Life is full of emotional ups and downs. But when the “down” times are long lasting or interfere with your ability to function, you may be suffering from a condition called depression. Research has shown that in the United Kingdom 1 in 4 people will experience some kind of mental health problem in the course of a year. Treatment can alleviate the symptoms in over 80 percent of the cases. Yet because it is often unrecognised, depression continues to cause unnecessary suffering.
Depression is a pervasive and impairing condition that affects both women and men, but women tend to experience depression at roughly twice the rate of men. Researchers continue to explore how special issues unique to women – biological, life cycle, and psychosocial – may be associated with women’s higher rate of depression.
No two people become depressed in exactly the same way. Many people have only some of the symptoms, varying in severity and duration. For some, symptoms occur in time-limited episodes; for others, symptoms can be present for long periods if no treatment is sought. Having some depressive symptoms does not mean a person is clinically depressed. For example, it is not unusual for those who have lost a loved one to feel sad, helpless and disinterested in regular activities. Only when these symptoms persist for an unusually long time is there reason to suspect that grief has become depressive illness. Similarly, living with the stress of potential layoffs, heavy workloads, or financial or family problems may cause irritability and “the blues”. Up to a point, such feelings are simply part of human experience. But when these feelings increase in duration and intensity and an individual is unable to function as usual, what seemed a temporary mood may have become depression.
SYMPTOMS OF DEPRESSION
A thorough diagnostic evaluation is needed if three to five or more of the following symptoms persist for more than 2 weeks, or if they interfere with work or family life. An evaluation involves a complete physical checkup and information gathering on family health history. Not everyone with depression experiences each of these symptoms. The severity of the symptoms also varies from person to person.
Persistent, sad, anxious or “empty” mood
Loss of interest or pleasure in activities, including sex
Restlessness, irritability, or excessive crying
Feelings of guilt, worthlessness, helplessness, hopelessness, pessimism
Sleeping too much or too little, early- morning awakening
Appetite and/or weight loss or overeating and weight gain
Decreased energy, fatigue, feeling “slowed down”
Thoughts of death or suicide, or suicide attempts
Difficulty concentrating, remembering, or making decisions
Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders and chronic pain.
CAUSES OF DEPRESSION
There is a risk of developing depression when there is a family history of the illness, indicating that a biological vulnerability may be inherited. However not everybody with a family history develops the condition. In addition depression may occur in people who have had no family members with it. This suggests additional factors, possibly biochemistry, environmental stressors, and other psychosocial factors, are involved in the onset of depression.
Evidence indicates that brain biochemistry is a significant factor in depression. It is known, for example, that individuals with depression typically have dysregulation of certain brain chemicals, called neurotransmitters. Additionally, sleep patterns, which are biochemically influenced, are typically different in people with depressive disorders. Depression can be induced or alleviated with certain medications, and some hormones have mood-altering properties. What is not yet know is whether the “biochemical disturbances” of depression are of genetic origin, or are secondary to stress, trauma, physical illness, or some other environmental condition.
Environmental and Other Stressors
Significant loss, a difficult relationship, financial problems, or a major change in life pattern have all been cited as contributors to depression. Sometimes the onset of depression is associated with acute or chronic physical illness. In addition, some form of substance abuse disorder occurs in about one third of people with any type of depression.
Other Psychological and Social Factors
People with certain characteristics – pessimistic thinking, low self-esteem, a sense of having little control over life events, and a tendency to worry excessively – are more likely to develop depression. These attributes may heighten the effect of stressful events or interfere with taking action to cope with them or with getting well. Upbringing or sex role expectations may contribute to the development of these traits. It appears that negative thinking patterns typically develop in childhood or adolescence. Some experts have suggested that the traditional upbringing of girls might foster these traits and may be a factor in women’s higher rate of depression.
DEPRESSION IS A TREATABLE CONDITION
Even severe depression can be highly responsive to treatment. Indeed, believing one’s condition is “incurable” is often part of the hopelessness that accompanies serious depression. Such individuals should be provided with the information about the effectiveness of modern treatments for depression in a way that acknowledges their likely scepticism about whether treatment will work for them. As with many conditions, the earlier treatment begins, the more effective and the greater the likelihood of preventing serious recurrences. Of course, treatment will not eliminate life’s inevitable stresses and ups and downs. But it can greatly enhance the ability to manage such challenges and lead to greater enjoyment of life.
The first step in treatment for depression should be a thorough examination to rule out any physical illness that may cause depressive symptoms. Since certain medications can cause the same symptoms as depression, the examining physician should be made aware of any medications being used. If a physical cause for the depression is not found, a psychological evaluation should be conducted by the physician or a referral made to a mental health professional.
