• Definition of depression
• Forms of depression
• How is it diagnosed?
• Who is prone to depression?
• Depression and suicide
• Treatment methods in depression
• Electroconvulsive Therapy (ECT)
• Other treatments
• Recommendations to family members of the patient
Definition of depression
What sets depression apart from the sorrow and grief we experience during everyday events is that depression is a permanent and more intense manifestation of this psychological state of sorrow.
The main characteristics associated with this psychological state are pessimism, fatigue, hopelessness and lack of joy. A person who is suffering from depression feels worthless and has lost self-confidence. He believes that he has not achieved anything in life, or that his achievements are mostly coincidental. He lacks hope for the future and is convinced that he will be unsuccessful in his job, unable to provide for his family, and that his health will fail him. He often thinks that life is not worth living. In some cases the sufferer sees suicide as the only way out of the situation and he attempts suicide. 15% of sufferers who do not receive treatment or receive inadequate treatment do attempt suicide.
A person suffering from depression often groundlessly blames himself for unimportant things. For example, insignificant events that happened in the past, where he feels he has not acted honestly, can continually occupy his mind and torment him. In fact, an event that the person has long forgotten, can come back as a vivid picture in this mind and trigger intense and painful emotions.
A lack of interest in everyday events and an inability to enjoy life are common symptoms in depression. The patient no longer takes any pleasure in things he used to enjoy in the past. He has lost his joy of life, constantly lacks energy, and even small tasks require great effort and are often left uncompleted. It is understandable that most patients believe that this fatigue is due to a physical illness.
In major depression a slowing down of the patients movements, walk and speech may be noticeable. Common physical symptoms are insomnia, loss of appetite, weight loss, constipation, reduced libido, and in women irregular menstrual cycles. Difficulties remembering and focusing are also very common.
Types of depression
Atypical depression: In this type of depression the psychological state of the patient temporarily improves after a positive life experience. This is accompanied by improved appetite and sleep. Fatigue is particularly marked.
Agitated depression: The patient is extremely restless, hyperactive and anxious. It can be difficult to communicate with a patient in this condition. It is more common in patient of an advanced age.
Melancholic depression: A state of major depression, in which positive life experiences do not alleviate the sadness of the person. Symptoms are decreased need for sleep, lack of appetite, weight loss, slowing down of movements and thought.
Psychotic depression: In major depression the patient has completely lost his functionality. Eating habits and self care have significantly deteriorated. When this condition is accompanied by delusions (persistent wrong thoughts) and hallucinations (faulty perception) it is called psychotic depression. The person may be convinced that he has an incurable major illness, is bankrupt, has committed a major crime or is a sinner.
Postnatal depression: A serious type of depression which typically begins after childbirth and often does not require any psychological reasons to trigger it out. Due to a strong feeling of hopelessness the person is incapable of taking care of the baby. In more severe forms the patient may harm herself or the baby.
Seasonal depression: In this type of depression, which is generally seen in young people, the recurrent bouts of depression usually occur during the same season, particularly during the winter months.
How is depression diagnosed?
Depression should be diagnosed by a psychiatrist. It is important that the symptoms of depression are distinguished from the picture presented by physical illnesses like goitre, hepatitis, kidney failure, vitamin deficiency, stroke, Parkinson’s disease and other psychiatric disorders (dementia, anxiety disorder etc). On the other hand, depression may be secondary to one of these illnesses and develop during the course of its progress. The psychiatrist may ask for blood tests and imaging like MR and BT to clarify details.
Depression and suicide
Suicide is an important health problem. Studies conducted in developed countries show that suicide is the 5th most common cause of death. Suicide should not be regarded as a normal behaviour or a normal response of the person to what happens around him. 70% of patients who lose their lives through suicide suffer from depression before they carry out the act, and 15% of sufferers from depression commit suicide. Effective treatment of depression significantly reduces this risk. Therefore, particularly in cases where depression is accompanied by thoughts of suicide, follow-up by a psychiatrist can be a life-saver. Suicide attempts or thoughts of suicide, for whatever reason, should be taken very seriously, and the patient should urgently be assessed by a psychiatrist. In some cases the patient may have to be admitted to a psychiatric clinic.
Who develops depression?
Depression is not the result of a personality weakness. Research shows that 25% of the population, at one time or another in their life, had a period which could be defined as depression. This occurrence rate is twice as high in women than in men. When we look at the data at hand, we can see that depression is a brain disorder. With the help of various methods like MR imaging which display the brain structure, it has been established that in patients with depression there is a deterioration in the functioning of brain centres that deal with emotion, decision making and cognitive abilities. Although it is often the case that patients suffering from depression have, especially before their first bout of depression, experienced a negative event, depression should not be regarded as a natural result of negative events. Many patients suffering from depression do not describe a significant life event in their past history. Individuals with other sufferers of depression in their family tree are under higher risk to develop the condition. This shows that hereditary factors combined with various environmental and/or physical factors (for example loss of work-status-money, loss of a loved one, marital problems, past failures, major physical illnesses (like cancer), brain diseases (like stroke, brain haemorrhage, Parkinson’s disease), use of alcohol and substances, various drugs etc.) lead to depression.
