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More than the Blues

Life is full of emotional ups and downs and everyone experiences the "blues" from time to time. But when the "down" times are long lasting or interfere with an individual’s ability to function at home and at work, that person may be suffering from a common, serious illness -- depression.

Clinical depression affects mood, mind, body and behaviour. Research has shown that 5 - 6% of the population will have a depressive disorder during the course of their lives, and nearly two thirds do not get the help they need. Treatment can alleviate the symptoms in over 80% of cases. Yet, because it often goes unrecognised, depression continues to cause unnecessary suffering.

What Is A Depressive Disorder ?

A depressive disorder is a "whole-body" illness, involving your body, mood and thoughts. It affects the way you eat and sleep, the way you feel about yourself, and the way you think about things. A depressive disorder is not the same as a passing blue mood. It is not a sign of personal weakness or a condition that can be willed or wished away. People with a depressive illness cannot merely "pull themselves together" and get better. Without treatment symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people who suffer from depression.

Types of Depression

Depressive disorders come in different forms, just as do other illnesses, such as heart disease. This brochure briefly describes three of the most common types of depressive disorders. However, within these types there are variations in the numbers of symptoms, their severity, and persistence.

Major depression is manifested by a combination of symptoms (see symptom list) that interfere with the ability to work, sleep, eat, and enjoy once pleasurable activities. These disabling episodes of depression can occur once, twice, or several times in a lifetime.

A less severe type of depression, dysthymia, involves long-term, chronic symptoms that do not disable, but keep you from functioning at "full steam" or from feeling good. Sometimes people with dysthymia also experience major depressive episodes.

Another type is bipolar disorder, formerly called manic-depressive illness. Not nearly as common as other forms of depressive disorders, bipolar disorder involves cycles of depression and elation or mania. Sometimes the mood switches are dramatic and rapid, but most often they are gradual. When in the depressed cycle, people may have any or all symptoms of a depressive disorder. When in the manic cycle, any or all symptoms listed under mania may be experienced. Mania often affects thinking, judgment, and social behaviour in ways that cause serious problems and embarrassment. For example, unwise business or financial decisions may be made when an individual is in a manic phase. Bipolar disorder is often a chronic recurring condition.

Symptoms of Depression

Not everyone who is depressed or manic experiences every symptom. Some people experience a few symptoms, some many. Also, severity of symptoms varies with individuals.


  • Persistent sad, anxious, or "empty" mood
  • Feelings of hopelessness, pessimism
  • Feelings of guilt, worthlessness, helplessness
  • Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
  • Insomnia, early-morning awakening, or oversleeping
  • Appetite and/or weight loss or overeating and weight gain
  • Decreased energy, fatigue, being "slowed down"
  • Thoughts of death or suicide; suicide attempts
  • Restlessness, irritability
  • Difficulty concentrating, remembering, making decisions
  • Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain

Who Gets Depression ?

Depression affects people of both sexes, and all races, cultures and social classes. It is estimated that 5 - 6% of the population may suffer from major depression during the course of their life. It is reported that depression is twice as common in women than it is in men.

Depression In Children

Whilst depression is more common in adults, it occurs in at least 2 in every 100 children. Children are more likely to become depressed if they come from broken homes, have suffered from abuse or neglect, or have lost a parent early in their life. Another contributing factor is childhood illness.

Depression In Adolescence

Because ups and downs are common in adolescence, depression is often considered to be a normal part of growing up. Whilst teenagers do go through depressed moods, clinically diagnosable depression does occur, and affects 5 in every 100 teenagers. Like "adult" depression, it can cause interference with daily activities, including a deterioration in academic performance, a loss of interest in friendships and a decreased enjoyment in activities and hobbies. Furthermore, depression is a major cause of suicide.

Depression In The Elderly

A lot of the factors associated with depression are bound to be more common in older people. For example, they may have a physical illness, such as arthritis. This can prevent people from getting out and about, so that they feel lonely. For some illnesses or diseases the medication one takes may trigger depression. As one becomes older, the chances are that they may suffer a bereavement, either of a partner or a close friend. This may act as a trigger for depression.

Older people with symptoms of depression often worry that they are becoming ‘senile’. For example, they may be worrying that they cannot seem to concentrate, or that their memory is not as good as it used to be. If they are actually aware of these changes, it is more likely that they have depression rather than dementia. People with senile dementia do lose their faculties, but they don’t usually realise that this is happening to them. Depression and dementia are completely separate conditions.

