Most of us have times when we feel miserable, dissatisfied with our lives or feel bad about ourselves. Mild depression doesn’t stop you leading your normal life, but things feel more of a struggle and less worthwhile.
Depression is a serious and common mental illness. It is a feeling of constant sadness. It affects sleep, appetite and concentration. It can be a normal part of grieving when somebody dies, a relationship ends or your life changes in some way. Sometimes there is no obvious reason and depression can come out of the blue. It affects your ability to think, eat and sleep, as well as your mood. Severe depression can stop you living your life the way you want to. You may feel total despair or suicidal.
Doctors may say you have ‘clinical depression’ is when these negative and thoughts carry on for a long time, or go beyond normal changes of mood.
Depression is common. According to the World Health Organisation 340 million people have depression worldwide. As per 2009-2012 data, 7.6% of Americans have depression with females as the major victims. In USA, it is one of the most common health issue and almost 20 million people are believed to have depression. In UK, studies estimate that from 7% to 12% of men will have diagnosable depression in their lifetime. The figure is from 20% to 25% for women. Depression is more common in older people, but it can also affect young people. About 5% of children are believed to have clinical depression or an anxiety disorder.
The experience of depression and the symptoms vary from person, but may include:
- Feeling sad/despairing/angry/anxious/irritable – for all or most of every day. You may feel worse in the morning and slightly better in the evening
- Feeling worthless and guilty, being preoccupied with negative thoughts and seeing the worst in everything
- No longer enjoying activities that used to give pleasure -such as eating, reading, sport, television, sex, listening to music
- Loss of appetite or over-eating, weight loss or gain
- Sleep problems: – you may have difficulty getting to sleep at bedtime, or waking in the early hours and being unable to sleep again, or difficulty getting up in the morning
- Feeling tired or lacking energy every day or nearly every day
- Feeling agitated, fidgety, restless, unable to relax
- Having problems concentrating, making decisions and/or remembering things
- Regularly having thoughts of death (not just a general fear of dying) or suicide
Depression feeds on itself as you get depressed about being depressed. You may feel that nothing can help you, but depression can be treated, and people usually recover. Depression and anxiety often go together, but anxiety often disappears when the depression is treated. If you have had five or more of the symptoms listed above, for at least two weeks, you should see your doctor. Depression can be caused by a number of other conditions, or may even be a side-effect of medication you are taking.
Causes of Depression – What causes it?
Social, emotional and physical factors all play their part in depression. Many people know exactly why they are feeling depressed. It could be a physical illness, financial or relationship problems or difficulties at work. A loved one may have died, or there may be life changes to deal with such as a new baby or moving to a new area. Other people have no idea why they feel depressed.
Scientists have found alterations in the brain’s structure and the way it works when somebody is clinically depressed. This suggests there may be a biological basis. Depression runs in families to some extent. If a parent has depression, it is more likely that their children will also be depressed at some point in their lives. It is not clear how much this is due to genetics or to do with their environment or upbringing.
It can be hard to seek help when you feel depressed, but deciding to do something about your depression is the most important step you can take. Depression can be treated effectively by medication or talking therapies or a combination of both. People also find self help and support groups useful once they are over the worst. Your doctor or therapist will talk to you about your feelings and symptoms. They may also ask about events in your life. To get another perspective, they may ask if they can speak to your family members or a close friend.
Your therapist will usually treat you themselves or, you may be referred to a psychiatrist. If you are severely depressed you may be admitted to the psychiatric ward of a hospital. Many people with depression struggle on alone, without any professional help, and although it can get better on its own, depression can cause a lot of disruption in your relationships and home life.
Treatment for Depression
When you are severely depressed, or clinically depressed, you may find that drug treatment is the only help. Or you may be offered a combination of drugs and talking therapies, usually if your depression has not responded to treatment. Individuals find different things helpful. Antidepressant drugs are often useful for getting you through the worst – and may help for atypical depression (when people experience weight gain, or are oversleeping as part of their depression), but they don’t look at the cause or the root of depression. Talking therapies can help people who want to understand themselves their depression better.
