Medical Encyclopaedia
Check out the A to Z guide of medical conditions. Read up about the most common medical conditions, their symptoms and find out what treatment and support is available.
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Depression
Introduction:
Depression is a more frequently occurring illness than many people think, with almost one in five people in the UK diagnosed with it at some point in their lives. But how can you recognise the signs of depression and what can you do to get help?
- There are several types of depression diagnosed by doctors
- What causes depression?
- What are the symptoms of depression?
- Drug treatments for depression
- Your GP may recommend the following non-drug therapies:
- Are there any herbal alternatives?
- Herbal and vitamin supplements:
- Can exercise help depression?
- Can food help my depression?
Being depressed doesn’t just mean that you are unhappy, or that you’ve had a bad day.
The mental health charity MIND says that at its most severe, major depression (clinical depression) can be life-threatening, because it can make people suicidal or simply lose the will to live.
It used to be widely thought that depression was a temporary state of weakness and that it was possible to "pull yourself out of it". We now know that clinical depression is not something you can remedy yourself. It is a medical disorder with a biological or chemical basis, and needs to be treated as such.
There are several types of depression diagnosed by doctors
- Major Depressive Disorder is a mood disorder characterised by depressed mood, a lack of interest in everyday activities, changes in weight and sleep, fatigue, feelings of worthlessness and guilt, difficulty concentrating and thoughts of death and suicide. If a person experiences the majority of these symptoms for longer than a two-week period, they may be diagnosed with major depressive disorder
- Dysthymia and dysthymic disorder refer to a mild-to-moderate, chronic state of depression. There is no laboratory test for dysthymia, so a diagnosis must be made by a mental health professional after reviewing a patient’s symptoms and medical history. The patient will be tested against the DSM-IV manual, which is used to classify psychological disorders
- Bipolar Disorder is an illness that consists of periods of elevated moods (manic episodes) and depression. Mood swings can be mildly manic (hypomania) to more extreme highs. Periods of mania can last for hours, days, weeks or even months before depression returns
- Postpartum Depression can occur during pregnancy, during which changing hormones can affect mood. Postpartum depression can range from mild symptoms which disappear without treatment all the way up to postpartum psychosis, which left untreated, may ultimately result in the mother harming herself and her child
- Seasonal Affective Disorder (SAD) causes depression, fatigue, weight gain due to carbohydrate cravings during the winter months. It is caused by a biochemical imbalance in the hypothalamus due to the shortening of daylight hours and the lack of sunlight in winter. SAD can be a serious illness for some people and can stop them from functioning normally without continuous medical treatment, while for others it is a mild but debilitating condition causing discomfort but not severe suffering
- Premenstrual Dysphoric Disorder is related to premenstrual syndrome (PMS), with symptoms such as nervous tension, anxiety, fatigue, feelings of irritation and depression. Physical symptoms can include swelling or bloating in the abdomen or extremities, loss of appetite, food cravings, general aches and pains, as well as tenderness in the breasts. Such symptoms can show a week before having your period, but eventually go when the period starts
- Atypical Depression doesn’t follow the usual symptoms of depression, but is fairly common. Those with the illness can have improved moods when good things happen, but overreact when stressful or bad situations occur, by overeating or reacting strongly to rejection
What causes depression?
Sometimes a stressful event can trigger depression. At other times it seems tooccur spontaneously, with no identifiable specific cause. It may occur only once, or it may happen in repeated episodes during your lifetime. For some people, it is a chronic condition, requiring ongoing treatment.
While the actual causes of depression are still unclear, one of the most probable explanations is an imbalance of a chemical messenger (neurotransmitter) in the brain called serotonin.
Serotonin is considered to be the brain's mood-elevating and tranquillising hormone, and low levels have been found to have a negative effect on mood and feelings of wellbeing.
What are the symptoms of depression?
Although you will need to see your GP or doctor for a diagnosis or a referral to a mental health consultant, the following symptom checklist could help you to find out if you could be suffering from depression.
- Do you constantly feel unhappy or angry without due cause?
- Have you suffered a bereavement or change in circumstances during the past 12 months?
- Feel hopeless, guilty and anxious?
- Have little interest in things that used to be pleasurable?
- Have little appetite?
- Suffer from insomnia, or are sleeping constantly?
- Find it difficult to concentrate?