Depression After Childbirth

  • "Baby blues" - feeling of sadness, anxiety, irritability, fears of not being able to cope, sadness about the "losses" that come along with this new "gain" (loss of figure, career, status, etc.) It affects about 85% of all mothers and is generally considered a normal reaction to childbirth. It is usually short-lived, starting a couple of days after the birth and typically easing off by the end of the second week. The best form of help is support from family and friends and the opportunity to take regular rests.
  • Post-partum depression - affects about 20% of new mothers. The general "baby blues" feeling does not go away and develops into a full depression. Sometimes mothers may have appeared to be well for the first few weeks and only develop depression later. Any or all of the following feelings may be experienced: diminished energy, fatigue, difficulty concentrating, sleeping and eating disturbances, loss of interest, lowered sexual interest, suicidal ideas, mood swings, anxiety, restlessness, apathy, loss of positive feelings towards loved ones, guilt about "not loving the baby enough". The best form of help here involves support from family and friends, as well as from mental health professionals. Very often some form of medication is needed and in certain cases the mother may need to be admitted to hospital.

What Causes Depression ?

Just as depression takes many different forms, it has many possible causes. In fact, depression is often caused by a combination of factors.

But why does one person become depressed while another remains unaffected ? There’s no clear answer. For each person, there is a complex, individual pattern of factors that work together to either allow or prevent depression at any given time.

Sometimes it is possible to point to a specific event that seems to have triggered a depression. But other times depression comes on for no apparent reason, even for individuals whose lives are going well. Some possible reasons include:

External events. Loneliness resulting from relationship difficulties may contribute to depression. So can financial worries, legal problems, retirement, or other stresses. Grief due to the death of a loved one may, but usually does not, progress to full-blown depression.

Genetics. Researchers now realise that inherited factors are important. In other words, having close relatives who have had depression means that you are more likely to become depressed. People with a genetic susceptibility may be more vulnerable to depression when something upsetting happens.

Physiological or "biochemical" factors. One particularly interesting area of research today involves the "biochemistry of depression". Depression is believed to be caused by an imbalance of brain chemicals called neurotransmitters. In other words, when the functioning of certain neurotransmitters is disturbed, depression can occur.

Another contributing physiological factor can be medical illness, including strokes, Cushing’s disease, and thyroid problems. Various medication, such as treatments for high blood pressure, birth control pills, and steroids (like cortisone), have also been implicated. Last but not least, alcohol and other commonly abused substances take their toll.


Depression is one of the most treatable mental illnesses. Between 80 and 90% of all depressed people respond to treatment and nearly all depressed people who receive treatment see at least some relief from their symptoms. Along with the great strides made in understanding the causes of depression, scientists are closer to understanding how treatment of the illness works.

Before any treatment programme begins, however, a complete evaluation is essential. Depression is a complex illness, and many factors in a depressed person’s life may feed into their condition. For example, a number of prevalent illnesses (such as hypothyroidism or hypertension) and commonly used medications can bring on depression. An evaluation will reveal the presence of these conditions or medicines to the psychiatrist. The evaluation will also include a medical/psychiatric history that will outline the patient’s physical and emotional background, and a mental status examination, to uncover changes in the patient’s mood, thoughts, patterns of speech, and memory that are manifestations of depression. The psychiatrist may also perform or order a physical exam for the patient to rule out undiagnosed medical problems that might be related to depressive illness.


How Effective Are They ?

If you take 100 people with depression and give them all an antidepressant, around 70 will make a good recovery. So the medicines can be very effective. If one particular medicine doesn’t work for you, its a question of trying another until one is found that does work.

Are Some Antidepressants Better Than Others ?

No. We don’t know why, but all antidepressants are equally successful, providing you take an effective dose for a sufficient period of time.

What Does That Mean - Effective Dose And Sufficient Period Of Time ?

Antidepressants need to reach a certain dose before they begin to work. The level of the dose varies for different antidepressants. For some you need to start lower and build up to the effective dose.

Antidepressants don't work quickly. For most people, a response occurs within about 2-3 weeks from reaching this minimum dose. For some, it may take a month and in elderly people even longer, perhaps as long as 6 or even 8 weeks. It is very important to persevere, to give the treatment a full chance of working. Lots of people stop too soon because they don’t think the drug is working and nobody has explained to them how long they need to take it for.

Different Types of Antidepressants

There are four different classes, or types of antidepressants:

  1. Tricyclics (TCA)
  2. Selective serotonin reuptake inhibitors (SSRI’s)
  3. Monoamine oxidase inhibitors (MAOI’s)
  4. Others include : Aurorix, Effexor, Serzone

Tricycylics - What Exactly Are They ?

