Depression: Introduction And Symptoms

by Rethink

Introduction

Everyone experiences variations in mood, blues that come and go, disappointments, the normal grief that accompanies the loss of someone you love. But a severe or prolonged depression that interferes with the ability to function, feel pleasure, or maintain interest is not a mere case of the blues. It is an illness. A depressive disorder is an illness that involves the body, mood and thoughts. It affects the way a person eats and sleeps, the way you feel about yourself, and the way you think about things. A depressive disorder is not a sign of personal weakness or a condition that can be willed or wished away. People with a depressive illness cannot merely "pull themselves together" and get better.Without treatment, symptoms can last for weeks, months, or years.

Depression affects many people of all ages. It is estimated that one in five people will suffer from depression at some point in their lives. More than 80% of those suffering from depressive illness can be treated successfully with modern medications.

Symptoms of Depression

Listed below are a number of symptoms associated with depression. Not everyone who is depressed will experience every symptom. Some people experience a few symptoms, some many. Severity of symptoms varies with individuals and also varies over time.

• feelings of helplessness and hopelessness
• feeling useless, inadequate, bad
• self hatred, constant questioning of thoughts and actions, an overwhelming need for reassurance
• being vulnerable and "over-sensitive"
• feeling guilty
• a loss of energy and motivation, that makes even the simplest tasks or decision seem difficult
• self harm
• loss or gain in weight
• difficulty with getting off to sleep, or (less frequently) and excessive desire to sleep
• agitation and restlessness
• loss of sex drive
• finding it impossible to concentrate for any length of time, forgetfulness. A sense of unreality.
• physical aches and pains, sometimes with the fear that you are seriously ill.

In severe depression, these feelings may also include:

• suicidal ideas
• failure to eat or drink
• delusions and/or hallucinations

In many instances the symptoms of depression may be masked. Mens's depression is often masked by alcohol or drugs, or by the socially acceptable habit of working excessively long hours.

In older people depressive symptoms are often missed and symptoms are dismissed as a normal part of aging. Often older people are reluctant to discuss feelings of hopelessness, sadness, loss or interest in normally pleasurable activities or extremely prolonged grief after a loss.

What Are the Different Types of Depression?

Depressive disorders come in different forms, just as is the case with other illnesses such as heart disease. Some of the more common types of depressive illness are discussed here.

Major Depression

Major depression consists of a series of symptoms which interfere with the ability to work, study, sleep, eat, and enjoy once pleasurable activities. Such a disabling episode of depression may occur only once but more commonly occurs several times in a lifetime.

Dysthymia

this is a less severe type of depression which involves long-term chronic symptoms that do not disble, but keep you from functioning well or from feeling good. Many people with dysthymia also experience major depressive episodes at some time in their lives.

Manic Depression

Not nearly as common as other forms of depressive disorders, manic depression, also called bipolar disorder, is characterised by cycling mood changes: severe highs (mania) and lows (depression). For the purpose of this, manic depression will be dealt with in a separate section here.

Postnatal Depression

This is not "the baby blues" which occurs 2-3 days after the birth and goes away. Postnatal depression can occur from about 2 weeks and up to 2 years after the birth.

Seasonal Affective Disorder

SAD is a type of depression which generally coincides with the approach of winterstarting with September and lasting until Spring brings longer days and more sunshine.

How Is Depression Caused?

Depression like most mental illnesses is probably caused by a combination of genetic and environmental causes.

Genetics

Some types of depression run in families, suggesting that some element of depression may be inherited. This is true for major depression in some families. What is inherited is not known but may include changes in brain structures or brain function, including alterations to the physiological ability to respond to stress, and/or the influence of hormones. What is clear is that in people experiencing depression there is a change in their brain chemicals or neurotransmiters. The chemicals affected include serotonin, noradrenaline and dopamine. Serotonin has a role in maintaining normal patterns of appetite, sleep and sexual activity. Noradrenaline is involved in regulating mood and energy and possibly has a role in social interactions. Dopamine probably has a role in gaining pleasure. It is not known whether a change in the neurotransmitters causes the depression or whether the depression causes a change in neurotransmitters but drugs that rebalance these chemicals can help relieve the symptoms of depression.

