Depression

Depression is quite common and can be a serious illness. About 1 in 10 would suffer from severe depression at some point in their lives. Women are more affected than men.

Symptoms can be both psychological and physical

Psychological symptoms

  • continuous low mood or sadness,
  • feelings of hopelessness and helplessness,
  • low self-esteem,
  • tearfulness,
  • feelings of guilt,
  • feeling irritable and intolerant of others,
  • lack of motivation and little interest in things,
  • difficulty making decisions,
  • lack of enjoyment,
  • suicidal thoughts or thoughts of harming someone else,
  • feeling anxious or worried, and
  • Reduced sex drive.


Physical symptoms

  • slowed movement or speech,
  • change in appetite or weight (usually decreased, but sometimes increased),
  • constipation,
  • unexplained aches and pains,
  • lack of energy or lack of interest in sex,
  • changes to the menstrual cycle, and
  • Disturbed sleep patterns (for example, problems going to sleep or waking in the early hours of the morning).


Socially the individual would be withdrawn, not performing well at work, taking part in fewer social activities, avoiding contact with friends and has reduced hobbies and would derive no pleasure from pursuing them.

Causes

  • Family history- individuals with a family history of depression are more likely to suffer from depression. Reduced levels of certain chemicals in the brain known as neurotransmitters such as dopamine, nor-epinephrine and serotonin are seen in depression and the genes that are responsible for producing these chemical mediators can be defective in depressive individuals.
  • Psychological - due to an upsetting event such as bereavement, redundancy, divorce or monetary difficulties.
  • Physical – due to hormonal imbalance as may occur with menstruation, pregnancy, childbirth, miscarriage and menopause.
  • Social – due to less social pursuits such as going out, limited or no friends.
  • Excessive drinking
  • Recreational drugs such as cannabis and cocaine
  • Some of commonly used medications can cause depressions as a side effect.


Diagnosis

  • A thorough history
  • A focused examination and blood tests to rule out conditions such as underactive thyroid which can mimic or cause depression
  • A questionnaire derived from the Diagnostic and statistical manual of mental disorders.


Treatment

Depression is usually divided into mild, moderate and severe depression.

Mild depression

  • Usually doesn't need medication
  • Behavioural therapy and physical exercise might help


Moderate depression

  • Talking therapy which involves sessions with a clinical psychologist or psychiatrist.
  • Anti-depressant medications might be prescribed.


Severe depression

  • Anti-depressants together with talking therapy help.
  • Psychotherapy which is intensive talking therapy with a multi-disciplinary approach involving psychologists, psychiatrist, specialist nurses and occupational therapists.


Talking therapy

  • Cognitive behavioural therapy – is based on the principle that the way we feel is dependent on the way we think about things in life. It strives to change the way we think about things and coping with negative thoughts.
  • Interpersonal therapy – strives in improving interpersonal relationships.
  • Counselling – it helps the individual to talk about the problems he is facing and in finding solutions to the problems.


Medications

Anti depressant medications usually take about 2 to 4 weeks to work. If the dose is not effective then the dose might have to be increased or if it causes side effects either the dose needs to be lowered or the drug discontinued altogether. It is advisable that this is done by a medical practitioner or a treating psychiatrist. If the medication appears to be working at a set dose then they can be continued for up to four to six months. If they don't work then the medication cn be changed to a different group of drugs.

Group of drugs for depression

  • SSRIs (selective serotonin reuptake inhibitors) - these drugs are commonly used to treat depression. They act by increasing a chemical called serotonin in the brain. Commonly used examples include Fluoxetine, citalopram and sertaline. These medications are best prescribed and monitored by your medical practitioner or a treating psychiatrist.
  • TCAs (tricyclic antidepressants) – these drugs were widely used in the past, but still prescribed. They increase chemicals such as serotonin and nor-adrenaline in the brain which improve mood. Examples include amitriptyline, imipramine and dothiepin.
  • MAOIs (monoamine oxidase inhibitors) – this group of drugs are used when increased sleep and appetite are part of depression. Examples include phenelzine. These drugs are to be used with caution as they do interact with other medications. They are also known to cause “hypertensive crisis” after ingestion of foods containing tyramine especially aged cheese.
  • SSNIs (selective serotonin nor-epinephrine inhibitors) - such as venlafaxine, nefazodone and mirtazapine. They increase the levels of serotonin and nor-epinephrine which improve mood.


Electroconvulsive therapy (ECT) – ECT is used when medications don't work and in very severe depression. Under anaesthesia and medication to relax muscles electric shock is administered head through electrodes placed on the head. Common side effects are confusion and memory loss.

Lithium – sometimes lithium can be prescribed. It is vital that the levels of lithium in the blood are monitored closely as high levels could cause toxicity.

Please consult the online doctor for bespoke, evidence based and confidential medical advice.