TYPES OF TREATMENT FOR DEPRESSION
The most commonly used treatments for depression are antidepressant medication, psychotherapy, or a combination of the two. Which of these is the right treatment for any one individual depends on the nature and severity of the depression and, to some extent, on individual preference. In mild or moderate depression, one or both of these treatments may be useful, while in severe or incapacitating depression, medication is generally recommended as a first step in the treatment. In combined treatment, medication can relieve physical symptoms quickly, while psychotherapy allows the opportunity to learn more effective ways of handling problems.
There are several types of antidepressant medications used to treat depressive disorders. Each acts on different chemical pathways of the human brain related to moods. Antidepressant medications are not habit- forming. Although some individuals notice improvement in the first couple of weeks, usually antidepressant medications must be taken regularly for at least 4 weeks and in some cases, as many as 8 weeks, before the full therapeutic effect occurs. To be effective and to prevent relapse of the depression, medications must be taken for about 6 to 12 months, carefully following the doctor’s instructions. Medication must be monitored to ensure the most effective dosage and to minimize side effects. For those who have had several bouts of depression, long-term treatment with medication is the most effective means of preventing recurring episodes.
In mild to moderate cases of depression, psychotherapy is also a treatment option. Some short-term (10 to 20 weeks) therapies have been effective in several types of depression. “Talking” therapies help clients gain insight into and resolve their problems through verbal give-and-take with the therapist. “Behavioural” therapies help clients learn new behaviours that lead to more satisfaction in life and “unlearn” counter-productive behaviours.
Research has shown that two short term psychotherapies, interpersonal and cognitive-behavioural, are helpful for some forms of depression. Interpersonal therapy works to change interpersonal relationships that may cause or exacerbate depression. Cognitive behavioural therapy helps change negative styles of thinking and behaving that may contribute to the depression.
THE PATH OF HEALING
Reaping the benefits of treatment begins by recognising the signs of depression. The next step is to be evaluated by a qualified professional. Although depression can be diagnosed and treated by primary care physicians, often the physician will refer the client to a psychiatrist, a psychologist, a psychotherapist, a counsellor. Treatment is a partnership between the client and the mental health professional.
If there are no positive results after 2 to 3 months of treatment, or if symptoms worsen, discuss another treatment approach with the professional. Getting a second opinion from another health or mental health professional may also be in order.
Here again are the steps to healing:
Check your symptoms again from the initial list
Talk to a health or mental health professional
Choose a treatment professional and a treatment approach with which you feel comfortable
Consider yourself a partner in treatment and be an informed consumer
If you are not comfortable or satisfied after 2 to 3 months, discuss this with your provider. Different or additional treatment may be recommended
If you experience a recurrence, remember what you know about coping with depression and don’t shy away from seeking help again. In fact the sooner a recurrence is treated, the shorter its duration will be.
Depression can make you feel exhausted, worthless, helpless and hopeless. Such feelings make some people want to give up. It is important to realise that these negative feelings are part of the depression and will fade as treatment begins to take effect.
Along with professional treatment, there are other things you can do to hep yourself get better. Some people find participating in support groups very helpful. It may also help to spend some time with other people and to participate in activities that make you feel better, such as mild exercise or yoga. Just don’t expect too much from yourself right away. Feeling better takes time.
Blehar MC, Oren DA. Gender Differences in depression. Medscape Women’s Heath, 1997; 2:3. Revised from: Women’s increased vulnerability to mood disorders: Integrating psychobiology and epidemiology. Depression, 1995;3:3-12.
Frank E, Karp JF, and Rush AJ. Efficacy of treatments for major depression. Psychopharmacology Bulletin, 1993; 29:457-75.
Lebowitz BD, Pearson JL,Schneider LS, Reynolds CF, Alexopoulos GS, Bruce ML, Conwell Y, Katz IR, Meyers BS, Morrison MF, Mossey J, Niederehe G, and Parmelee P. Diagnosis and treatment of depression in late life: Consensus stament update. Journal of the American Medical Association, 1997; 278:1186-90.
Andreasen, Nancy. The Broken Brain: The Biological Revolution in Psychiatry. New York: Harper & Row, 1984.
Carter, Rosalyn. Helping Someone with Mental Illness: A Compassionate Guide for Family, Friends and Caregivers. New York: Times Books, 1998.
Fieve, Ronald R. Moodswing. New York: Bantam Books, 1997.