Depression

Depression

The word depressed is a common everyday word. People might say “I’m depressed” when in fact they mean “I’m fed up because I’ve had a row, or failed an exam, or lost my job”, etc. These ups and downs of life are common and normal. Most people recover quite quickly. With true depression, you have a low mood and other symptoms each day for at least two weeks. Symptoms can also become severe enough to interfere with normal day-to-day activities.

Who gets depression?

About 5 in 100 adults have depression every year. Sometimes it is mild or lasts just a few weeks. However, an episode of depression serious enough to require treatment occurs in about 1 in 4 women and 1 in 10 men at some point in their lives. Some people have two or more episodes of depression at various times in their life.

What are the symptoms of depression?

Many people know when they are depressed. However, some people do not realise when they are depressed. They may know that they are not right and are not functioning well but don’t know why. Some people think that they have a physical illness – for example, if they lose weight.

There is a set of symptoms that are associated with depression and help to clarify the diagnosis. These are:

Core (key) symptoms

  • Persistent sadness or low mood. This may be with or without weepiness.
  • Marked loss of interest or pleasure in activities, even for activities that are normally enjoyed.

Other common symptoms

  • Disturbed sleep compared with the usual pattern. There may be difficulty in getting off to sleep, or waking early and being unable to get back to sleep. Sometimes it is sleeping too much.
  • Change in appetite. This is often a poor appetite and weight loss. Sometimes the reverse happens with comfort eating and weight gain.
  • Tiredness (fatigue) or loss of energy.
  • Agitation or slowing of movements.
  • Poor concentration or indecisiveness. Even simple tasks can seem difficult.
  • Feelings of worthlessness, or excessive or inappropriate guilt.
  • Recurrent thoughts of death. This is not usually a fear of death, more a preoccupation with death and dying. For some people despairing thoughts such as “life’s not worth living” or “I don’t care if I don’t wake up” are common. Sometimes these thoughts progress into thoughts and even plans for suicide.

An episode of depression is usually diagnosed if:

  • There are at least five of the above nine symptoms, with at least one of these a core symptom; and:
    • Symptoms cause distress or impair normal functioning, such as affecting work performance; and
    • Symptoms occur most of the time on most days and have lasted at least two weeks; and
    • The symptoms are not due to a medication side-effect, or to drug or alcohol misuse, or to a physical condition such as an underactive thyroid or pituitary gland. (However, see section later on depression and physical conditions.)

Many people with depression say that their symptoms are often worse first thing each day. Also, with depression, it is common to develop physical symptoms such as headaches, palpitations, chest pains and general aches. Some people consult a doctor at first because they have a physical symptom such as chest pains.

Severity of depression

The severity of depression can vary from person to person. Severity is generally divided as follows:

  • Severe depression – all of the nine symptoms listed above are present. Also, symptoms markedly interfere with normal functioning.
  • Moderate depression – more than the five symptoms are present. Also, symptoms will usually include both core symptoms. Also, the severity of symptoms or impairment of functioning is between mild and severe.
  • Mild depression – five of the symptoms listed above are present. Normal functioning is only mildly impaired.
  • Subthreshold depression – Fewer than the five symptoms are present. So, it is not classed as depression. But, the symptoms are troublesome and cause distress. If this situation persists for more than two years it is sometimes called dysthymia.

What causes depression?

The exact cause is not known. Anyone can develop depression. Some people are more prone to it and it can develop for no apparent reason.

An episode of depression may also be triggered by a life event such as a relationship problem, bereavement, redundancy, illness, etc. In many people it is a mixture of the two. For example, the combination of a mild low mood with some life problem, such as work stress, may lead to a spiral down into depression.

Women tend to develop depression more often than men. Particularly common times for women to become depressed are after childbirth (postnatal depression) and the menopause.

Depression and physical conditions

Depression is more common than average in people coping with serious or severe physical diseases. Although the treatment of the physical disease may take priority, the treatment of depression is also useful to improve overall well-being.

Undiagnosed physical conditions

Various physical conditions may at first seem to mimic depression. the most common examples are:

  • An underactive thyroid gland (hypothyroidism) – can make you feel quite low, weepy and tired. A blood test can diagnose this.
  • An underactive pituitary gland (hypopituitarism) – There are various symptoms that can develop. These include loss of sex drive, sexual problems, infertility, uncontrollable weight gain and feeling low, depressed and even suicidal. There are various causes of hypopituitarism, including head injury.
  • Head injury – even a relatively mild one, even many years ago. For example, studies have shown that rates of suicide (presumably related to depression) are more common than average in people who have previously had a head injury.
  • Polymyalgia rheumatica – this condition mainly affects older people. Typical symptoms include stiffness, pain, aching, feeling depressed and tenderness of the large muscles around the shoulders and upper arms. Feeling depressed can be the first main symptom before the other symptoms predominate.
  • Early dementia – is sometimes confused with depression.
  • Certain drugs, both prescribed and street (illicit) drugs – can cause side-effects which may mimic depression.

