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DEPRESSION - a patient's guide
Drs Dion Martley & Brandon Nemenzik
Overview
Depression is a common problem
One in eight people will suffer from depression at some
time in their lives
Risk factors include a family history, a previous depression,
and an upsetting event
Clinical depression is believed to be caused by a chemical
imbalance in the brain
Symptoms include feeling low, sleeping problems, and loss
of energy
Treatment involves antidepressants and psychotherapy/counselling
Severe depression can lead to suicide
A small percentage of sufferers may need hospital treatment
What is it?
Depression is a serious mental illness, affecting many
people in the population.
It is estimated that one in eight people will require
treatment for depression at some time in their lives. There
is some evidence that depression is becoming more widespread
in western countries.
Depression is more serious than the normal lows associated
with living. With clinical depression the depressed mood
continues for weeks and is believed to be caused by a chemical
imbalance in the brain.
The problem is common in all age groups.
Depression is largely under-diagnosed and without treatment
the condition can lead to serious problems and even suicide.
Major risk factors for depression include a family history,
stressful life problems, substance abuse, being a woman,
and a prior history of depression.
It is normal to feel depressed after a distressing event
such as the break up of a relationship or bereavement.
One in 10 women will suffer depression after child birth.
Some people are more prone to depression because of their
personality, body chemistry, and early childhood experiences.
What are the symptoms?
Symptoms of depression will vary between people. Not everyone
will complain of feeling depressed, some will only report
problems sleeping or vague physical ills.
A person is considered to be suffering depression if they
feel depressed for most of the time or have lost interest
or pleasure in activities they normally find rewarding.
They also need to experience four or more of the following
symptoms for more than two weeks:
A change in appetite or body weight, such as weight loss
or weight gain
Not being able to sleep or sleeping too much or unrefreshing
sleep
Decreased activity or restlessness.
Loss of energy and feeling tired
Feeling worthless or guilty
Difficulty thinking clearly and concentrating
Thoughts of suicide or wanting to die
Serious depression needs to be distinguished from normal
sadness and bad moods associated with living.
A full physical examination and some blood tests are usually
done, to help exclude or diagnose any physical problems
which may cause symptoms similar to depression (e.g. diabetes,
or underactive thyroid gland).
What can be done to help?
Depression is treated with a combination of antidepressants
and psychotherapy. The earlier the treatment starts the
better the chance of recovery.
One recent study found a combination of the use of the
drug nefazodone (Serzone) for 12 weeks and psychotherapy
to treat chronic depression was successful in 85 percent
of patients who had been depressed for two years. The use
of the drug alone had a 55 percent response rate and psychotherapy
alone was successful in 52 percent of cases.
No single antidepressant has been shown to be more effective
than others. Some people will respond better to one drug
than another. All antidepressants have some side effects
and these considerations may influence the choice of drug
given to individual patients. The first drug that is tried
may not give the full desired response in 30-40% of sufferers;
it may be necessary to try a different medication in these
cases. The exact choice of medication is determined by the
nature of symptoms and other medical conditions (e.g. the
risk of certain side effects in some patients).
The right medication should be highly effective and be
able to remove all symptoms of depression.
There is a tendency for mildly and moderately depressed
people to be prescribed newer antidepressants like a selective
serotonin reuptake inhibitor (SSRI), and for severely depressed
people to be given the older tricyclic antidepressants or
venlafaxine.
Treatment involves three phases: treating the depressive
symptoms, continuation of treatment to prevent a relapse,
and maintenance treatment to prevent a recurrence of depression
- this may continue for one year to a lifetime, depending
on the likelihood of the depression returning. Drug treatment
should be used for at least four to six months. Research
has shown a higher risk of recurrence of symptoms if medication
is discontinued before this.
There are side effects with all antidepressants. Tricyclic
antidepressants can cause constipation, a dry mouth, blurred
vision, and confusion. SSRIs can cause nausea, diarrhoea,
anxiety, insomnia and loss of appetite. Long term use can
cause sexual dysfunction, However, SSRIs generally have
fewer side-effects.
Antidepressants take up to six weeks before they start
to work. Some treatments may fail to show an improvement.
If there is no improvement or only a slight improvement
in symptoms after 6 to 8 weeks on one antidepressant then
another medication should be considered. The possibility
of another psychiatric disorder, a personality disorder,
or another physical medical problem should also be considered.
Drug treatment should be considered if psychotherapy or
counselling alone has no obvious response after 12 weeks.
Many experts believe those with moderate to severe depression
should be prescribed antidepressants regardless of whether
psychotherapy is also used.
When coming off antidepressants, the dose should be tapered
off gradually under supervision to prevent rebound effects
such as irritability, anxiety, headache and dizziness.
It should be stressed that antidepressant use does not
lead to addiction.
Hospital treatment may be necessary for severe sufferers
of depression who fail to respond to drug treatment. In
some case electro-convulsive therapy (ECT) may be used treat
depression.
There are many things you can do to help yourself. Be
sure to eat a good balanced diet even though you may not
feel like eating. Do not attempt to drown your sorrows,
alcohol is a depressant and will end up making you feel
worse. Try to rest in bed even if you can't sleep. And try
to get some exercise and continue activities you normally
enjoy, even if it takes considerable effort initially.
Future trends
New drug treatments for depression continued to be developed.
New behavioural therapies to treat depression are also being
evaluated.
Getting help
Your doctor, psychiatrist or psychologist will be able
to help.
The Mental Health Foundation of New Zealand, Ph 09 638
8573.
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