They are a group of antidepressants that have been around for over 30 years. They are effective in treating depression and are also sometimes used for other reasons, like pain relief, for treatment of anxiety and to help people sleep. Millions of people have taken these antidepressants and have recovered from depression by using them.

Are Tricyclics Safe To Take ?

They are safe to take in the prescribed dose, but they don’t suit everyone. There are some conditions whereTricyclics are best avoided. You should tell your doctor if any of the following apply to you.

A. If you have illnesses such as:

  • epilepsy
  • liver problems
  • diabetes
  • kidney problems
  • glaucoma
  • prostate trouble
  • heart complaints

B. If you are taking other medication, including medication from your chemist, especially antihistamines or a medicine for stomach acid called Tagamet (cimetidine).

C. If you are pregnant or breast feeding, or are trying for a baby.

Tricyclics are dangerous if you take an overdose. If you do take one, or suspect that someone has taken one, dial the emergency services immediately. Tell the doctors what drug has been taken - this is important. The antidote is a glass of what is called "activated charcoal", but it needs to be taken soon afterwards. Activated charcoal reduces the amount of the drug absorbed into the body.

Selective Serotonin Reuptake Inhibitors (SSRI’s) - What Exactly Are They ?

The SSRI’s are among the newer antidepressants and have been available since 1988. They are effective in treating depression and are sometimes used for other reasons like treatment of anxiety or panic and some eating disorders. They are widely used and millions of people who have taken them have recovered from depression.

Are SSRI’s Safe To Take ?

They are safe to take in the prescribed dose, but don’t suit everyone. There are some conditions where you need to take extra care, so if any of the following apply to you, discuss them with your doctor.

A. If you are taking other medication, including medication from your chemist, especially:

  • Theophyline (for asthma)
  • Warfarin (following a stroke)

B. If you are pregnant or breast feeding or trying for a baby.

MAOI’s - What Exactly Are They ?

These are antidepressants that work by deactivating an enzyme called Monoamine Oxidase. The MAOI’s have been around for about 30 years and are effective for all types of depression, including depression where people eat and sleep more than usual, and depression where other antidepressants have not worked well. Thousands of people with depression have taken them and have recovered using them. They are not widely used because they have a reaction with certain foods.

If switching between an MAOI and another antidepressant, there will need to be an interval of a week or two between treatments.

Moclobemide has not been around for as long as the MAOI’s and although it works in a similar way, does not cause the same problems with food restrictions.

Are MAOI's Safe To Take ?

They are safe to take in the prescribed dose, but they don’t suit everyone. There are some conditions where they should not normally be used. If any of the following apply to you, tell your doctor:

A. If you have illnesses such as:

  • Diabetes
  • Heart trouble
  • Epilepsy
  • Liver trouble
  • Overactive Thyroid (hyperthyroidism)
  • A condition called phaeochromocytoma

B. If you are taking medicines, especially those for coughs and colds which you can get without a prescription - see "medicines to avoid".

C. If you are pregnant, breast feeding or trying for a baby.

What About The Foods And Medicines I Need To Avoid ?

Some foods contain a naturally occurring chemical called Tyramine. Your body uses this to help control your blood pressure. If you mix Tyramine with MAOI’s, your blood pressure can rise very suddenly and you may feel hot or flushed or have a headache. This can be dangerous. Your chemist will give you a card with foods and drinks to avoid.

The medicines you need to avoid are those for coughs, colds and flu and strong pain killers such as pethidine. Always ask your chemist or doctor before you buy any of these medicines. The chemist can give you a card with a list of medicines to avoid.

A Few Words On Medication ...

How Soon Can I Expect It To Work ?

Any insomnia should improve within a few days, though you probably won’t notice any difference in your mood for a few weeks, but keep going. You’ll have good days and bad days, but this is normal. Eventually, you will have more and more good days - just give your medication time to work.

How should I Take The Medication ?

Look at your medicine bottle or packet. Follow the doctors instructions carefully. Take your dose with a full glass of water. Never change the dose itself - always ask your doctor or pharmacist if you’re not sure what the dose is.

What If I Miss A Dose ?

Don’t worry. Take it as soon as you remember, as long as it is only a few hours after the usual time. Otherwise, wait until your next dose is due and take it as usual - don’t try to catch up by doubling your next dose.

Can I Take Alcohol With Antidepressants ?

