Depression is an extremely prevalent mental health experience affecting millions of people all over the world, and British Columbia is no exception. Many of our Clinical Counsellors at Nightingale report that clients ask “Is this depression?” as they outline feelings of powerful pessimism, lack of energy and motivation, helpless and hopelessness, and, often, loneliness and isolation. This lack of clarity about what depression is makes it more difficult to bear, as it adds confusion to the already challenging cluster of symptoms.
Severity and the Symptoms of Depression
Part of what makes depression so hard to identify (and to find treatment for) is that severity of depression has an enormous range.
In its more mild form, depression can look and feel like a kind of laziness or lassitude, a little less energy throughout the day: a feeling of sluggishness, like we are dragging our heels. Our mind can become kind of thick and foggy, even if our thinking is still functional. Activities, hobbies, relationships, and even thoughts which once kept our interest no longer seem to have the same exciting or meaningful quality to them. Things don’t feel quite right, and maybe we are waiting, expecting to feel better tomorrow. Our mood can feel volatile, irritable, and low. These mildly depressed feelings might be similar to being worn out—but when it becomes chronic, when no amount of sleep or rest seems to let us “bounce back,” we can wonder what’s going on.
As severity increased to moderate or considerable levels of severity, many people became increasingly concerned. The depressed feeling is now more constant, lasting for more hours of the day, or more days of the week. It is also stronger: the lack of energy can make it difficult to do the things we normally take for granted. We struggle to complete our responsibilities to work or to friends and family or other relationships. Perhaps we are only able to do some of them, and we give up on many of the tasks which just a few days or weeks ago felt easy and natural to accomplish. At this point we may find that family, friends and coworkers are wondering if something might be wrong with us, our low mood having taken over many parts of our day. No longer just “worn out,” we can start wondering if we are facing a deeper “burnout.” The lethargy increases and we can find ourselves spending more and more time in bed. The pace of time may change, slowing down, and our mental fogginess can thicken. Time flies, even though any given minute seems to last forever. People, things, activities, or ideas that usually interest us now provide very little stimulation, and we can begin to feel a certain distance or disconnection from ourselves or from the world.
At this stage, the question “Is this depression?” can come from inside ourselves, from family members, or other people who care about us, as the symptoms can become noticeable to others. Some people are experts at effectively hiding their mental health from others, and this can be true even of quite distressing and de-stabilizing depressive experiences! Many people will consider different health services at this point, looking for some type of treatment, perhaps unsure if this is illness, a mental health disorder, or an emotional/experiential issue.
When depression becomes severe, it is clear to many people (and/or their family members or other close connections) that professional help is required for these problems. Often, at this point, people will call their doctor for support. At Nightingale Counselling, many of our clients with severe depression have arrived indirectly, through referral from their family physician to include Registered Clinical Counselling along with other interventions as part of a depression treatment plan.
Severe depression is completely overwhelming and can take over our lives during the time we are in crisis. During this condition, it is common for people to stop nearly all forms of self care: showering and other basic hygiene stop, socializing is minimized as much as possible. In severe depression, perhaps we only get out of bed once per day, for a brief and agonizing move to get some food and use the washroom.The strange patterns of passing time can continue. Our physical lack of energy can become enormous, like a heavy weight is upon us, or as if our muscles are too pained, exhausted, and/or weak to support any movement. The foggy feelings in our mind can extend into a kind of dissociation in which we may feel entirely disconnected from ourselves or from the world. Looking at our own body can feel as if what we see with our eyes isn’t a part of ourselves at all. We may see the entire self, as if watching from above or as a film. Or a profound sense that things aren’t “real” might take over. This can have both pain-relieving and pain-increasing qualities to it, in a complicated relationship with each other.
The awfulness of severe depression can lead to suicidal thoughts.
NOTE: If you are currently feeling suicidal, please call your local suicide support network. In British Columbia, please call 1-800-SUICIDE, for free, non-judgemental, and compassion support.
Suicide is a very real risk for those suffering from severe depression. For many, the resiliencies that they experience in their life during non-depressed times feel very far away. People who do not seem to be at risk for depression during “ordinary times” can still become at risk during severe depression. If you, or your friend, loved one, family member, etc., is feeling profoundly depressed (even if this includes very different symptoms than those described above), please reach out for professional mental health resources and support.
Support for active crisis—such as those actively planning suicide—include the suicide hotline ( 1-800-SUICIDE) and 911.
Support for those at risk of, but not currently in an active crisis include your doctor or the Vancouver General Hospital Access and Assessment Centre (call 604-675-3700). (If you are having intrusive suicidal ideations, are beginning to consider plans for suicide, or have increasing intentions toward suicide.)
Support for those with suicidal thoughts and ideations, but without plans or intentions, can include Therapists and Counsellors.
Treatment for Depression
For those with severe depression, treatment often involves a professional team and includes oversight by a doctor, medicinal interventions, and supportive counselling services. For those with major depression, you are welcome to reach out directly to our Counsellors at Nightingale, especially if you want to ensure that treatment for your depression will involve more than medicine. Where problems in living have become particularly severe, a collaborative health care approach will be best. Counsellors are trained to work alongside other mental health professionals including Psychologists and Psychiatrists.
For most people with symptoms of depression, it will not become severe, nor will it be useful to search for a medical diagnosis of depressive disorder. A great many people suffer from more ordinary kinds of mild to moderate depression, and for these people counselling therapy can be a highly useful intervention without the need of additional health services.
There are many types of depression that we might call ordinary and not a clinical disorder. They include the following:
● Grief and loss can create a deep melancholy and sadness that can have a lasting impact.
● Seasonal affective disorder can be a useful name to understand the change in mood that many can feel in the winter months (especially in Vancouver where the rainy season can be dull and wet and long!).
● Feelings of intense loneliness and disconnection, whether in the aftermath of breakup, or during a long pandemic, or even something that seems to always be there in the background of life.
● A long pattern of suppressed emotions can lead to a certain numbness and flatness that can relate to depressive problems.
● A profound feeling of frustration, uselessness, helplessness, or hopelessness can generate low mood and a collapse out of the world.
● A sense that we have no purpose or no meaning (what some philosophers call existential dread).
What is depression?
The list above outlines a series of “natural disasters” that can occur in even the most resilient person living the most ordinary life. Life is hard, and throughout our years we will undoubtedly experience loss, sadness, difficult emotions, and other powerful experiences. Our connection with ourselves, the world, and our loved ones can ebb and flow. We meet most of these challenges and demands effectively, but sometimes it can all be too much. We lose that internal feeling that tomorrow will be better and that the work we do today can influence our situation. When we lose those feelings (of hopefulness, usefulness, and purpose) we become depressed. This is where therapy enters.
Why we become depressed during these times is in interesting topic, which deserves its own article!
How does counselling therapy help?
Because depression is so prevalent, nearly all therapeutic styles have strategies for treating depression. Successful depression counselling should involve two parts: stabilization and root cause exploration. Stabilization is important because learning tools and techniques to help manage and control your symptoms are essential for resuming day to day functioning, and building the capacity (mental and emotional) required to look for root causes. With a baseline of stabilization and enough improved mood and energy, Counsellor and client should look for the cause(s) and triggers of depression and begin building broader structures of resilience to try to prevent or reduce further occurrences of depression. A registered Therapist should have training and experience in both of these phases of depression counselling.