March 16th, 2005

Yellow head

All About Depression

No one needs to taught how to be depressed, as everybody has experienced some level of depression in their lives. Heart-break, bereavement, and loneliness come to us all. Sadness is a part of life we have no choice but to endure. However there is a difference between the ordinary, everyday sadness and the chronic depression which often affects sufferers for years.

The common symptoms of depression are: Changes in sleep habits, like insomnia, early morning awakening, or sleeping too much: changes in eating habits, such as loss of appetite or weight gain; decreased energy, feeling of fatigue; restlessness and irritability; difficulty in concentration, remembering, difficulty in making decisions; feelings of hopelessness, helplessness, guilt or worthlessness; persistent sad, anxious, or empty feelings; loss of interest in one's pleasurable activities, such as involvement with loved ones or hobbies, and thoughts of death or suicide.

Depression isn’t a ‘blue mood’ which you can snap out of. Depression is a serious biological illness that effects behaviour, thoughts and feelings. Make no mistake about it, depression can, and often does, kill. I myself have witnessed two suicides on the ward where I used to work. Plus I've experienced depression myself.

In the brain, there are naturally occurring substances called 'neurotransmitters'. These are the chemical messengers which carry electrical signals from one nerve cell in the brain to another, across spaces called 'synapses'. The neurotransmitters that play a significant role in maintaining our mood are primarily 'serotonin and norepinephrine'. When these neurotransmitters are in low levels, the vegetative symptoms of depression become clinically evident.

Or to sum up: depression makes thinking sluggish.

The treatment of depression is twofold, namely, psychopharmacotherapy and psychotherapy. The former consists of drugs called "antidepressant medication". Over the years, a host of antidepressant medications have become available, such as Prozac, Clomipramine and many others. The antidepressants help to restore the balance of the neurotransmitters in the brain and thereby, relieve the vegetative symptoms of depression.

The curious thing about antidepressants is that unlike other drugs, which act on the brain, such as tea, coffee, alcohol, nicotine, minor tranquillisers, etc, they don’t act immediately. The only thing antidepressants do in the first thirty minutes is produce side effects. The lifting of the depressed person’s mood can take up to two weeks (occasionally longer). This can unfortunately mean that the patient may feel a lot worse in the short term and not better at all (I don’t know how many times I’ve heard patients complaining that their drugs aren’t working, when they’ve only been in hospital a week). However when the antidepressants do finally kick in, their effects do tend to stay around longer than with other drugs.

Another odd feature about antidepressants is that they only appear to work on people who are depressed. They have no effect on anyone else.

In the end though, drugs are not enough. Depression has many causes. Social factors such as a patient’s loneliness may be an element. A patient might have serious debts, or be going through a painful divorce. All these aspects should be taken into account when treating them. We do often refer people to Citizen’s Advice (for debt or housing problems, for example) or to social venues which have been set up to cater for ex-psychiatric patients. We also have an advocacy service based within the hospital, for those who may need help with their Social Services or Housing Benefit problems.

There is also psychotherapy for those who need to resolve coexisting life problems. A better self-awareness can enable the patient to develop better coping mechanisms.

The feelings of despair and helplessness that depression brings, can be alleviated through proper treatment. It’s more than possible to live a fulfiling life, despite the illness.

After the darkness of winter, the light of spring lifts the mood.