Medication
Antidepressants are the most common drug treatments for depression. They aim to restore chemicals in the brain to a healthy level. This usually involves increasing levels of noradrenaline and serotonin (two chemicals found in the brain that affect mood). There are several classes of antidepressant based on their chemical and pharmacological properties.
Antidepressants usually take between two and eight weeks to work. Some experts recommend that if a 20% improvement is not seen in the first 2-4 weeks, then antidepressant should be changed. Others advise their patients to stay on a treatment for 1 to 2 months atleast.
There is no evidence that any one antidepressant works better than another for depression. 40% of people do not benefit at all from them. About 35% of people with depression recover without any treatment. A further group gets some help from antidepressants but continue to have some symptoms of depression.
The side effects of antidepressants are important in deciding which drug is prescribed. Other considerations are the costs of the drugs and their potential toxicity. Newer antidepressants are generally less toxic, which means they are safer in overdose. But some have the potential to cause dependence; for this reason, people considering changing or stopping antidepressants should consult their doctors.
Antidepressants fall into three main categories:
Tricyclic Antidepressants (or TCAs) , such as imipramine, clomipramine, amitriptyline. These were one of the first drug treatments for depression and are still used widely today. They have a wide-ranging action in the brain; as well as lifting mood, they cause drowsiness. This can be useful for depressed people who also have sleep problems, but is an unwanted effect for others. Other side effects of these older tricyclics include weight gain, dizziness and sexual problems (impotence in men or a reduced desire to have sex in men and women). They also affect the heart and circulatory system, so are unsuitable for people with heart problems.
Side effects of TCAs can include:
- dry mouth, constipation, urinary retention, blurred vision and increased heart rate
- ringing in the ears (tinnitus), muscular pains
- postural hypotension – fainting or ‘blacking out’ when moving from lying or sitting to a standing position
- gastric irritation, weight change, allergic skin reactions and jaundice
- cardiovascular effects including irregular heart beat
- hormonal effects such as loss of libido, impotence
- manic or delusional symptoms (rare)
- potential for dependence
Monoamine oxidase inhibitors (or MAOIs) such as moclobemide. These drugs act to block the action of a chemical called monoamine oxidase, which normally breaks down noradrenaline in the brain. People on older types of MAOI (e.g. phenelzine, trancypromine) have to watch their diet carefully – foods like cheese can interfere with their medication. Moclobemide, a newer and safer type of MAOI, does not have this particular side-effect – and has fewer side-effects generally – but there are still certain foods and drugs that people taking moclobemide should avoid.
Side effects of MAOIs are similar to the tricyclic.
Selective reuptake inhibitors or Serotonin reuptake nhibitors (SSRIs) such as Citalopram, Fluoxetine, Fluvoxamine, Paroxetine, Sertraline are a newer type of anti-depressants with a slightly different action to tricyclics and different side effects. These can include feeling or being sick, headache, upset stomach, diarrhoea, constipation, restlessness, anxiety, weight loss and sexual problems (impotence in men or a reduced desire to have sex in both men and women). Other reuptake inhibitors include the noradrenaline reuptake inhibitors (e.g.Reboxetine) and the serotonin/ noradrenaline reuptake inhibitors (e.g.Venlafaxine).
Side-effects of SSRIs can include:
- gastrointestinal disturbance including nausea, vomiting, diarrhoea
- headache, insomnia, anxiety (especially at the start of treatment)
- loss of libido, impotence
- allergic skin reactions (treatment should be stopped)
- weight gain
- serotonin syndrome -a rare but potentially fatal disorder caused by combining different drugs that interact with serotonin. Symptoms include agitation,
- sweating/shivering, talking/acting with uncontrollable excitement
Mood Stabilizers (Not Antidepressentants)
Although they are not antidepressants, however mood stabilizers such as Lithium, Carbamazapine, are sometimes used to treat depression when other drugs have failed to work. People with anxiety and depression may also be prescribed tranquillisers such as Lorazepam for a short course, usually only about two weeks.
These drugs are more commonly used in the treatment of bipolar illness (or manic depression). They have a range of side-effects and people taking them need to be monitored closely. Lithium is expensive and generally unpopular for treatment of depression. Newer anticonvulsant drugs such as gabapentin and lamotrigine have shown some antidepressant activity, but more research is needed.
