Depression is the most common of all mental illnesses and one in
ten of the population will experience an episode of this illness
at some time during their life.It is now thought to be caused by
an imbalance in the function of neurotransmitters and recent advances
in medication for depression supports this theory.
It is not a sign of weakness,nor is it "your fault"
or"feeling sorry for yourself". It is not something to be ashamed
of or something your Doctor won't take seriously.
There is a genetic component - if a parent or sibling
has suffered from this illness, you may be more likely to experience
Depression may be seen in any disease process which
affects the brain, such as brain tumours, epilepsy and of course,
Signs and Symptoms
1. Feelings of sadness,helplessness worthlessness
2. Concentration is difficult and thoughts may be
3. Physically the person may feel weak and fatigued.
The perception of pain is often heightened.
4. Changes in appetite are common - some people lose
their appetite and others may find they are "comfort eating".
5. Due to the slowing of bodily functions some people
may experience constipation and even urinary retention.
6. Changes in sleep disturbance is one of the earliest
signs of Depression. These may be difficulty getting to sleep (Initial
insomnia) or difficulty staying asleep (early morning wakening).
Some people may find themselves sleeping more than usual, especially
during the day.
7. The person's mood may vary during the course of
the day. In severe depression the person may feel at their worst
first thing in the morning, with some improvement during the day.
The reverse is seen in less severe cases.
8. Social participation is decreased and the person
9. A loss of enjoyment of activities that were once
pleasurable - for example: hobbies, outings, sex, work.
10. Persistant thoughts of self harm or suicide. This
requires immediate intervention from a Mental Health Professional.
If necessary go to your nearest Emergency Department.
Not all people with depression will have all of these
signs and symptoms,and their intensity will differ from person to
person. However if you are experiencing any of these symptoms you
should your Doctor.
Now for the good news!
Recent advances in drug therapy mean that even severe
cases of Depression can be treated quickly and effectively. The
advent of the class of drugs known as Selective Serotonin Re-uptake
Inhibitors (SSRI) such as:
These drugs have far fewer side effects and work more
quickly than the older tricyclic antidepressants. The most common
side effect is mild nausea which usually subsides within the first
week or two of treatment. Some people do experience a delay in sexual
response. It is also important to take SSRI drugs in the morning.
These medications are not sedating and taking them at night may
cause difficulty sleeping.
For the few patients who can't tolerate SSRIs, other
antidepressants such as Venlafaxine and Moclobemide may be suitable.
There is still a place for tricyclics - especially for those people
whose sleep disturbance is the most prominent feature. They can
also be a useful adjunct to other pain relief.
Many people report noticing some improvement in sleep
pattern within a few days along with a 'lift" in mood. Within three
weeks most people report a significant improvement in symptoms.
Although you may feel well within a short time, these drugs should
be continued for 6-12 months to minimize the likelihood of a relapse.
These drugs are notaddictive. You will not become dependant on them
and you will not suffer withdrawals when you cease them. Despite
that you should not cease them abruptly as that may cause a period
of rebound Depression. Tapering off is best.be guided by your treating
Doctor or nurse.
Some people with CNS SLE find that their Depression
is improved with Prednisone, but this is not always the case. Others
with mild Depression report that St John's Wort is beneficial. Before
commencing any prescribed or over the counter medications you should
consult your Doctor. Your GP should keep your Rheumatologist informed
of any changes to your medication regime.
2. CBT (Cognitive Behavioural Therapy)
A behavioural therapy that aims to address dysfunctional emotions and behaviours through action/goal oriented procedures. Patients are encouraged to challenge their patterns and beliefs and replace "errors in thinking such as overgeneralizing, magnifying negatives, minimizing positives and catastrophizing" with "more realistic and effective thoughts, thus decreasing emotional distress and self-defeating behavior."
Therapy can be either computer based or with a therapist.
CBT has six phases:
- Assessment or psychological assessment;
- Skills acquisition;
- Skills consolidation and application training;
- Generalization and maintenance;
- Post-treatment assessment follow-up.
Many people find the idea of ECT very confronting.
Hollywood's portrayal of the procedure in films such as "One Flew
Over The Cuckoo's Nest" is very gruesome - and also inaccurate.
ECT is used less frequently due to the effectiveness of the newer
anti-depressants, however in cases of severe psychotic Depression
it is a life saving procedure.
The patient is given a light General Anaesthetic prior
to the procedure. The electrodes are applied to the patient's head
and a brief electric shock is given. Following the procedure the
patient is given oxygen and taken to a recovery suite for observation
of blood pressure, pulse and conscious state. Some people complain
of a headache and transient amnesia
ECT is usually given as a course of 6 treatments on
alternate days.Sometimes extra treatments may be required after
review the treating Psychiatrist.
ECT is only used as a "last resort" for people who
are extreme suicide risks or who are so ill that they are not eating
or drinking and are in danger of dying as a result of this.In these
cases one cannot wait for medication to start working.
In most countries, the law requires that a second
opinion from an independent Psychiatrist must be sought prior to
ECT if the patient is unable to give legal consent to this treatment.
Myths abound about suicide. The most common one is
"People who talk about committing suicide never do it". This is
not the case.Most people who experience suicidal ideation as a result
of Depression are ambivalent about their feelings. Taking talk of
suicide seriously and seeking professional help immediately is the
best and most effective of preventing suicide
People may also believe that raising the topic of
suicide "will put thoughts into a depressed persons head".It won't
- the thoughts may well be there already. Often asking directly
is the only way to find out.
People who are thinking of committing suicide may,
but not always, give some indication of their intent.these may include
"putting their affairs in order", giving away treasured possessions
and saying things like "You'd be better off without me".
Sadly, sometimes suicide is impossible to predict.
Family members and friends feel guilty that they "didn't see it
coming" and may blame themselves.It is important that the bereaved
receive counselling following such a tragic event.
Prognosis for Depression
The vast majority of people who suffer from Depression
can be successfully treated and return to normal health in a relatively
short period of time. This is also true for people with the most
severe depressive illness.
Unfortunately, Depression can recur - so it is important
that you and those close to you recognize the warning signs so treatment
can be commenced as quickly as possible. If you begin to experience
the signs and symptoms mentioned earlier. The sooner you are treated,the
better it is for you.
If you suspect that you or someone you know might
be depressed see your GP or other Health Professional as soon as
possible. You do not have to put up with this debilitating illness!