UNDERSTANDING, TREATING, AND OVERCOMING DEPRESSION. INTERVIEW WITH MARGJE DE ROOIJ, A RELAPSE PREVENTION SPECIALIST AT THE KUSNACHT PRACTICE

How can we define depression?

Depression is a common but serious mental health disorder where people experience a low mood for a prolonged period of time, and it's really impacting their daily life. So they have difficulty functioning at home in their families, for example, at work or with their friends.

How does depression affect emotional well-being?

Depression can affect people in multiple ways. I would say it can affect people's way of thinking. So their thinking patterns can become very negative, for example, or it can even result in feelings of or thoughts around hopelessness. It affects people's feelings. So it can trigger sadness, irritability, anxiety as well. And also it affects behavior. So what people do is that people stop doing the things that they normally did, and that gave them pleasure or a sense of achievement, or a sense of purpose. It can affect people in multiple facets of their life.

What are the causes of depression?

The causes of depression it can be triggered by something, or it can be that there's no trigger identified. What we commonly see is that certain risk factors are present in people

with depression that present with depressive symptoms. For example, physical illness; it can be very difficult to deal with a diagnosis; and that can trigger feelings of sadness. Another common symptom is serious life events. At first life events, a divorce, for example, losing your job. Great transitional periods can also trigger periods of depression. Think about retirement or becoming a parent. These major life shifts can trigger depression as well. But as I said before, it can be that there's no trigger identified and that it is just unlucky that a person develops it.

In what ways can depression affect a person's daily life?

Depression can affect a person's life, like individually, like their self-worth. But also in relation to their family. It can be that there are more tensions in family circles, for example, people find it very difficult, to activate themselves to do stuff with their children. Then there is also the aspect of the work environment where people experience the feeling of dread, going into work, rather staying at home, finding it really difficult to find a motivation to get out and be active. Socially can also impact the fact that people might not go out with their friends anymore. They find excuses for not having to socialize. Quite often, what we see with people in depression is that they do the things that are sort of counterproductive. Right? They stopped doing the things that gave meaning to their life, which only reinforces their feelings of missing out. So I would say then, of course, there's also a high comorbidity with other mental health disorders or even with physical illness as well. Depression can impact a person's life in all facets, I would say.Interpersonally and also physically.

Does depression have an effect on physical health as well?

The literature shows a huge correlation between depression and somatic health. There's an increased risk of heart disease and other mental health conditions. But what I'm more concerned about is the risk of suicide. Unfortunately, depression goes hand in hand with feelings of hopelessness. It depends, of course, on the severity of the depression, but with sense, with feelings of hopelessness comes the risk of suicidal thoughts and ideation. And I think mental health institutions, but also support networks, need to be very vigilant.

Can you outline the methods used to treat depression at the Kusnacht Practice?

An integral part of the treatment of depression is psychotherapy, where we really look at the underlying causes of depression. Alongside psychotherapy, we offer counseling and mindfulness, really, to stay more in here and now and to strengthen the resources. So we look at it from both sides: the origin and also protective factors to strengthen the resources of a person. BIO-R®, another pillar of The Kusnacht Practice, focuses really on rejuvenation and biomolecular restoration. That's an integral part as well in the treatment of depression. And they look at diet and exercise like the foundations to keep a person healthy. And then, of course, their somatic health, treating the underlying illness, and making sure that systematically a person is healthy is also a protective factor when it comes to the treatment of depression.

Do you use medicine as part of depression treatment in The Kusnacht Practice?

In the treatment of depression, The Kusnacht Practice tries to focus on psychotherapy as much as possible; of course, there are fewer cases, or when absolutely necessary then pharmacotherapy is possible.

Is it possible to completely cure depression? What does the Kusnacht Practice treatment typically include?

