Family doctor

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.