Taking alcohol with antidepressants can make you feel very drowsy. Drinking alcohol, even in moderation can delay or reduce your response to antidepressants, so its’ best avoided. However, don’t stop taking your medication if you fancy a drink at the week-end, just be sensible and limit it to ONE drink.

When I Feel Better Can I Stop Taking It ?

No. You need to allow time for the brain chemicals to recover fully. This takes at least 4 - 6 months in most people, sometimes longer. How long you need to take it for is something you should discuss with your doctor.

Are Antidepressants Addictive ?

No. This is a common mistake. People often confuse antidepressants with a type of tranquiliser called "benzodiazepines". Tranquilisers are habit forming and people can find it difficult to stop taking them. This is not the case with antidepressants. These are quite safe when used for long periods of time.

Side Effects

Antidepressants may cause mild and, usually, temporary side effects in some people. Typically these are annoying, but not serious.Each medicine has its own pattern of side effects. Some medicnies may cause some of the symptoms on the list, but not others; your doctor can advise you in this regard. The most common side effects and ways to deal with them, are:

  • Dry mouth -- drink lots of water; chew sugarless gum; clean teeth daily.
  • Constipation -- eat bran cereals; prunes; fruit; and vegetables.
  • Bladder problems -- emptying your bladder may be troublesome, and your urine stream may not be as strong as usual; call your doctor if there is any pain.
  • Sexual problems -- sexual functioning may change, if worrisome, discuss with your doctor.
  • Blurred vision -- this will pass soon; do not get new glasses.
  • Dizziness -- rise from bed or chair slowly.
  • Drowsiness -- this will pass soon; do not drive or operate heavy equipment if feeling drowsy or sedated.
  • Headache -- this will usually go away.
  • Nausea -- even when it occurs, it is transient after each dose.
  • Nervousness and insomnia -- these may occur during the first few weeks; dosage reductions or time will usually resolve them.
  • Agitation -- this may happen early in treatment, and is usually transient, if not, consult your doctor.

Lastly...on Medication

People often are tempted to stop medication too soon. It is important to keep taking medication until your doctor says to stop, even if you feel better beforehand. Some medications must be stopped gradually to give your body time to adjust. For individuals with bipolar disorder or chronic major depression, medication may have to become part of everyday life to avoid disabling symptoms.

Never mix medications of any kind -- prescribed, over-the-counter, or borrowed -- without consulting your doctor. Be sure to tell your dentist or any other medical specialist who prescribes a drug that you are taking antidepressants. Some of the most benign drugs when taken alone can cause severe and dangerous side effects if taken with others. Some drugs, like alcohol, reduce the effectiveness of antidepressants and should be avoided.

Anti-anxiety drugs or sedatives and sleeping tablets are not antidepressants. They are sometimes prescribed along with antidepressants; however, they should not be taken alone for a depressive disorder. Stimulants, such as amphetamines, are also inappropriate.

Be sure to call your doctor if you have a question about any drug or if you are having a problem you believe is drug related. Consult your doctor immediately should you fall preganat whilst on any medications.

Psychotherapy Treatment

Psychotherapy involves the verbal interaction between a trained professional and a patient with emotional or behavioural problems. The therapist applies techniques based on established psychological principles to help the patient gain insights about him or herself and thus change his or her maladaptive thoughts, feelings, and behaviour. There are several forms of this "talk treatment" that have proven useful in helping the depressed person.

In the spring of 1986, scientists announced results of research into the effectiveness of short-term pscyhotherapy in treating depression. Their findings indicated that for some categories of patients and under certain circumstances, some types of cognitive behavioural therapy and interpersonal therapy were as effective as medications for depressed patients. Medications relieve the symptoms more quickly, but patients with moderately severe depression who received psychotherapy instead of medicine had as much relief from symptoms after 16 weeks.

The data from this study will help scientists better identify the depressed patients who will do best with psychotherapy alone and which patients may benefit from medications. In general, psychiatrists agree that severely depressed patients do best with a combination of medication and psychotherapy.

Cognitive Behavioural Therapy -- This treatment approach is based on the theory that people’s emotions are controlled by their views and opinions of the world. Depression results when patients constantly berate themselves, expect to fail, make inaccurate assessments of what others think of them, feel hopeless, and have a negative attitude toward the world and the future. The therapist uses various techniques of talk therapy and behavioural prescriptions to identify and correct the negative thought patterns and beliefs.

Interpersonal Psychotherapy -- This therapy is based on the theory that disturbed social and personal relationships can cause or precipitate depression. The illness, in turn, may make these relationships more problematic. The therapist helps the patient understand his or her illness and how depression and interpersonal conflicts are related.

