A feeling of sadness that can range from occasional low spirits to constant and overpowering despair.

Depression is the most common serious psychiatric illness, and it becomes more common with age. Girls are especially exposed due to their hormones.

Plummeting hormone levels can trigger depression when menstruation stops at the menopause, after the arrival of a child and after a miscarriage or conclusion. About 1 in 6 women seek help for depression at some time in their own lives, as opposed to only 1 in 9 guys. Most depressed people find they feel somewhat better as the day advances.

Risk Factors

■ Depression before or a family history of depression.
■ Poor health (like a stroke or heart attack).
■ Widowhood and widowerhood.
■ Loss of a partner.
■ Character issues.
■ Isolation.
■ Deficiency of assurance.
■ With aged individuals, alterations in health and conditions, including giving up the family house.

Causes

The basis for depression is complex but is likely related to a decrease in the amount of specific substances in the brain, called neurotransmitters, which keep us in a great disposition by stimulating brain cells. The best known of these disposition lifts is serotonin.

Depression is commonly a natural response of the individual to life, with its disappointments, relationship problems and stresses, for example serious illness, bereavement, divorce or money worries. Psychiatrists call this type reactive depression and. in general, both the reason and the degree of depression arc understandable to an onlooker sharing the same culture.

Biochemical reasons

Depression beyond these understandable limits is thought to have a largely biochemical cause. Within the brain, nerves communicate by means of biochemical messengers called neurotransmitters. There are hundreds of types, several of which are thought to be linked to moderate and severe depression -these include noradrenaline, dopamine and serotonin.

Depression considered mainly biochemical in origin is called endogenous or psychotic depression. There is no hard cut off between endogenous and reactive types of depression; rather they merge into each other and overlap, although extremes of each type are clearly of a different order of magnitude.

Other causes

Depression is sometimes the expression of an underlying problem – commonly alcoholism (see Alcohol and alcoholism). The elderly, especially if suffering from early dementia, become depressed probably in reaction to awareness of their deteriorating health and memory. Depression after childbirth affects up to 20% of women and can fast become very severe. Depression in young people can occur because of early schizophrenia, where the individual is struggling to cope with disordered thought. Rarely, depression can result from brain disease, although there are usually additional features more specific to brain disease, such as paralysis or epilepsy.

Depression runs in families, as do other serious psychological illnesses such as schizophrenia. The close relatives of severe depressives are therefore two or three times more likely to become severely depressed than the general population.

Symptoms

Depressed individuals get no enjoyment out of life; they tecl sad and may tell others how sad they feel. They dwell on the things that go wrong at the exclusion of things going right. As depression deepens they cry more easily and arc increasingly preoccupied by thoughts of death, decay or bad events. They suffer sleep disturbance and often wake in the early hours of the morning, worrying (see Insomnia). This is the common pattern of reactive depression of one degree or other.

It symptoms go beyond this point, the depression is more endogenous in nature. Often great agitation accompanies the depression while some sufferers become withdrawn and apathetic. Eventually, they think of suicide or even attempt it. In the most depressed state, the individual may end up mute and unresponsive, shut away in a world where they feel themselves rotting from within and where suicide is not awful but a logical release. Clearly such profound psychotic depression goes way beyond our normal experience of depression, and is not something out of which one can ‘pull oneself together’.

■ Tiredness.
■ Slumber issues.
■ Stress.
■ Weepiness.
■ Depression, despair, anguish, gloom and blackness.
■ Loss of fondness towards oneself and others.
■ A sense of failure, unworthiness, even self-loathing.
■ Loss of interest in life.
■ Loss of sex drive.
■ Loss of self esteem and trust.
■ Modified desire (generally a loss of desire).
■ Lethargy, slovenliness and apathy.
Insomnia or sleeping for long periods as a means of escape.
■ Early-morning awakening – usually between 2 a.m. and 4 a.m.
■ A confidence the world is against you, paranoia, persistent thoughts of death, even suicide.

Physical symptoms and investigations

Beyond the recognizable look of sadness, severely depressed people neglect themselves and lose their appetite. Often they suffer from constipation and complain of generalized pains for which no physical cause can be found. Except in the most obvious cases, doctors will do a physical examination and basic blood tests. The conditions most often confused with depression are an underactive thyroid gland (see Thyroid problems) and, much less commonly, brain disease such as a brain tumour or dementia. An underlying cause may be discovered, such as alcohol abuse, which needs specific handling.

Treatment

Try and see your physician at the same time if you are feeling depressed. Don’t wait and trust your mood will pass. In the instance of of weepiness after the arrival of a baby, see your physician if you’re still depressed after fourteen days. The more postnatal depression remains untreated the more difficult it’s to treat.

It is common human experience that sharing problems are comforting. Psychological treatment of depression is based on this, although the actual theories may vary. The best known, psychoanalysis, holds that many psychological problems are the result of unconscious conflicts between repressed desires, conflicts influenced in turn by childhood experiences. Psychoanalysis aims to uncover and come to terms with conflicts, and can take years of therapy.

