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The facts about depression
Depression is a medical condition characterized by long-lasting feelings of
intense sadness and hopelessness coupled with additional mental and physical changes.
The condition often affects a person's personal, social, and professional life.
About one in five women and one in ten men will suffer from depression at some point in their life. Depression in children and adolescents occurs less commonly than in adults. Almost 1.5 million Canadians have serious depression at any given time, but less than one third of these people seek medical help.
Depression
What is depression?
Pharmaceutical companies would have us believe depression is a well-understood condition
caused by insufficient serotonin in certain parts of our brains. Thus, the correct treatment
is to simply choose the right pill to adjust one's serotonin levels back up to normal levels.
Although that's a persuasive and simple story for marketing drugs to busy doctors and the public,
it's probably not completely accurate. A great neurobiologist said not so long ago:
"Explaining human brain function based upon our current knowledge of neurobiology
and neurochemistry is like analyzing samples from the sewers of Moscow and deciding
what Muscovites had for breakfast that morning."
We do know depression interferes with the function of several parts of the brain,
including the limbic system and the cerebral cortex. So depression interferes
with how we feel, some of our bodily functions such as appetite and sleep,
and how efficiently we are able to think.
Diagnosis
Depression isn't always obvious, especially to the sufferer.
Sometimes it looks like irritability, or it might be confused with dementia
or senility. The traits used for diagnosis of depression reflect the parts of
the brain affected. Clinical diagnosis requires that several of the following
symptoms must be present with enough severity to significantly interfere with
one's ability to perform day-to-day activities:
- sleep disturbance (early awakening/insomnia or always sleeping)
- appetite changes (loss of appetite/weight or overeating)
- low energy
- feelings of hopelessness, sadness, despair
- poor concentration
- difficulty making decisions
Risk factors
There is a definite genetic link: if parents, grandparents,
or siblings suffer from depression, risk is significantly increased.
Certain hormonal changes, such as those seen following pregnancy
or menopause, are associated with increased risk of depression.
Sudden, unexpected emotional trauma or loss can precipitate a
depressive episode. Certain times of year, such as Christmas
or anniversaries of times of grief may be associated with
depressive episodes. Some drugs (alcohol, marijuana,
barbiturates, benzodiazepines, beta-blockers, clonidine,
corticosteroids) cause depression or make it worse.
Depression is often associated with medical conditions
such as heart disease, multiple sclerosis, some types
of arthritis, stroke, hypothyroidism, Cushing's disease,
Parkinson's disease and some types of cancer.
Once you have had one depressive episode, your risk of future depressive
episodes increases with every bout. After a single episode one's likelihood of
a further bout of depression is 50%, after two episodes it goes up to 70%, and after three it is 90%.
Treatment
A wide variety of treatments have proven to be effective in the prevention
and treatment of depression. Adequate rest, a good exercise program,
and balanced nutrition are important, especially for those who have an
increased risk of depression. Cognitive behavioural therapy (CBT) is a
counselling technique in which the therapist helps the person identify
and correct inaccurate, negative patterns of thought. CBT has been shown
to be at least as effective as antidepressant medications in treating
mild and moderate depression.
A wide variety of antidepressant medications have been developed that
have been shown to have some effectiveness. Interestingly, although
they all work for some people, they have a remarkably wide range of
actions in the brain. Some are stimulants, like amphetamines, that
increase the secretion of dopamine. Some block the reabsorption of
serotonin, increasing its levels in the brain. Some work apparently
by increasing the concentration of norepinephrine, another excitatory
neurotransmitter.
There have been conflicting scientific reports on the effectiveness of
herbal remedies, especially St. John's wort. One study showed the
placebo group with depression did better than either the group
taking St. John's wort or those taking an SSRI medication
(a medication in the class of antidepressants called selective
serotonin reuptake inhibitors).
Some people whose severe and crippling depression has not responded to other
types of treatment are successfully treated with electroconvulsive therapy.
Although an extreme measure, it is important to remember that severe
depression is a horrible, potentially fatal disease.
As with other chronic illnesses that have biological as well as psychosocial
roots and manifestations, the best treatments combine biological or pharmaceutical
interventions with psychosocial treatments in the form of group or individual
counselling and behavioural change, including exercise, diet, social activities,
and spiritual activities. A study reported in the British Medical Journal showed
that patients who had been successfully treated for depression were much less likely
to relapse and to have much better emotional and physical functioning if they received
ongoing support by health care providers. The group who only received a brief single
treatment intervention were much more likely to relapse into depression. The take-home
message from this study is that depression is a chronic disease subject to relapse,
so effective treatment requires maintenance of relapse-prevention activities,
including medication, social support, counselling, exercise, and balanced activities.
What to do
Read about it. Talk to your doctor and your community mental health agency.
Consider getting cognitive behavioural therapy from a skilled psychotherapist,
but ask first to make sure the therapist has experience with this method. Work
out a rigorous, regular exercise program. Pay attention to what you eat. Get out
of the house and connect with others through social activities, hobby groups,
music, or mutual support groups. Remember, depression is a chronic, often recurring
illness for which recovery or long-term remission can be expected, especially
if the sufferer continues to do the things that work for them.
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