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DEPRESSION

Department of Psychiatry at Far Eastern Memorial Hospital 2008.6

According to the World Health Organization, major depression is the leading cause of disability worldwide. It is the most common psychiatric disorder, and it takes a significant toll on individuals, families, and society. Depression also negatively affects the economy through diminished productivity and use of healthcare resources

What Is Depression?

Depression is a serious medical illness that negatively affects how you feel, the way you think and how you act. Depression has a variety of symptoms, but the most common are a deep feeling of sadness or a marked loss of interest or pleasure in activities. Other symptoms include:

    • Changes in appetite that result in weight losses or gains unrelated to dieting
    • Insomnia or oversleeping
    • Loss of energy or increased fatigue
    • Restlessness or irritability
    • Feelings of worthlessness or inappropriate guilt
    • Difficulty thinking, concentrating, or making decisions
    • Thoughts of death or suicide or attempts at suicide.
Depression is very common. It affects nearly one in 10 adults each year—nearly twice as many women as men. Depression can strike at any time, but most common during the late teens to mid-20s and in older adults. Fortunately, depression is treatable.

How Depression and Sadness Are Different

The death of a loved one, loss of a job, or the ending of a relationship are difficult experiences for a person to endure. It is normal for feelings of sadness or grief to develop in response to such stressful situations. Those experiencing trying times often might describe themselves as being “depressed.” But sadness and depression are not the same. While feelings of sadness will lessen with time, the disorder of depression can continue for months, even years.

Patients who have experienced depression note marked differences between normal sadness and the disabling weight of clinical depression. A depressive disorder is not the same as a passing blue mood. It is not a sign of personal weakness or a condition that can be willed or wished away. People with a depressive illness cannot merely "pull themselves together" and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people who suffer from depression.

Postpartum Depression

Postpartum depression—an illness associated with the delivery of a child—is caused by changes in hormones and can run in families. It is distinguished from “baby blues”—an extremely common reaction following delivery—both by its duration and the debilitating effects of indifference the mother has about herself and her children. About one in 10 new mothers experience some degree of postpartum depression; women with severe premenstrual syndrome are more likely to suffer from it.
Women with postpartum depression love their children but may be convinced that they are not able to be good mothers.

What Causes Depression?

Depression can affect anyone—even a person who appears to live in relatively ideal circumstances. But several factors can play a role in the onset of depression:

Biochemistry. Abnormalities in two chemicals in the brain, serotonin and norepinephrine, might contribute to symptoms of depression, including anxiety, irritability and fatigue. Other brain networks undoubtedly are involved as well; scientists are actively seeking new knowledge in this area.

Genetics. Depression can run in families. For example, if one identical twin has depression, the other has a 70% chance of having the illness sometime in life. However, not everybody with the genetic makeup that causes vulnerability to bipolar disorder will have the illness. Apparently additional factors, possibly stresses at home, work, or school, are involved in its onset.

Personality. People with low self-esteem, who are easily overwhelmed by stress, or who are generally pessimistic appear to be vulnerable to depression.

Medical illnesses.  Medical condition such as brain tumor, vitamin deficiency, stroke, a heart attack, cancer, Parkinson's disease, and hormonal disorders can cause depressive illness, making the sick person apathetic and unwilling to care for his or her physical needs, thus prolonging the recovery period.

Environmental factors. Continuous exposure to violence, serious loss, difficult relationship, financial problem, neglect, abuse, poverty or any stressful (unwelcome or even desired) change in life patterns may make people more vulnerable to depression.
Very often, a combination of genetic, psychological, and environmental factors is involved in the onset of a depressive disorder. Later episodes of illness typically are
precipitated by only mild stresses, or none at all.

How Is Depression Treated?
Depression cannot be controlled simply by exercise, changing diet, or taking a vacation. It is, however, among the most treatable of mental disorders: between 80% and 90% of people with depression eventually respond well to treatment, and almost all patients gain some relief from their symptoms.

Before a specific treatment is recommended, a psychiatrist should conduct a thorough diagnostic evaluation, consisting of an interview and possibly a physical examination. Certain medications as well as some medical conditions such as a viral infection can cause the same symptoms as depression. The doctor should ask about alcohol and drug use, and if the patient has thoughts about death or suicide. The purpose of the evaluation is to reveal specific symptoms, medical and family history, cultural settings and environmental factors to arrive at a proper diagnosis and to determine the best treatment.,

Medication: Antidepressants may be prescribed to correct imbalances in the levels of chemicals in the brain. These medications are not sedatives, “uppers” or tranquilizers. Neither are they habit-forming. Generally antidepressant medications have no stimulating effect on those not experiencing depression.

