How Common is Depression?
Depression is the "common cold of mental health problems". The World Health Organization (WHO) recently ranked depression as the leading cause of morbidity in developing nations in the next century.
Everyone has felt sad at one time or another. Usually it is due to a disappointment, frustration or losing someone. Such sadness is normal. Time heals, the mood lifts and people continue to get on with their lives.
In some people, depression can be so severe that it dominates their lives, preventing them from coping as they used to. Depression of this degree is an illness and needs treatment.
You Are Not to Blame
Depression is a medical illness. It is not due to moral weakness or a character flaw. It cannot be willed or wished away.
What Are The Types Of Depression?
Major depression is manifested by a combination of symptoms that affect our work, interests and feelings towards family and friends. These disabling episodes can occur twice or several times in a lifetime.
Dysthymia is a less severe type of depression. People with dysthymia have long-term depressive symptoms and it prevents them from functioning at an optimal level.
Symptoms Of Depression
Certain characteristic symptoms can give you or your family a clue that you are depressed:
- Depressed or low mood
- A loss of interest and enjoyment in life
- A lack of drive or motivation that makes even simple tasks or decisions difficult or impossible
- Feeling tired all the time
- Agitation or restlessness
- Loss or gain in appetite with loss or gain in weight
- Sleeplessness or excessive sleeping
- Loss of self confidence, avoiding people
- Feeling useless, inadequate, helpless or hopeless
- Feeling guilty or worthless
Thoughts of suicide; these are very common in depression and they are much better admitted than covered up. They signal that you need help.
What Are The Causes Of Depression?
Some types of depression run in families, indicating hereditary or genetic factors in the transmission of depressive disorders. In some families, major depression seems to occur generation after generation.
Studies have also suggested some biological component in depression. It may be associated with having too little or too much chemicals in the brain. Certain medications have mood altering properties. Antidepressant medication act by altering and normalizing the biochemical imbalances in the brain.
Life events such as loss of a job, retirement, divorce, death of a loved one or moving to a new house can precipitate a depressive illness. Social circumstances also play a part. If we are alone, have few or no friends, suffer from a chronic illness, then we may be more vulnerable to depression.
People with life threatening or long-term physical illness such as cancer, stroke, arthritis or heart disease are also more vulnerable to depression.
Personality may also play a part in depression. Some of us are more vulnerable than others because of the individual make-up or early life experiences.
Very often, a combination of genetic, psychological and environmental factors is involved in the onset of depression.
The good news is that whatever the cause, depression is treatable.
How is Depression Treated?
Treatment for depression is well established. 85% of people with major depression have fairly good treatment outcome. Treatment consists of drug (antidepressant medication) and non-drug therapy. Usually, a combined treatment is best: medication to gain relatively quick relief and psychotherapy to learn more effective ways to deal with life stresses.
All antidepressant medications are equally effective but they have different side effects. The most often used antidepressants include tricyclics, monoamine oxidase inhibitors, lithium and selective serotonin inhibitors (SSRI).
Be patient when you take the medication. Antidepressant medications do not begin working the day you take them but your mood will improve after one to two weeks. However, you may notice some improvement on the first day, especially in your sleep and feeling less tense and anxious. They are not addictive.
You can eat a normal diet (if not, your doctor will tell you). The medications are compatible with painkillers, antibiotics and contraceptives. However, you should avoid alcohol as the medication and alcohol combined can make you too drowsy.
Do not stop the medication once you start to feel better as you may relapse into depression again. You should discuss this with your doctor and let him advise you when to stop.
Like all medications, antidepressants have some side effects, though these are usually mild and tend to wear off as treatment goes on.
What Are The Common Side Effects Of Antidepressant Medication?
The common side effects and their remedies are:
- Dry mouth - drink more water
- Constipation - eat more fruits, cereals, prunes and vegetables
- Drowsiness - this will pass soon; do not drive or operate heavy machinery if feeling sedated
- Dizziness - rise from bed or chair slowly
- Some side effects with the newer medications:
- Headache - this will usually go away
- Nausea and stomach discomfort - transient; take medication with food
- Nervousness and insomnia - these may occur during the first few weeks, reducing the dose will usually resolve them.
Non Drug Therapy
Psychotherapy involves talking things through with a trained counselor or therapist. Talking to someone who can really listen and understand you without passing judgment can be a tremendous relief. You learn how to solve problems and cope with life stresses better.
Exercise not only improves your health but it also gives you a sense of accomplishment. Endorphins ('feel good' hormones) are released during exercise and this can elevate your mood.
Relaction Therapy This involves deep breathing exercises and progressive muscle relaxation.
Support Groups Support groups offer fellowship and you get to hear first hand accounts of how others with depression, like you, have learnt to cope. Presently SAMH, IMH and the Behavioural Medicine Clinic at HPB run support groups. The group at IMH is a psychoeducation group, i.e. you learn about the depressive illness and methods of coping.
Electroconvulsive Theraphy (ECT): ECT is only indicated for those with severe depression who have not responded to treatment or are highly suicidal. It involves giving a light general anaesthetic and an electric current is passed through the brain for a few seconds. The whole procedure takes only about 15 minutes and the patient is only aware of having gone to sleep.
How Can You Help Yourself ?
- Don't bottle things up. If yohave recently had some bad news, try to talk to close friends or relatives about how yofeel. It helps to talk things through and sometimes to have a good cry.
- Don't set yourself difficult goals. Be realistic. Set priorities and do what yocan.
- Do something - get out of the house for a walk or some exercise. While yomay not be able to work, it is always good to try to keep up with some light activities such as housework. This will help take your mind off those painful feelings.
- Eat a good balanced diet, even though yomay not feel like eating.
- Resist the temptation to drown your sorrows with alcohol. Alcohol actually depresses the mood, so while it may give yoimmediate relief, this is very temporary and yomay end up more depressed. It is also bad for your physical health.
- Remind yourself that yoare suffering from depression, something that many other people have gone through, and that yowill eventually come out of it, as they did.
Living With A Depressed Person - How Can You Help?
- The most important thing anyone can do for the depressed relative or friend is to get him or her appropriate diagnosis and treatment. On occasion, it may require making an appointment and accompanying him or her to the doctor.
- Yomay need to encourage the person to take his medication and stay with it until the symptoms begin to abate (a few weeks).
- Offer emotional support. Spending time with them and encouraging them not only to talk but also to keep going are worthwhile.
If the depressed person is getting worse or has started talking about suicide, take these statements seriously and report them to the person's therapist.
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