We all have those days when we need to drag ourselves out of bed and don't feel the motivation to do anything. But while this “down-in-the-dumps” feeling may hit us every once in a while, there is a major difference between just feeling down and suffering from full-blown depression. However, not everyone is aware of the difference. “People are going through depression. A lot of them are not educated to realize that they are depressed,” says Rola Ashour, youth and adult counselor and psychotherapist who works at the Adult and Child Therapy (ACT) Center in Jeddah, a multidisciplinary mental health care private practice. On the one hand there are those that say they are depressed when they have one bad day, and on the other there are people who do not leave the house for months but think they only go through a difficult period. Down or depressed? Mental health workers usually follow the Diagnostic and Statistical Manual to determine whether someone is depressed or ‘just' down, and although only a professional can diagnose a person there are certain symptoms that point towards depression: Sad mood, loss of interest in life, and a sense of guilt or worthlessness are among them. Other symptoms are fatigue, insomnia or excessive sleep, as well as changes in appetite and/or weight. In general, if a person cannot function in his daily life due to these feelings health practitioners speak of depression. It is also difficult to estimate how common depression is in the Kingdom – statistics on this are not available – but Ashour and her colleagues at the Act Center think it is as common here as it is in other parts of the world, although the way depression is viewed and treated has changed tremendously. “There's a trend now that is moving towards seeing therapists and working on it,” explains colleague Tala Al Soleiman. For a long time, the psychoanalytical and developmental psychologist says, psychotherapy and psychological counseling didn't exist as such in the Kingdom. Instead, people with mental health problems used to see a psychiatrist and take medications without trying to solve their issues through therapy. For one part, there was this taboo on talking about private issues and problems. “Complaining to anyone other than God was considered ‘unappreciative',” explains Ahour. Secondly, there is the power of pharmaceutical companies who simply want to sell antidepressants and are not interested in other forms of solving depression. “Sometimes it is easier for [patients] just to take the medication, because to make changes in your life takes effort,” adds Al Soleiman. Luckily, this has been changing over the past decade, not in the least part because of the side effects these medicines have. “[Patients] sometimes live on medication and they don't feel highs either,” Al Soleiman continues. In other words, the antidepressant numbs a person's feelings, whether of happiness or sorrow. Nowadays, there is a trend towards a more authentic life, including accepting the ups and downs. This tendency is part of the positive psychology trend, a branch of psychology that focuses on the strengths and virtues that enable individuals to thrive. Prone to be depressed? While everyone may suffer from depression, some groups are more disposed to be depressed than others. Women, for instance, are twice as susceptible as their male counterparts, although the difference in rates begins to wind down once people reach their 50s. Genetic factors also play a major role: Studies have shown that in most cases of depression, around half of the cause is genetic. In other words, depression can run in the family. The other half is unrelated to genes and includes psychological and physical factors. Among the non-gene related factors are being single and living alone. This is partly due to social pressure, warns Al Soleiman. Especially women over 30 years are expected to be married and have children, and if you do not meet this ideal you may start thinking something is wrong with you, while you could be perfectly happy with the life you live. However, Ashour warns, “loneliness can be very detrimental to the psycho.” This explains the higher rate of depression among singles as well as the elderly, although the latter is also a result of biological changes. When we age, our bodies simply produce less of the ‘feel-good hormones'. In the US, “about 75 percent of people over 65 are depressed,” illustrates Reem Alharithy, ACT general manager as well as trauma and PTSD (post-traumatic stress disorder) therapist. Generally speaking, the more you are connected to people, the less likely you are to feel lonely and suffer from depression. Having a purpose in life is also indispensable, adds Al Soleiman, whether this is a job, taking care of the kids, going to the gym every day, or just being given minor responsibilities. A last group of causes are physical factors. Depression has been linked to problems of the thyroid and other hormonal conditions, says Alharithy. Thyroid disease can often be solved with medications. Other hormonal conditions include post-partum depression due to the shift in hormone levels that takes place after pregnancy. This type of depression usually subsides after a few months, but for severe cases counseling or drugs can be a solution. How to solve depression? Beside medication, counseling is the only proven solution to treat clinical depression, but that does not mean there is nothing a depressed person can do to boost his mood. According to Ashour, physical exercise is a great way to feel better. “It increases serotonin,” a hormone related to depression disorders. Indeed, new research from the University of Texas found that just a single 40-minute period of exercise can have an immediate effect on mood, while exercise has been linked to higher self-esteem, better sleep, less stress, and more energy. Another proven way to change the way you feel is to surround yourself with positive energy by spending time with positive people and avoid the eternal complainers, adds Alharithy. As depression and loneliness go hand in hand, spending time with people you can trust and who support you is an important step in getting rid of depression. Avoiding negativity, however, goes beyond evading negative people. “Limiting time on social media has actually proven to make a big difference,” says Khashoggi, adult and child psychotherapist and counselor. A new and promising way to treat depression is by practicing mindfulness, a trend described as being aware of one's self, one's emotions, and the world around us without judgment. It is a way of being in the present, without worrying about the past and future, a practice to focus on the now and here. According to the Act Center psychologists, it is possible to practice mindfulness without the help of a professional – by reading books or searching the Internet. However, the psychologists add that most depressed people are unlikely to be able to initiate their own healing process. Depression is a disease, just like any physical disease, and it needs proper treatment carried out by professionals in order to be cured.
