Living with
Depression

What is depression?

It is natural to feel sad or down at times. This is a normal part of everyday life, but when someone experiences sad or negative feelings that interfere with their normal functioning and that last for at least two weeks, they could be suffering from depression.
The first sign of depression is often a change in the person’s usual behaviour.

How do you know you have depression?

It is important to note that different people experience depression differently (for example, children may display unusual behavioural problems).
In some people depression is characterised not so much by a sad mood, as by increased irritability, unexplained pain, or other symptoms such as:

  • Persistent sad, anxious or “empty” mood
  • Loss of interest or pleasure in hobbies and activities that were once enjoyed, including loss of sexual desire sometimes
  • Feelings of hopelessness and pessimism
  • Feelings of guilt, worthlessness, helplessness or self-reproach
  • Insomnia, early-morning awakening or oversleeping
  • Appetite and/or weight loss or overeating and weight gain
  • Decreased energy, fatigue and feeling run down
  • Restlessness, irritability and/or hostility
  • Difficulty concentrating, remembering or making decisions
  • Persistent physical symptoms such as headaches, digestive disorders and chronic pain
  • Thoughts of death or suicide and/or suicide attempts.

What are the different types of depression?

  • Major depressive disorder (MDD): A period of severe depression when most of the symptoms of depression are experienced.
  • Dysthymia: Some depression symptoms are present over an extended period of time.
  • Bipolar disorder: Alternating periods of severe depression followed by extreme highs. This kind of depression is also known as “manic-depression”.
  • Seasonal affective disorder (SAD): Depression may occur only during specific seasons of the year, usually winter or autumn.
  • Post-natal depression: Feelings of sadness, anxiety, irritability and fear of not being able to cope that occur after childbirth.

How can you be diagnosed with depression?

Because of all the different ways depression can show itself in an individual, and how symptoms can vary be between different individuals, the diagnosis of depression is often difficult.
Eating and sleeping patterns can be exaggerated but in different directions; in other words, a person with depression may either sleep or eat too much or too little.
Observable symptoms of altered behaviour may also be externally minimal, while an affected person may be experiencing profound inner turmoil.

 

Your doctor may diagnose you with depression through one or more of the following ways:

  • Physical examination and history taking: Your doctor can look for physical signs of underlying medical conditions that can cause depression, such as signs of thyroid disease. While talking and interacting with a patient, a doctor can also observe their behaviour and general mood and ask questions about their general daily-life experience.
    Depression commonly occurs along with other chronic medical conditions like heart disease or cancer, and can worsen a patient’s health further. If you have any underlying or pre-existing, chronic medical condition, your doctor will probably ask you about your emotions and mood at check-ups or during screening.
    It is therefore very important that you try to be as honest and open as possible with your doctor and mental health professional.
  • Laboratory tests (blood tests): Your doctor can check for hormone and vitamin levels in the blood (particularly for levels of B vitamins and vitamin D). Blood tests can show if you have thyroid disease, for example.
  • Psychiatric exam: A psychiatrist or psychologist will talk to you about your thoughts, feelings and mood. They may use a questionnaire to help them.
    They will also determine whether you have any other mental health condition, like dementia or bipolar disorder, that are associated with depression. They may want to also talk to your family or caregiver to determine your everyday functioning.
  • DSM-5: Your doctor or mental health professional may use the criteria for depression listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association (these are the symptoms listed earlier).

Who gets depression?

Depression is a medical disorder that affects people of both sexes, all ages and races, cultures and social classes.
About 10 % of the general population will suffer from a depressive illness in any given year.
Women are twice as likely as men to have depressive symptoms.

What causes depression?