Hormonal causes

Women experience depression about twice as often as men. Many hormonal factors may contribute to increased rate of depression in women, particularly such factors as menstral cycle changes, pregnancy, miscarriage, postpartum period, pre-menopause, and menopause.

A study by the National Institute for Mental Health showed that in the case of severe premenstral syndrome (PMS), women with a preexisting vulnerability to PMS experienced relief from mood and physical symptoms when their sex hormones were suppressed. Shortly after the hormones were re-introduced, they again developed symptoms of PMS.

Many women are also particularly vulnerable after the birth of a baby. The hormonal and physical changes, as well as the added responsibility of a new life, can be factors that lead to postpartum depression in some women. While transient "blues" are common in new mothers, a full-blown depressive episode is not a common occurrance and requires active intervention.

Hormonal changes may also be responsible for the onset of depression in men. Recent research suggests that a decrease in testosterone can lead to the development of depression in older men.

Physical illness

Mood change and depression are more common in people suffering from physical illnesses than in people who are well. Although a person can develop depression in association with almost any physical illness, some diseases are more likely to lead to depression than others. The cause of these depressions is unclear but there is good evidence that some illnesses directly affect the parts of the brain and the chemical systems that control our mood and behaviour. Below are some of the more common conditions in which depression is likely to occur:

• Parkinson's disease
  About 40% of those with Parkinson's disease will suffer from an episode of depression. It is often missed because some of the symptoms of Parkinson's disease are similar.
• Dementia
  People with dementia suffer from more depressive symptoms and more depressive illnesses than other people. The difficulty these peopl have in communicating their distress means the depression can be missed and not treated.
• Multiple sclerosis
  Depression is more common in this condition too. It is not clear how much of the depression arises from the effects of the disease on the brain and how much results through the consequences of the disability.
• Heart disease
  Depression is more common in people with heart disease. It is increased in those suffering from angina, and is two to three times more common in people after a heart attack. Depression in such circumstances also leads to problems for people recovering from a heart attack, making them more at risk to another heart attack.
• Stroke
  Depression is much more common in people after a stroke and is probably increased in people having 'ministrokes' too. Again, those who suffer depression tend to have a more severe and prolonged illness than those with no depression.
• High blood pressure (hypertension)
  Studies have shown this also leads to increased rates of depression.
• Hypothyroidism
  Low levels of thyroid hormones can lead to depression, which may be very severe.
• Cushing's syndrome This is a rare disease caused by an excess of certain steroid hormones that can lead to severe depression.
• Infections
  Certain viral infections, for example glandular fever and influenza, are prone to trigger depression in vulnerable people.

Medication and Depression

Certain types of medication are associated with increased rates of depression. These include:

• calcium channel blockers,
  (e.g. nifedipine, nimodipine, verapamil)
• beta-blockers,
  (e.g. propranolol, atenolol, metoprolol)
• corticosteroids
  (e.g.dexamethasone, hydrocortisone)
• levodopa
  (e.g. madopar, sinemet)

If depressive symptoms develop after taking a new medicine, then advice should be sought from a doctor about whether to try an alternative.

How Is Depression Treated?

The first step to getting treatment is to see your doctor. They should rule out any physical causes of depression. The choice of treatment should be based on a thorough assessment by your doctor but antidepressant medications and talking treatments have both been found to be effective in the treatment of depression. Some people with milder forms may do well with a psychological therapy alone. People with moderate to severe depression most often benefit from antidepressants. Most do best with combined treatment: medication to gain quick symptom relief and psychotherapy to learn more effective ways to deal with life's problems, including depression. Sometimes when the depression is severe of life threatening or for people who cannot take antidepressant medication, electroconvulsive therapy (ECT) is useful. Complementary therapies can also have a role in decreasing stress and preventing relapses.

Medication

People with moderate to severe depression often benefit from antidepressants. Two thirds of people will respond to any given antidepressant.

