What is Depression?

Some people say that depression feels like a black curtain of despair coming down over their lives. Many people feel like they have no energy and can't concentrate. Others feel irritable all the time for no apparent reason. The symptoms vary from person to person, but if you feel "down" for more than two weeks, and these feelings are interfering with your daily life, you may be clinically depressed.

Most people who have gone through one episode of depression will, sooner or later, have another one. You may begin to feel some of the symptoms of depression several weeks before you develop a full-blown episode of depression. Learning to recognize these early triggers or symptoms and working with your doctor will help to keep the depression from worsening.

Most people with depression never seek help, even though the majority will respond to treatment. Treating depression is especially important because it affects you, your family, and your work. Some people with depression try to harm themselves in the mistaken belief that how they are feeling will never change. Depression is a treatable illness.

Working with your doctor, you can learn to manage depression. You may have to try a few different medications to find the one that works best for you. Your doctor may also recommend that you see a therapist and/or make certain lifestyle changes.

Depression has no single cause; often, it results from a combination of things. Whatever its cause, depression is not just a state of mind. It is related to physical changes in the brain, and connected to an imbalance of a type of chemical that carries signals in your brain and nerves.

Some of the more common factors involved in depression are:

• Family history. Genetics play an important part in depression. It can run in families for generations.
• Trauma and stress. Things like financial problems, the breakup of a relationship, or the death of a loved one can bring on depression. You can become depressed after changes in your life, like starting a new job, graduating from school, or getting married.
• Pessimistic personality. People who have low self-esteem and a negative outlook are at higher risk of becoming depressed.
• Physical conditions. Serious medical conditions and medications to treat those conditions may contribute to depression.
• Other psychological disorders. Anxiety disorders, eating disorders, schizophrenia, and (especially) substance abuse often appear along with depression.

While depression can affect anyone, its effect may vary depending on your age and gender.

• Women are almost twice as likely to become depressed. The higher risk may be due partly to hormonal changes.
• Men. Although their risk for depression is lower, men are more likely to go undiagnosed and less likely to seek help. They may show the typical symptoms of depression, but are more likely to be angry and hostile or to mask their condition with alcohol or drug abuse. Suicide is an especially serious risk for men with depression, who are four times more likely to kill themselves.
• Elderly people may lose loved ones or become physically ill which may contribute to depression. Others may attribute their symptoms to natural aging and the elderly may be reluctant to talk about their symptoms and so their depression may go untreated.

Self-Advocacy / Depression

Treatment for depression can involve a variety of different approaches, and often people find that a combination of these work best. When talking to your doctor about the most appropriate treatment, it’s useful to have a basic understanding of the options. Antidepressants work by normalising the activity levels of brain chemicals which affect our mood. Current medical advice is that antidepressants are not addictive. There are several different types of antidepressant treatment available. Following are the four main types:

Tricyclic Antidepressants (TCAs) First available in the 1950s, TCAs are still commonly used to treat depression. Some patients experience troublesome side effects with tricyclics.

Selective Serotonin Re-uptake Inhibitors (SSRIs) Introduced in the 1980s, SSRIs are the other major type of antidepressant. They tend to cause less side effects, and are less sedative than other types. Many patients find SSRIs easier to take.

Monamine oxidase inhibitors (MAOIs) MAOIs are generally used in patients who have not responded to other treatments. They are not often used as a first line treatment due to the special diet patients are required to follow whilst taking them.

Reversible Inhibitors of Monoamine Oxidase (RIMAs) RIMAs are a similar antidepressant drug treatment to MAOIs. They are usually prescribed in higher doses for those patients who have not responded to other treatments.

There are also a number of other antidepressants that don’t ‘belong’ to these four main classes.

Most side effects from antidepressant drugs usually cease after about three weeks. No one should stop taking their medication or change the dosage without talking to their doctor first.

Although medication can help lift your mood, it does not tackle any underlying problems you may be experiencing. Psychological therapies can help to explore what may have contributed to your depression in the first place, and what might be keeping you depressed.

There are lots of different psychological therapies. None have been proven to be ‘better’ than any other, and so it is more a question of finding a therapy, and therapist, which suits you. The most common kinds of psychological therapies are:

Cognitive Therapy How you think largely determines how you feel; when you are depressed, you feel very negative. Cognitive Therapy works by challenging these negative thought patterns, and suggesting changes to destructive behaviour.

Interpersonal therapy This focuses on your relationships with other people. It teaches you how to communicate more effectively and improve your view of yourself.

Psychodynamic Therapy This helps people to understand past conflicts, release aggression and reduce feelings of guilt or inadequacy.

Counselling The term refers to a wide range of techniques and approaches, some of which draw from the above therapies. As a general rule, counselling offers people the opportunity to talk through issues in their everyday lives that may be contributing towards their depression.

Complementary, or 'alternative' treatments can support or even is some case replace conventional treatments for depression. Research on acupunture, herbal medicines and aromatherapy for example suggests that these treatments can help to reduce anxiety and to alleviate mild depression.

Treatment for depression can involve a variety of different approaches; these could include antidepressant medication, psychological therapy, or self-help options. Often people find that a combination of these work best.