Depression is a state of low mood, of feeling sad that can affect a person’s thoughts and behaviour. Everyone can feel sad and low for a period of time facing with adverse events in life but with some people it can last for months, years and sometimes for no obvious reasons. This is a major depression that can be serious leading to aversion to activity, social withdrawal and sometimes contemplating suicide.

People with depression can feel sad, anxious, empty, hopeless, helpless, worthless, guilty, ashamed, or angry.  They usually lose interests in normal daily activities, have poor concentration, have disturbed sleep with insomnia or excessive sleeping and fatigue, disturbed appetite with overeating or anorexia. They may present with vague symptoms such as fatigue, headache, aches and pains or digestive problems.

 

Causes of depression:

-         Depression could be caused by multiple factors such as genetic, chemical imbalance, personality and adverse life events.

-         Adverse life events in childhood such as mental/physical /sexual abuse, neglect or unequal parental treatment of siblings, bullying … Other life events may precipitate depression such as childbirth, relationship problems, financial difficulties, social isolation, peer group rejection, medical diagnosis of cancer, HIV etc or a serious injury.

-         Depression is sometimes associated with substance abuse such as heroin, amphetamines, cannabis, alcohol..

-         Depressed mood can be a symptom of a number of psychiatric syndromes such as bipolar disorder, post-traumatic stress disorder, adjustment disorder with depressed mood, borderline personality disorder, major depressive disorder and anxiety disorder.

-         It is interesting to note that soldiers exposed to the atrocities of war are usually not depressed during wartime as their mind concentrates on survival but when the wartime is over a lot of veterans could not forget those memories and suffer from depression/ anxiety and post -traumatic stress disorder. Therefore if the mind thinks too much about the past, something that could not be changed, they can get depressed and could not enjoy the present time and the peace when the war is over.

-         Similarly, in third world countries when people face with starvation in poor living condition, people have to focus on survival and the rate of depression is not high.

 In developed countries, the rate of mental illnesses is increasing despite the marked improvements in living conditions but more people are dissatisfied with their life, probably because they have more time to think about their problems.

-         Moreover in modern society, individualism is highly promoted, so the importance of the “self” is very high. If anything happens not the way you want, you become unhappy and depressed.

 

Self- help treatment:

Many different types of treatment are available for depression such as antidepressants, counselling and psychotherapy by health professionals, physical treatment and lifestyle changes. In the scope of this discussion, we only concentrate on self- help treatment.

 

1- Depression can be treated:

Some people who are depressed for a long time may identify themselves with depression and they live a life of social isolation and harbouring self -deprecating thoughts such as helplessness, hopelessness, low self- esteem and they are comfortable in their black hole and never have any thoughts that they could ever be better.

The first thing is to believe that depression is only a mental state that could be changed, a state that follows the rule of impermanence as everything else in this life. You need to have the will, the determination to get out of the black hole in your mind. When there is a will there is a way.

 

2- Regular exercise:

Regular physical exercise is the best way to help your mind relax. It may be difficult to start as most depressed people do not have any motivation and effort to do anything.

You can start with simple walking in your own house with your mind only aware of your footsteps like right foot, left foot forward and try to ignore any other thoughts. This is the principle of walking meditation to practice on mindfulness to keep your mind peaceful.

When you are comfortable with walking indoors, you can set up a regular schedule to walk outside in mindfulness as well.

 

3- Connect yourself with nature and humanity:

Try to connect yourself with nature such as having contact with pets, plants, gardens, parks, forests, mountains and seaside.

When you go out in the open space, sit down and contemplate the beauty of nature, of the sunset, of the sunrise and feel yourself a part of nature. You can see the vastness of nature and realise that you and your problem are small comparing to the universe and humanity. You will see that when you are looking at your problem too closely, you will see that your problem takes the whole part of your visual field and there is nothing else in this life. Open your eyes and see the beautiful nature and see the problems of other people in the world, children living in poverty and dying from starvation, people  living in fear daily of being killed in the war, people killed in natural disasters such as earthquakes, tsunami…

Hopefully you come to realise that you have been looking and counting all the misery that happened in your life so far, and therefore you are seeing everything as depressing and life not worth living.  Count your blessings instead, such as you are living in a peaceful country far from the war, a lucky country that many refugees just dreamed to live in, a democratic country that people can receive welfare payments, free medical treatments and having freedom of speech..

 

4- Avoid drugs and alcohol:

Some people try to take up drugs or alcohol to escape from the emotional pain but drugs and alcohol are often the cause of depression or making depression worse and difficult to treat.

