DEALING WITH DEPRESSION
George Mwangi
The word depression describes a range of moods, from low spirits to a severe problem that interferes with everyday life. Depression is a common mental disorder that presents with depressed mood, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, low energy, and poor concentration. Depression is a common disorder in all ages and genders; it may range from mild, bordering on normality, to severe (psychotic) depression accompanied by hallucinations and delusions.
People experiencing severe or 'clinical' depression are always sad or upset. The experience of depression is an overwhelming feeling which can make people feel quite unable to cope, and hopeless about the future. Depressed people may experience a change in appetite and may have difficulty sleeping or getting up. They may feel overwhelmed by guilt and may think about death or suicide. There is often an overlap between anxiety and depression, people who are depressed may become anxious or agitated.
Depression occurs in people of all genders, ages, cultures and backgrounds.
This is a brain disorder, there are various causes, including genetic, environmental, psychological, and biochemical factors. Depression can occur along with other serious illnesses, such as diabetes, cancer, heart disease, and Parkinson's disease. Depression can make these conditions worse and vice versa. Sometimes medications taken for these illnesses may cause side effects that contribute to depression symptoms. Depression affects each person in different ways, so symptoms caused by depression vary from person to person. Inherited traits, age, gender and cultural background all play a role in how depression may affect you.
Notable symptoms of depression
– Feelings of sadness or unhappiness
-Irritability or frustration, even over small matters
– Loss of interest or pleasure in normal activities.
-Agitation or restlessness, for instance, pacing, hand-wringing or an inability to sit still.
-Trouble thinking, concentrating, making decisions and remembering things
-Slowed thinking, speaking or body movements
– Indecisiveness, distractibility and decreased concentration
– Irritability or angry outbursts
– Fatigue, tiredness and loss of energy; even small tasks may
seem to require a lot of effort
– Reduced sex drive
Changes in appetite — depression often causes decreased appetite and weight loss, but in some people, it causes increased cravings for food and weight gain.
– Feelings of worthlessness or guilt, fixating on past failures or blaming yourself when things aren't going right
– Unexplained physical problems, such as back pain or headaches
-Insomnia or excessive sleeping
– Crying spells for no apparent reason
– Frequent thoughts of death, dying or suicide
Causes of depression
What causes depression many may be asking?
There are many possible causes of depression. You may have an increased risk of experiencing depression because of your particular biological makeup. On the other hand, depression is also related to what is happening in your life, and the kind of support you receive from others.
Is depression inherited one may ask?
There is some evidence that depression seems to run in families, but there is no single gene that causes depression. A family history of depression may increase the risk, but this may be because of difficulties the family has in coping, and it certainly does not mean that depression is inevitable. Genes seem to be more important than childhood experiences in determining the risk of bipolar disorder.
Is depression caused by changes in the brain one may ask? We know that depression is associated with changes in the activity of certain brain chemicals, known as neurotransmitters, which affect our mood and thinking. These chemicals, such as serotonin, are also affected by factors such as activity and exercise. Drug treatment aims to restore 'normal' levels of neurotransmitter activity
Can childhood experience cause depression?
Past experiences which may be difficult or traumatic, such as losing a parent when very young; can affect a person's ability to cope with difficult situations. Children who experience abuse or lack of affection are also more at risk of experiencing depression in later life.
Stress has been cited as a notable cause of depression. An episode of depression can be 'triggered' by stressful things that happen in our lives, particularly events involving a loss of some kind – such as unemployment, leaving home, death of a family member or friend. Even a happy event can also bring a sense of loss; for example, parents can feel they have 'lost their son or daughter when they get married, even if they are very happy for them. If you have had to cope with a lot of changes or stressful events, one more may seem like the 'last straw'.
Older people often have to cope with repeated losses, including the death of close friends and family. There is an important difference between expressing grief – which is a healthy reaction to loss or bereavement – and depression. Men living alone after the death of their wives seem to be particularly at risk of depression. Young people also experience stress, for example, due to problems at school, starting work or a course of study, or problems with relationships. It can be quite difficult to tell whether a young person is going through 'normal' adolescent turmoil or is showing signs of depression.