Although some improvements may be seen in the first few weeks, anti-depressant medications must be taken regularly for 3 to 4 weeks (in some cases, as many as two to three months) before the full therapeutic effect occurs. Sometimes the dosage must be increased to be effective. Sometimes the doctor will try a variety of antidepressants before finding the most effective medication or combination of medications.

Patients often are tempted to stop medication too soon. They may feel better and think they no longer need the medication. Or they may think the medication isn't helping at all. It is important to keep taking medication until it has a chance to work, though side effects (see section on Side Effects, page 13) may appear before antidepressant activity does. Once the individual is feeling better, it is important to continue the medication for at least 9 to 12 months to prevent a recurrence of the depression. After two or three episodes of major depression, long-term maintenance treatment may be suggested to decrease the risk of future episodes. Some medications must be stopped gradually to give the body time to adjust. Never stop taking an antidepressant without consulting the doctor for instructions on how to safely discontinue the medication. Questions about any antidepressant prescribed, or problems that may be related to the medication, should be discussed with your doctor.

Psychotherapy: Psychotherapy, or “talk therapy,” is sometimes used alone for treatment of mild depression; for moderate to severe depression, it is often used in combination with antidepressant medications. Psychotherapy may involve only the individual patient, but it can include others. For example, family or couples therapy can help address specific issues arising within these close relationships. Group therapy involves people with similar illnesses.

Depending on the severity of the depression, treatment can take a few weeks or substantially longer. However, in many cases, significant improvement can be made in 10 to 15 sessions.

How to Help Yourself If You Are Depressed

Depressive disorders make one feel exhausted, worthless, helpless, and hopeless. Such negative thoughts and feelings make some people feel like giving up. It is important to realize that these negative views are part of the depression and typically do not accurately reflect the actual circumstances. Negative thinking fades as treatment begins to take effect. In the meantime:

  • Set realistic goals in light of the depression and assume a reasonable amount of responsibility.
  • Break large tasks into small ones, set some priorities, and do what you can as you can.
  • Try to be with other people and to confide in someone; it is usually better than being alone and secretive.
  • Participate in activities that may make you feel better.
  • Mild exercise, going to a movie, a ballgame, or participating in religious, social, or other activities may help.
  • Expect your mood to improve gradually, not immediately.
  • Feeling better takes time.
  • It is advisable to postpone important decisions until the depression has lifted. Before deciding to make a significant transition (e.g. change jobs, get married or divorced), discuss it with others who know you well and have a more objective view of your situation.
  • People rarely "snap out of" a depression. But they can feel a little better day-by-day.
  • Remember, positive thinking will replace the negative thinking that is part of the depression and will disappear as your depression responds to treatment.
  • Let your family and friends help you.

How Family and Friends Can Help the Depressed Person

  • Help him or her get an appropriate diagnosis and treatment. This is the most important thing anyone can do for the depressed person. This may involve encouraging the individual to stay with treatment until symptoms begin to abate (several weeks), or to seek different treatment if no improvement occurs. On occasion, it may require making an appointment and accompanying the depressed person to the doctor. It may also mean monitoring whether the depressed person is taking medication. The depressed person should be encouraged to obey the doctor's orders about the use of alcoholic products while on medication.
  • Emotional support. This involves understanding, patience, affection, and encouragement. Engage the depressed person in conversation and listen carefully.
  • Do not disparage feelings expressed, but point out realities and offer hope.
  • Do not ignore remarks about suicide. Report them to the depressed person's therapist. Invite the depressed person for walks, outings, to the movies, and other activities. Be gently insistent if your invitation is refused. Encourage participation in some activities that once gave pleasure, such as hobbies, sports, religious or cultural activities, but do not push the depressed person to undertake too much too soon. The depressed person needs diversion and company, but too many demands can increase feelings of failure.
  • Do not accuse the depressed person of faking illness or of laziness, or expect him or her “to snap out of it.” Eventually, with treatment, most people do get better. Keep that in mind, and keep reassuring the depressed person that, with time and help, he or she will feel better.

Conclusion
Depression is never normal and always produces needless suffering. With proper diagnosis and treatment, the vast majority of people with depression will overcome it. If you are experiencing symptoms of depression, see your family physician or psychiatrist, describe your concerns and request a thorough evaluation. You will feel better.   

References:
National Institute of Mental Health “Health Information on Depression”
American Psychiatric Association “Let’s Talk About Depression”
Medscape “Depression Resource Center”

 

 
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