Psychological Therapies

The three most promising treatments at the moment are cognitive behavour therapy (CBT), interpersonal therapy and problem-solving therapy.

Cognitive therapy is discussed in our therapy section. Cognitive behaviour therapy treats depression by:

• Helping you to recognise vicious circles that keep you depressed
• Teaching you to examine your behaviour and make changes if necessary
• Identifying your negative thoughts
• Challenging your negative thoughts and teaching you to think more realistically
• Helping you to recognise beliefs and assumptions that contributed to your depression and showing you how to change them.

Cognitive behavour therapy therapy tackles the symptoms and the underlying problmes that have contributed to your depression. It also helps to reduce the chance of getting depressed again in the future.

Interpersonal therapy concentrates on your relationships with other people. the focus of the therapy is on improving relationships, learning to communicate more effectively, and improving your view of yourself. The emphasis in treatment is on the here and now and on specific problems. Interpersonal therapy often looks at the following four areas:

• Grief.
• Changes in role
• Disputes with other people
• Putting other people down.

Problem-solving is often a part of other therapies. However, more recently problem solving has been used as a short term therapy in its own right. It is usually brief, often around four to six sessions and involves the following stages:

• identify your current problems
• recognise your strengths and weaknesses an what sources of help are available from family and friends, support groups etc.
• Learn a systematic way of tackling problems that can be used now and in the future
• Learn to put solutions into practice and to deal with the obstacles and setbacks.

Electroconvulsive Therapy (ECT)

ECT is an effective form of treatment for people with depression. ECT may be used when a severely depressed patient has not responded to antidepressants, is unable to tolerate the side effects of antidepressants, or must improve rapidly.

When you receive ECT your doctor should explain fully the benefits and dangers of ECT, and you must give your consent before ECT can be administered. Your consent can be withdrawn at any time in which case the treatment will be stopped. After giving consent, you will undergo a complete physical examination, including a chest x-ray, electrocardiogram, and blood and urine tests. A series of ECT's usually consists of six to twelve treatments. Treatments can be given to either in-patients or out-patients. Nothing should be eaten or drunkfor 8-hours before a treatment. An intravenous drip is started and through it medications are given to induce sleep, relax the muscles of the body, and reduce saliva. Once these medications have taken effect, an electrical stimulus is administered through the head. The electrical stimulus produces brain wave changes similar to an epileptic seizure. It is believed that this seizure activity leads to the improvement seen after a series of ECT. About 30 minutes after the treatment you will awaken from sleep. You may feel a bit confused at first but soon enough you will be able to eat breakfast and return home if you are an outpatient.

In studies of people treated with ECT it has been found that 80% of such people report that they were helped by treatments. About 75% say that ECT is no more frightening than going to the dentist.

While ECT is a highly successful way of helping people come out of depressions, it has to be followed by antidepressant therapy. If antidepressants are not given after a series of ECT, there is a 50% relapse rate within 6 months.

There is no scientific evidence that ECT causes brain damage. ECT does cause memory problems. These memory problems may take a number of months to clear. A small number of people who have received ECT complain of longer lasting memory problems.

Depression: Mortality Rates

Major depression has been shown to be associated with increased mortality fairly consistently. Minor depression, on the other hand, has been linked with an increased death rate in some studies, but not in others. This link between depression and mortality is well established for younger people but is inconclusive amongst elderly people. Some of the increase in mortality rate is due to suicide and other unnatural causes of death. However, to a lesser extent, studies have also reported excess mortality from natural causes.

Depressed people are known to be more likely to smoke, drink alcohol to excess, eat poorly and be relatively inactive as well as suffer from physical illnesses. As such these may increase rates of mortality.

Research shows that increased risk of mortality can be reduced in depressed people by high levels of support resulting from improvements in symptoms.

About the Author

www.rethink.org
Rethink is the largest severe mental illness charity in the UK. We are dedicated to improving the lives of everyone affected by severe mental illness, whether they have a condition themselves, care for others who do, or are professionals or volunteers working in the mental health field.