Clinical Depression (CD) is most evident when a combination of four or five symptoms occurs without any apparent traumatic or stressful events present.
One of the key characteristics of CD is suicidal thoughts – these are prolonged and generally consistent. Having said that, not every individual with CD has suicidal ideations.
The inability to enjoy almost any aspect of life is another sign of CD – this is not just having low days, this is not being able to enjoy any aspect of your life. If you engage with normal experiences and you do have ‘high’ moments which are not drug-induced, you will not have CD. There will be lots in your life which can be changed so as you can alter low days, such as scheduling, place of work, liaising with your pastoral team, your friends, starting new friendships etc. With ongoing and planned behaviour analysis, you really can learn to 'enjoy' your life.
A family history of depression is an indicator of CD - we have a lot of evidence to show that CD is a genetic illness. Most often CD will last for long periods of time but it can subside within six months to one year even when left untreated.
If you do feel that you have CD, you will want to explore medication. I am not a big proponent of medication, however in the case of CD we have lots of evidence to show that it really is needed. If someone has CD and they respond favorably to antidepressant medication, this might also be a good indication that their depressive disorder is caused by an underlying chemical imbalance instead of a stressful situation. Medication is very important in treating depression because when left untreated, CD can cause brain cell (neuron) damage over a long period of time. Studies have shown that the antidepressants will protect the neurons from damage from the stress hormones produced at the time someone has a depressive episode. Therefore, antidepressant medications have a long-term beneficial effect in that they are protective in preventing neuronal death or damage.
We do know that those who experience substance abuse often suffer with depression (we have no idea if this is cause or effect…. ).
There is a difference between clinical depression and an episode of depression. We have done both the disorder and the experience a huge injustice and caused lots of complications in the field by giving them the same name! The reason a behaviour analyst will ask you to take lots of data and get booked in for series of intervention is because we want to find out what is really going on for you.
Depression is treatable, as is anxiety, as is addiction. It is rare to have a comorbidity of all three and if there is a struggle with more than one, it is important to find out what the main struggle is. It is rare for addictions to span multiple ‘drug’s – ie across illegal drugs, alcohol and sex. It is important to determine if you actually have an addiction as opposed to a susceptibility and a history of reinforcement and punishment (this is also what addiction is, but it has a different reinforcement schedule which maintains it).
Anyhow, what I am trying to say is that we can find out all of the answers, but it will take ongoing intervention. Behaviour analysis is evidence based and interventions are based on what is actually going on. This isn’t a short term intervention – there is often a long history we need to address. We will need to teach you to truly understand what is maintaining your behaviour and we will need to change some of your current environment around.
When you say you have had a bad couple of days, what do you mean? Have a think about what a bad couple of days really looks like and really feels like. Are you able to label it? If not, your behaviour analyst will want to take a look at your ability to label and teach you this skill. It is hugely important in reducing symptoms of depression.
This journey you are on is about recovery – recovery from all of the behaviours you have engaged in in the past and in the current which cause you to feel and behave the way you do. That means that you have to be serious about change – changing your current environment, becoming truly accountable and really addressing the function of your behaviour. It is important to get in there during the bad days, not just afterwards.
A lot of situations that look like depression actually stem out of guilt (being down about what we have done/do) or shame (being down about who we are/think we are). ‘Depressive behaviours’ kill motivation and actually become motivating themselves. We need to teach motivation to NOT engage in certain behaviours and ENGAGE in others – however, in order to become self motivated we need other people involved. It will be crucial for you to learn your patterns. We use a social rhythm diary with our clients which is hugely beneficial. We need to determine where exactly you are jumping on that addiction or depression train and have you turn around before you get there – it may be a setting event (something that happens a couple days in advance perhaps) or a thought/chain of thoughts. Again, learning about behaviour will really help you here. We need to look at rituals, and we need to look at thought processes and recurrence of thoughts.
What motivates you? I mean truly motivates you? What gives you meaning and value to your life? If you say God, tell me what that looks like for you.
Do you feel good enough? If not, there is something lacking and we need to find out what that is. This intervention really has to be ongoing and stable. We need to discover where the lies are you are telling yourself and undo these, and we need to undo any isolation you are engaging in. We also need to look at control.
You have likely been successful in the past to a certain point, but now is the point that you have to really step out (ie the Israelites). Don’t be afraid – we’re not going anywhere, and there is nothing that you can say that will shock us or make us go anywhere. You need to occupy and take the whole land, not just keep fighting for bits of it. You need to go further than you have ever gone before and further than you think you need to. This is about living a completely new life. It needs to be radically full of faith, hope and love. Your life doesn’t need to be as it has been, but in order to change that you need to be radical and you need to commit to and stick at this.