Classic psychoanalysis is too time-consuming for most people and so is less available than counselling, of which there arc many varieties with differing theoretical frameworks. Counselling lets people talk about what underlies their depression (or many other emotions), while the counsellor gently tries to guide their thoughts towards a positive outcome. Counselling docs not have to be given by a professional to be effective and there are undoubtedly people who are naturally ‘good listeners’, who can help others simply by psychological support, although it is difficult to prove this scientifically. Psychological approaches are most useful in mild to moderate depression, which appears to be a reaction to sad life events but where the individual can still cope with life.

Drug therapy

Serious depression that is long lasting or profound needs treatment in addition to psychological support. It is a dangerous condition since 5-10% of sufferers-will attempt suicide. (This is why everyone treating them has to be constantly judging the risks and deciding if they should be referred to a psychiatric unit – for enforced treatment if necessary.) Drug treatment reduces depression and this suicide risk rapidly. It also brings the individual to a point at which he can look more rationally at his problems and so get more out of psychological support. Drug treatment is continued for six to twelve months on average.

It is controversial whether antidepressants are of any benefit for people with mild depression but psychiatrists increasingly believe that they are useful in people whose depression, although mild to an outsider, is significantly affecting their quality of life.

Tricyclic antidepressants used to be the drugs most widely used. They work by altering the levels of neurotransmitters in the brain, taking two to three weeks to do so. Drug names include imipramine, amitriptyline and dothiepin.

Kach drug varies a little in its type of action and side effects, but they all share the common side effects of drowsiness, dry mouth, blurred vision and, in overdose, dangerous heart
rhythm irregularities. The danger of overdose is critical, because of the constant risk that a depressed person may attempt suicide. Nevertheless, tricyclic drugs remain extremely useful and effective in treating serious depression.

SSRIs (selective serotonin reuptake inhibitors) are increasingly popular. The name refers to levels of a neurotransmitter in the brain – serotonin. These drugs have fewer side effects and, crucially, are much safer in overdose than tricyclics and are therefore used for anyone posing a serious suicide risk. As they do not generally cause drowsiness they are useful in treating people who arc working or having to cope with family responsibilities. Drug names include fluoxetine and paroxetine. New classes of antidepressants such as venlafaxine combine the benefits of SSRTs and tricyclic antidepressants.
Other treatments

There arc many other drugs for selected cases. In particular, lithium is useful for people who swing between depression and excitement bipolar affective disorder (manic-depressive psychosis). Electroconvulsive therapy (ECT) is a controversial option for the most severe and resistant eases of depression where there is a major suicide risk. For some reason, passing a high voltage across the brain cures depression, so ECT may be the only therapy left for someone in the deepest depression.

Complementary Treatment

Western herbalism – St John’s wort can be helpful for mild depression. Bach flower remedies – try mustard if the depression comes for no apparent reason, gentian if you know the cause, gorse for a sense of hopelessness, sweet chestnut for utter despair, willow for bitterness and self-pity. Art, dance movement, drama or music therapists can help you become aware of the underlying unconscious causes by enabling you to express feelings through the arts. Greater understanding leads to improved self-esteem and motivation. Shiatsu-do calms the nervous system and has positive benefits on the emotions. Useful aromatherapy oils include neroli, rose, jasmine and bergamot. Use as inhalations (two to four drops in a bowl of hot water, or on a handkerchief) or in the bath (six drops). Nutritional therapy – try supplementing F5 vitamins. Ollier therapies to try: healing; cymatics; yoga; hypnotherapy; tai chi/chi hung; acupuncture; auricular therapy; Alexander Technique; homoeopathy; Ayurveda; chakra balancing; autogenic training; biodynamics.

Getting Help

Don’t attempt to survive alone. Trim on individuals. Join a self-help group and get help coping with your regular issues. Avoid being alone and make a point of being with people you enjoy. Don’t be scared to approach organizations for example the Samaritans.

Self Help

For moderate depression

WORK: If work diverts you, raise your workload.

KEEPING ACTIVE: Almost any action helps reduce depression and will bring the joy of accomplishment. Finishing a job provides you with a sense of self-value, which itself is an antidote to depression.

SEX: Great, wholesome sex makes all facets of life appear brighter, so if your libido isn’t depressed, keep sexually active. DIET: Avoid junk food and sugar and increase your consumption of wholegrain cereals, vegetables, fruit, lean meats, low fat dairy products and fish.

The amino acid tryptophan has been discovered to alleviate depression and natural sources contain turkey, chicken, fish, peas, nuts and peanut butter. Where potential eat them with carbs, like potatoes, pasta and rice, which ease the brain’s uptake of tryptophan. Cut out or reduce caffeine and alcohol.

EXERCISE: Exercise relieves a variety of mental strain. Additionally, it raises blood circulation to the brain. Jogging for 30 minutes three times weekly can be as effective as psychotherapy in treating depression. So, a regular routine of exercise – walking, swimming or whatever allure – is great for your disposition. AROMATHERAPY: Essential oil of clary sage is both a strong relaxant and emotionally uplifting. It can relieve mental fatigue and encourage sound sleep. Place two to three drops into a bowl of steaming water and inhale or inhale four to six drops from a tissue. EASINESS: Relaxation techniques to reduce tension, for example massage, yoga, aromatherapy and meditation, are helpful in relieving the tension that’s common with depression.