Following the death of Robin Williams, we look at the symptoms of depression, how to recognise it in others and how it can be treated
Symptoms
The tragic death of Robin Williams, who is believed to have committed suicide, has put the issue of depression firmly in the spotlight, demonstrating that even those who appear to lead the most charmed lives can fall victim to the black dog of depression. The actor has always been open about his fight with the illness, recently telling an interviewer, "Do I get sad? Oh yeah. Does it hit me hard? Oh yeah." But what do we do when concerned about friends and loved ones who are struggling with these issues?
In the UK, one in four people will experience a mental health problem in the course of a year, and depression is the is the most common type, so it's worth brushing up on the warning signs and knowing how to approach people you're concerned about.
What is depression?
Depression, by its nature, is hard to diagnose. However, the World Health organisation describes depression as "a common mental disorder, characterised by sadness, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, feelings of tiredness, and poor concentration." It's also a condition which is incredibly hard to describe and can be experienced in different ways. Sufferers often hide their condition from those around them.
Depression can strike at any time, and can affect anyone, and if you're concerned that a friend or loved one might be depressed, knowing the warning signs can be a big help. "Warning signs include not sleeping, loss of appetite, loss of enjoyment in activities that previously would have excited, irritability (particularly in men) negative thinking and thoughts which are dominated by hopelessness, worthlessness or guilt," explains Dr Paul McLaren, consultant psychiatrist at the Priory Hospital Hayes Grove.
The stigma associated with mental illness is diminishing but sadly, it still exists. It's important to remember that depression can affect anyone at any time of their lives, but knowing the risk factors can be useful. "Depression results from a complex interaction of social, psychological and biological factors," explains Professor Katharine Barnard, a health psychologist based at the University of Southampton. "Women are more likely to suffer from depression than men, and a previous episode of depression increases your chances of developing it again. People with relatives with clinical depression are at greater risk themselves."
Depression or a bad mood?
One issue which can make the identification of depression tricky is the fact that the world has generally become a more stressful place to live in. News reports herald a constant reportage of death and destruction and, closer to home, the financial crisis has wreaked havoc for many of us. So how can we tell whether a friend is simply suffering from a bad case of the blues or potentially experiencing something more serious?
"One of the key questions to ask is about loss of enjoyment," says Dr Paul McLaren. "When we are depressed we lose the capacity to react to good things happening. This is the best way of distinguishing between depression and stress." If you're concerned about a friend's dark moods, try to remember when the situation started. "Watch out for prolonged symptoms lasting for two weeks or more and an inability to ‘snap out of it’ in a few days and resume usual mood," advises Professor Katharine Barnard. "People suffering from depression often feel sad, hopeless and disinterested in life in general."
How to approach the situation
When it comes to approaching a friend or relative you're concerned about, tread carefully. Telling them to "snap out of it" or joking that "life can't be that bad" is unlikely to help someone suffering from depression. "Be frank and open about your concerns," says Dr Paul McLaren. "Don't try to cheer them up or to jolly them along, as this can make someone who is depressed feel more alienated and rejected. Depression is not a life choice that we can switch on and off. It's a serious malfunctioning of the brain that usually requires treatment with a talking-based treatment or medication."
Treatment
The good news is that recent developments relating to the treatment of depression are yielding impressive results, with more sophisticated therapies and medication which doesn't have the side effects which were once common. "The main psychological treatment for depression is cognitive behaviour therapy and there is a strong evidence base for its effectiveness in mild to moderate depression," explains Dr Paul McLaren. "With moderate to severe depression medication is required. While there are a number of drugs available there is no wonder drug, and the newer drugs, while safer, are no more effective than older antidepressants."
Dr McLaren adds that there's continued research into other types of treatment, but a combined approach remains the most effective option. "A new physical treatment is transcranial magnetic stimulation (TMS) which is like ECT but uses a magnetic field to produce therapeutic changes, rather than the electric current which is used in ECT. However while initial trials in this have been encouraging, its use has remained limited. The most effective treatment for moderate to severe depression is a combination of psychological and pharmacological treatment delivered in a timely manner."
Whether you're concerned about a friend or believe you may be suffering from depression yourself, there are plenty of organisations which can help, details of which are below:
- Mind - The UK's largest mental health charity.
- Sane - Another large UK charity set up to help people suffering from mental health problems
- Rethink - A UK-based charity which deals with all type of mental health problems, including schizophrenia and bipolar disorder.
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