Depression is a serious condition that his marked by a continual low mood, sadness and often physical symptoms such as low energy, and poor concentration. Up to 7% of the population suffers from depression at any one time, and everyone has a 20% chance of having at least one episode of depression over their lifetime. Depression can reoccur even after effective treatment. If a person has had one episode of depression they have a 50% chance of having a second episode, if they have a second episode they have a 70% a third episode, then the chance of further episodes is 90%.
Depression can affect children and adults in all walks of live. Depression is not a constant state and can improve over time and people may find themselves becoming depressed again after a period of remission. Depression is the strongest predictor of suicide which means if someone is depressed their risk of suicide is higher than someone who is not depressed. If we think someone is depressed we should definitely ask them if they are feeling suicidal. There are some myths about suicide, for example, if you talk about it, they might do it, if the person suddenly appears improved they are no longer at risk, or suicide attempts or suicide talk is just attention seeking. None of this is true and if people say these things they are still at risk. People rarely are successful o the first suicide attempt. Typically a successful suicide is preceded by two or more attempts. Talking to someone about suicide reduces the risk; however, it does not eliminate risk. Some people may be so suicidal that they need emergency assistance or specialist care.
Depression is not the same as feeling very sad or upset, or dealing with loss and grief, or reacting to a crisis or life problems or major changes, although people may feel like they are depressed at these times.
These are considered normal reactions signalling a period of psychological adaption to changes, which is referred to as adjustment. A person going through adjustment would be expected to make progress working through their thoughts and feeling and eventually return to normal mood. However, beware as some people can get stuck in the adjustment process, become suicidal, and in some cases may develop depression.
It is often thought that elite athletes may be immune to depression due to their success, lifestyle and fitness. This is not the case and athletes are at least the same level of risk as the rest of the community. This is because the causes of depression are varied and cumulative. The causes of depression can be genetic such as family history or predisposing genes, some types of health problems can also cause depression, issues from our past can create a high risk, such as abuse, rejection, trauma, and learning negative beliefs about our self-worth and unhealthy boundaries with others, these make us vulnerable to the current problems we may deal with in our lives. Therefore a difficult life history compounded by current life problems or dissatisfaction creates a significant risk for depression. Athletes also may have a number of these risk factors and must deal with high levels of stress regarding performance, selection, negotiation of contracts, and recovering from injury. In fact Athletes must manage life stressors and challenges to a greater extent than a lot of people in the community. So we can see that there are lots of factors that can depression given the right set of circumstances. If we have several risk factors our likelihood of becoming depressed may be high, such as when our health or genes can create problems and we might be struggling with past hurts or traumas and have negative beliefs about ourselves and the world, and we may be overwhelmed by problems we have in our lives.
So if you know an athlete or anyone who you might feel is depressed, there are some common symptoms to look for:
- Has the person felt down of depressed for most days or most of the time for a minimum of two weeks?
- Have they lost pleasure in the activities that would normally make them happy?
If the person answers yes to at least one of these questions, and there has not be a previous loss or change in their life (adjustment) we then want to know some more things. If they have answered no to both questions they are probably not depressed.
Some more questions are:
- Has there been a change in appetite or body weight?
- Are they experiencing trouble sleeping?
- Are they slowing down or becoming fidgety?
- Do they have low energy or tiredness nearly every day?
- Are they feeling guilty or do not like themselves?
- Do they have difficulty concentrating or making decisions?
- Is the way they feel causing them distress or affecting their role e.g. performance in their sport, or employment, study and relationships?
- Do they think about hurting or killing themselves?
If the person you are talking to answers yes to a minimum of 5 of these questions they might be depressed. If they are young they may have trouble understanding or answering these questions, yet it is still possible to discuss what we can with them and consider whether their behaviour fits any of these symptoms. For example a younger person may have more behavioural problems, or more withdrawal and acting out behaviour. We may also need to look more closely at the persons behaviour if they are from different cultural backgrounds and/or where English is a second language.
The good news is that depression responds well to treatment such as counselling and medications. Cognitive therapy explores how our negative thoughts and beliefs reinforce our depressed feelings. If we learn to change our depressed thoughts we will no longer experience depressed mood. For example, if a person had an all or nothing belief or thought that they are a failure as part of the series of thoughts that make them feel depressed, they can be taught to challenge and replace these thoughts. The first step is to be objective; how true is this really? Clearly a person is not a failure in every area of life and there are many successes. This rational-mind middle ground challenge to negative thinking counters the extreme distorted thinking of depression, and often improves mood. Another common through pattern for depressed people is to catastrophize which is to see the worst possible outcome in every situation. Once again using a rational mind to challenge this, what is the evidence that our catastrophic prediction will come true, has it ever in the past, what is the realistic outcome in this situation?, can also improve mood.
Behavioural therapy explores the things that are worrying us or are going wrong and these are typically real problems in our life and can feel very overwhelming. However, if we set about working on these problems we will feel some control over our lives again. Other approaches focus on dealing with underlying issues, which includes the things from our past that trouble us, and the need to understand ourselves and our reactions to others better. Does counselling work? Yes, it has been shown to work as well as, if not better than medication for most people. Research shows that counselling may improve areas of brain function in somewhat similar ways to medication. Medication also can be very effective but there are also problems with side effects. For some people medication might be their preferred approach. While you can do a lot to manage your own depression, or help others with depression, don’t forget the risks. It is often better to get professional help from a mental health clinician or a GP than go it alone.