Depression is sadness that has gone on so long it affects our body and behaviour. You might notice changes in your sleep, appetite, sex drive or ability to stay interested in things you previously could.
The causes of depression
Depression is often connected with bad experiences like bereavement, losing your job, splitting up with a loved one. Sometimes it is connected with anxiety or low self-esteem. But not everyone has the same reaction. Some people are more likely to get depression than other.
Why is that? Psychologists like to think that our minds, bodies and communities affect whether we get depression, how long it lasts and how well it responds to treatment. They look at the problem from all sides: the biological, the psychological and the sociological. They call it the Bio-psycho-social model:
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Biological – how our bodies developed and particularly the genetics we inherited from our biological parents.
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Psychological – our unique way of thinking about the world, have we got negative thinking habits, and can we change these.
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Sociological – the way we were raised, the people who influenced us and the experiences we had.
The three states each interact with each other.
Bio → psych
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↖
Social
Eg My asthma causes me to worry about my future, which makes me avoid social events and I get lonely.
Eg I didn’t know anyone sporty growing up, now I have got really unfit, and I think people don’t like me.
Eg I’m haunted by bad memories, which affects my sleep badly, so I hang out with my friends and drink a lot.
Treatment and interventions
Treatments can also be aimed at the bio, psycho or social vulnerabilities. Different approaches tackle depression in different ways and different people prefer different approaches.
Antidepressant tablets are prescribed by GPs in the first instance and psychiatrists if it is for a more complex and severe depression. These tablets take at least two weeks to work and must be taken regularly as the instructions say.
Social approaches to depression look at what changes to the person‘s life might help: changing the company you have, the activities you do, or getting support with basic daily life skills from friends family or community providers (places of worship, clubs, mental health charities).
Psychological approaches tend to be provided by psychologists and counsellors. The aim is to look at how your negative thoughts are dragging you down. These thoughts might be rapid, jumping into your head when you are getting on with your daily life. They tend to make big blatant statements like ‘I’m rubbish, I’ll be bound to fail, everyone hates me.’
Or they can be slow thoughts that have been in your head and possibly in your families’ way of talking for years. Eg ‘This family always has bad luck’, ‘you mustn’t tell people your problems’, ‘Only weak people cry’.
Another type of thoughts are traumatic memories. Normally memories fade away. But when something really bad has happened the memory stays around and is still distressing you even though it was a long time ago. A therapist will help you find ways for these memories to be less troubling.
With all of these, the psychologist will help you try to develop different ways of thinking about what is bringing you down and will try to help you develop more positive ways of thinking that are less likely to give space for depression.
When to seek treatment
Everyone feels sad or hopeless sometimes. There is no shame in feeling low. It’s good if you can talk informally to your friends and family.
But you should seek help for depression if it’s negatively impacting your general life. Maybe you’re risking your finances because you can’t work properly; or your relationships are crashing because you’re snapping at your wife or ignoring your children; or
your physical health is getting worse because you are drinking more alcohol or forgetting to take other tablets. Start with your GP and ask what help is available. Getting through depression can take some time.
If you are having thoughts or plans to hurt yourself or kill yourself – you should seek emergency help by contacting 999 or going to A&E.
The 999 line has a video relay service. Download the ap (and help your friends download the ap, just in case you ever need it). Or you use the Relay UK ap – download it in advance of needing it.
The Text 999, Emergency SMS must be registered in a advance.
The Samaritans are a mental health charity and are really good at listening. They can be contacted by phone (if you can use one), email at jo@samaritans.org.uk or text on 0330 094 5717.
SignHealth also has a Crisis Text Service specifically for deaf people. Text DEAF to 85258 (Shout Partnership) for 24/7 support.
How common is depression in deaf people?
In the 1960s and 70s researchers thought the deaf people were much less likely to suffer from depression than hearing people. But then it was noticed that the researchers were only measuring the number of people deaf people who went to hospital with depression. But most deaf people didn’t know they could as for help or go to hospital. The researchers had only counted the deaf people who had good access to a mainstream (hearing) service, which was very rare.
It wasn’t that they didn’t have depression, it was that they didn’t have a way to get any help.
Now that research is improving. The results show that deaf people are actually more like to get depression than hearing people. And that they have a much harder time getting treatment.
Why is it that deaf people are more likely to get depression? Because deaf people are more like to have been bullied, isolated, abused, more likely to have another physical illnesses, and just exhausted at having to concentrate so much harder than hearing people.
Access for deaf and hard of hearing people to depression assessment or treatment
Each deaf person will have their own experience of good and bad access to their GPs, pharmacists and community support. When you are feeling good, you might cope with the bad access. But when you are feeling vulnerable this is a real barrier.
When you can’t stop crying or have not had enough sleep or can’t stop snapping at your loved ones, this is not a good time to have to explain to a GP receptionist how to book an interpreter or try desperately to lipread a new GP that you’ve never met before.
When we are depressed, it is like our social battery is running low. Try to get a good relationship and good interpreter plans sorted with your GP before you need to. Check out the 999 Aps before you ever need them. Start looking after your mental health now.
Depression overlaps with lots of further conditions such as anxiety, addiction, trauma, we will cover these in future articles.
By Dr Sally Austen, consultant clinical psychologist
