you been feeling down in the dumps lately? Maybe you are not feeling up to going out to the movies and gym like you used to. Also, you have noticed a significant decrease in your appetite and your clothes have been fitting you looser.
These may be indicators of depression. It is natural to feel down at times, but if it is affecting your daily occupational and social functioning, then it may be time to seek help.
Depression is a common disorder worldwide and is a significant cause of morbidity. It is also known that depression is associated with other chronic illnesses such as diabetes and heart disease. It is unfortunate that even with the increased knowledge and public health campaigns, many people are unaware of the symptoms and signs of the condition and fail to seek treatment.
Depression knows no boundaries and affects people of all ages, including children and adolescents.
Depression can present with both emotional and physical symptoms, including depressed mood, loss of interest in activities of daily living, hopelessness, guilt, disturbed sleep, fatigue, difficulty concentrating, and suicidal ideations. Children may present with physical symptoms such as persistent aches and pains, headaches and digestive problems.
WHO IS AT RISK?
As mentioned, depression can affect anyone, however, it is believed that genetics play a significant role. Having a parent or sibling with the disorder increases your risk. Women are at least twice as likely to become depressed compared to men.
WHAT CAUSES DEPRESSION?
Various theories have been implicated to cause depression, including the stress-diathesis model, which states that environmental stressors increase risk of depression in people who are genetically predisposed. Other triggers include certain medications, alcohol or substances, hormonal changes or even seasons.
Depression post-delivery in mothers has also been established.
In managing a patient with depression, it is important to first take a complete history, looking for symptoms of depression and asking specifically about suicidal ideations and attempts. It is important to ask about any family history of depression and any substance use.
Following this, a complete physical exam looking for stigmata of any medical conditions must be undertaken.
Treatment of depression is from a holistic, biopsychosocial approach.
Studies suggest different types of talk therapy can fight mild to moderate depression. Cognitive behavioural therapy aims to change thoughts and behaviours that contribute to depression. Interpersonal therapy identifies how your relationships impact your mood. Psychodynamic psychotherapy helps people understand how their behaviour and mood are affected by unresolved issues and unconscious feelings.
Some patients find a few months of therapy are all they need, while others continue long term.
MEDICATION FOR DEPRESSION
Antidepressants affect the levels of brain chemicals, such as serotonin and norepinephrine. There are many options. It is important to give at least two to three weeks for antidepressants to start taking effect. May patients only take the medication for a few days or “on and off”, which will be of no therapeutic use.
It is also unsafe to stop antidepressants without consulting with your doctor, as they may cause symptoms of withdrawal on sudden discontinuation, including flu-like symptoms, nausea, diarrhoea, and tremors.
Change in lifestyle, including regular exercise, a regular sleep schedule, and a healthy diet are a part of the holistic management of depression. Also included is reducing stress levels, avoiding multi-tasking and increasing socialising with friends and family.
At this time, there is not enough evidence to suggest recommendation of herbal and over-the-counter supplements dueto lack of proven efficacy and risk of side effects. It is vital to let your doctor know if you are on any supplements due to risk of medication interaction.
Electroconvulsive therapy (ECT)
ECT is an effective and safe modality of treatment for depression, however, it is usually reserved as a last resort for treatment-resistant cases.
It is high time that we take control of our emotions and seek help because, as we all know, there is no good health without mental health.
Dr Ashish Sarangi MBBS is a resident in psychiatry at the University Hospital of the West Indies. He may be contacted via email at