A Family Doctor's Tale - DEPRESSION

DOC I HAVE DEPRESSION

Depression is a very common mental ilness seen in a family doctor's clinic.
There is an alteration of mood which exceeds normal sadness.


Everyone has felt sad at one time or another.
It may be due to a disappointment, frustration or losing someone.
Time heals, the mood lifts and people continue to get on with their lives.


In some people, depression can be so severe that it dominates their lives, preventing them from living their lives as they used to.
Depression of this degree is a medical illness and needs treatment.


The severe form of depression may take 2 forms:


1.Major depression is manifested by a combination of symptoms that affect our work, interests and feelings towards family and friends.
2.Dysthymia is a lesevere type of long term depression with symptoms that prevents them from functioning at an optimal level.


Many patients suffer from Depression because of:


1.hereditary or genetic factors in the transmission of depressive disorders.


2.biological component in depression. It may be associated with having too little or too much chemicals in the brain.


3. medications have mood altering properties. Antidepressant medication act by altering and normalizing the biochemical imbalances in the brain.


4. Life events such as loss of a job, retirement, divorce, death of a loved one or moving to a new house can precipitate a depressive illness. Social circumstances also play a part. If we are alone, have few or no friends, suffer from a chronic illness, then we may be more vulnerable to depression.


5. People with life threatening or long-term physical illness such as cancer, stroke, arthritis or heart disease are also more vulnerable to depression.


6. Personality may also play a part in depression. Some of us are more vulnerable than others because of the individual make-up or early life experiences.


Very often, a combination of genetic, psychological and environmental factors is involved in the onset of depression.


The good news is that whatever the cause, depression is treatable.


Certain characteristic symptoms can give you or your family a clue that you are depressed:


1.Depressed mood
2.lethargy and fatigue
3.loss of interest and enjoyment in life
4.lack of drive or motivation that makes even simple tasks or decisions difficult or impossible
5.loss of concentration
6.Loss of self confidence, avoiding people
7.Sleeplessness or excessive sleeping
8.Agitation or restlessness
9.ideas of being useless, inadequate, helpless or hopeless
10.Feeling guilty or worthless
11.Loss or gain in appetite with loss or gain in weight,libido
12.Thoughts of suicide;
These symptoms are very common in depression and they are much better admitted than covered up.


The most important part of treatment of depression is:


Reassurance and support is most important in treatment of depression.
Recognition of suicide risk must be remembered when treating a depressed person.
Treatment for depression is well established.
Majority up to 90% of people with major depression have fairly good treatment outcome.
Treatment consists of drug (antidepressant medication) and non-drug therapy.
Usually, a combined treatment is best:
1.medication to gain relatively quick relief and
2.psychotherapy to learn more effective ways to deal with life stresses.


Antidepressant Medication
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All antidepressant medications are equally effective but they have different side effects. The most often used antidepressants include tricyclics, monoamine oxidase inhibitors, lithium and selective serotonin inhibitors (SSRI).


Antidepressant medications do not begin working the day you take them but your mood will improve after one to two weeks. However, you may notice some improvement on the first day, especially in your sleep and feeling less tense and anxious.


The medications are compatible with painkillers, antibiotics and contraceptives. However, you should avoid alcohol as the medication and alcohol combined can make you too drowsy.


Do not stop the medication once you start to feel better as you may relapse into depression again. You should discuss this with your doctor and let him advise you when to stop.


Antidepressants like all drugs have some side effects, though these are usually mild and tend to wear off as treatment goes on.
The common side effects and their remedies are:


Dry mouth - drink more water
Constipation - eat more fruits, cereals, prunes and vegetables
Drowsiness - this will pass soon; do not drive or operate heavy machinery if feeling sedated
Dizziness - rise from bed or chair slowly


Some side effects with the newer medications:
Headache - this will usually go away
Nausea and stomach discomfort - transient; take medication with food
Nervousness and insomnia - these may occur during the first few weeks, reducing the dose will usually resolve them.




Non Drug Therapy
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Psychotherapy
Psychotherapy involves talking things through with a trained counselor or therapist. Talking to someone who can really listen and understand you without passing judgement can be a tremendous relief. You learn how to solve problems and cope with life stresses better.
Exercise Exercise not only improves your health but it also gives you a sense of accomplishment. Endorphins ('feel good' hormones) are released during exercise and this can elevate your mood.
Relaxation Therapy
This involves deep breathing exercises and progressive muscle relaxation.
Support groups offer fellowship and you get to hear first hand accounts of how others with depression, like you, have learnt to cope. Presently SAMH, IMH and the Behavioural Medicine Clinic at HPB run support groups. The group at IMH is a psychoeducation group, i.e. you learn about the depressive illness and methods of coping.


Electroconvulsive Theraphy (ECT)
ECT is only indicated for those with severe depression who have not responded to treatment or are highly suicidal.
It involves giving a light general anaesthetic and an electric current is passed through the brain for a few seconds.
The whole procedure takes only about 15 minutes and the patient is only aware of having gone to sleep.


We should try to prevent depression through :


1.try to talk to close friends about bad news


2. Be realistic. Set priorities and do what you can.


3. Do something - get out of the house for a walk or some exercise. While you may not be able to work, it is always good to try to keep up with some light activities such as housework. This will help take your mind off those painful feelings.


4. Eat a good balanced diet, even though you may not feel like eating. 


5. Resist the temptation to drown your sorrows with alcohol. Alcohol actually depresses the mood, so while it may give you immediate relief, this is very temporary and you may end up more depressed. It is also bad for your physical health.


6. Remind yourself that you are suffering from depression, something that many other people have gone through, and that you will eventually come out of it, as they did.


7.Get a friend or relative to help you make appointments to see the doctor and provide support both emotional or encouragement to take medication