Depression

Depression is a serious, recognised condition. It is more than just feeling down and a little fed up, those are feelings we all get from time to time. People with depression can't simply, 'snap out of it'. Having depression should not be perceived as a weakness or of being a failure.

Mild to moderate depression impacts your daily life, which can make everything seem an effort and remove any pleasure from activities you used to enjoy. In cases of severe depression symptoms will be more intense and thoughts of self-harm or suicide may also be present.

Depressive illness is quite common, roughly 15% of the population will experience it in their lifetime. The figure may actually be higher; many people may not realise they have the condition or are embarrassed to ask for help. Women are over two times more likely to suffer from depression than men - though men are more likely to commit suicide. Most of the 5,000 suicides in the UK each year are linked to depression.

Emotions associated with grief are not dissimilar to those of depression, but they are different. Grief is a natural response to loss, with feelings of sadness that come and go between periods of normality. Depression is an illness with a constant low mood, few pleasures and no belief that there is light at the end of the tunnel.

Psychological Symptoms

  • continuous low mood, or sadness
  • feelings of hopelessness and helplessness
  • low self-esteem
  • tearfulness
  • feelings of guilt
  • difficulty making decisions
  • feeling irritable and intolerant towards others
  • lack of motivation, and little interest in things in general
  • lack of enjoyment
  • reduced sex drive
  • feeling anxious or worried
  • suicidal thoughts, or thoughts of harming someone else
  • psychosis (in extreme cases, rare)

Physical Symptoms

  • slowed movement and speech
  • change in appetite and weight (your weight will usually decrease, but sometimes it may increase)
  • digestive complaints, such as indigestion, constipation or diarrhoea
  • unexplained aches and pains
  • lack of energy
  • changes to the menstrual cycle in women

Social Impact

  • not performing well at work
  • taking part in fewer social activities and avoiding contact with friends
  • reduced hobbies and interests
  • difficulties at home and with family life

Diagnosis

You should visit your GP if you believe you are suffering from depression. You may have blood or urine tests to rule out conditions such as an under-active thyroid that can cause similar symptoms. Interviews and questionnaires are used to assess whether or not you have depressive illness, and if so how severe it is. Doctors compare the answers from interviews and questionnaires against the criteria set out in the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases to reach a diagnosis.

Psychological Therapies

Cognitive Behavioural Therapy helps you challenge the validity of your negative thoughts in an effort to make you feel better and more comfortable in yourself. The way we feel is often as a result of the way we think, and vice versa. If referred for CBT, you would have approximately six sessions; enough to gain a basic understanding of the principals, not too much that the therapy becomes a dependency.

Counseling therapy helps you to look at the issues in your life and help discover ways to deal with them. A counselor will not tell you what to do or how to do something, but will assist you in finding new solutions to your difficulties.

Treatment in Mild Depression

In mild depression, anti-depressants are not normally used first (unless you have a previous history of the illness), rather exercise and activity are encouraged as they are proven to make individuals feel better. Talking with others about how you feel can also help, be they friends, relatives, or perhaps a self-help or peer-support group recommended by your GP. Dysthymia is chronic mild depression where the symptoms last for two years or more. It is more common amongst the 55+ age group and requires anti-depressant treatment.

Treatment in Moderate Depression

If you have moderate or ongoing mild depression you may be recommended for talking treatments or be prescribed anti-depressants.

Treatment in Severe Depression

In severe depression the combination of a talking therapy and an anti-depressant is more effective than relying on just one or the other. Cognitive Behavioural Therapy can be an effective tool in combating the negative thoughts and feeling associated with depression. Other specialist treatments like psychotherapy may also be suggested.

Treatment with Antidepressants

SSRIs (Selective Serotonin Reuptake Inhibitors) are a form of antidepressant that increase the level of serotonin in your brain, which in turn helps to raise your mood levels. TCAs (Tri-Cyclic Anti-Depressants) work in the same way as SSRIs but also increase levels of noradrenaline, which helps to improve your mood. SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors) such as Venlaflaxine are a powerful new form of anti-depressant that have proved to be successful in treating depression. If several different types of anti-depressant have not worked for you, Lithium (commonly used as a mood stabliser for Bipolar) may be prescribed.

Compulsory Detention (Sectioned under the Mental Health Act)

If your symptoms are extremely severe, you may be detained under the Mental Health Act - if there is deemed to be a danger that you will harm either yourself, or others. If this is the case you will have to stay in hospital so that you can receive the intensive treatment you require.

Electro Convulsive Therapy - (ECT)

ECT is sometimes used in very severe cases of treatment resistant depression, where anti-depressants have failed to alleviate symptoms. If you consent (see below) to ECT treatment, you will be given a general anaesthetic and a muscle relaxant. Electrodes will be placed on your head and an electrical current passed through your brain. No one knows exactly how ECT actually works, but the truth is that for most people it does work, and that is what is important. There can however be unwanted side-effect associated with ECT, such as memory problems.

Consent to ECT

  • From November 2008+, your consent to treatment is required before ECT can be administered
  • If you decline ECT, you can't be forced to have it (even if you are detained under a Section of the Mental Health Act)

unless

  • You are deemed to lack mental capacity, and
  • You have not written a prior advanced decision stating you do not wish to receive ECT, or
  • It is deemed a life-threatening emergency

Lived Experience

“When depression is predominating, I find the worst thing I can do is sit about and do nothing, or just passive activities like watching the television. It is hard to concentrate and that seems to make things feel worse, like you are failing to even follow a television programme.

For me, it is better to throw myself into an activity, even if it has to be done gently. I particularly mean physical activity, and something where you see a clear end result, even if it's just having vacuumed the house, or having cooked a meal. Recently I decided to tackle some much needed gardening, and if I just do a little at a time, I feel I have achieved something. It seems important to stick to one task at a time, and not be distracted by too many other things.

Exercise is great if you feel up to it, just a gentle walk perhaps that gets the endorphins going. I also find with depression it is better for me to avoid carbohydrate foods, they just make me feel more sluggish; protein-type foods seem to help more, as well as small amounts of caffeine. For me, it's about fighting the lethargy and just getting on and trying to do something, no matter how hard it feels.”