What is depression? (Take a depression quiz)

We all have experienced bouts of sadness but it is when these feelings are intense, persistent and stop us doing things we would usually do over a period of weeks or longer that we know we have depression. Major depression is a mood disorder. It is estimated that depression affects 4% of the adult population however some people may not know they are experiencing depression or they may feel that no one can help them. There are a number of types of depression including:

· Adjustment disorder with depressed mood - this is where a person experiences depression that is bought on by situations requiring change; this may be negative change for example the loss of employment or relationships breakdown, or positive change for example marriage or a new job.

· Clinical (major) depression - this is a severe form of depression that is thought to be associated with a chemical imbalance. Clinical depression can occur without reason and usually last longer than two weeks.

· Dysthymic disorders - this is where a person experiences two years, or more, of a depressed mood; this may be in conjunction with additional symptoms of depression. Dysthymic disorders may be displayed from an early age and may continue over the persons lifespan.

· Postnatal depression - is often experienced by women who have given birth . New studies have shown that fathers may also experience post-natal depression.

· Psychotic depression - is depression that is experienced in association with hallucinations or delusions.

· Bipolar - previously known as 'manic depression', is a mood disorder which is characterized by episodic mood swings; from high (mania) to low (depression).

 

Causes

Usually a combination of environmental & genetic factors. It can be triggered by extreme stress & often runs in families. Depression is more common in women or those with long term illnesses.

Depression is thought to be caused when the neurotransmitters in the brain malfunction.  

Either there are not enough neurotransmitters (serotonin, dopamine etc) to cross the gap to the waiting receptors or the receptors themselves are damaged & cannot receive the neurotransmitters.  What this means is the messages cannot travel properly from one part of the brain to the other & we have a  malfunction. This is what causes the inability to have rational thoughts. For example, someone may casually glance at you & if all the neurotransmitters are functioning correctly you will ascertain that they are just glancing at you, however if they are not , you may think that that person is staring at you, or doesn't like you. This is because the message is getting scrambled as it crosses the gap to the receptors. Antidepressants either increase the neurotransmitters or help with the reuptake into the receptors as in SSRI Selective serotonin reuptake inhibitors, these help with the imbalance & thus allow the brain to function normally. This is when psychotherapy including CBT (Cognitive Behavioural Therapy), comes into play. Once the brain is being rebalanced you can learn more appropriate ways of dealing with stress to minimise chances of a relapse. if you attempt to do these therapies while the brain is out of whack you will have a whole lot of knowledge, but be unable to implement it. Like knowing how to pull up your socks, but not being able to physically reach down far enough to do so.

The risk of future episodes increases with each additional episode. According to the American Psychiatric Association (APA):

Patients who experience one episode of major depression have a 60 percent risk of experiencing a second episode

Patients who experience two episodes have a 70 percent risk of experiencing a third episode

Patients who experience three episodes have a 90 percent risk of experiencing a fourth episode

Thus preventative treatment is also very important. See Complimentary therapies.

Diagnosis

* Two weeks of abnormal depressed mood  (Extreme sadness)
* Loss of interest and decreased energy
* Loss of confidence
* Excessive guilt
* Recurrent thoughts of death
* Poor concentration
* Agitation or retardation or Anxiety
* Sleep disturbance incl Difficulty getting out of bed for days on end or Being tired all the time but unable to sleep
* Change in appetite or weight

* Anger

* Bouts of uncontrollable crying

* Pessimistic

* Difficulty  making simple decisions

 

Major depression is common in children & teenagers, however the symptoms vary from adults.

Signs can be:-

                        missing or refusing to go to school

                        Poor proformance at school

                        Complaints of boredom

                        Changes in eating & sleeping patterns

                        Withdrawal from friends or activities they previously enjoyed

                        Problems with authority

                        Overreaction to criticism

                        Frequent physical complaints (headaches, stomachaches)

                        Patterns of dark images or themes or aggression towards self or others in drawings, poetry & other forms of expression.

Mild depression includes the first two symptoms and at least one other; whilst severe depression includes the first two symptoms and at least five others. People experiencing depression may also feel a sense of worthlessness or hopelessness; they may increase alcohol or drug use; they may become more sensitive to personal criticisms; they may become reckless or take unnecessary risks; they may stay away from school, work or other social events. People's experiences of depression will greatly vary, but if you are experiencing any number of these symptoms for a prolonged period of time it is worth speaking to your doctor or medical practitioner. Your Dr will normally check there are no underlying physical conditions that are causing the depression & will then do a mental health evaluation.

Treatment

Depending on the severity of the depression, a Dr might recommend you try psychotherapy alone, mainly in the cases of mild depression, but those with moderate to severe may require medication, usually antidepressants. Some of these are selective serotonin reuptake inhibitors, also known as SSRI inhibitors (eg. prozac, paxil, zoloft); or Monoamine oxidase inhibitors also known as MAOI antidepressants (Nardil, Parnate). MAOIs need to be taken with care as you need to adhere to strict dietary guidelines. If you have aged cheese or wine with MAOIs you can cause a sharp spike in blood pressure, known as a hypertensive crisis. This is characterizes by nausea, sudden & severe headaches, stiff neck, rapid heartbeat or palpitations, confusion & sweating.

In 2006 the first antidepressant skin patch (selegiline) was approved in the US. It isa MAOI but as the dosage is so small it does not require the dietary restrictions that oral MAOIs require.

Treatment of depression does not lead to an instantaneous recovery however antidepressants may help to reduce the intensity of depression and to correct any chemical imbalances until the natural balance is restored. Often when you start an antidepressant it takes 3-6weeks to fully work, so don't despair, reach out to others during this time & keep going with treatment. It is imperative that you stay in close contact with your Dr, phycologist or support network during this initial phase.

Exercise has also been shown to be beneficial, it releases endorphins in the brain which help elevate our moods & so should be encouraged.

Complementary Therapies

Talking with a health professional in a structured way, for example through therapy, has been shown to be beneficial in the treatment of depression. These therapies may be useful in assisting the person in understanding the way they react to their circumstances and relationships. There are many variations of psychotherapy however the those found to be most effective in the treatment of depression are interpersonal therapies, problem solving therapy and cognitive-behavioural therapy (CBT). It is also highly beneficial to join a community or peer support group, such as Even Keel, where you can meet and share with others.

Interpersonal therapy - This form of therapy looks at the interpersonal relationships that a person has in order to identify areas of conflict. The therapy then focuses on changing the conflict so that the relationship becomes more supportive rather than stressful.

Problem Solving Therapy - is a form of CBT that looks at the way a person solves problems (not at the problem).

Cognitive-Behavioural therapy - This therapy is a combination of cognitive therapy and behavioural therapy. Therefore the aim of the therapy is to modify problem behaviours whilst still focusing on self awareness and challenging self-defeating thinking.

Also it has been found that Omega 3 fatty acids  may be of benefit when used in conjunction with conventional medicine. It is important to speak with your health care professional before using herbal or dietary supplements. They often interact with prescribed medications or have other serious effects. For example St John's Wort has been shown to induce mania in people with bipolar.

Maintenance

Knowing and being able to recognise your signs of depression can help you access help early and faster. It is best to write a list of your signs to keep for future reference. An example list might include.

* Smiling less
* Insomnia
* Eating more
* Feeling worthless
* Watching more TV than normal
* Not drawing the curtains back in morning
* Staying home more often
* Not wanting to do fun things

Keep your checklist in a handy place and it may also help to give a copy to your partner, friend, or someone you trust so they can also recognise the signs that you are experiencing depression.

For Questions to ask your Dr about depression go to FAQ