Depression in Adults

Summary: Although everyone gets sad from time to time, depression is a severe problem with moods so sad that the person has troubles functioning, and may have various physical symptoms such as problems with sleep, appetite, and energy.
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What is Depression?

Everyone has times when they feel the ‘blues' or when they get sad from time to time. Depression on the other hand, is a sadness so severe that it can cause:

  • Difficulties functioning at home, work or school
  • Changes in sleep, energy, appetite and concentration,
  • Feelings such as sadness, anxiety, irritability or anger,
  • Low self-esteem or feelings of hopelessness. When extremely severe, people who are depressed may have thoughts of hurting themselves.

How Common is Depression?

Depression is a common condition that can affect anyone at any age. In any given year, it is estimated that it affects almost 1 in 10 adults each year, affecting more women than men. Although it can occur at any age, it usually starts in late teens to mid-20's.

Symptoms of Depression

Symptoms of depression include (but are not limited to) the following:

  • Sad, depressed (or irritable) mood most days
  • Loss of interest or enjoyment in activities
  • Problems with appetite
  • Problems with sleep
  • Problems with concentration
  • Feeling guilty, hopeless, or worthless
  • Thoughts that life isn't worth living (such as thoughts of suicide) or attempts at suicide

When the above symptoms are consistently present for more than 2-weeks, it may be depression.

What Causes Depression?

There is no single cause of depression, and every person's depression may result from a combination of different things. Many factors can contribute to depression:

  • Family history of depression: if other people in the family have had troubles with depression, then it may make someone at higher risk.
  • Stressful life situations or events, such as problems with relationships, or stresses at work, home or school. Particularly stressful situations may include childhood abuse or neglect; separation/divorce, or conflicts.
  • Imbalances in neurotransmitters, which can be triggered by lack of sunlight, or drug use, medications, or medical problems.

How is Depression Treated?

There are numerous effective treatments for depression, which are generally given by mental health professionals.

 

Commonly used therapies include:

  • Cognitive behaviour therapy (CBT): Helps individuals cope with depression by focusing on changing their thoughts and behaviours. In depression, individuals tend to have negative, depressive thoughts. In CBT, individuals learn to replace depressive thoughts with more positive, helpful thoughts.
  • Interpersonal psychotherapy (IPT): Helps with depression by focusing on improving relationships. Regardless of how the depression started, individuals with depression tend to have tension in their relationships from either 1) conflict or withdrawal, or 2) life transitions or changes. IPT helps improve these difficulties.
  • Solution-focused therapy: Helps by finding solutions. In depression, individuals tend to focus on life stresses and problems. In solution-focused therapy, individuals get support in finding solutions to these difficulties.
  • Medications: May be helpful in certain cases, and these may be prescribed by a family physician, paediatrician or psychiatrist. Medications are generally used only when other treatments have not been successful, or when the depression is so severe that other treatments are not possible.

Depending on the severity of the depression, more intensive support and services may be required, such as admission to a hospital.

Helping Someone Who is Depressed

If you know someone who is depressed, it affects you too. The first and most important thing you can do to help a friend or relative who has depression is to help him or her get an appropriate diagnosis and treatment. You may need to make an appointment on behalf of your friend or relative and go with him or her to see the doctor. Encourage him or her to stay in treatment, or to seek different treatment if no improvement occurs after six to eight weeks.

 

To help a friend or relative:

  • Offer emotional support, understanding, patience and encouragement.
  • Engage your friend or relative in conversation, and listen carefully.
  • Never disparage feelings your friend or relative expresses, but point out realities and offer hope.
  • Never ignore comments about suicide, and report them to your friend's or relative's therapist or doctor.
  • Invite your friend or relative out for walks, outings and other activities. Keep trying if he or she declines, but don't push him or her to take on too much too soon. Although diversions and company are needed, too many demands may increase feelings of failure.
  • Remind your friend or relative that with time and treatment, the depression will lift.

 

(Adapted from the National Institute for Mental Health (NIMH), retrieved from http://www.nimh.nih.gov/health/publications/depression/depression-booklet.pdf)

How Can I Help Myself If I Am Depressed?

The bad news is that when your mood is down, you tend to stop doing healthy activities and behaviours that would be helpful for your mood.  
 
The good news is that you can purposely choose to (re)start healthy activities and behaviours to help improve your mood. This method is known as behavioural activation, and has been shown in studies to be an effective treatment for depression. 
 