Psychodynamic Psychotherapy -- This therapy is based on the premise that human behaviour is determined by one’s past experience, genetic endowment, and current reality. It recognises the significant effects that emotions and unconscious motivation can have on human behaviour.

In summary, medication or psychotherapy, or a combination of the two treatment methods, usually relieves symptoms of depression in weeks. Even the most severe forms of depression can respond to treatment rapidly.


Is Self Help An Alternative To Medical Treatment ?

Emphatically not! professional advice and treatment should first be sought in all but very mild cases. The first step would be to consult your GP. If more specialised help is subsequently needed, a doctor will probably refer you to a psychiatrist or psychotherapist. But, self help will provide a back-up to whatever treatment has been recommended and this will help the depressed person to cope with the symptoms more easily and so hasten recovery.

What Can I Do To Help Myself ?

1. Read Books Many books are now on the market giving practical advice for sufferers, and these can of course also help their relatives and friends to understand the illness. Most of the books are written in simple, practical terms and are intended for the sufferers themselves, not for professionals. The main objective should be to understand the nature of the condition and its possible causes. This will help to remove much of the fear, guilt and misconception which many people have. Some books include simple descriptions of the possible causes of depression, while others give preference to a specific method of treatment such as medication or counseling from a trained therapist. Some list the various possible avenues to eventual recovery. Because depression is such a complex illness, each person has differing needs and recovery should be tailored to the individual.

2. By Practical Means The depression sufferer can attempt any of the suggestions given in the books which seem appropriate to them. Many people have found out that their depression is eased by a combination of the following:

a) Relaxation Depression frequently brings tension and anxiety which can be a real handicap. People become ultra-sensitive and irritable. There are many methods of relaxation using exercises, audio tapes, yoga, meditation, aromatherapy, massage, etc., all of which can be very effective in allaying anxiety and tension.

b) Exercise Many people who are depressed become exhausted and totally lacking in motivation. Despite this, some form of exercise, however gentle, will often have beneficial results, and if some exercise can be taken in the fresh air, this can add to the benefit.

c) A Change In Lifestyle A lot of people who have depression have been found to be perfectionists and drive themselves much too hard in most things they do. Our own impossible standards need to be lowered slightly and our ‘workload’ reduced in order that life can be lived at a slower pace. This change does not make us lesser people but puts us in command of our life rather than being at the mercy of the ‘rat race’.

d) Diet Under or over eating is a symptom of depression and it can be so easy to eat junk food. It is very important to try to have a well balanced diet which prevents us from feeling tired and run down as a result of a bad diet.

e) Avoid ‘Props’ Props, such as smoking, illicit drugs and dependence on alcohol are damaging. Alcohol in particular is a depressant and despite giving a temporary lift can definitely worsen depression.

f) Keep Occupied It can be of great help if the mind can be occupied by an interest or satisfying hobby, or by reading a book or watching a TV programme or film. While concentration can be difficult in depression, it is possible to train yourself to increase the amount of time you spend concentrating on something, simply by practice.

g) Holidays or Short Breaks If these are possible, they usually bring some relief by breaking up the routine where we can so easily get in a rut. Even an hour’s break every now and hen can help.

What To Do If A Family Member Or Friend Has Depression?

One important thing a family member or friend can do is to provide a caring, supportive environment for the depressed person. It is natural to hope that the symptoms of depression will be resolved right away, but is must be recognised that the patient will progress at his or her own pace. Try not to set yourself or the depressed person up for disappointments, and try to avoid pressuring the patient to "cheer up".

Remember that the first treatment may not be the best answer for the depression, and that the process of trial and error may take some time. Encourage the person with depression. Note any improvements. Consider further review with your doctor or even seeking a second opinion if weeks go by and the symptoms remain unchanged or worsen. Some people have to try more than one treatment or work with more than one health care professional before they find the right blend of personal rapport and optimal treatment.

The hopelessness of depression may cause the depressed person to think that there’s no use in seeing a physician or in taking medication. Help the depressed person to follow the doctor’s instructions.

Finally, try to be sensitive. Treat the person as normally as possible, but don’t try to act like nothing is wrong. The depressed person will usually appreciate that you are not denying the depression.

Remember, seeking treatment is a sign of strength - and it’s the first step toward feeling better. Also, recognise that symptomatic improvement is a step toward a larger overall goal - resolving the problems related to the depressive episode, improving relationships, and changing aspects of the relationship that either helped to lead to the depression or that are a result of the depression. This process takes some time, but can lead to a healthier, happier life.


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