Depression

WHAT IS DEPRESSION?

Most of us feel sad or miserable at times. These feelings may follow a disappointment, loss of a friend, loss of a job, or a number of other stressful or unpleasant life events. These feelings of sadness are very common and are experienced by everyone.

Most of the time we recover quite quickly from our sadness, especially if we have other good things happening in our lives. Some people, however, continue to feel extremely miserable for long periods of time even though there may no longer be a good reason for feeling this way. Friends are unable to jolly these people out of their depression and pleasant or lucky life events pass by unnoticed.

There are still other people who become extremely depressed for no obvious reason at all! At first they may just feel a bit down and find it difficult to get through the day. As their depression worsens they may lose their motivation to do anything at all until they reach the point where they have trouble even getting dressed in the morning.

Although there is a tendency to label all our unpleasant feelings as ‘depression’, there are clearly some people whose depression is much more severe than others. Severe depression that occurs for no obvious reason, or that continues for a long time despite the occurrence of pleasant life events and jollying from friends, is called ‘major depression’ or a ‘depressive disorder’.

THE FEATURES OF A DEPRESSIVE DISORDER INCLUDE:

1. Feeling miserable. This misery is present for much of the day but may vary in its intensity. The misery lasts at least a week or two. The individual who is depressed usually looks sad and ‘down’ and may cry often.
2. Loss of interest or pleasure in usual activities.
3. Loss of appetite with excessive loss of weight (e.g., 2-3 kgs or more).
4. Loss of interest in sex.
5. Loss of energy, even when not physically active.
6. Loss of sleep despite feeling exhausted. Sleep is typically restless and unsatisfying with early morning wakening (1-2 hours earlier than usual). Some people, however, may actually sleep a lot more than usual.
7. Persistent worrying about unimportant things.
8. Slowed or inefficient thinking with poor concentration, leading to difficulties sorting out problems or making plans or decisions.
9. Recurring unpleasant thoughts, particularly about being guilty, being a bad and unworthy person, or wishing to die.
10. Slowed activity and speech.
11. Fearfulness. Fears about people, places, and things are extreme, often leading to withdrawal from a wide range of everyday activities and friends.
12. Hearing voices when nobody is about that make unpleasant remarks about you.

Any of these features may serve as a warning signal of depression although many may also occur in disorders other than depression.

WHAT CAUSES DEPRESSION?

No-one knows exactly what causes depression although a number of theories have been investigated. It is clear that genetic factors are important in many cases of depression. Depression seems to run in families (as do other mood disorders such as bipolar disorder which involves periods of depression as well as periods of mania). Looking at twins who have exactly the same set of genes, if one twin has a depressive disorder there is a 70% chance that the other twin will also develop a depressive disorder. By contrast, if you look at non-twin brothers and sisters whose genes are not exactly the same, there is only a 15% chance that one will develop a depressive disorder if one of the other siblings has such a disorder. It seems that some people have a set of genes that makes them more likely to develop a depressive disorder.

Another theory for the cause of depression is that depression involves an incorrect balance of chemicals in the brain. Although the balance may be right most of the time, at other times the balance may change and the person becomes depressed. By giving the person antidepressant medication or other forms of medical treatment the balance can usually be corrected.

Stressful life events also seem to play a part in the onset or relapse of depression. Ongoing conflicts with others can take their toll on our well-being, as can other social and environmental stressors such as financial difficulties, retirement, unemployment, childbirth, loneliness, or loss of someone or something important. In vulnerable people these unpleasant life events may be enough to cause or worsen a depressive illness. The depressive reaction is often delayed, maybe even occurring several months after the event has occurred.

An individual’s personality characteristics may also be an important factor. When people are depressed they usually have a very negative view of themselves and the world. Good things are not appreciated and bad things seem overwhelming. Some people have a tendency to view things this way even when they are not depressed. In other words, they may have a depressive personality style. Have you ever noticed that some people are always pessimistic and seem to focus on the bad side of things rather than taking a positive view of the situation? People with this kind of personality style may be at greater risk of developing a depressive disorder.

Another possible cause of depression which should not be overlooked is physical illness or medications. Glandular fever, influenza, hepatitis, thyroid hormones, anaemia, diabetes, birth control pills, alcohol and other substances of abuse, or other medications such as those for heart or blood pressure conditions, may all cause symptoms of depression. For this reason you will be (or have already been) given a medical examination to rule out such causes of depression.

Despite the lack of conclusive evidence about the exact causes of depression it is reasonable to conclude that depression is a genetic and biological disorder that is affected by life stress and personality style.

HOW COMMON IS DEPRESSION?

Depression is extremely common. Surveys show that up to 25% of the population may suffer from this disorder at some time in their lives. Most cases of depression are mild but about one person in 20 will have a moderate or severe episode.

HOW IS DEPRESSION TREATED?

Since depression is affected by psychological factors and may involve changes in body chemistry, depression is usually best treated by a combination of medical and psychological treatments. Medical treatments include antidepressant medication, electroconvulsive therapy, and psychological treatments including cognitive and behavioural therapy, and learning how to cope with stress.

If you are experiencing the symptoms of depression it is advisable to seek consultation from your doctor.

Antidepressant medication

These drugs will usually relieve depression in most people and may help to prevent relapse of the illness. However, unless episodes of depression occur very frequently, most people do not take antidepressant medication every day of their lives. They only take the medication when they are depressed and continue taking the medication for about six months to one year after recovery.

How long do these drugs take to work?

Antidepressants do not relieve your depression straight away. These drugs take some time to have an effect on your mood. In the first few days the drugs are most likely to help with sleep and tend to have a calming effect, sometimes making people feel very tired and weak. However, after a week or two of taking the medication regularly this calming effect gives way to increasing alertness and energy. It may take up to eight weeks before the maximum benefits of antidepressant medication are noticed. Therefore, you should not expect to notice the benefits from this medicine too quickly.

There are a number of different types of antidepressant drugs. Ask your doctor for further information about these drugs and their side effects.

Psychotherapy

There are a number of different kinds of psychotherapy that are useful for people who are depressed. The following information outlines three useful forms of psychotherapy.

Cognitive therapy

People who are depressed tend to feel as if they are a hopeless failure. When something bad happens they blame themselves, but when good things happen they tell themselves they are just lucky. Furthermore, depressed people tend to believe that things will never get any better. Cognitive therapy aims to help people identify their negative ways of thinking and to teach them how to think in a more positive and helpful way. People learn that they have some control over what happens to them. They learn to bounce back from failure more effectively and to recognise and take credit for the good things in their lives.

Behavioural therapy

Depressed people tend to have trouble motivating themselves. They often sit for hours, thinking about their problems and missing out on good opportunities. Behaviour therapy aims to identify and change aspects of behaviour that may cause or prolong symptoms of depression. Some forms of behavioural change include activity planning, problem solving, goal planning, and social skills training.

Interpersonal therapy

This form of therapy aims to help people resolve one or more of their interpersonal problems that may be causing or prolonging symptoms of depression. For example, interpersonal therapy may target prolonged grief reactions after the death of a loved one, the adjustment to new life situations such as parenthood or divorce, or may help with the resolution of interpersonal disputes (e.g., marital problems or disputes with colleagues at work).