- Depressive mood – the person being in depressive disorder usually describes his/her mood as depressive, telling that he/she feels sadness, sorrow, frustration, despair. This depressive mood characteristically dominates the person’s life. This is often the case of breaking down in tears readily. However, the person may describe his/her mood with words such as “I don’t care anymore” or he/she might say that he/she doesn’t feel sorrow.
As we have already stressed, we look for other symptoms as well, apart from depressive mood.
- Anhedonia – Lack of pleasure in activities previously pleasant is the main symptom of depression.
- Anxiety – many people experience anxiety in a form of internal discomfort, fear, feeling of imminent danger, irritability or even panic attacks with concomitant physical symptoms such as sweating, rapid heartbeat etc.
- Sleep disorder – most people experience insomnia, and sometimes hypersomnia as well. Insomnia consists in the person’s inability to fall asleep, in waking up in the middle of the night, in difficulty to fall back asleep and in waking up early in the morning which is extremely often and annoying since the person wakes up early in the morning and cannot go back to sleep.
- Appetite disorder – anorexia appears accompanied/or not by weight loss.
- Fatigue & exhaustion
- Decrease in sexual mood
- Psychomotor slowdown – slowdown of thought, speech and motions
- Psychomotor agitation – irritability, restlessness, tension, or even agitation
- Helplessness – lack of hope
- Suicide thoughts or attempts
- Feelings & thoughts of guilt or/and worthlessness, low self-esteem
- Difficulty in concentration.
Postpartum period is characterised by an increased vulnerability in mood disorders. About 40-60% of women experience a mild depression (with symptoms such as intense mood changes, anxiety and discomfort). Postpartum depression appears 2-4 weeks after labour. It is associated with the presence of depression before and during pregnancy, social and personal problems, lack of social support and stressful life events. Postpartum depression may appear from the first day after labour up to 3 weeks later. Symptoms appearing are intense nervousness, intense changes in mood, confusion, difficulty in concentration and paying attention, loss of sleep and appetite and thinking disorder in the form of disorientation, delirious thoughts and illusions.
In the question what finally is going on, why so many women are depressive, researchers answer with the theory that women are high-risk group, given the combination of biological and genetic factors including hormonal changes in menstruation, climacteric and menopause.
Other factors to blame were social and cultural ones.
- Social roles – women often suffer from conflict of social roles (mother, wife and worker) and responsibilities in their lives, resulting in anxiety and depression. According to research, single and divorced mothers are more vulnerable in experiencing depression compared to married ones. When women are those who assume the role of the person who takes care (especially when there are children or/and elderly people in the family) they have to meet more demands, they have less personal time and tend to get very tired physically.
- Unequal social power – lack of social power and low social position of a woman may lead to inferiority feelings, discrimination in the workplace, part-time employment or unemployment. Low socio-economic status is a risk factor for depression. Another factor significantly contributing to depression is the emphasis modern society puts in the woman’s youth and beauty.
- Sexual and physical abuse – girls who are victims of sexual or physical abuse in childhood have increased risk of depression in adulthood. According to research in Great Britain, domestic violence takes place in 1 in 4 houses, while a research in London showed that 1 in 6 women has been a rape victim.
- Frustration by personal relationships – lonely and divorced women show higher rates of depression compared to married ones. However, marriage benefits for women decrease when satisfaction from marriage is low. Women place greater emphasis on their relationships with others, which makes them more vulnerable. When a relationship fails, many women lose their self-esteem and their identity because they do not know how to define themselves outside of their care for others. This might decrease the control they can exercise in their lives.
- Economic difficulties – poverty is more frequent in women than in men and it is a serious and chronic stressful factor that may lead to depression.
- Psychological factors – they are also responsible for depression in women such as:
- Release mechanisms – women, when they are mentally pressed, rake over their problem (i.e. they cry to reduce emotional tension, they try to detect the cause, they address friends), which sustains and deteriorates depression. Women tend to use strategies focusing on emotions as a way to face problems. This intensifies depression because it leads in recalling negative events and focusing on negative aspects of the person’s personality. On the contrary, men turn to action and avoidance as mechanisms of problem release.