Styles of thinking and coping
People who are depressed tend to think about bad experiences in ways that make them even more difficult to manage. If you have had bad experiences in the past, that you were unable to control, you may develop a 'hopeless' way of thinking. Feeling 'trapped' in a difficult situation or experiencing a feeling of humiliation can also lead to negative thinking and depression. This is why some forms of treatment aim to help you change your patterns of thinking.
Health & illness
We all tend to feel miserable when we are ill. But long-term health problems, which prevent someone from leading their usual life, may lead to depression. People who lose their eyesight or hearing can become depressed, as can people with heart disease, chronic lung diseases, and illnesses that prevent them from getting about, such as Parkinson's disease or a stroke. Family and friends can help a lot by helping people find new activities or interests following an illness.
Some types of depression run in families, indicating that a biological vulnerability to depression can be inherited. This seems to be the case, especially with bipolar disorder. Families in which members of each generation develop bipolar disorder have been studied. The investigators found that those with the illness have a somewhat different genetic makeup than those who do not become ill. However, the reverse is not true. That is, not everybody with the genetic makeup that causes vulnerability to bipolar disorder will develop the illness. Additional factors, possibly a stressful environment, are involved in its onset and protective factors are involved in its prevention. Indeed, major depression can also occur in people who have no family history of depression. An external event often seems to initiate an episode of depression. Thus, a serious loss, chronic illness, a difficult relationship, financial problem, or any unwelcome change in life patterns can trigger a depressive episode. Very often, a combination of genetic, psychological, and environmental factors is involved in the onset of a depressive disorder. Stressors that contribute to the development of depression sometimes affect some groups more than others. For example, minority groups who more often feel impacted by discrimination are disproportionately represented. Sociology-economically disadvantaged groups have higher rates of depression compared to their advantaged counterparts. Immigrants may be more vulnerable to developing depression, particularly when isolated by language.
Regardless of ethnicity, men appear to be particularly sensitive to the depressive effects of unemployment, divorce, low socioeconomic status, and having few good ways to cope with stress. Women who have been the victim of physical, emotional, or sexual abuse, either as a child or perpetrated by a romantic partner are vulnerable to developing a depressive disorder as well.
What are the different types of depression one may ask?
The most common forms of depression are:
• Major depression—having symptoms of depression most of the day, nearly every day for at least 2 weeks that interfere with your ability to work, sleep, study, eat and enjoy life. An episode can occur only once in a person's lifetime, but more often, a person has several episodes.
• Persistent depressive disorder (dysthymia)—having symptoms of depression that last for at least 2 years. A person diagnosed with this form of depression may have episodes of major depression along with periods of less severe symptoms. Some forms of depression are slightly different, or they may develop under unique circumstances, such as:
• Perinatal Depression: Women with perinatal depression experience full-blown major depression during pregnancy or after delivery (postpartum depression).
• Seasonal Affective Disorder (SAD): SAD is a type of depression that comes and goes with the seasons, typically starting in the late fall and early winter and going away during the spring and summer.
• Psychotic Depression: This type of depression occurs when a person has severe depression plus some form of psychosis, such as having disturbing false fixed beliefs (delusions) or hearing or seeing upsetting things that others cannot hear or see (hallucinations).
How does depression affect different people one may ask?
Depression affects different people in different ways. For example, Younger children with depression may pretend to be sick, refuse to go to school, cling to a parent, or worry that a parent may die. Older children and teens with depression may get into trouble at school, sulk, and be irritable. Teens with depression may have symptoms of other disorders, such as anxiety, eating disorders, or substance abuse. Older adults with depression may have less obvious symptoms, or they may be less likely to admit to feelings of sadness or grief. They are also more likely to have medical conditions, such as heart disease, which may cause or contribute to depression.
Women can also get postpartum depression after the birth of a baby. Some people get seasonal affective disorder in the winter. Depression is one part of the disorder. Women have depression more often than men. Biological, life cycle and hormonal factors that are unique to women may be linked to their higher depression rate. Women with depression typically have symptoms of sadness, worthlessness, and guilt.
