Depression: Looking at the wider picture. Anxiety, Personality, Life Situation, Addictions
- It is very common for people with depression to also experience other symptoms such as anxiety.
- In some cases, the person has been experiencing symptoms of depression for a long time, and it is helpful to explore issues such as personality, use of alcohol or other substances as well as other mental difficulties.
- Alcohol (as well as other substances) can be a coping mechanism for someone with depression, but can also worsen the depression on the long term or even be one of the causes.
Is Depression the primary problem?
Given the wide range of difficulties, it is unsurprising that clients describing Depression also experience other related problems. Some of these correspond to other mental health classifications. A particularly common one is anxiety.
We can all feel anxious. In small and controlled forms, Anxiety can be useful in terms of survival and development. When extreme, pervasive, or disproportionate to the threats we face, it can become very disabling.
Where people describe experiences involving Anxiety and Depression, it is vital to understand the relationship between the two. This may involve exploring which experiences started first, how the different problems affect each other, which are the most troubling, and which ones the client wants to work on first.
Sometimes, Depression can seem part of wider historical problems. Some people describe low mood and problems with relationships and functioning as being present for as far back as they can remember. Perhaps the problems emerged with, or in response to, difficult early life experiences. Sometimes these problems may be better understood as part of the individual’s Personality.
Formed when we are very young, Personality can involve our ways of seeing the world, ourselves, and how things should be. These ‘rules’ can govern how we behave, feel, and interact. When problematic, these Personality structures can lead to difficulties across all areas of a person’s life. If problems with emotions, functioning and relationships seem more associated with Personality, it may be helpful to consider them more as part of Personality Disorder than Depression.
This may involve looking to therapies which are known to help, such as Dialectic Behavioural Therapy (DBT). This can really support a person make changes to Personality and learn new ways of managing emotions, relationships, and wider issues.
In some cases, a clear cause or trigger to the client’s low mood or associated difficulties can be identified. For example, it is normal to feel intensely sad and want to withdraw following the death of a loved one. The lived experience, for a while, may feel similar to that of someone who has lived with Depression for many years.
However, unless the emotional reaction continues indefinitely after the loss, or develops into serious problems with functioning or thoughts about worthlessness or even suicidal thoughts, it may not be helpful to diagnose Depression. There may be very different needs in terms of talking therapies if the problems are clearly in response to loss. Bereavement Counselling can help discuss, work through and ultimately come to terms with a loss, working through different stages of adjustment to it.
In other cases, Depression may be maintained by a specific life situation or relationship. In such cases, it may be more helpful to draw on strengths and resources to make changes to the underlying situation, rather than or as well as working directly with the emotional difficulties.
Depression and Addiction
Sometimes people can struggle with Addiction at the same time as Depression. The two can be linked in different ways.
When fighting Depression, people can turn to alcohol or substances to help get them through. This is understandable, but usually leads to worsening depression or other associated problems. Other times, difficulties with alcohol or drugs can lead to problems or loss, which in turn can lead to Depression.
It is important to not judge or assume, but to work to understand the links. Often, I first support the person make changes to or stop their use of alcohol or substances to take back control, before working directly with the Depression.Dr Alberto Pertusa, Clinical Psychiatrist, Addcounsel