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Depression

Depression and stress

Reviewed by Dr John Powell, Specialist Registrar/© NetDoctor

What is depression?

Many people sit alone with their depression, and almost 50 per cent of people do not know they have depression or that it can be treated effectively by their doctor.

Depression is an illness characterized by a prolonged low mood which affects the ability to carry out day to day activities. It affects about five to 20 per cent of the population at some time in their lives and is more common in women.

Depression can be treated with a combination of psychological therapy and/or medication. If a person has experienced one depressive period, they are at greater risk of having another.

Why do people become depressed?

There are both predisposing and precipitating factors contributing to someone becoming depressed. Predisposing factors are features of one’s personality or lifestyle that make one susceptible to depression. These may be related to genetic factors, to early lifetime experiences, or to social circumstances.

Precipitating factors are triggers which directly lead to the episode of depression.

For example, stressful life events such as the loss of a job or the end of a relationship can trigger depression. Depression can also be a side effect of certain medications.

In depression the metabolism of the brain is affected. Levels of certain brain chemicals are altered. The purpose of antidepressant medication is to rectify any imbalance in the levels of these brain chemicals.

What does depression feel like?

Depression is characterized by a persistent low mood which affects the ability to carry out everyday activities. It is more than just feeling ‘down’ for a short while.

The symptoms of depression can include the following:

  • low mood.
  • lack of interest in and pleasure from usual activities and interests.
  • poor attention and concentration.
  • disturbed appetite, usually associated with weight loss, but it can also cause an increased appetite.
  • disturbed sleep, often causing waking in the early hours of the morning and, a feeling of being unrefreshed by sleep.
  • tiredness.
  • decreased sexual energy (libido).
  • feelings of worthlessness or hopelessness.
  • feelings of guilt or shame.
  • suicidal ideas and thoughts of self harm.

What can you do?

  • Recognize when you are suffering from depression.
  • Seek help when the symptoms start appearing.
  • Have a lifestyle which encourages positive mental health – spend time with friends, talk to others about particular worries or stresses, make time for enjoyable past times, take regular exercise, do not drink alcohol to excess, avoid smoking and illicit drugs.

How can the doctor recognize depression?

The doctor will make a diagnosis based on the symptoms you describe. It is, therefore, important to tell the doctor if you have been suffering with any of the symptoms of depression. In some cases you may also be asked to complete a short questionnaire asking you about these symptoms.

  • The doctor will also conduct a physical examination and in some cases arrange for blood samples and other investigations to be done in order to exclude other causes for the symptoms.

For example some symptoms of depression can also be caused by disorders such as anemia or lack of thyroid hormone.

What is the course of the illness?

Some episodes of depression may resolve spontaneously without treatment. However, this is not always the case and treatment is often required. Treatment can shorten both the duration and the severity of a depressive episode.

Most people only get a single or a few depressive periods during their lives. But, in a few cases, there can be frequent relapses and preventive (prophylactic) therapy may be necessary.

The risk of relapse is reduced if an antidepressant medicine is continued for six months after recovery from an episode of depression

How is depression treated?

Treatment of depression needs to be tailored to the individual. Most episodes of depression are managed in primary care or by psychiatrists in outpatient clinics. People with more severe depression sometimes need to be admitted to hospital for inpatient treatment.

Research studies have shown that the following treatments are effective for mild or moderate depression:

  • antidepressant medicines (including tricyclic antidepressants (TCA), selective serotonin reuptake inhibitors (SSRIs), monoamine oxidase inhibitors (MAOIs))
  • certain types of psychological therapy, specifically cognitive therapy and interpersonal therapy
  • research also suggests that St John’s wort and problem-solving therapy are effective treatments for some people with mild or moderate depression.

Research has also shown that the following treatments are effective for severe depression:

  • antidepressant medicines
  • electroconvulsive therapy (ECT) appears to be an effective treatment for severe depression which has failed to respond to other treatments or where a quick effect is desirable (for example in some cases of severe postnatal depression).




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