Treatment methods in Depression
It is proven that in depression the function of certain neurotransmitters (transmitter molecules) and primarily of serotonin is affected. Treatment often aims at correcting the function of these chemicals in the brain. If left untreated, depression lasts 6-18 months. Latest studies show that in 30% of patients it lasts longer than 2 years, whereas with the correct treatment its duration is only 2-3 months in average. When we consider the adverse impact that depression has on the patient’s family, work and social life, the significance of early diagnosis and treatment becomes clear. The aim of the treatment is to return the patient to the healthy state he had been in before the condition set in. With the use of existing treatments, a marked improvement can be achieved in over 80% of patients.
The following is taken into consideration when deciding on the treatment of a patient suffering from depression:
• Severity of the depression
• Past medical history, family history
• Presence of absence of thoughts of suicide
• Age and gender of the patient
• Present illnesses, and drugs used by the patient.
Drug treatment in depression
The first choice of medication in the treatment of depression are drugs called antidepressants. These drugs act on the receptors in specific parts of the brain. Your doctor will decide which antidepressant is best suited to you.
What we need to know about antidepressants:
• These drugs should only be used under the supervision of a doctor.
• It takes 2-4 weeks before the patient experiences the full effect of the medication. They have no immediate beneficial effect. In fact, in the early stages some complaints may be exacerbated by the medication.
• Your doctor should decide whether the drug is sufficient for your needs, whether or not to change it, or if additional medication is required in order to strengthen the effect.
• After a certain level of improvement is achieved, you should continue with the treatment for at least 6-9 months. The decision to stop the medication at the end of the treatment should be discussed with your doctor and you should act in accordance with his recommendation.
• Contrary to what is commonly believed, antidepressants do not act by tranquillizing the patient. Your ability to think and decide will not be affected during use of antidepressants.
• Antidepressants do not cause drug dependency.
• Side effects associated with antidepressants are usually mild and short-term. They usually occur during the first week of drug use. The patient may experience nausea, vomiting, headaches or a feeling of confusion. Longer term side effects may be a lack of sexual drive, difficulties in erection and ejaculation. Weight gain is only associated with a certain group of this medication and does not reach extreme levels. Do not refrain from sharing such side effects with your doctor, he will welcome it. If any unexpected side effects occur during treatment you must contact your doctor immediately.
Electroconvulsive Therapy (ECT, Shock Treatment)
ECT is a treatment method which is used in patients who are thought to be non-responsive to drug therapy and who are therefore diagnosed with what is called resistant depression. The results are really impressive. In patients with a high suicide risk or patients rejecting food, this method – when applied in the early stages of the condition – can save lives. Its effect sets in fast and after 7-14 sessions of treatment the patients generally show marked improvements.
When you undergo ECT treatment
• You will first be assessed by a psychiatrist and an anaesthetist.
• Before the procedure you will be given a general anaesthetic of short duration.
• Then you will be administered a muscle relaxant drug.
• A weak electrical current will be given to both sides of your temple, which will set off a seizure.
• A seizure consists of a rhythmical electrical activity in the nerve cells. Because you are anaesthetised and your muscles are completely relaxed, we will only see minor muscle spasms in your body.
• After the session the medical team will stay with you until you regain consciousness and ask you to rest for a short while.
• ECT is a safe treatment method that has been extensively used over the past 60 years.
• ECT does not cause any damage to the brain cells or affect your cognitive or decision making abilities.
• ECT is not a method that inflicts pain. It is applied completely in accordance with general medical principles and on the basis of medical knowledge accepted world-wide.
• The most common side effect of ECT is short-term mild to medium memory disturbance, which clears by itself within a few weeks. Short-term memory disturbance which clears by itself, is a side effect only seen in some of the patients.
• ECT can also be used in patients of advanced age and in pregnant patients without any significant side effects.
There are studies that have shown that psychotherapy is effective in mild depression, and sometimes also in medium degree depression. The effectiveness of cognitive behavioural therapy and interpersonal therapy is scientifically proven. Treatment usually ranges between 6-12 sessions. It’s usefulness in cases of depression in which physical symptoms are at the forefront, has not been proven.
Other treatment methods
• Transcranial Magnetic Stimulation
• Light therapy
• Insomnia therapy
Recommendations to relatives of the patient
• Depression is an illness; you should not blame your relative for his emotions, behaviour or thoughts.
• It is important that you provide sufficient information on the patient to his doctor.
• You should encourage the patient to undergo treatment. Do not shy away from cooperating with the doctor who undertakes the treatment of the patient.
• You should not be critical of the patient.
• During this difficult time in his life your relative’s ability to make decisions may be affected by the psychological state he is in, therefore it is ill-advised for him to makes important decisions during this period. You should suggest to your relative that he postpone important decisions at least until the picture presented by his depression improves.