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Depression

 

Definition

Depression is common, affecting approximately 10% of the UK population. This has led it to being erroneously referred to as “the common cold of mental health problems”. The title of Lewis Wolpert’s book on depression, ‘Malignant Sadness’ more aptly describes how incapacitating the symptoms of can be. It has an incapacitating effect on mind and body and is often referred to as Major or Clinical Depression.

Clinical Symptoms
  • Persistent low mood
  • Reduced capacity for interest and enjoyment
  • Decrease in activity – avoidance of social situations and activities at work or home
  • Reduced self-esteem and self-confidence and ideas of guilt or worthlessness
  • Thoughts of hopelessness and suicidal ideation
  • “Physical” symptoms – sleep disturbance, especially early morning waking, fatigue and reduced energy, slowing of thoughts or movement, agitation, tearfulness, loss of libido and changes in appetite and weight
Causes

Depression is considered to be multi-factorial in origin, the following being most relevant:

  • Biological – twin and family studies have confirmed that the inheritance of a genetic vulnerability in many sufferers. In addition depression is associated with a reduction in brain chemicals known as neurotransmitters (serotonin and noradrenaline) in particular parts of their brain. Hormonal changes are also relevant as demonstrated by higher incidence of depression during the post-partum period and the menopause. Illicit drug and alcohol misuse are major aggravating factors.
  • Psychosocial – individual character traits such as perfectionism and low self-worth can predispose an individual to depression as can early childhood trauma e.g. death of a parent, physical illness, abuse and neglect. Adverse life events in adulthood are common triggers of depression especially if there is a background of chronic stressors e.g. marital difficulties, work pressure and financial worries.
Treatment

The importance of self-help such as regular exercise, sleep and diet in the treatment of depression cannot be over-emphasised. This will greatly assist in the delivery of medical and psychological treatment.

  • Medication – the role of medication, antidepressants and mood stabilisers in the treatment of depression is now well established. The most commonly prescribed are the SSRIs that act on serotonin followed by the SNRIs which act on noradrenaline as well. The older tricyclic antidepressants (TCAs) and the monamine oxidase inhibitors (MAOIs) still have a role in more treatment-resistant depressions. Mood stabilising medications such as lithium and the atypical antipsychotics can also be of great benefit in some depressions. These days the use of ECT is generally restricted to more severe cases unresponsive to medication and presenting with suicidal ideation. Hospital admission for more severely effected patients allows for the full range of treatments to be delivered on a more intensive, coordinated basis.
  • Psychotherapy – cognitive behavioural therapy (CBT) has been shown to be effective in helping people with depression better manage negative thoughts and beliefs, as well as to developing more effective strategies to cope with difficulties they face. Interpersonal therapy and psychodynamic psychotherapy also have a place in some depressions.

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