The following strategies have antidepressant properties and can improve both physical and mental health: 
  • Practice self-acceptance and self-compassion. One of the problems in having depression, is that many of us tend to have a self-critical voice that makes us feel guilty or ashamed for being depressed. Perhaps it's because we think that being self-critical will be helpful, but unfortunately, it usually doesn't help and just makes us feel worse. There is an alternative... Accept that you are imperfect and flawed, because after all, you are only human. Humans get depressed, and you are human. Every one of us is flawed and imperfect, and hence we do suffer from depression and other problems. At the same time, it means you are not alone...

    Do you struggle at finding that self-compassionate voice? If so, try to think about what you'd tell a friend who is suffering from depression, or dealing with a difficulty? You'd say things like "It's okay, I'm here with you..." Try to work at being a bit more accepting and supportive of yourself. Because after all, you are human, and humans get depressed, and it’s okay. 

    "It's not your job to like me. It's mine" -- Toni Bernard
     
  • Relationships
.
    Humans are social creatures and need social interaction.
    • ​Don’t isolate yourself, but seek out ways to spend positive quality time with people. 
    • If you have people that make you feel supported, then great. Thank them for being supportive.
    • If you have people that are not so supportive, then gently let them know what you need. Most of the time, what people need for emotional support is simply someone to listen and validate your feelings (as opposed to someone giving you advice and judgement). So you might say things like, "I know that you want to be helpful. Right now, all I need is for you to listen and validate how I feel. I'll let you know if I need advice or suggestions on what to do. Thank you." 
    • Do things with other people such as going for a walk, a meal or having a coffee, tea or hot chocolate…
       
  • Sleep
. Ensure that you sleep ideally 9-11 hrs a day
. There is an epidemic of sleep deprivation in many modern societies. Interestingly enough, the symptoms of sleep deprivation match those of depression... 
     
  • Exercise. At least 30-minutes a day of aerobic exercise (e.g. walking)

, ideally outside.
     
  • Nutrition and diet. Ensure a well balanced diet consistent with Canada’s Food Guide recommendations, and try to ensure that you:   

    • Eat plenty of multicolored fruits and vegetables (“rainbow diet”)

    • Get enough omega 3 fatty acids, e.g. consume fish, or vegetable sources such as flax seeds  

    • Limit excessive calories

    • Limit processed foods 

    • Limit soft drinks  

    • Limit animal fats 

       
  • Nature
. Spend more time in nature. The exact time is uncertain, but studies on eye health suggests that humans need at least 10 hrs / week (i.e. at least 1-hr daily outside). 

     
  • Reduce overuse of technology
. Do not let devices replace human contact or contact with nature
. Limit recreational screen time, e.g. watching movies / TV.
     
  • Recreation
. Ensure that there are enjoyable and pleasurable activities that may be:  
    • Fun and humour, e.g. watching or listening comedy

    • Creative, e.g. art, music, dance, reading 

    • Games and sports

       
  • Relaxation and stress management. Ensure that you have ways to relax and manage stress levels. Modern society is stressful, and it is thus important to have practices such as relaxation, meditation, deep breathing or mindfulness to help cope with stress. 

     
  • Religious and spiritual involvement
. Find a way to feel deep connection and meaning to other people, the world and the universe. This might involve religious practices such as belonging to a Church, or it might be contemplative practices such as meditation, or spending time in nature. 
Consider practices such as self-acceptance, self-compassion, and mindfulness.

     
  • Contribution and service to others.
 Be helpful and contribute to others. This can range from simply doing good deeds for others (e.g. helping someone with their household chores such as cooking, groceries or laundry), or volunteer work, or other work. 


If you Suspect Depression

If you suspect that you may have depression:

  • See your doctor. Your doctor can make sure there aren't any medical problems (such as hormone imbalances) that might be causing or contributing to the depression. Your doctor can also help recommend where else to get help, such as seeing mental health professionals such as a psychologist, psychiatrist or social worker.

In a Crisis?

If you are thinking about harming yourself, or know someone who is, then get help immediately:

  • Call a family member, friend or co-worker.
  • Call 911 or go to a hospital emergency room to get immediate help or ask a friend or family member to help you do these things.
  • Call a crisis line.

If you know someone else who is in an immediate crisis, then:

  • Help the other person get help
  • Make sure that you don't leave the other person alone.

For More Information

About this Document

Written by the eMentalHealth Team and Partners, including Dr. Jeanne Talbot, Psychiatrist, Royal Ottawa Mental Health Centre.

Disclaimer

Information in this pamphlet is offered ‘as is' and is meant only to provide general information that supplements, but does not replace the information from your health provider. Always contact a qualified health professional for further information in your specific situation or circumstance. 

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Date Posted: Oct 29, 2008
Date of Last Revision: Jan 5, 2017

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