- Reaction to stress – women are more vulnerable in stressful situations because of female hormones.
- Self-image – body image is closely linked to self-esteem in woman and low self-esteem is a risk factor for depression.
- Family history with mood disorders
- Previous existence of the person’s mood disorder
- Loss of one parent before the age of 10
- Physical or sexual abuse in childhood
- Psycho-social stressful factors (job loss, loss because of death, grief, dissolution of marriage, serious illnesses)
- Lack of relationship of trust with the partner (bad relationships, neglect, abuse)
Women are considered more prone to depression during a loss or another serious negative event in life. Destructive events of life and the long-term difficulties women face lead to low self-esteem, feelings of failure and rejection and when there are no ways to deal with them successfully, feelings of sorrow and despair are created. Chances to experience depression are not necessarily increased by loss or threat of a loss but by simultaneous existence of humiliation, degradation and entrapment, when the sense of the person’s personal value is offended and there is a sense that there is no escape. These elements make a difference between a depressive and a non-depressive course.
The women’s interest, the motive that will push them to seek counselling help, will start from getting informed about and realising the condition and their place in society. Information at a local level should precede but also at a national one, through the Media, informative lectures, awareness groups and many activities. People’s awareness for the roles of their gender and realisation of their choices should start early in life.
School is the basic institution through which a person socialises after family. In the ages of 6, 7, or 8 children can get informed about behaviours of men and women focusing on their equality. At school stereotypes linked to choices, expectation and behaviour of men and women can be more easily removed, thus expanding their identities.
Family and friends may as well help! Since depression is a condition weakening and exhausting the woman, it is more likely that sometime she will seek help from her milieu. Nonetheless, women who haven’t experienced depression may not completely understand what they have to deal with. Even without evil intention, beloved ones and friends may, unwittingly, say or do something that may harm the woman.
It is important to offer emotional support. This means that the depressive woman should be handled with understanding, be surrounded by affection and be offered courage. Try to be close to her, by talking to her, listening carefully to what she has to say. Don’t underestimate any feeling expressed by her. Offer her hope. Invite her to walks, visits etc. It would be better for this woman to try and develop some new interests and social life, either by participating in various groups, or by working out, or dancing. To try little by little to find herself again and continue her life with strength and optimism.
The counselling procedure in the therapeutic approach of women should target change, equality, strengthening, balance between independence and interdependence, and appreciation of diversity. Therefore, it should target the adaptation of an environment constantly changing which we cannot control.
Depressive people very often feel the stigma accompanying mentally ill people. This makes them refuse to seek for help in the early stages of the disorder, before specific negative cognitive, emotional and behavioural models settle in them. Instead of just recognising that they might need some professional help, they often feel and characterise themselves as “weak” and “”losers” (or they are afraid that others might characterise them as such), due to increased difficulty in coping with many issues in their lives.
Before we proceed in discussing the cognitive-behavioural therapy of depression, we should stress that cognitive-behavioural therapy is not just a compilation of useful techniques that can be used in a uniform manner for all conditions.
Cognitive-behavioural therapy is based on the idea that the ways we interpret situations significantly affect how we feel and behave as a response to these situations. When someone is depressive, usually he/she cannot see things clearly. Everything carries a negative burden and alternatives in problem solution are not visible. Let’s think of an example. Let’s suppose that you think that nothing can help you with this depression and you believe in this idea 100%, you have absolutely no doubt in your head. Which emotion and which behaviour would follow this thought? Right. You would feel desperate. Would you be here? Of course not, would you? What would happen with your depression if you didn’t even come for therapy? Nothing great, right?
Therefore, you can see that before you even test a therapy that will help you solve your problems, you would have rejected problem solution. What you need is to learn the way to actively interpret situations. To accomplish this, it is important to detect and evaluate especially these thoughts, admissions and beliefs related more to deterioration of your mood or to maladaptive behaviours, because in many cases there are other, more adaptive or/and accurate ways to see the same situation. Often, when we are upset, images come very fast to our mind, which doesn’t help us at all, but we don’t bother examining them. In cognitive-behavioural therapy you will learn everything regarding detecting, evaluating and modifying dysfunctional beliefs and this means that you become more and more the therapist of yourself.
