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Depression

 

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 yourself.

Depression may be seen in any disease process which affects the brain, such as brain tumours, epilepsy and of course, SLE.


Signs and Symptoms

1. Feelings of sadness,helplessness worthlessness and hopelessness.

2. Concentration is difficult and thoughts may be "slowed".

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 Social participation is decreased and the person becomes withdrawn.

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.


Treatment

1. Medication

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:

Fluoxetine
Paroxetine
Sertraline and
Citalopram

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:

  1. Assessment or psychological assessment;
  2. Reconceptualization;
  3. Skills acquisition;
  4. Skills consolidation and application training;
  5. Generalization and maintenance;
  6. Post-treatment assessment follow-up.

3. ECT

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.


Suicide

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.


Conclusion

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!

Caroline Townley
RMHN RN

 
 

 

 
 

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