Some myths and other points about depression

Depression is common but many people don’t admit to it. Some people feel there is a stigma attached, or that people will think they are weak. Depression is one of the most common illnesses that doctors deal with. People with depression may be told by others to “pull their socks up” or “snap out of it”. The truth is, they cannot, and such comments by others are very unhelpful.

Understanding that one’s symptoms are due to depression and that it is common, may help one to accept that they are ill and need help.

What are the treatment options for depression?

In general, treatments are divided into those used for mild depression and those used for moderate and severe depression.

What if I don’t have any treatment?

Most people with depression will get better without treatment. However, this may take several months or even longer. (The average length of an episode of depression is 6-8 months.) Meanwhile, living with depression can be difficult and distressing (and also for family and friends). Relationships, employment, etc, may be seriously affected. There is also a danger that some people turn to alcohol or illegal drugs. Some people think of suicide. Therefore, many people with depression opt for treatment.

Treatment options for moderate or severe depression

Antidepressant medicines

Antidepressant medicines are commonly used to treat moderate or severe depression. A medicine cannot alter circumstances. However, symptoms such as low mood, poor sleep, poor concentration, etc, are often eased with an antidepressant. This may then allow patients to function more normally and increase their ability to deal with any problems or difficult circumstances.

An antidepressant does not usually work straightaway. It can take 2-4 weeks before the effect builds up fully. A common problem is that some people stop the medicine after a week or so as they feel it is not helping.  Time should be given.  Also, if it is helping, the course recommended by a doctor should be followed. A normal course of an antidepressant lasts for at least six months after symptoms have eased. Some people stop their medication too early and the depression may then quickly return.

There are several types of antidepressants, each with various pros and cons. For example, they differ in their possible side-effects. If the first one does not suit, then another may be found that will suit. Antidepressants are not tranquillisers and are not thought to be addictive.

At the end of a course of treatment it is usual to reduce the dose gradually over about four weeks before finally stopping. This is because some people develop withdrawal symptoms if an antidepressant is stopped abruptly.

 

Psychological (talking) treatments

Various psychological treatments have been shown in research trials to be good treatments for depression. In general, a combination of an antidepressant plus a psychological treatment is thought to be better than either treatment alone.

Other treatments

Electroconvulsive therapy (ECT) may be advised as a last resort if you have severe depression which has not improved with other treatments.

Exercise.

Exercise on average, seems to improve depressive symptoms. Regular exercise is generally a good thing to do anyway.

Some dos and don’ts about depression (this can maybe be in a separate box)

  • Don’t bottle things up and ‘go it alone’. Try to tell people who are close to you how you feel. It is not weak to cry or admit that you are struggling.
  • Don’t despair – most people with depression recover. It is important to remember this.
  • Do try to distract yourself by doing other things. Try doing things that do not need much concentration but can be distracting, such as watching TV. Radio or TV is useful late at night if sleeping is a problem.
  • Do eat regularly, even if you do not feel like eating. Try to eat a healthy diet.
  • Don’t drink alcohol. Drinking alcohol is tempting to some people with depression, as the immediate effect may seem to relieve the symptoms. However, drinking heavily is likely to make your situation worse in the long run. Also, it is very difficult either to assess or to treat depression if you are drinking a lot of alcohol.
  • Don’t make any major decisions whilst you are depressed. It may be tempting to give up a job or move away to solve the problem. If at all possible you should delay any major decisions about relationships, jobs, or money until you are well again.
  • Do tell your doctor if you feel that you are getting worse, particularly if suicidal thoughts are troubling you.
  • Sometimes a spell off work is needed.
  • Sometimes a specific psychological problem can cause depression but some people are reluctant to mention it. One example is sexual abuse as a child leading to depression or psychological difficulties as an adult. Tell your doctor if you feel something like this is the root cause of your depression. Counseling may be available for such problems.

Will it happen again?

A one-off episode of depression at some stage in life is common. However, some people have two, three, or more episodes of depression. Each episode can be treated. But, if one is prone to recurring episodes of depression, taking  an antidepressant long-term (as prescribed by a doctor) may prevent depression from recurring.

 

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