A number of different factors may contribute to the onset of depression. Very often, a combination of these factors plays a role in precipitating a depressive illness, including:

  • Genetic vulnerability: The likely development of depression, and predisposition to depression, is inherited. Therefore, you are more likely to suffer from depression if someone in your family has, or had, depression.
  • Psychological make-up and environmental factors: Being under increased stress or experiencing trauma or personal loss can put you at increased risk for depression.
  • Medical conditions: Common chronic medical conditions like thyroid disease, stroke, cancer and Cushing’s disease are all linked to depression.
    Depression can also be triggered by other mental health conditions, including anxiety disorders, schizophrenia, bipolar disorder, post-traumatic stress disorder, eating disorders and substance abuse.
  • Certain medications: These include steroids, birth control agents and some high blood pressure medications. Alcohol and certain recreational drugs, like cannabis (or marijuana or ‘weed’) and cocaine, have common depressive effects, and such substance use can cause depression.
  • Neurobiological variables: The symptoms of depression are mediated by chemicals in the brain, called neurotransmitters, such as serotonin and noradrenaline/epinephrine, levels of which fluctuate.
    Fluctuating hormone levels in the body, such as during pregnancy or post-partum/post-natal (in the weeks and months after giving birth) or because of medical conditions like thyroid disease, can also trigger depression.

What treatment is available for depression?

Like other medical illnesses, depression can be treated. In most cases the best treatment for depression is a combination of medication and psychotherapy (talk therapy).

Antidepressants are not addictive or habit-forming and can be safely used over an extended period. There are different types of antidepressants and each may have different side-effects, such as nausea, blurred vision, drowsiness, dry mouth, and sexual problems.

 

Benzodiazepines (tranquillisers) may sometimes be prescribed for the short-term control of anxiety symptoms that often accompany depression. These run the risk of dependency though.

 

Additionally, many types of antidepressant medications are available, but your genes may affect how you respond to them. It may be helpful to ask a family member who has depression what antidepressant they responded well to, as this medication may be able to help you too. However, you may need to try several medications or a combination of medications before you find one that works.
Be sure to discuss possible side-effects of any antidepressants you are taking with your doctor or pharmacist.

Some of the most common types of antidepressants are listed below:

  • Selective serotonin reuptake inhibitors (SSRIs): These types of antidepressants are usually the most commonly prescribed by a doctor, especially as the first choice after diagnosis. This is because SSRIs are considered safer and generally cause fewer side-effects than other types of antidepressants. SSRIs include sertraline , citalopram, escitalopram, fluoxetine, paroxetine  and vilazodone.
  • Serotonin-norepinephrine reuptake inhibitors (SNRIs): These are also commonly prescribed types of antidepressants, which include duloxetine, venlafaxine, desvenlafaxine and levomilnacipran.
  • Tricyclic antidepressants: While these drugs, such as amitriptyline, are usually very effective, they can also cause more severe side-effects than SSRIs. Therefore, tricyclic antidepressants are generally not prescribed unless you have tried an SSRI first.
  • Monoamine oxidase inhibitors (MAOIs). MAOIs, such as tranylcypromine, are typically prescribed when other medications fail to work. This is because they can have serious side-effects. Using MAOIs requires adherence to a strict diet because of dangerous interactions with certain foods (such as certain cheeses, pickles and wines, for example), some medications and herbal supplements.
    These medications cannot be combined with SSRIs.

Some improvements may be experienced immediately on starting antidepressant usage, but the full beneficial effects of pharmacotherapy are usually only achieved over a period of weeks or months, so this will require patience.
Medication must be taken regularly according to your doctor’s instructions and advice.

This means that you will also have to talk to your doctor about antidepressant use if you are planning to become pregnant, or are pregnant or breastfeeding.
Also speak to your doctor immediately if you experience suicidal thoughts, especially when you have just started taking an antidepressant; have started taking a different type of antidepressant or if your dosage has been changed – this is especially important for teenagers and children who are taking antidepressants.
Importantly, do not stop taking your antidepressant medications, or substitute or change their use, without first consulting your doctor, as withdrawal symptoms and worsening of your condition may occur if you suddenly stop taking your medication. If you need to stop taking your medication, your doctor must carefully instruct you on how to gradually and safely reduce the dosage first.

 

Psychotherapy may help you gain self-insight, change negative thoughts and feelings, and learn new behaviours and coping strategies. Talking about your emotions and depression with a trained professional can help reduce symptoms.
The different psychotherapy approaches most often used in depression are cognitive behavioural therapy (CBT), interpersonal psychotherapy and psychodynamic psychotherapy.