- Feel lethargic or constantly run down?
If you answer yes to two or more of the above, visit your doctor to discuss your mental health.
Drug treatments for depression
Most cases of depression are treated with a wide range of anti-depressant drugs.
The most well known drug treatment for depression and anxiety are Selective Serotonin Reuptake Inhibitors (SSRIs).
Examples of these include fluoxetine (Prozac ®) venlafaxine (Effexor ®), paroxetine (Seroxat ®) and citalopram(Cipramil ®).
Serotonin (or 5-HT) is a naturally occurring chemical believed to be active in areas of the brain which regulate mood and thinking. In people suffering from depression and anxiety, serotonin levels may not be high enough. SSRIs increase the amount of this serotonin chemical messenger in the brain by stopping cells reabsorbing the chemical. This can help correct the lack of action of serotonin and improve symptoms of anxiety or depression.
SSRIs are also used to treat other conditions, such as obsessive-compulsive disorder (OCD) social phobia and anxiety, post-traumatic stress disorder (PTSD), panic disorder (panic attacks), agoraphobia and pre-menstrual syndrome.
It may take up to two weeks or more before SSRI drugs begin to effect your mood, and an extra three or four weeks before reaching maximum effect. In some people, the drug may take even longer to work, especially older patients.
Side effects of SSRI include: nausea; low sex drive, lack of orgasm and also in men, abnormal erection or ejaculation; blurred vision; diarrhoea or constipation; dizziness; dry mouth; feeling agitated or shaky; insomnia or feeling very sleepy; loss of appetite; sweating; and yawning. You should read the patient information leaflet that comes with your medication, or ask your doctor, if side effects become a problem.
In some cases, antidepressants may actually make depressive symptoms worse early on in treatment or when the dosage is changed. If you notice any worsening symptoms, you must see your doctor, who will monitor you more closely. If the symptoms are very bad, you might have to stop taking the medication.
Another group of drugs, known as tricyclic antidepressants (TADs), are also used to improve symptoms of depression and anxiety. Like SSRIs, TADs take a while to work fully. A course of treatment usually lasts for six months or more.
Side-effects, such as dry mouth, constipation, sweating, impaired sexual functioning, blurring of vision and drowsiness, can occur, but they often fade after about a week as you get used to the drug. Drinking fluids will help reduce the effects of a dry mouth.
Doctors believe that depression is caused by a reduction in the brain chemicals serotonin and noradrenaline. Both these chemicals control and regulate mood and their release from brain cells acts to enhance mood. However, the chemicals are reabsorbed and the mood enhancing effect is reduced. TCAs block the reabsorption of noradrenaline and serotonin into cells, which then extends their mood boosting effect.
Your health status will be assessed by your doctor to determine which TCA is
best for you. For example, TCAs are not prescribed to patients who are
pregnant, breastfeeding, suffer from glaucoma, have an enlarged prostate, or
have certain liver disorders. The information sheet that comes with your pills
will list the types of possible side effects and what to do if you get them. If
a side effect persists, you should tell your doctor. You should reduce the dose
gradually before stopping treatment.
The decision to take antidepressants depends on the diagnosis you receive from
your GP or consultant. While TCAs work for many people, not everyone will
respond in the same way and there are other treatment options if this happens.
Talk to your doctor, if you feel you are not getting benefit from your
prescribed treatment.
Examples of tricyclic antidepressants are amitriptyline, doxepin, amoxapine, lofepramine, trimipramine, dosulepin and nortriptyline.
The National Institute for Health and Clinical Excellence (NICE), which produces guidelines on the treatment of illnesses in England, has said that routine use of anti-depressants is not recommended for the initial treatment of mild depression because the risk-benefit ratio is poor.
Your GP may recommend the following non-drug therapies:
- Psychotherapy: the traditional on-the-couch-style therapy (not necessarily), which has long been used to help treat depression. During a session with a therapist the patient’s history, habits and attitude to life and certain situations are discussed. If there is a specific problem that is causing the depression, the therapy can show patients how to break down the problem into more manageable sections
- Counselling: similar to psychotherapy, although the form of treatment is based on listening and empathy
- Hypnosis (hypnotherapy) can be quite effective with milder types of depression and anxiety. Hypnosis produces an altered state of consciousness in which certain senses are heightened and others seem to fade into the background. Much of the benefit from hypnosis is obtained by the simple act of learning to relax in stressful situations
- Cognitive Behavioural Therapy (CBT) may be used in association with hypnosis and Neurolinguistic Programming (NLP), both of which have also demonstrated some success in the treatment of depression
Are there any herbal alternatives?
