A B C D E F G H I J K L M N O P R S T U V W

DEPRESSION

What is Depression ?

Feeling sad or depressed is something we have all been through to one degree or another. Sometimes this depression is severe enough to require the help of a health professional. This may occur because the depression has been going on for a long time or because the symptoms are troublesome. The symptoms of depression vary from unhappiness to misery and despair, and even suicidal thoughts. Concentration is often lost and you may have difficulty in coping with home and work. Your appetite may be affected and weight loss may occur. Sleep may be disturbed, either with difficulty getting off to sleep or waking in the middle of the night or early morning. Symptoms are often worse in the morning and uncontrollable crying can occur. Your memory may also be affected and sex drive may be lost. Symptoms of anxiety may occur and may show itself as headaches, tension pains or palpitations. In severe instances, feelings of guilt and worthlessness and sometimes even hallucinations can occur.

How does Depression occur ?

Depression can occur due to a multitude of causes. It may be a result of a physical illness, bereavement, alcoholism, childbirth, or severe life events. It may occur as a result of problems that occurred in early childhood or as a result of present difficulties relating to home or work.

Why does Depression occur ?

It has been suggested that people who tend to get depressed may have inherited a subtle chemical abnormality in their brain. This might make them more sensitive or susceptible to one or more of the life events mentioned above.

Treatment Involved for Depression

Treatment involves a combination of psychological approaches which may be supplemented by drug treatment. PSYCHOLOGICAL “talking treatment” or psychotherapy plays an important part in the management of the depressed person. You will be given the opportunity and the time to talk about your feelings and emotions. This may be something that is difficult for you to do within your own family. More importantly, the therapist is able to be more objective. Exploring your life and your problems or difficulties with a therapist will provide you with understanding and support. This 'therapist' may be the general practitioner, a psychologist, a specialist psychotherapist or a counsellor. Psychotherapy may be brief or more long term. It may sometimes involve the patient's family. Some psychologists use behaviour therapy. In depression, a vicious circle can occur. Negative thoughts lead to a depression which makes you unable to carry out everyday tasks. This in turn leads to more negative thoughts. Cognitive or behaviour therapy seeks to break this circle by encouraging and supporting you to carry out simple tasks first. Successful accomplishment increases confidence and helps to break the vicious circle. Many depressions may be helped by psychological treatments. However sometimes drug treatment is needed. DRUGS There are three main groups of antidepressant drugs. These are: monoamine oxidase inhibitors (MAOIs), tricyclic and related antidepressants, and selective serotonin reuptake inhibitors (SSRIs) and related antidepressants. MAOIs can interact with other drugs being taken and certain foods. They are not used much these days. Tricyclic and related antidepressants have to be started at a low dose and gradually built up. They may not work immediately. Sleep disturbance and anxiety symptoms are the first to improve but other symptoms may take up to 2 weeks or longer to improve. SSRIs and related antidepressants have less side effects and generally work quicker than the others. Most can be started at the recommended dose from the first day. The tablets may be taken spread out during the day or as one dose. There is evidence that treatment with all these drugs needs to be continued for at least four to six months to prevent recurrence. Sometimes longer. They are not addictive. Other treatments: Electroconvulsive treatment (ECT) is used occasional in severe depression. It has been used when there has been no response to the drugs or the symptoms are serious and disabling. St John’s Wort (Hypericum perforatum), available from chemists, has been found to be sometimes effective in mild and moderate depression. However, it can interact with some other drugs. Check with your pharmacist or doctor that it is safe for you to take St John’s Wort. Massage and aromatherapy may help some people.

During Treatment for Depression

PSYCHOTHERAPY Although effective, psychotherapy may often be slow. The therapist tries to be as objective as possible. He or she will not allow his or her feelings to enter into the consultation. The problems which are brought to the surface can be painful and difficult for the depressed person to cope with, but the therapist will provide a safe and supportive environment. ANTIDEPRESSANT DRUGS Tricyclic drugs are often divided into two groups, depending on whether they are sedating or stimulating. Side-effects are common, mainly drowsiness, weight gain, blurred vision, dry mouth and constipation. These tend to decrease after a few days of starting the treatment. Some people are unable to take these drugs because they suffer from serious heart disease, glaucoma or symptoms of an enlarged prostate gland. MAOI drugs interact with many other drugs and certain foods (e.g. cheese, chocolate and red wine). If these are prescribed, a card is usually given showing which foods are to be avoided. Increasingly the newer SSRIs are being used as they have less side effects. In particular they are less sedative and generally cause less weight gain. They may cause headaches, nausea or vomiting and feelings of anxiety, but usually these improve after a little while. They have to be used with caution in people with epilepsy, heart or kidney disease.

If Depression is Left Untreated

Most people with depression do seek professional help. In some ways, this is the first and most important step towards recovery. However, most depressions do eventually improve with the passage of time. The treatment helps to shorten the time taken to achieve recovery. Rarely depression can become so severe that there is a serious risk of suicide.

Effects on Family of Depression

People with depression need the support of their family and friends. Sometimes no great expertise is needed: a person who will listen, a shoulder to cry on and someone to be there may be all that is needed. The threat of suicide can be very distressing for all concerned. Urgent professional help should be sought if the depressed person is having suicidal thoughts.