Awareness of clinical depression is growing and more anti-depressant drugs are being prescribed than ever. Here’s how medication and  talk therapies work together to create light at the end of the mind’s dark tunnel

By Dr. Thomas Ungar

It’s a crying shame. When you’re depressed, nothing seems worth doing. Everything seems doomed, life looks hopeless and going to see a doctor about it sounds like just another pointless waste of time. Welcome to the Catch 22 of the depressed person. Because the symptoms of this illness often impair a person’s ability to seek help, it can take something as serious as a suicide attempt to bring a person into treatment. Luckily, there’s an increasing awareness that depression is more than just a bad mood and more people are getting treatment for depression than ever before.

How depressed is depressed? We all know that everybody feels down from time to time. Feeling sad or blue, crying, or being depressed about something is a normal part of being human. But when feeling down becomes a predominant mood that doesn’t go away, it might be a medical illness known as Clinical Major Depression. Although the causes are not entirely understood, impaired function of certain neurotransmitters, the brain chemicals that trigger mood and mental states, are definitely part of the picture. What often seems to happen is that an event in someone’s life, such as loss or death, causes normal feelings of sadness and grief. These emotions cause chemical changes in the brain, and then, as the person comes to terms with the situation, the chemical balance returns to normal. However, in some people, possibly due to a hereditary pre-disposition, the brain’s chemical function stays stuck in low gear. Sometimes, though, there is no obvious trigger, and depression sets in purely as a result of brain chemical malfunction.

The resulting depression is as real as diabetes, high blood pressure or arthritis, and as with any other medical illness, the condition takes on a life of its own. Unfortunately, there is no single blood test or X-ray that can diagnose depression. The standard diagnosis is based the presence of five out of nine depression symptoms for longer than two weeks, when no other cause such as recent bereavement or physical illness is present. A depressed mood persisting over at least two weeks is one of the most important symptoms and the one that gives depression its name. Other symptoms include a lack of interest and motivation, disrupted sleep, feelings of guilt, a decrease in energy, lack of concentration and changes in appetite. The most serious effect of the illness, though, is the possibility of suicide. About two-thirds of people who suffer from depression think about it and 10 to 15 percent actually commit suicide. For this reason, depression should never be taken lightly or left untreated.

Depression is one of the most common mental health disorders and affects about six percent of people at some time in their lives. Major depression can appear in any age group, but most episodes occur between the ages of 20 and 50. The first depressive episode typically happens around 40, often with no warning that a tendency exists. The illness cuts across all income and socio-economic groups, and although women are believed to be twice as likely to suffer from depression as men, the reasons are still unclear. People who have a family history of depression or suffered losses early in life may be more at risk.

The goal of treatment for depression is to restore the delicate balance of neurotransmitters, so that the brain can function normally again. For milder cases of depression, this can often be achieved through psychotherapy or counseling, by consciously redirecting thought patterns. Exercise is also known to affect neurotransmitter levels and can be an important part of an overall strategy for mild depression. Many people report a benefit from the herb St. John’s Wort, although, because self-diagnosis can be dangerous, it should not be used without the advice of a
medical professional. It is important to make sure the therapist is qualified to treat depression and knows when ‘talking therapy’ alone is not enough.

When depression becomes moderate to severe in intensity, medications are often used. Many types of anti-depressant medications are now available that are safe and have few side effects. These medications work by chemically restoring the normal natural balance of neuro-transmitters in the brain that the illness has altered, and are usually used in conjunction with psychotherapies. With anti-depressants, it’s important to understand that the drugs are not effective for the first two weeks. Since this is when the patient is most depressed, it’s critical that the person gets extra support during this period to prevent abandonment of the treatment.

In extreme cases of depression, when someone has stopped eating or drinking or is actively seeking suicide, ECT (electro convulsive therapy, commonly known as “shock treatment”) is used. Despite the negative public image, ECT remains an effective, if drastic, treatment and is invaluable in extreme cases.

Now that so many more people are aware of depression and its serious nature, more and more people who suffer from the illness are finally getting treatment. However, many of the symptoms of depression are also symptoms of other illnesses. Hypo-thyroid, liver problems, anaemia, infections, diabetes, alcohol abuse, or anything that causes fatigue and sleep disruption can look like depression. Therefore, it’s very important to eliminate other possible causes of the symptoms.

One of the biggest obstacles to treating depression is getting the depressed person to accept treatment in the first place. Depression clouds thinking and makes it difficult for the person to realize that things aren’t normal. That’s why it’s very important for people close to someone suffering from depression to talk about it and to urge the person to see a doctor. Many patients come in for help, not because they themselves have decided they need help, but to make someone else happy. Other times, it’s an employer or an insurance issue that prompts them to seek treatment. And sometimes it’s the policeman who drags them away from the sixteenth story window. With depression, we need to overcome our reluctance to interfere in someone’s life and recognize that untreated depression is not only frustrating – it can be life-threatening.

The good news about depression is that, unlike other mental illnesses such as schizophrenia, depression doesn’t usually mean a life-time of drug dependency. Once the mental balance has been restored, usually within six months to a year with treatment, most patients can stop taking medications and are able to return to normal life. Depression may recur, however, many people never experience the illness again. Chances for recovery are good, which is the best reason of all to start looking on the bright side.

The depression facts
If five or more of the following symptoms persist together over the same two week period or longer, it’s time to see a doctor.

1. Do you feel depressed, empty or
irritable most of the day, just about every single day?
2. Do you not care about doing the things you used to enjoy?
3. Have you noticeably gained or lost weight, even though you haven’t been trying? Does food seem boring and unappealing? Or are you eating
continuously and enjoying it less?
4. Is sleeping a problem every night?
5. Do you feel worthless or responsible for things that you know are out of your control?
6. Have other people noticed that you’re moving more slowly or that you’re more fidgety than before?
7. Do you feel tired, worn out, with no energy, nearly every day?
8. Are you having trouble focusing, concentrating and making decisions?
9. Do you find yourself thinking about death? Does death seem attractive?

Medical emergency
In the case of severe depression or suicidal thoughts, go directly to a hospital emergency ward.

– Dr. Thomas Ungar is a Psychiatrist at North York General Hospital