Side-effects of lithium can include:
- increased frequency/volume of urine
- excessive thirst
- skin complaints and rashes
- cognitive defects, such as memory problems, difficulty in decision making
- long term kidney problems
Side-effects of carbamazepine can include:
- nausea, vomiting, indigestion
- confusion, dizziness, drowsiness
- skin reactions and jaundice
- hair loss
- weight gain
Benzodiazepines
Drugs such as diazepam, lorazepam and bromazepam are commonly used for treating anxiety disorders. Because they enable people to sleep easily, they are also sometimes used for treating the sleep disturbance, which is a symptom of some forms of depression. These drugs have the potential to cause dependence, so they should not be used for more than 2-4 weeks at a time.
Side effects of benzodiazepines are generally not severe, but may include:
- drowsiness
- light-headedness
- muscle weakness/lack of co-ordination (ataxia)
- visual disturbances
- skin rash
- reduced blood pressure
Antidepressants usually take between two and eight weeks to work – so instant relief is not possible with these drugs. If, after two months, your treatment still doesn’t seem to be helping or you are getting side-effects, talk to your doctor before deciding to stop taking it. There are many different treatment options available – he or she may suggest an alternative drug, talking therapies, or for severe depression ECT may be suggested.
Other Treatments For Depression :
Electro Convulsive Therapy
Electroconvulsive therapy (ECT) is sometimes given to severely depressed people when anti-depressant drugs have failed to work. It is not known why or how it sometimes works for depression. It is one of the most controversial forms of treatment for depression. Its effects on the brain are unclear, but clinically it is reported to improve cases of severe depression, and it is the quickest available form of antidepressant treatment. The treatment involves a series of electric shocks to the head, which produce seizures. Muscle relaxant drugs are given beforehand to prevent the seizures running through the body and causing convulsions which could damage it.
Side effects of ECT can be severe and include:
- Nausea/vomiting
- Muscle aching
- headache
Talking therapies
Talking therapies like support groups, psychotherapy or Cognitive Behavior Therapy (CBT) can help mild to moderate depression. By exploring and understanding yourself and your depression, you can sometimes find ways of coping. Spending time with somebody who listens attentively to what you have to say can be therapeutic in itself. You may find talking therapies most useful when a severe depression has passed; it can also help you notice and take action if you are getting depressed again. They can help people who want to understand themselves and their depression better and can prevent depression in the future by helping people notice symptoms and take action to stay well. Self-help and support groups can help ease the isolation and low self esteem that people with depression often feel.
Counselling
Counselling helps people look at what they are facing now and to find ways of coping. There is evidence that it can help people adjusting to life events such as bereavement, postnatal depression, illness, disability or loss. Many GP’s now employ counsellors in their practices.
Cognitive Behavioral Therapy (CBT)
CBT aims to help people change patterns of thinking or behavior that are causing problems. It is a structured therapy where tasks are given in between sessions. It has been proven effective for depression and anxiety.
Psychotherapy
Psychotherapy involves looking for connections between present feelings and actions and past events. It is especially useful in helping people with long term or recurring problems to get to the root of their difficulties. There is some evidence that it can help depression. NHS psychotherapists normally work in hospitals or specialist clinics.
Alternative therapies and other non drug treatments
A number of non-drug approaches are said to help depression, both alongside and instead of antidepressant drugs. These include light therapy, Transcranial Magnetic Stimulation (TMS), aromatherapy, acupuncture or meditation. Only those therapies which are somewhat proven to help are discussed here.
St John’s Wort
St John’s Wort, a plant available as an over-the-counter food supplement, has become a popular treatment for depression. In 1996 a research paper published in the British Medical Journal 9 concluded that St John’s Wort was as effective as the antidepressant imipramine for mild to moderate depression. St John’s Wort was better tolerated than the imipramine, with milder side effects.
Little is known about how St John’s Wort works in depression. The active chemical in the plant has some MAOI activity, but it is unclear whether this accounts for its effect.
