Hope For All

sxydaniella · Posted: Mon Oct 22, 2007 10:23 pm Post subject: depression *trigger*

Depression is a serious illness. Health professionals use the terms 'depression', 'depressive illness' or 'clinical depression' to refer to something very different from the common experience of feeling miserable, or fed up, for a short period of time.
The facts
If you are depressed, you may have feelings of extreme sadness that can last for a long time. These feelings are severe enough to interfere with your daily life, and usually last for weeks, or months, rather than days.
Depression is quite a common condition, and about 15% of people will have a bout of severe depression at some point in their lives. However, the exact number of people with depression is hard to estimate because many people do not get help, or are not formally diagnosed with the condition.
Most of the 5,000 suicides committed each year in the UK are linked to depression. On average, 15% of people with recurrent depression (repeated attacks) have an increased risk of suicide.
Women are twice as likely to suffer from depression as men, although men are far more likely to commit suicide. This may be because men are more reluctant to seek help for depression.
Depression can affect people of any age, including children. Studies have shown that 2% of teenagers in the UK, are affected by depression.
People with a family history of depression are more likely to experience depression themselves. Depression affects people in many different ways and can cause a wide variety of physical, psychological (mental) and social symptoms.
What is depression?
Doctors describe depression in the following three ways:
by how serious it is - if it is mild, it is likely to have some impact on your daily life, if it is moderate, it is likely to have significant impact on your daily life and, if it is severe, daily activities may be almost impossible.by physical symptoms - if you have depression, you will probably have one or two (or maybe more) physical (somatic) symptoms, such as tiredness or a loss of appetite.by psychotic symptoms - if you have depression, you may also have psychotic symptoms, such as hallucinations, or delusions. However, these symptoms do not affect everyone with depression.A few people still think that depression is 'not a real illness', and that it is some sort of 'weakness', or admission of failure. This is simply not true. Depression is a real illness with real effects, and it is certainly not a sign of failure. In fact, famous leaders, such as Winston Churchill, Abraham Lincoln and Mahatma Gandhi, all experienced bouts of depression.
If you are depressed, you often lose interest in the things that you used to enjoy. Depression can interfere with your work, your social life, and your family life. In addition, there are many other symptoms, which can be physical, psychological, and social.

Psychological symptoms

Psychological symptoms of depression include:
continuous low mood, or sadness, feelings of hopelessness and helplessness, low self-esteem, tearfulness,feelings of guilt,feeling irritable and intolerant towards others,lack of motivation, and little interest in things in general,lack of enjoyment,difficulty making decisions,suicidal thoughts, or thoughts of harming someone else,feeling anxious or worried, and a reduced sex drive.Physical symptoms
Physical symptoms of depression include:
slowed movement and speech,change in appetite and weight (your weight will usually decrease, but sometimes it may increase), digestive complaints, such as indigestion, constipation or diarrhoea ,unexplained aches and pains,lack of energy and a lack of interest in sex, andchanges to the menstrual cycle (in women).Social symptoms
Social symptoms of depression include:
not performing well at work,taking part in fewer social activities, and avoiding contact with friends,reduced hobbies and interests, anddifficulties in home and with family life.Grief and depression
Even though grief and depression share many of the same characteristics, there are important differences between them. Grief is an entirely natural response to a loss, while depression is an illness. However, sometimes, it can be hard to distinguish between feelings of grief and depression.

People who are grieving find that feelings of loss and sadness come in waves, but they are still able to enjoy things, and are able to look forward to the future. However, those who are depressed have a constant feeling of sadness, they do not enjoy anything and have little sense of a positive future.

