Jason Brien.
What is depression?
Clinical depression (also known as major depression, major depressive disorder or unipolar depression) is a serious mental illness that negatively affects how a person thinks. There are a variety of different symptoms with not all people suffering from depression experiencing all of the symptoms. However, if a person experiences some or all of these symptoms for the majority of the day, every day for more than two weeks, then they should seek medical or professional help.
What are the symptoms of depression?
Depressive symptoms fall across 3 categories;
Psychological Symptoms
•Feeling hopeless and helpless.
•Continuous low mood or sadness.
•Tearfulness.
•Low self esteem.
•Irritability.
•Intolerance of others.
•Guilt ridden.
•Little motivation or interest in things.
•Finding it hard to make decisions.
•Not finding any enjoyment in life.
•Anxiety (Some people with depression will also have feelings of anxiety. Anxiety is a feeling of fear and concern. It can have behavioural, social and cognitive aspects).
•Suicidal thoughts or thoughts of harming themselves.
Social Symptoms
•Taking part in fewer social activities.
•Avoiding contact with friends and family.
•Not doing well at work.
•Neglecting hobbies and interests.
•Having difficulties in home and family life.
Physical Symptoms
•Moving more slowly than usual.
•Speaking more slowly than usual.
•Change in appetite and weight – this is usually a decrease, but can sometimes be an increase.
•Lack of energy.
•Lack of interest in sex.
•Unexplained pains and aches.
•Changes in a female’s menstrual cycle.
•Disturbed sleep – such as, finding it hard to fall asleep at night, waking very early in the morning.
What causes depression?
Many factors can lead to depression. It is thought that there could be a hereditary component due to chemical changes in brain function. A normally functioning brain is simply a massive communication system that controls everything from your heartbeat, to walking, to your emotions. Neurons in your brain send and receive messages from the rest of your body, using brain chemicals called neurotransmitters. These brain chemicals, in varying amounts, are responsible for our emotional state. Depression happens when these chemical messages are not delivered correctly between brain cells, disrupting communication.
How is depression treated?
Talking Therapies
Research has shown that talking therapies, such as counselling, psychotherapy, life coaching, etc, are some of the best treatments for depression. People may have therapy for a few months to work on key issues, whilst others may have therapy for years to work on larger problems. The choice will depend on the individual and what works best for them. There are many different forms of talking therapy, but the most common are:
Interpersonal Therapy which focuses on the person and their relationship with others and how that affects you. The professional will help the person to identify and change unhealthy behaviours.
Cognitive Behaviour Therapy (CBT) helps people to see how their behaviours and the way in which they think about things can play a role in their depression. The professional will help the person to try to break away from their unhealthy/distorted way of thinking and learn new healthier patterns.
Problem Solving Therapy focuses on specific problems the person may face then helps them to find some solutions to their difficulties.
Medication is also a key treatment for depression. There are many different antidepressant drugs available and more become available all the time. If one antidepressant does not work, another may, so it is important for the person with depression to work closely with their doctor to determine the most successful treatment. Examples include:
SSRI (selective serotonin reuptake inhibitors) – These have mild side effects, but can include dizziness, insomnia, weight change, headaches, sexual problems.
SNRI (serotonin and norepinephrine reuptake inhibitors) – Again can include side effects such as anxiety, dizziness, fatigue, sexual problems, insomnia.
TCAs and MAOIs (tricyclic antidepressants and monoamine oxidase inhibitors) – Can seriously interact with other drugs and certain foods. They can cause dry mouth, changes in blood pressure and blood sugar levels, nausea, dizziness etc. They are not often used as a first treatment with depression.
All people taking antidepressant medication need to be closely monitored as they are also linked to an increased risk of suicide. It is important for any person with depression to work closely with their doctor to look at the benefits and risks of any treatment.
What if talk therapies and medication don’t work?
ECT (Electroconvulsive Therapy):
ECT is a more extreme treatment for depression. It can be an effective and safe treatment for people with severe depression who have not been helped by therapy or medication. With ECT a doctor uses electrical charges to create a controlled seizure. They use electrodes attached to the skull to present the charge. The seizures appear to affect the chemical balance and functioning of the brain. The person is also given anaesthesia and a muscle relaxant during the treatment.
ECT tends to work quickly, with 70 – 90% of people showing an improvement. The person may have 12 sessions of ECT over a few weeks. Some people will also have a maintenance therapy of ECT to prevent the depression from returning. There is a common side effect of temporary memory loss.
VNS (Vagus Nerve Stimulation):
VNS is a treatment option for people with severe depression, for whom medication and therapy have not been effective. VNS involves the implantation of a small electrical generator into the person’s chest, similar to a pacemaker. The device has wires attached to the vagus nerve that runs from the neck into the brain. Electrical pulses are then delivered through the vagus nerve to the area of the brain that is thought to be responsible for regulating our moods. The charges also change the chemical balance in the brain and relieve the depression.
Transcranial Magnetic Stimulation:
This is another non-drug treatment that can be used for medication/therapy resistant depression. TMS uses a magnetic field to induce a small electric current to a specific area of the brain. It does not cause loss of consciousness or seizures. It is used to treat milder depression in people who have not benefited from trying two or more antidepressant treatments. It does not require sedation. The person will be treated four or five times a week for four weeks.
References
https://www.nature.com/articles/s41398-019-0460-3
https://jamanetwork.com/journals/jamapsychiatry/fullarticle/482031
https://www.neurologic.theclinics.com/article/S0733-8619(10)00137-4/fulltext