People thinking of using St John’s Wort, especially those taking other medication should seek medical advice before using it. Several types of medication, including oral contraceptives, diuretics, and other antidepressants, may interact with the chemicals in St John’s Wort. A few cases of mania/hypomania have been reported in people taking it.
Exercise
Exercise releases mood improving chemicals – endorphins into the brain. It is especially helpful in preventing depression returning. A recent study compared the benefits of exercise with and without antidepressants over a four-month period in people with major depression. There was no difference between the two groups after four months, but six months after finishing the treatment, relapse rates were significantly lower in the exercise group. Also, individual exercise during the follow-up period reduced the chances of having major depression at the end of the study.
What Can I Do to Help Myself (or a Friend/Loved One With Depression)?
What you can do depends very much on how depressed you are feeling. If you are very low you may be unable to act, and may need professional help to get you to a point where you can help yourself. Try anything which makes you feel better about yourself. This might include:
Talking about how you feel: Telling your family and friends how you feel is important – pretending you are alright can be the hardest part of the illness. Meeting other depressed people and releasing pent up feelings can help you feel less isolated.
Looking after yourself physically: this may involve regular exercise such as running or dancing, cutting down on alcohol and tobacco, eating well and noticing if you are exhausted and need a break. Exercise is especially good as it releases mood improving chemicals i.e. endorphins into the brain.
Reducing stress and learning how to relax and take time for yourself: Try to reduce the stress in your life, and learn to recognize when you are becoming stressed. Learning and practicing relaxation techniques or yoga can be helpful. Some people find alternative therapies like massage, aromatherapy or meditation relaxing and pleasurable.
Once your depression has lifted it is important to continue looking after your mental health. Keeping a diary can be helpful; it’s a useful way of focusing on how you feel and can help you recognize if an episode of depression is on its way. Be aware of what might trigger your depression. Bear in mind that It is often people who know you very well who can spot warning signs of depression first. If you get help and support at early, you may avoid a crisis.
Inform yourself as best you can: use the Internet, local libraries and your doctor to find out about your condition and your medication. Give your family and friends may information on depression to read – it may make it easier for them to appreciate what you are going through. Also, find out what activities are available to you in your local area. Even if you don’t feel like taking part in them now, you may do in the future.
Final Words
More and more people are diagnosed with depression every year, but there is surprisingly little research into its causes and treatment. Our lifestyle can be one of the major contributor as we are using and consuming stuff that we shouldn’t. Consumer technology like mobile phones are increasingly making us loner and we are now systemically being programmed for running away from the problems rather than facing it.
Not much is known about the chemical changes caused by depression, or how anti depressant drugs actually work. The role of psychological therapies in the prevention and treatment of depression also needs to be explored. The causes and effective treatments for depression vary between people and the best depression treatment is likely to take into account each individual in the context of their life.
New potential therapies for depression are on the horizon. The success of the newer antidepressants has focused attention on the role of neurotransmitter systems in depression, Other brain changes such as hormonal disruption also occur in depression. Early trials suggest that oestrogen may have a role as a treatment for depression.
Corticotrophin-releasing factor (CRF), which is released in response to stress, may also have a role in future depression treatments. More CRF is present in the cerebro-spinal fluid (the liquid that bathes the brain and spinal chord) of depressed people who are not on medication. Chemicals that block the action of CRF in the brain might be a new way of treating depression; they might act more quickly and work for a greater proportion of people.
References & Citations:
https://www.sciencedaily.com/releases/2017/10/171030134631.htm
https://www.mentalhealth.gov/what-to-look-for/mood-disorders/depression/index.html
https://www.cdc.gov/mentalhealth/basics/mental-illness/depression.htm
https://www.nimh.nih.gov/health/topics/depression/index.shtml
https://www.fda.gov/forconsumers/consumerupdates/ucm095980.htm
https://medlineplus.gov/antidepressants.html
https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072481/
https://www.mayoclinic.org/drugs-supplements-st-johns-wort/art-20362212
http://www.umm.edu/health/medical/altmed/herb/st-johns-wort
Depression Support Groups:
https://adaa.org/supportgroups
http://www.dbsalliance.org/site/PageServer?pagename=peer_support_group_locator
