know that suppressed emotions are stored in the body and can cause physical conditions, as the body can be seen as a mirror of the mind.

Pain in the mind is frequently translated into pain in the body. Depression and anxiety are often the reasons behind conditions like fibromyalgia and irritable bowel syndrome.

Other typical physical symptoms of anxiety and depression are; constant tiredness, changes in weight, inflammation, muscle and headache pains, tiredness and chronic fatigue syndrome, frequent illness and low resistance to infection.

Subconscious and conscious thoughts about power: ‘My depression gives me power. I don’t have to do anything, and people worry and fuss over me. I always get my way.’ So, what is depression? There are many differing views about what depression is, however, it is simply a thoughtbased state of mind – but a state of mind that in most cases has been induced by circumstances beyond our control. The path to healing is to get that control back.

In next week’s special feature on depression, we look at the role of relationships in depression and examine the effects on children and adolescents and suggest strategies for parents and families affected.

We examine whether there is a place for antidepressant medication and begin our program of understanding the origins of depression and we start to look at practical strategies to manage it.