Depression: Let’s talk!

​Depression is a major challenge to health and is the focus of World Health Day 2017. The theme “Depression: let’s talk” recognizes that depression is a treatable condition and seeks to address the fact that, despite this, globally more than 300 million people suffer from it. More women are affected by depression than men. At its worst, depression can lead to suicide. It is characterised by persistent sadness, a loss of interest in activities that you normally enjoy, and an an inability to carry out daily activities.

Signs and Symptoms

If you have been experiencing some of the following signs and symptoms most of the day, nearly every day, for at least two weeks, you may be suffering from depression:

-Persistent sad, anxious, or “empty” mood

-Feelings of hopelessness, or pessimism

-Irritability

-Feelings of guilt, worthlessness, or helplessness

-Loss of interest or pleasure in hobbies and activities

-Decreased energy or fatigue

-Moving or talking more slowly

-Feeling restless or having trouble sitting still

-Difficulty concentrating, remembering, or making decisions

-Difficulty sleeping, early-morning awakening, or oversleeping

-Appetite and/or weight changes

-Thoughts of death or suicide, or suicide attempts

-Aches or pains, headaches, cramps, or digestive

 -problems without a clear physical cause and/or that do not ease even with treatment

Not everyone who is depressed experiences every symptom. Some people experience only a few symptoms while others may experience many. Several persistent symptoms in addition to low mood are required for a diagnosis of major depression, but people with only a few – but distressing – symptoms may benefit from treatment of their “subsyndromal” depression. The severity and frequency of symptoms and how long they last will vary depending on the individual and his or her particular illness. Symptoms may also vary depending on the stage of the illness.

Causes

There are a number of factors that may increase the chance of depression, including the following:

Abuse:- Past physical, sexual, or emotional abuse can increase the vulnerability to clinical depression later in life.

Certain medication:- Some drugs, such as isotretinoin (used to treat acne), the antiviral drug interferon-alpha, and corticosteroids, can increase your risk of depression.

Conflict:- Depression in someone who has the biological vulnerability to develop depression may result from personal conflicts or disputes with family members or friends.

Death or a loss: Sadness or grief from the death or loss of a loved one, though natural, may increase the risk of depression.

Genetics:- A family history of depression may increase the risk. It’s thought that depression is a complex trait, meaning that there are probably many different genes that each exert small effects, rather than a single gene that contributes to disease risk. The genetics of depression, like most psychiatric disorders, are not as simple or straightforward as in purely genetic diseases such as Huntington’s chorea or cystic fibrosis.

Major events:- Even good events such as starting a new job, graduating, or getting married can lead to depression. So can moving, losing a job or income, getting divorced, or retiring. However, the syndrome of clinical depression is never just a “normal” response to stressful life events.

Other personal problems:- Problems such as social isolation due to other mental illnesses or being cast out of a family or social group can contribute to the risk of developing clinical depression.

Serious illnesses:- Sometimes depression co-exists with a major illness or may be triggered by another medical condition.

Substance abuse:- Nearly 30% of people with substance abuse problems also have major or clinical depression.

Treatment and Therapies

Depression, even the most severe cases, can be treated. The earlier that treatment can begin, the more effective it is. Depression is usually treated with medications, psychotherapy, or a combination of the two. If these treatments do not reduce symptoms, electroconvulsive therapy (ECT) and other brain stimulation therapies may be options to explore.

Quick Tip: No two people are affected the same way by depression and there is no “one-size-fits-all” for treatment. It may take some trial and error to find the treatment that works best for you.

Medications

Antidepressants are medicines that treat depression. They may help improve the way your brain uses certain chemicals that control mood or stress. You may need to try several different antidepressant medicines before finding the one that improves your symptoms and has manageable side effects. A medication that has helped you or a close family member in the past will often be considered.

Antidepressants take time – usually 2 to 4 weeks – to work, and often, symptoms such as sleep, appetite, and concentration problems improve before mood lifts, so it is important to give medication a chance before reaching a conclusion about its effectiveness. If you begin taking antidepressants, do not stop taking them without the help of a doctor. Sometimes people taking antidepressants feel better and then stop taking the medication on their own, and the depression returns. When you and your doctor have decided it is time to stop the medication, usually after a course of 6 to 12 months, the doctor will help you slowly and safely decrease your dose. Stopping them abruptly can cause withdrawal symptoms.

Please Note: In some cases, children, teenagers, and young adults under 25 may experience an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed. This warning from the U.S. Food and Drug Administration (FDA) also says that patients of all ages taking antidepressants should be watched closely, especially during the first few weeks of treatment.

if you are considering taking an antidepressant and you are pregnant, planning to become pregnant, or breastfeeding, talk to your doctor about any increased health risks to you or your unborn or nursing child.

Psychotherapies

Several types of psychotherapy (also called “talk therapy” or, in a less specific form, counseling) can help people with depression. Examples of evidence-based approaches specific to the treatment of depression include cognitive-behavioral therapy (CBT), interpersonal therapy (IPT), and problem-solving therapy.

Brain Stimulation Therapies

If medications do not reduce the symptoms of depression, electroconvulsive therapy (ECT) may be an option to explore. Based on the latest research:

-ECT can provide relief for people with severe depression who have not been able to feel better with other treatments.

-Electroconvulsive therapy can be an effective treatment for depression. In some severe cases where a rapid response is necessary or medications cannot be used safely, ECT can even be a first-line intervention.

-Once strictly an inpatient procedure, today ECT is often performed on an outpatient basis. The treatment consists of a series of sessions, typically three times a week, for two to four weeks.

-ECT may cause some side effects, including confusion, disorientation, and memory loss. Usually these side effects are short-term, but sometimes memory problems can linger, especially for the months around the time of the treatment course. Advances in ECT devices and methods have made modern ECT safe and effective for the vast majority of patients. Talk to your doctor and make sure you understand the potential benefits and risks of the treatment before giving your informed consent to undergoing ECT.

-ECT is not painful, and you cannot feel the electrical impulses. Before ECT begins, a patient is put under brief anesthesia and given a muscle relaxant. Within one hour after the treatment session, which takes only a few minutes, the patient is awake and alert.

-Other more recently introduced types of brain stimulation therapies used to treat medicine-resistant depression include repetitive transcranial magnetic stimulation (rTMS) and vagus nerve stimulation (VNS). Other types of brain stimulation treatments are under study.

If you think you may have depression, start by making an appointment to see your doctor or health care provider. This could be your primary care practitioner or a health provider who specializes in diagnosing and treating mental health conditions.

Beyond Treatment: Things You Can Do

Here are other tips that may help you or a loved one during treatment for depression:

-Try to be active and exercise.

-Set realistic goals for yourself.

-Try to spend time with other people and confide in a trusted friend or relative.

-Try not to isolate yourself, and let others help you.

-Expect your mood to improve gradually, not immediately.

-Postpone important decisions, such as getting married or divorced, or changing jobs until you feel better. Discuss decisions with others who know you well and have a more objective view of your situation.

-Continue to educate yourself about depression.