 

5- Find support:

Do not try to solve your problem by yourself, open up to someone you trusted such as your relatives, your partner, your friends or your health professional. It is difficult to talk about your problems to someone else but remember that depression is common and you are not alone or the only one to feel that way, so do not be ashamed to admit that you are depressed.

 

6- Practice mindfulness:

Mindfulness involves being aware moment to moment of what happened in front of you, in your mind and what your body is doing at the present moment.

You try to see things as they are without being distorted by your subjective mind.

When you are depressed, you will see things becoming grey and sad. This is like you are seeing things through your “depressed mood lens” and everything will be distorted in the process. If you could put down that “lens” you will be able to see the true nature of things.

Practice mindfulness is to practice to see things as they are at the present moment without the comments in your mind.

There are 3 practical ways of practising mindfulness

-         Mindfulness in daily living: when you do anything, you are fully aware of what you are doing and ignore any other distracting thoughts that come to the mind.

When you are depressed, you have very low energy to do things as all your energy are consumed in thinking about the past or absorbed in ruminations about your problems.

Try to set up a schedule of what you have to do in a day and follow it to the letter. When you do it, try to concentrate at the task on hand without anticipating the next step and ignore any other interfering thoughts. If you are thinking too much you will dissipate all your energy and every task will appear more difficult than it is in reality.

 

-         Walking meditation: this is a very easy way to practice to bring peace and calmness in your mind.

Walking meditation can just be as profound as sitting meditation and has the advantage of incorporating activity into meditation. The informal and easy way is for you to be aware of your alternating footsteps, left foot and right foot.  Paying attention to the body as you walk will help you to enjoy simply being alive at the present moment. You just simply let go of any other depressing thoughts, of any other worries.

You are better to set aside a regular walking time about 20 min or more to get the best benefit. The pace of walking may vary according to your need, that is fast or slow as long as you aware of your steps and let go of everything else. You can put down your burden at last, as you are carrying it all the time previously and it makes you feel down and depressed.

 

-         Meditation:

You can do a formal meditation and set aside initially 10 min and increasing duration when you get used to it. You can also do an informal meditation at any time that you have a moment when you sit or lying down before you sleep and your mind starts to think a lot.

 

a- Practice to be aware of your breath: we all breathe but we are mostly unaware of it.

Just be an observer and observe the breath in and out through your nostrils or feel the abdomen inflates and deflates. Ignore and let go of any other interfering thoughts. You will experience peacefulness in your mind without so much depressing thoughts.

 

b-Develop insight into your problems:

When your mind is relatively peaceful, you are aware of the thought that come to your mind without following it. The thoughts that keep coming up are usually the thoughts relating to your problems that make you depressed. Do not fear of these thoughts as they help you to understand yourself. Do not follow and elaborate on the thought and it will take control of your mind again. Everything is impermanent and the thought will come and go by itself if you are not caught by it.

 

c- Practice compassion and loving kindness: this practice will help to develop a selfless and altruistic love and will give you the positive changes in your attitude toward accepting yourself and others.

 

d- Change your reaction to your own problem.

During meditation, when the thought comes up, you are aware of it and if normally it arouses in you a negative reaction such as anger, hatred, shamefulness,you  nowcome to accept it and change your reaction to that thought by using loving kindness and compassion. In that way you can solve your problem and conflict one by one.

 

 

Suicidal ideation

 

The range of suicidal thoughts can vary greatly from fleeting thoughts to extensive thoughts and detailed planning.

Most people who have suicidal ideation do not go on to attempt suicide but it is considered a risk factor.

Most suicidal people do not want to die but they do not want to live with the pain. Some do it as a gesture of asking for help or attention or to punish someone else. Others will harm themselves on impulse under intense anger or under the influence of alcohol and drugs.

When I was an intern working in the hospital, I met a young 17year old girl who attempted suicide by connecting the exhaust pipe into her car. Unfortunately, she was rescued but it was too late as her brain was hypoxic for so long and she then lived but remained in a vegetative state.

 

Death is thought of as a way to escape. But no-one knows what happens after death. Is that a better or worse situation?

Most people who believe in a religion do not consider that death is the end.

In my opinion, when your mind is deep in depression, you are already living in hell in this life. If you are killing yourself, at the time of death your state of mind is full of pain, of anger, of hopelessness. After death, you may carry on that extreme suffering in your mind and you may be in perpetual suffering as how can you change it?

 

You are living now so make the utmost effort to get out of your depression.

Depression can be treated successfully and do not be deterred by the long road of recovery.

 

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