Men with depression are more likely to be very tired, irritable, and sometimes angry. They may lose interest in work or activities they once enjoyed, have sleep problems, and behave recklessly, including the misuse of drugs or alcohol. Many men do not recognize their depression and fail to seek help.
Notable ways of dealing with depression
There is a range of ways to deal with depression, and often they are best used in conjunction with each other. The primary medical options are Cognitive Behavioural Therapy (CBT), antidepressant medication, and in some severe cases, Electroconvulsive Therapy (ECT). Education and coping strategies are also important when learning to manage your depression.
Psychoeducation
Psychoeducation refers to learning about the way depression develops and is maintained. Education for people with depression is extremely valuable. Education provides a knowledge base that potentially gives the person greater control over his or her disorder. Greater control in turn may lead to reduced feelings of helplessness and an increased sense of well-being. Providing education for families or caregivers is also very important to help increase the support and assistance they provide to the person. The most essential pieces of information for a person with a major depressive episode are that depression is a common disorder and that effective treatments are available. It is important to remember:
Depression is an illness, not a sign of weakness or a character defect.
Recovery is the rule, not the exception.
Treatment is effective, and there are many treatment options available. There is a suitable treatment for most people.
The goal of treatment is to get completely well and stay well.
The rate of recurrence is quite high: half the people who had one episode of depression will have a recurrence and the rate increases with the number of previous episodes.
The person and his or her family can be taught to recognise and act upon early warning signs of depression. By seeking early treatment, the severity of the episode may be greatly reduced.
Cognitive Behavioural Therapy (CBT)
CBT is an excellent treatment for depression, alone or in conjunction with medication. CBT involves learning to:
Control the negative thoughts that lead to loss of interest and feelings of worthlessness
Combat the emotions of sadness and hopelessness, and loss of energy, even when not physically active.
Counteract the behaviours related to poor concentration and thoughts of death
Techniques for problem-solving are also taught whether the problem is a consequence or cause of the depression. CBT is very effective and 80% of people with mild, moderate or severe depression improve.
CBT will often be recommended when:
The depression is mild, moderate, or severe.
The person has had a prior positive response to CBT.
A competent, trained clinician who has expertise in CBT is available, or the person is prepared to use internet CBT.
There is a medical contraindication to taking medications.
The depressed person prefers CBT.
Electroconvulsive Therapy (ECT)
ECT is an effective form of treatment for depression, especially if:
There are medical contraindications to medication.
There is a need for rapid improvement because of suicidal intent or refusal to eat.
The person has experienced treatment failure following CBT, several medications, or combined medication and CBT treatment trials.
The person has had a previous positive response to ECT.
Somatic symptoms are prominent.
Psychotic symptoms are present.
ECT involves the application of a brief electric current to carefully selected sites on the scalp. These electric currents which are administered by a psychiatrist and anesthetist, produce a minor seizure in the brain. Before the procedure, the person is given a short-acting general anesthetic and a muscle relaxant to reduce awareness of the procedure and prevent a physical seizure. Although many people are fearful of ECT, this technique is arguably the safest and most effective medical treatment for severe depression, although there can be some memory-related side effects. ECT works more quickly than antidepressant drugs and CBT. You can also use antidepressants and CBT alongside ECT, as they can help prevent relapse after ECT is completed.
Medication
For some people, antidepressant medication will be the first line of treatment for the elimination of severely depressed moods. It would be inadvisable to manage very severe depression without a trial of medication. For mild to moderate depression, antidepressant medications are not often recommended as a first-line treatment. Different antidepressant medications work in different ways. You may need to trial more than one type to find the medication that works best for you. Make sure to keep in close contact with your prescribing physician during the early stages of taking medications the side effects can often be difficult to deal with.
Some things to remember when taking antidepressant medications are:
Take the medication daily.
Don't stop the medication without contacting the health professional who prescribed it.
Side effects lessen as your body adjusts. If the side effects don't diminish or are unreasonable, contact your health professional.
Don't stop the medication when you feel better.
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George Mwangi