Treatment for depression usually involves a combination of using medication and psychological therapies.
Mild depression
If you are diagnosed with mild depression, but your GP thinks you will improve, you should have another assessment in two weeks time to monitor your progress. This is known as 'watchful waiting'.
If you have mild depression, antidepressants are not usually recommended as a first treatment. Exercise seems to help some people with depression. While your progress is being monitored, your GP may refer you to an exercise scheme with a qualified fitness trainer.
Talking through your feelings may also be helpful for mild depression. You may wish to talk to a friend or relative, or your GP may suggest a local self-help group. Your GP may also recommend self-help reading materials and computerised cognitive behaviour therapy (CBT) (see below for further details).
If your depression is mild, but you have a history of depression, your GP may suggest that you start a course of antidepressants (see below for further details).
Chronic mild depression (present for two years or more) is called dysthymia. It is more likely in people over 55 years of age and can be difficult to treat. As with mild depression, if you are diagnosed with dysthymia, your GP may suggest that you start a course of antidepressants.
Moderate depression
If you have mild depression which is not improving, or you have moderate depression, your GP may recommend a 'talking treatment', or prescribe an antidepressant (see below for further details).
Severe depression
If you have severe depression, your GP may recommend that you take an antidepressant, together with talking therapy. In cases of severe depression, a combination of an antidepressant and cognitive behaviour therapy (CBT), usually works better than having just one of these treatments.
If you have severe depression, or your depression does not respond to treatment from your GP, you may be referred to a mental health team. These teams are usually made up of psychologists, psychiatrists, specialist nurses, and occupational therapists. They often provide intensive specialist talking treatments, such as cognitive therapy or psychotherapy.
Talking treatments
Cognitive behavioural therapy (CBT)
Cognitive behavioural therapy (CBT), problem-solving therapy, and counselling, are examples of talking treatments. You normally have a fixed number of sessions - usually 6-8 sessions over 10-12 weeks. Some GP practices have counsellors specifically to help patients with depression.
Cognitive behavioural therapy (CBT) is based on the principle that the way we feel is partly dependent on the way we think about things. It teaches you to behave in ways that challenge negative thoughts - for example, being active to challenge feelings of hopelessness.
Interpersonal therapy (IPT)
Interpersonal therapy (IPT) focuses on your relationships with other people and on problems, such as difficulties with communication, or coping with bereavement. There is some evidence that IPT can be as effective as medication or CBT, but more research is needed.
Counselling
Counselling is a form of therapy that helps you to think about the problems you are experiencing in your life, in order to find new ways of dealing with them. Counsellors support you in finding solutions to problems, but do not tell you what to do.
Research has shown that antidepressants and talking therapies are equally effective in treating mild, or moderate, depression, but having the two types of treatment together does not seem to offer any extra benefits. Your preference and the availability of talking therapies will be taken into account when deciding which treatment is most appropriate for you.
Antidepressants
Antidepressants take 2-4 weeks to take effect. If the first antidepressant you try is not effective, or causes side effects, it may be necessary to change the dose. Sometimes, a different type of antidepressant will be recommended.
Your GP, or specialist nurse, should see you every 1-2 weeks when you start taking antidepressants. You should continue taking the antidepressants for at least four weeks (six weeks if you are elderly) to see how well they are working. If your antidepressants are working, treatment should be continued at the same dose for at least four to six months (12 months if you are elderly) after your symptoms have eased. If you have a history of depression, you should continue to receive antidepressants for up to five years, or longer.
Antidepressants are not addictive but withdrawal symptoms are quite common if you stop taking them suddenly, or you miss a dose.
SSRIs
If your GP thinks you would benefit from taking an antidepressant, you will usually be prescribed an SSRI (selective serotonin reuptake inhibitor).These are as effective as the older TCAs (tricyclic antidepressants) and have fewer side effects. Fluoxetine, paroxetine, citalopram and sertraline are all examples of SSRIs. You will normally only be prescribed other sorts of anti-depressants, if the SSRI's do not prove to be effective.
SSRIs increase the level of a natural chemical in your brain called serotonin which helps to lift your mood. You may have some side effects when you start taking SSRIs, such as nausea, headache, sleep problems and anxiety. However, these tend to improve over time.
SSRIs such as Paroxetine should not be prescribed for children under the age of 18 years. Research shows that the risk of self-harm and suicidal behaviour may increase if they are used to treat depression in this age range. Fluoxetine is the only SSRI that may be prescribed for under-18s, but only when specialist advice has been given.
Other antidepressants include:
TCAs (tricyclic antidepressants), such as dothiepin, imipramine, and amitryptyline. These are used to treat moderate to severe depression. They work by raising the levels of the chemicals serotonin and noradrenaline in your brain which both help to lift your mood. You should not smoke cannabis if you are taking TCAs because it can cause your heart to beat rapidly.MAOIs (monoamine oxidase inhibitors), such as phenelzine sulphate, is sometimes used to treat 'atypical depression'. This is when you tend to eat and sleep more than usual. You should not smoke cannabis if you are taking MAOIs because it may affect the way these medicines work, and it is not clear what effect this may have on you.New antidepressants, such as venlafaxine, nefazodone, and mirtazapine, work in a slightly different way from SSRIs and tricyclics. These drugs are known as SSNI's (Serotonin-norepinephrine reuptake inhibitors). Like TCA's, these antidepressants work by changing the levels of serotonin and noradrenaline in your brain. Studies have shown that a SSNI like venlafaxine can be more effective than a SSRI, though it is not routinely prescribed as it can lead to a rise in blood pressure.St John's wort
St John's wort is a herbal treatment that some people take for depression. Though there is some evidence that it may be of benefit in treating mild or moderate depression, its use is not recommended. This is because the quantity of its active ingredients vary among individual brands and batches, so it is uncertain what sort of effect it could have on you.
Taking St John's wort with other medications, such as anticonvulsants, anticoagulants, antidepressants and the contraceptive pill, can also cause serious problems.
You should not use St John's wort if you are pregnant or breastfeeding as there is not enough evidence that its use is safe in these situations.
Electro convulsive therapy (ECT)
Sometimes, other treatments, such as specialist medicines, or electro convulsive therapy (ECT), may be advised if you have severe depression. Electro convulsive therapy (ECT) works for severe depression, but it is only used when antidepressants and other treatments have not worked.
If ECT is recommended for you, you will first be given an anaesthetic and medication to relax your muscles. You will then receive an electrical 'shock' to your brain through electrodes placed on your head. You may be given a series of ECT sessions. For most people, the treatment works well in relieving severe depression, but the effect may not be permanent. Some people may experience unpleasant side effects, including memory problems.
Lithium
If you have tried several different antidepressants and have experienced no improvement, your doctor may offer you a type of medication called lithium, in addition to your current treatment.
There are two types of lithium - lithium carbonate and lithium citrate. Both are usually effective, but if you are taking one that is effective, it is best not to change. In order to work, you have to have a certain level of lithium in your blood. If this level becomes too high, the lithium can become toxic. Therefore you will need blood tests every three months to check your lithium levels. You should also avoid going on a low-salt diet because this can also cause the lithium to become toxic - consult your GP for advice about your diet.
Before you start taking lithium, you should have an electrocardiograph (ECG) to check your heart.