DEPRESSION

Depression has been recorded since antiquity. Everybody feels ‘blue’, ‘sad’ or ‘upset’ at times or at some stage in his or her life. Transitory feelings of sadness or discouragement are perfectly normal, especially during particularly difficult times in a person’s life. A person who cannot get over these feelings may suffer from an illness called depression. In modern medicine it is well recognized that depression is an illness caused by an imbalance of neurochemicals in the brain.

How to tell when you are depressed

You can determine whether you are depressed, and also measure the severity of the depression by completing this Questionnaire.

Depression is a serious illness (a medical condition) and should not be confused with other mood conditions such as ordinary grief, burnout or disappointment. The two major indications of a major depression are either:

  • Feeling sad, blue, down in the dumps that lasts two weeks or more;
  • Diminished interest in pleasurable activities, including sex;

If any of the above important symptoms are present, also look for:

  • Significant weight loss or gain;
  • Sleeplessness or excessive sleeping;
  • Slowed body movements or thoughts;
  • Fatigue;
  • Feelings of worthlessness or guilt;
  • Impaired concentration, indecision or forgetfulness; and / or
  • Thoughts of death or suicide.

If you have either one of the first two symptoms, coupled with any four of the last seven, it means that you probably have a major depression. When the symptoms last for at least two weeks or if they include thoughts of suicide you should consult your doctor immediately.

What Causes Depression?

With our current medical knowledge we must assume that no single cause gives rise to depression. In some cases environmental stress, personal circumstances and life events (psychosocial cause) can give rise to a depressive episode. These events may be death of a loved one, physical illness, financial hardship, retirement and retrenchment. Genetic research also supports the theory that there are family links in depression. Ultimately depression has a neurochemical cause which forms the basis of modern medical management.

Treatment for Depression

Depression is one of the most easily treated emotional disorders today. More than 80 % of depressive patients should recover within a few weeks thanks to a variety of effective treatments that have become available.

MEDICAL TREATMENT

Antidepressants are highly effective treatments. The choice of an antidepressant can be made from one of several classes of antidepressants. The most commonly used first line treatment for depression is the Selective Serotonin Reuptake Inhibitors (SSRI’s). Older classes of antidepressants are the Tricyclic Antidepressants and Monoamine Oxidase Inhibitors. Several new classes of antidepressants have been launched in recent years. Electroconvulsive or ‘shock’ therapy (ECT) is considered by many to be a very effective treatment for severe depression. It is used as a last line of treatment when all the other options were not successful.

What can you expect when treated with an antidepressant?

This is a graphic representation of the phases during treatment.

depression_treatment

  • The onset of action of all antidepressants is slow and you can expect at least two weeks of taking the antidepressant medication before you would start feeling better.
  • A full response would only be felt after 6 to 8 weeks.
  • It might be necessary for your doctor to adjust the dose of the medication upwards, or even change the medication to another class should you not have an adequate response.
  • The duration of treatment should be at least 6 months to a year. Some patients might even have to stay on a maintenance dose of medication for a longer time, in some cases even for life.
  • Never stop or change the dose of your medication without consulting your doctor. The patient must be committed to treatment and follow-up with his or her doctor at regular intervals.
  • Antidepressants do not have any addictive properties.
  • Maintenance is probably the most important facet in successful long-term treatment of depression – This can only be done by monitoring the outcome (Results) of treatment of depression on a regular basis.

PSYCHOLOGICAL TREATMENT

Even if medication is working, the value of psychotherapy is important. Therapy is useful during or after medication to repair other problems associated with depression. Psychotherapy involves the verbal interaction between a trained professional (usually a psychologist) and a patient with emotional or behavioural problems. The therapist applies techniques based on established psychological principles to help the patient gain insights about him or herself and thus change his or her maladaptive thoughts, feelings and behaviour. Several forms of this ‘talk treatment’ have proven useful in helping the depressed person. Today it is well recognized that Cognitive-Behavioural Therapy is most effective in dealing with patients with depression.

It is also important that depressed patients take responsibility for their own well being and develop a lifestyle that enhances this well being. The way you live your life, take care of yourself, and feel about yourself affects mood instability and depression. A concerted effort to alleviate stress in your life will go a long way to stabilize your mood. Making positive changes in your lifestyle and changing negative thought patterns to positive ones will also enhance overall well being. Take stock of your life, look at your lifestyle, build positive self-esteem and self-confidence, develop new ways of thinking, use relaxation techniques, change your diet, get regular exercise and join support groups.

How can family and friends help?

The willingness to listen to the negative thoughts and emotions of the depressed person is very important. Family and friends should be able to talk about and recognize feelings of such a person. (The following articles can be used as guidelines in understanding and developing these skills. Emosionele Inteligensie en Aktief Luister ). Family and friends should also be willing to find out more about depression, to learn the symptoms, and to help with treatment. Depression affects functioning, personality, attitude and perspective. People should know what to expect during the early stages of depression and over the long term. Relationships and lives will most probably be disrupted. An afrikaans article is available called ” Hoe om depressielyers te verstaan en te ondersteun “.

Depression usually means a loss of self-esteem or self-confidence. By maintaining as normal a relationship as possible, talking through unwarranted negative thinking, encouraging efforts to improve, and acknowledging that the person is suffering from an illness will improve the depressed person’s self-worth. Telling him “pull your-self together” will only worsen the situation, so do not use this, thinking it is a form of encouragement.

Understanding, care and respect will go a long way in giving the depressed person hope that his condition will eventually improve and his life return to normal.

Never ignore remarks about suicide or death. Report them to the treating doctor.

Self-help books can also be a valuable source of information. Consult your local bookstore or ask for “The Depression Workbook” by Mary Copeland (New Harbinger Publications).

If you have any more questions regarding Depression consult your Doctor.

Support Groups

The Depression and Anxiety Support Group, Johannesburg branch can be reached at Depression and Anxiety Group. Trained counsellors will be able to provide you with counselling and further information and booklets on Depression and Anxiety. They can also put you in touch with a branch in your area.

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