What is depression? The word depression causes much confusion. It is often used to describe someone who is feeling ‘low’, ‘miserable’, ‘in a mood’, or having ‘got out of bed on the wrong side’. However, doctors use the word in two different ways. They can use it to describe the symptom of a ‘low mood’. They also use the term ‘depression’ to refer to a specific ‘depressive illness’. The confusion is made all the worse because it is often difficult to tell the difference between feeling gloomy and having a depressive illness. Doctors make a clinical diagnosis of depression after assessing the severity of the low mood, other associated symptoms and the duration of the problem.
Medically defined, ‘depressive illness’ is very common. Many people who suffer with clinical depression have family members who also suffer from this condition; a tendency to be depressed can be inherited from your mother or father. It is important to recognise that depression is definitely not a sign of weakness. It is a true medical illness. There are a number of well-recognised ‘signs’ (things you can see, hear, etc) and ‘symptoms’ associated with depression (things the sick person experiences). People who have depression need proper medical care. They may need to see a doctor, but there are things that they can do for themselves, and things their family and friends can do to help them. What they cannot do is obey the ‘pull yourself together’ advice – no matter whether they/you think they should be able to. It is generally not the case that people suffering from depression need to ‘pull their socks up’. Here are a few facts:
Signs Depression affects all age groups, from children to elderly people. As mentioned earlier, depression, like all illnesses, has a pattern of signs and symptoms. Not everyone who is depressed shows all of them, and having one or two doesn’t necessarily mean that you are depressed. The main signs and symptoms are:
Feelings of unhappiness that don’t go away
Losing interest in life
Becoming unable to enjoy anything
Finding it hard to make even simple decisions
Feeling utterly tired
Feeling restless and agitated
Losing appetite and weight (some people find they do the reverse and put on weight)
Difficulty in sleeping
Waking up earlier than usual (typically around two hours), or oversleeping for some people
Loss of sexual appetite
Losing self-confidence
Feeling useless, inadequate and hopeless
Avoiding other people
Feeling irritable
Feeling worse at a particular time of day, usually mornings
Thinking of suicide, or hurting yourself (this is common in depression). It is much better to talk about this than ignore it. Contrary to popular belief, asking someone who is suicidal to talk about it does not make them more likely to hurt themselves. For some people, just having someone listen to them can save their life.
Brain chemistry Studies have shown that people who are depressed have chemical changes in certain parts or pathways of the brain. Whether or not these chemical changes are the cause of depression or the result is not known. The changes may include alterations in the number or sensitivity (how well they work) of little structures (receptors) on the surface of nerve cells that receive chemical messages that make the brain work. In particular, receptors for three chemicals: 1) 5-hydroxytryptamine (5-HT, also known as serotonin), 2) noradrenaline, and 3) dopamine.
5-HT is involved in maintaining normal patterns of appetite, sleep and sexual activity: abnormalities in 5-HT pathways might lead to the disturbance of sleep, increased anxiety and irritability and loss of sexual interest.
Noradrenaline helps to regulate mood and energy levels, and possibly has a role in social interactions: changes in noradrenaline may lead to tiredness, loss of enthusiasm and social withdrawal.
Dopamine is thought to have a role in gaining pleasure, and changes here could lead to the sense of being unable to get enjoyment from usually pleasurable activities. Abnormalities in dopamine may be especially important in patients with ‘manic’ depression.
Treatment Firstly, it is important to emphasise that untreated depression will not get better on its own. Depression can be, and is, treated successfully every day. In recent years the way it is treated has changed. No longer are doctors just ‘dolling out tablets’. It is now recognised that tablets, on their own, are not the best way to help people suffering from depression. Rather, people who are depressed need four kinds of support: 1) A listening ear. Having an opportunity to talk through problems with someone who will not be judgemental is vital. Often it is necessary to go to a professional counsellor who, because they are detached from the person’s personal life, can be confidential, and non-judgemental. 2) Practical help with day-to-day matters. Depressed people may struggle to look after themsleves properly. Friends who make sure they eat well, and are there to help them study, or cope with housework, etc, can be a great support. 3) Spiritual encouragement. The spiritual life of depressed people often suffers. People with depression should be encouraged to explore spiritual avenues. Prayer is an excellent way to establish a connection with God. He can help! 4) Medication. Medication is often required to help restore the proper balance of the chemical messengers in the brain.
What about herbs? Many people have heard of the plant hypericum perforatum (St John’s wort) as a treatment for depression – but does it work? In Germany, many doctors prescribe hypericum in favour of synthetic antidepressants. A number of clinical studies have shown that for mild to moderate depression, hypericum is as effective as standard antidepressants, and has fewer side effects.
The chief drawback is that the herb causes other substances to be metabolised through the body too quickly. This is obviously very significant for people on the contraceptive pill or the blood-thinning drug warfarin, who are at risk of a stroke. The drug also interacts with anti-viral drugs, such as those used to treat AIDS. So should it be used? The view among doctors is divided, but all agree that people should tell their doctor if they are taking hypericum.
Advice If you have a partner, friend or relative you think might be suffering from depression, here are some things you could do to help:
Listen. People who are depressed may talk less, more slowly, and convey what they want to say less clearly. They may speak in a way that they feel clearly shows their needs, but is not clear to you. Listen carefully and be sure you understand them.
Understand. Depressed people are not lazy; they are struggling to regain their mental balance, and need to know that they are not being blamed for being the way they are. Even if they are receiving treatment, it may take months for you to see an improvement. Be patient.
Learn. Depression is an illness like any other, and learning about it can help you and the affected person cope better.
Look after yourself. It is important that you lead as normal a life as possible. This helps the ill person see what they are aiming for, and doesn’t pull you into a state of depression also. Looking after anyone who is ill is a stressful experience, so bear in mind that you may need some help yourself.
Encourage. Letting someone who is depressed know that they are valued, reminding them of their skills, and encouraging them to keep in touch with people can, for some, make the difference between giving up and fighting on.
Medication. Depression can be treated. While medication is certainly not the only treatment, for many it is a vital component, to restore good mental health as quickly as possible. Most antidepressant medication takes about two weeks before it starts to work, so it is important that you encourage the person to continue taking it.
What is depression?