 

Joining a support group, relaxation techniques, regular exercise and lifestyle changes, including a balanced diet, have also been noted as beneficial in managing depression.

What to do and where to go for help?

The vast majority of people with depression respond well to treatment.
The first step in fighting depression is to discuss your symptoms with an experienced professional, like your family practitioner at the local clinic or day hospital.

Living and managing

  • Take care of yourself: Eat a healthy, well-balanced diet and get enough exercise and sleep. Engage in activities that you enjoy and that can help you to manage your stress levels, like listening to music, doing art, cooking, gardening or dancing.
  • Avoid alcohol and recreational drugs: You may think that alcohol or some illicit drugs make you “feel better”, but, in fact, they worsen depression and make it harder to treat.
  • Pay attention to warning signs: Talk with your doctor and mental health professional about ways to recognize if your symptoms are worsening or if you have any triggers that may be causing them to worsen (for example, using alcohol or certain situations that bring up memories of past trauma).
  • Stick to your treatment plan: Do not skip your medication or psychotherapy appointments or visits to your mental health professional. Sometimes it seems that you are doing better than other days and you may think that your depression has “gone away” but symptoms can often reappear between good periods.
  • Learn more about depression: Educating yourself about depression can make you feel empowered and more motivated to stick to your treatment plan. It can also help decrease the negative feelings or stigma you may feel if you have depression.
    Find out more about depression on Let’s Talk. You can find resources that you may find useful in helping to manage stress and stay positive. You can also find out about where to get help if you are struggling to cope and need someone to talk to.
Sources

Let’s Talk. (n.d.) Conditions: Depression. Available from: http://letstalkmh.co.za/condition/depression/

 

Mayo Clinic staff. (n.d.) Diseases and Conditions: Depression. Mayo Clinic. Available from: https://www.mayoclinic.org/diseases-conditions/depression/symptoms-causes/syc-20356007

 

Mayo Clinic staff. (n.d.) Diagnosis and Treatment: Depression. Mayo Clinic. Available from: https://www.mayoclinic.org/diseases-conditions/depression/diagnosis-treatment/drc-20356013

 

WebMD. (n.d.) Depression Diagnosis. Available from: https://www.webmd.com/depression/guide/depression-diagnosis#1

 

MedlinePlus. (2020) Health Topics: Caregiver Health. Available from: https://medlineplus.gov/caregiverhealth.html?utm_source=twitter&utm_medium=social&utm_term=&utm_content=&utm_campaign=

 

WebMD. (2005) Depression: The link between depression and other mental health illnesses. Cleveland Clinic. Available from: https://www.medicinenet.com/script/main/art.asp?articlekey=55161#:~:text=Depression%20can%20be%20triggered%20by,millions%20of%20Americans%20each%20year.

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Sources

Let’s Talk. (n.d.) Conditions: Depression. Available from: http://letstalkmh.co.za/condition/depression/

 

Mayo Clinic staff. (n.d.) Diseases and Conditions: Depression. Mayo Clinic. Available from: https://www.mayoclinic.org/diseases-conditions/depression/symptoms-causes/syc-20356007

 

Mayo Clinic staff. (n.d.) Diagnosis and Treatment: Depression. Mayo Clinic. Available from: https://www.mayoclinic.org/diseases-conditions/depression/diagnosis-treatment/drc-20356013

 

WebMD. (n.d.) Depression Diagnosis. Available from: https://www.webmd.com/depression/guide/depression-diagnosis#1

 

MedlinePlus. (2020) Health Topics: Caregiver Health. Available from: https://medlineplus.gov/caregiverhealth.html?utm_source=twitter&utm_medium=social&utm_term=&utm_content=&utm_campaign=

 

WebMD. (2005) Depression: The link between depression and other mental health illnesses. Cleveland Clinic. Available from: https://www.medicinenet.com/script/main/art.asp?articlekey=55161#:~:text=Depression%20can%20be%20triggered%20by,millions%20of%20Americans%20each%20year.