Depression

 

Who gets depression? 

About 1:2 adults have depression at some time in their life. Sometimes it is mild or lasts just a few weeks. However, an episode of depression serious enough to require treatment occurs in about 1:4 and 1:10 men at some point in their lives. Some people have two or more episodes of depression at various times in their life.

What are the symptoms of depression?

Many people know when they are depressed. However, some people do not realise when they are depressed. They may know they are not right and are not functioning well but do not know why. Some people think they have a physical illness – for example, if they lose weight. There is a set of symptoms, which are associated with depression and help to clarify the changes:

These are

• Persistent sadness or low mood, with or without tearfulness
  
• Marked loss of interest or pleasure in activities, even for activities you normally enjoy
  
• Disturbed sleep compared with your usual pattern. This may be difficulty getting off to sleep or waking early, and being unable to get back to sleep. Sometimes it is sleeping too much
  
• Change in appetite. This is often a poor appetite and weight loss. Sometimes the reverse happens with comfort eating and weight gain
  
• Fatigue (tiredness) or loss of energy
  
• Agitation or slowness of movements
  
• Poor concentration or indecisiveness. For example, you may find it difficult to read, work etc. Even simple tasks can seem difficult
  
• Feeling of worthlessness or excessive or inappropriate guilt
  
• Recurrent thoughts of death. This is not usually a fear of death, more a preoccupation with death and dying. For some people, despairing thoughts such as ‘life is not worth living’ or ‘I don’t care if I don’t wake up’ are common. Sometimes these thoughts progress into thoughts and even plans for suicide.
  

• Symptoms occur most of the time or on most days and have lasted two weeks and
• The symptoms are not due to a medication side effect or due to a drug or alcohol misuse or to a physical condition such as an under-active thyroid gland

What are the treatment options for depression?

In general, treatments are divided into those used for mild depression and those used for moderate and severe depression.

What if I don’t have any treatment?

Most people with mild depression will get better without treatment. However, this may take several months or even longer (the average of an episode of depression is six to eight months). Meanwhile, living with depression can be difficult and distressing (and also for your family and friends). Relationships, employment, etc, may be seriously affected. There is also a danger that some people turn to alcohol or illegal drugs. Some people think of suicide. Therefore, many people with depression opt for treatment.

Antidepressant medicines

Antidepressant medicines are commonly used to treat moderate or severe depression. A medicine cannot alter your circumstances. However, symptoms such as low mood, poor sleep, poor concentration, etc, are often eased with an antidepressant. This may then allow you to function more normally, and increase your ability to deal with any problems or circumstances.

An antidepressant does not actually work straight away. It can take two to three weeks before the effect builds up fully. A common problem is that some people stop the medicine after a week or so as they feel that it is not helping. You need to give it time. Also, if it is helping, follow the course that a doctor recommends. A normal course of an antidepressant lasts for at least six months after the symptoms have eased. Some people stop their medication too early and the depression may quickly return. At the end of a course of treatment, it is usual to reduce the doses gradually over about four weeks before finally stopping. This is because some people develop withdrawal symptoms if an antidepressant is stopped abruptly.

Some side effects of common antidepressants include tummy upsets, drowsiness, short-lived anxiety, sleep disturbance, reduced appetite and weight changes. Others are frequent urination, decreased sex drive, increased sweating, excessive yawning, fatigue and diarrhoea. Less common side effects include blood pressure changes, dilated pupils, mood swings, headaches and dizziness. Very rare side effects include convulsions, hallucinations and severe allergic reactions. Generally these side effects improve with time as the body gets used to the medications.

Psychological (talking) treatments

Various psychological treatments have been shown in research trials to be good treatments for depression. In general, a combination of antidepressants plus psychological treatment is better than either treatment alone. Therefore, if available, you should consider having both treatments. Typically, most psychological treatments for depression last in the range of 12-20 bi-weekly sessions of 50 minutes per session. The common psychological treatments offered are Cognitive Behavioural Therapy (CBT), which may be face-to-face or online. Computer CBT can be accessed free online at www.livinglifetothefull.co.uk, a website designed by a Consultant Psychiatrist. There are also walk-in counselling services that may help such as SANE, MIND, Relate. Please see the links below.

Exercise

In addition to the above treatments, regular exercise is thought to help to improve symptoms (if you are able to do some exercise).

Some Do’s and Don’ts about Depression

• Don’t bottle things up and go it alone. Try to tell people who are close to you how you feel. It is not weak to cry or say that you are struggling.
  
• Don’t despair – most people with depression recover
  
• Do try and distract yourself by doing other things. Try things that do not much concentration but can be distracting, such as watching TV. Radio, or TV is useful late at night if sleeping is a problem.
  
• Do eat regularly, even though you do not feel like eating. Try to eat a healthy diet
  
• Don’t drink too much alcohol. Drinking alcohol is tempting to some people with depression, as the immediate effect may seem to relieve the symptoms. However, drinking heavily is likely to make your situation worse in the long run. Also it is very difficult to either assess or treat depression if you are drinking a lot of alcohol.
  
• Don’t make any major decisions whilst you are depressed. It may be tempting to give up a job or move away to solve the problem. If at all possible, you should delay any major decisions about relationships, jobs or money until you are well again.
  
• Sometimes a spell off work is needed. However too long off work might not be so good as dwelling on problems and brooding at home may make things worse.
  
• Sometimes a specific psychological problem can cause depression but some people are reluctant to mention it. Tell your doctor or counsellor if you feel something very confidential is the root cause of your depression.
  

Follow Up

Your doctor will give you regular appointments when you are diagnosed with depression and it is important to keep these. It is important that you continue your antidepressants, even after the symptoms have stopped, for a period of six months after the first episode of depression. Your doctor may advise that you continue to have psychological treatment for longer periods of time after stopping your antidepressants for relapse-prevention.

Emergencies

If you are having suicidal thoughts, it is very important that you contact your doctor immediately to discuss this further. If you cannot contact your doctor, you can contact the A & E Department at Basildon, Broomfield or Queens Hospitals or the Emergency Duty Officer of the Community Mental Health Team (CMHT). See links below.

Links

CMHT Duty Officer/Trust Emergency

Contact No: 01268 366 000 or 0300 123 0808,

in hours phone 01277 265 300 or 01277 265 301 (Duty Officer)

Basildon Hospital: 08451 553 111 Broomfield Hospital,

Chelmsford: 08448 220 002

Queen’s Hospital, Romford: 08451 304 204

Depression Alliance  www.depressionalliance.org 0845 1 232 320

Relate           www.relateorg.uk     or    www.relatenelondon.org.uk       01708 441 722

MIND           www.brentwoodmind.org.uk     08457 660 163

Samaritans    www.samaritans.org

SANE           www.sane.org.uk