Depression explanation


Depression is a condition that is considered a ‘mood disorder’. Its main characteristics are a long-lasting low mood, lethargy and/or a loss of interest or an inability to enjoy anything. One in seven Dutch people experience depression during their lifetime. Depression is twice as common in women as in men.

What are the symptoms?

The Diagnostic Manual for Psychologists (DSM-5) indicates that the following symptoms are associated with depression:

  1. Depressed mood during most of the day, almost every day;
  2. Reduction of interest or pleasure in (almost) all activities, almost all day, almost every day;
  3. Inadvertent, obvious weight loss or weight gain, or a decreased or increased appetite almost every day;
  4. Sleep complaints: not being able to sleep (sufficiently), sleeping too much, almost every day;
  5. Psychomotor agitation, restlessness or inhibition almost every day;
  6. Fatigue or loss of energy almost every day;
  7. Feelings of worthlessness, or excessive and wrongful guilt;
  8. Diminished ability to think or concentrate, or indecisiveness;
  9. Recurring thoughts of death, suicidal thoughts, fantasies about suicide with or without plans, or attempted suicide;

To be diagnosed with depression, 5 or more of the above symptoms must be present for a period of at least two consecutive weeks.

How does depression develop?

There are a lot of factors that influence the onset of depression, such as biological or genetic factors, environmental factors and life events. These are often major life events such as job loss, death of a loved one or conflicts. It can also be due to problems that have been going on for a long time but are starting to become a burden. It is also possible that we are burdened for too long with too many problems at once or confronted with too many problems too quickly. Sometimes even pleasant but far-reaching changes can also give rise to a lot of stress: think of a move, promotion at work or a change of job, for example.

The vicious circle of behaviour

A low mood and fatigue are often accompanied by the emergence of negative or sombre thoughts. These can make you feel less motivated and, in turn, you will do less during the day. When you do less, you can feel guilty or less satisfied about your day. This in turn reinforces the feeling of gloom, further decreasing your motivation. This vicious circle causes someone to withdraw further and further.

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One of the most effective forms of treatment is Cognitive Behavioural Therapy (CBT). CBT focuses on your thoughts and behaviour. With the help of your therapist, you will try to break the vicious behavioural circle with the help of behavioural activation and by applying structure to your days. In small steps, we will try to increase the amount of daily activities you do that give you energy and make you feel positive. This process addresses symptoms such as avoidance, withdrawal and inactivity. The goal is to get you to be more active again, resulting in experiencing more satisfaction. This activation can also reduce fatigue and improve sleep, making you feel better step by step. It is important to keep a consistent schedule, eat regularly, exercise more and keep in touch with friends and family.

The second part of the treatment consists of cognitive therapy. Cognitive therapy is a systematic method that helps you to understand the thoughts that lead to unpleasant feelings. You learn to think differently, and, in turn, your negative feelings will decrease. Three steps are taken:

  • You learn how to become aware of negative automatic thoughts;
  • You learn to become aware of the underlying beliefs that reinforce these thoughts;
  • You learn to challenge and investigate the negative automatic thoughts and opinions by asking critical questions about them. You will then consider whether alternative perspectives or thoughts are possible. You do this with the help of a thought record.

Source: PsyQ: what is CBT

Keijsers, G. P. J., Van Minnen, A., Verbraak, M., Hoogduin, C. A. L. & Emmelkamp, P., (2011). Protocol-based treatments for adults with psychological complaints.

DSM-5: Dutch translation, American Psychiatric Association, Boom Publishers (2014)

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