Our resident medical expert, talks to us about Depression...
It is unhappily the case that many people (non-sufferers) have great difficulty in accepting that depression is an actual illness, believing that a ‘snap out of it’ approach is the answer. Such individuals will have a rude awakening if ever they are unfortunate to suffer a bout of depression themselves. Depression is a disabling illness like no other and is more common than people may realise. In Britain it affects 1 in 10 people, tending to affect women more often than men. It not only causes low mood but commonly energy levels will be low, sleep and concentration will be affected, confidence and general enthusiasm for day to day life blighted. In many cases, a person may be physically well but still be immensely tired, which in fact may be the only symptom to start with. That being said it is always worth being investigated for physical problems as depression can sometimes be a manifestation of certain other conditions such as an under-active thyroid gland or low (or high) calcium levels.
Once associated physical conditions have been excluded, depression will fall into 2 main categories - exogenous and endogenous. There are other forms of depression such as ‘vascular depression’ (which tends to affect the elderly), post-natal depression, seasonal affective disorder (SAD) and manic depression but this is not the article to discuss these.
Exogenous depression is the type which is triggered from a major life event eg marital break-up, loss of job or house, or financial mire for example, giving rise to a reactive depression. Endogenous depression is the type that comes ‘from nowhere’; a person may have the perfect life - great job, lovely partner, financial security etc. and still become depressed. The bottom line is that both involve a chemical imbalance within the brain which antidepressants (ADs) work to improve.
Over-diagnosis of depression
Nobody can be happy 100% of the time but if you have more ‘down days’ than good days then a diagnosis of depression certainly needs to be excluded. However, as a consequence of a number of factors, people often consider themselves to be depressed when in fact they may just be unhappy. There is a distinction between the two and an important one at that.
People are far more health-aware these days, depression is more openly talked about and human nature certainly of modern times tends to have a propensity to want to 'medicalise' everything, not least unhappiness. Marital disharmony, break-up or loss of job will naturally cause a degree of emotional anguish and unhappiness - they are bound to as they are very negative life events. However it does not necessarily follow that such unhappiness will trigger an actual clinical depression. Even so, some people seem to find it easier to label their particular mental state of unhappiness as a depression as to do so will afford them the belief that it will have a medical ‘fix.’
At times ADs have been subject to bad press and vilified as zombifying agents’ with addictive potential. There is perhaps some credence in this as they are indeed drugs which should not be stopped abruptly if someone has been taking them for a lengthy period. Some people have reported feelings of mental emptiness, whereby negative feelings may well have been eradicated, but at the expense of emotions and feelings in general. That being said, ADs are capable of turning lives around and have probably saved many from suicide.
Antidepressants were first developed in the 1950s and have been used with increasing regularity since then. There are many different types and all essentially work by regulating or increasing certain chemicals in the brain. One such chemical is Serotonin (the production of which is stimulated by light).
Choice of Antidepressant
As with all medication, antidepressants can have potential side effects, depending of course on which one is used. In some instances such side effects will be desirable eg Mirtazapine is an AD which is known to cause drowsiness and as such is taken at night to aid sleep. However, many side effects from ADs will be undesirable. Anyone taking an antidepressant should be aware that it can typically take 3-4 weeks before a noticeable benefit is seen and that there can sometimes be a transient worsening of symptoms initially. Anxiety is often a feature of depression and as such some antidepressants are tailored as much towards improving this symptom, as the depression itself. Indeed, many drugs used to treat anxiety per se are from the antidepressant family.
As may be expected, there is often a degree of trial and error as to which will suit (and indeed be effective) in any one individual. It would also be fair to say that many people will hold an unrealistic expectation of what ADs can achieve. To support this it is necessary to address the issue of depression itself.
If you are unfortunate enough to suffer from depression then it needs to be borne in mind that antidepressants are only one part of the solution to ‘getting better’; the following can also play a significant part:
Tackling the cause:
It may seem obvious but if there is a clear identifiable cause at the root of the depression that it should be dealt with. This is often easier said than done but in reality most problems do have a solution, even if not immediately apparent.
Counselling, group therapy, CBT, psychotherapy:
These non-pharmacological methods help some but not all. Often it comes down to how receptive a person is to this mode of treatment, and certain personality traits would naturally have a bearing on this. However it is undoubtedly the case that such treatments are effective and can be used alone to treat depression or as an adjunct to medication.
Diet and Exercise:
Taking regular exercise most days in the week and having a healthy diet are also important; people should obviously eat healthily in any case but especially during a depressive illness.
Many people will often use alcohol as a ‘crutch’ to help them through depression but the truth is that alcohol can exacerbate the problem long term, or at least serve as an obstacle to getting better.
Studies have also shown that cannabis use, particularly over a long period can cause depression, so obviously this also should be avoided.
Doing something positive for someone else:
On perhaps a more selfless note, it is considered by many that the act of doing something good or positive for another person be it a stranger, relative or friend can provide reciprocal benefits to lift a depressed mood.
If you only take one message away from this article then please let it be this. No matter how low you become, how despairing you may feel, there is always a way back to normality and feeling well again.