Depression is a very common disorder, yet often goes untreated, resulting in immeasurable suffering for the individual as well as family and friends. Understanding that depression is an illness that can be treated easily and effectively can help you avoid this suffering.

What is depression?

The most common form of depression is feeling very ‘low’. When it is severe and persistent it is called depressive illness. It is characterised by changes in mood, thoughts, motivation, appetite, sleep and sexual drive. Depressive psychosis (such as manic depression) is a much more severe illness, in which a person may lose contact with reality.

What causes depression and who is at risk?

Genetic factors pay an important role in psychotic depression, with close family members at a higher risk of developing it. In depressive illness, personality seems to be the determining factor. People at risk of developing depressive illness are more likely to be introverted, obsessive and low in self-esteem. A range of factors can also cause depressive illness:

• Events involving loss, such as the death of a loved one (bereavement) or the end of a relationship.
• Illness including hepatitis, influenza, glandular fever, shingles, or long-term conditions such under activity of the thyroid gland (hypothyroidism) or Parkinson’s disease.
• Stressful social circumstances such as poor living conditions.
• Old age, often due to social isolation.
• Young people may suffer depression if there is a divorce or separation in the family or if they have suffered abuse or neglect. Men experiencing problems in their marriage are at greater risk for developing depression.
• Twice as many women as men suffer from depression, due to a combination of hormonal and social factors.

What are the symptoms of depression?

One of the first signs of depressive illness is the loss of pleasure in life. Sadness and misery can set in and the future seems hopeless. Crying spells are common and life may not seem worth living. Accompanying these emotional changes can be decreased motivation, including low energy, fatigue, apathy and an inability to concentrate or make decisions. Other symptoms include changes in appetite, weight, sleep rhythm, sex drive and posture.

It is common for people with severe depression to wake early in the morning and experience a twice-daily (diurnal) change of mood, with the worst mood occurring in the morning. When it is severe, feelings of dislike, self-blame and worthlessness can even turn into thinking about suicide.

In addition to these symptoms, people with psychotic depression may experience delusions, complaining that they feel wicked or worthless, have a disease, or even have already died. Anorexia and weight loss is common in these people.

What is the treatment for depression?

In severe depression, there is an imbalance of chemicals in the brain. Studies have shown that antidepressant medication can shorten the length of depressive illness; it is usually more effective for the most severe forms. Antidepressant medications try to restore the balance of the brain chemicals, serotonin and noradrenaline. Two types of antidepressants are commonly used:

• tricyclic antidepressants, such as amitriptyline and imipramine
• selective serotonine reuptake inhibitors (SSRI’s), such as fluoxetine and paroxetine

Both medications have their own sets of advantages and side-effects, tricyclics are an older class of medication and can take up to six weeks before their benefit is felt Other stronger medicines, such as lithium, may be used to treat depressive psychosis.

Psychological treatments

Psychological treatment can be useful in combination with medication or for people whose depression has not responded to antidepressants. It may also reduce the likelihood of depressive illness returning.

Complementary therapy

Therapies such as the Alexander technique, which aims to improve posture and movement, relaxation techniques such as yoga, and t’ai chi may also help promote a sense of well-being and reduce stress.

What is the outcome of having depression?

About two thirds of people with depressive illness, who are treated effectively, will be free of their symptoms within four to six weeks. The rest will recover following a longer course of treatment. People with depressive psychosis respond extremely well to treatment but are at risk of the condition returning.

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