Not everyone likes taking antidepressants; some people prefer to use more natural alternatives, such as additional vitamins and minerals, which have been shown to help some people suffering from depression.
Remember, however, that any supplements should be taken as part of a healthy diet and should not be used to make up deficiencies in your normal eating pattern.
Always ask your GP, if you are receiving treatment for depression about any supplements.
Herbal and vitamin supplements:
- St John's Wort, sometimes called the 'sunshine herb', St John’s Wort has often been considered a natural alternative to SSRIs. This herb can, however, interact with some prescription drugs, so check with your GP before taking it
- Folate, the naturally occurring form of folic acid. Depressed patients have been shown to have low levels of folic acid, so boosting this may help
- S-Adenosyl-methionine is a building block of serotonin, but is not often used in the UK. It is more popular in Europe and the US and is often given as an injection
- Selenium is an important trace element found in vegetables, meat, fish and Brazil nuts. Selenium is an antioxidant and may prevent cell damage and helps produce thyroid hormone. It is not known how selenium helps with depression
- Omega-3 acids are found in oily fish, such as mackerel and salmon and have been shown to help prevent heart and joint disease. They are also used in depression, but doctors are unsure how Omega-3 helps
Can exercise help depression?
The benefits of regular exercise are numerous. Exercise builds muscle, burns fat, makes heart and lungs work more efficiently, lowers the density of damaging sugars in the blood and is a major factor in protecting against osteoporosis.
Best of all, exercise makes you look better and feel better, since it releases mood-elevating compounds called endorphins. The US National Institute of Mental Health estimates that around thirty minutes of physical activity not only helps to lift your mood, but also keeps it elevated for at least 24 hours.
What exercise is best for me?
- Aerobic exercise– walking, gardening, hiking, bicycling, lap swimming, jogging or cross-country skiing. You should aim to do 20 to 60 minutes at least five times a week
- Strength training – a review published in the US Journal of Ageing and Physical Activity found that strength training can improve a person's mood. It found that adults who included it in their exercise programme were not only happier, but had more overall vigour and calmness.Strength training uses free weights, weight machines, callisthenics and resistance techniques.
- Stretching your body to maintain its flexibility is probably the most underrated part of anybody's exercise programme, as it helps to regulate stress levels. Yoga, dance, T'ai Chi or Pilates all include stretching; you should include them as part of your fitness routine as often as possible
Can food help my depression?
A poor diet may well be short of vital nutrients which are not just necessary for our overall health, but also assist in creating good moods. Some foods create blood sugar 'peaks', resulting in mood swings.
Avoid refined wheat-based foods, sugars and fats, eat a healthy, widely-based diet which includes plenty of fresh fruit and vegetables, only small helpings of red meat, and make sure you drink plenty of water.
Try these foods to improve your mood stability:
- Brown rice: good replacement for pasta or potatoes
- Oily fish: contains high levels of omega-3 fatty acids. Low levels of omega-3 can cause feelings of depression
- Garlic: gives you energy and ideal for boosting immunity
- Ginger: helps fight colds and ‘flu
- Berries: packed full of antioxidants
- Oats: porridge is a good weapon to fight off winter blues because of the way it is digested
- Mustard: good for treating muscular pain and creates and sustains warmth
- Water: It's important to keep up your daily intake of two litres of water each day
There are also some foods you should avoid, if you have ever suffered from depression:
- Sugary foods, such as chocolate, may give you an initial 'lift', but your feelings of depression will only increase afterwards. This is because the 'high' you feel comes from the sugar or caffeine rush, and the 'down' afterwards will lower your mood even more
- Over-indulging in alcohol will only make you feel worse as it acts as a global depressive on the brain
- Foods containing saturated fats will only increase your feelings of lethargy
Clickthrough information and support links:
MIND
Manic
Depression Fellowship
Seasonal Affective
Disorder
Bipolar Disorder – Royal College of Psychiatrists
References:All Dr Foster Research (DFR) health content is provided for general information only, and should not be treated as a substitute for the medical advice of your own doctor or any other health care professional.
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