Depression is a serious but treatable mental health disorder. And this can be in remission. At The Kusnacht Practice the treatment protocol is targeting all aspects of mental health. We’re working from a holistic point of view; we're not only looking at the root cause, but we also look at the strengths of the people. We are not only looking at their mental side but also at their somatic health and BIO-R®, which looks at biomolecular restoration and rejuvenation. They really focus on keeping our body and mind healthy and young, and that can also be a hugely protective factor. So exercise, sleep restoration and diet. They are the core foundations of keeping our mind and our body healthy. So what we do at The Kusnacht Practice is we are strengthening all the resources of the person in making sure that the risk factors are reduced, as much as possible.

What is the typical duration of depression treatment at The Kusnacht Practice?

For the treatment of depression, we recommend a minimum stay of six, ideally eight, weeks of treatment. Here, at The Kusnacht Practice, in which the first two weeks are really centered around assessment, and getting to know you personally on a very deep level, and also to identify the goals that you want to work with and we are left with. Then we have at least a month to work more intensively as well and to help you reach your goals. Of course, I suppose ability and maybe as well the recommendation to stay a little bit longer in our care, and after discharge we can also support you through our Continuing Care Programme. So we make an assessment, an in-depth treatment, but also prolonged support to help you reach your goals.

What advice would you offer to individuals whose loved ones are grappling with depression?

It can be very hard for people to see their loved one suffer from depression. And my first advice to you is to read about a condition. What is depression? What are the common symptoms? What are warning signs that you need to be aware of? It would be my first recommendation.The second recommendation will be like to instigate maybe a conversation with your loved one about your concerns, using concrete examples, and have an open and honest conversation about it, and see if that person is already ready to accept help. Another tip was to really know what kind of help lines are out there in case you need support on the spot because you are very concerned about the wellbeing of your loved one. And my last advice to you would be to look after yourself. It can be incredibly demanding on yourself and on your own mental health to see someone suffer. And I always recommend people to follow the advice given on an airplane: to put on your own oxygen mask first before helping others. Another advice would be: not to suffer in silence. If you're worried about a loved one, reach out to professionals.

What are the early signs that someone may be dealing with depression?

Depression is not only impacting the individual; it is impacting the whole system. And I would say is to be mindful of the behavior, make a distinction between their behavior and what is underlying that behavior. I can imagine that it must be incredibly frustrating if somebody is canceling all the appointments, or is retracting, is not opening up. I can imagine that it might trigger quite a lot of inner conflict in yourself as well and might trigger some feelings of frustration or anger. And that is absolutely legitimate to feel that way. But in helping others, it would be really good to park that feeling, and reach out to ask them. Instead of putting it all the inside. Open up the conversation in a non-judgmental way, in a caring way, so the person knows that it comes from a place of love and care.

Are there specific red flags that may suggest a person is suffering from depression?

If a person is suffering from depression, it can take many shapes and forms. Some become very irritable. So when everything becomes snappy and only snappy responses, you see. That might be a symptom of depression. When somebody is making up a lot of excuses not to attend social events or sort of says, no, I'm fine, everything is fine. Trying to avoid the topic of conversation, that might also be a red flag. Sudden changes in mood as well. Sometimes, if you know, Depression can last for a long period of time. If, all of a sudden, it goes really well according to the person, that can be a red flag as well.

Who is most susceptible to depression? Are there certain groups more commonly affected?

I think the answer is rather short to everyone: no matter your age. We do know, however, that depression is a little bit more than that; women are overrepresented in the numbers. So according to research, women are more likely to develop depression than men. But it might also be that men are underdiagnosed, of course. Depression is a collective name and it's a collective mental health disorder; that there can be differences between it. Of course, it can vary in severity. You can have a mild depression and a severe depression. You can have a depressive episode, or you can have, chronic depression. So there are differences, and not only in the intensity and the duration but there's also, for example, seasonal affective disorder. Where people, especially in autumn, become more down and experience more and more gloominess and finding and more difficult to activate. There's a lot of attention as well for postpartum depression, for example. That's something that's going to happen during pregnancy or after giving birth. It not only happens to women, but also fathers can be affected. These are interesting sub-categories of depression, I would say, that we are at The Kusnacht Practice, as well as specializing it.