“DEPRESSION”
There are many myths and misconceptions about the nature of ‘Depression’. These notes are an attempt to give an explanation of this common illness based on a continued updating from the medical literature, more than 40 years of Clinical Experience, and dialogue with some of the world’s leading authorities such as Doctor Joseph H. Talley of Grover, North Carolina and Doctor Zoran Fulgosi of Toronto.
- What is ‘Depression’?
It is a biochemical disorder in which the brain fails to produce certain vital chemicals in sufficient amounts to maintain normal physical and psychological well-being. The symptoms caused by this shortage are very varied indeed and so are the patients’ reactions to them.
- What causes ‘Depression’?
We don’t know! Sometimes it seems to be related to losses, worries or stress in a person’s life; more often it occurs for no good reason in a totally normal individual; when this happens, it is always easy to find an ‘explanation’ in one’s life-style for the symptoms – job, finances, health, marriage, politics, global warming etc!
- How does someone feel when he has ‘Depression’?
He will always feel some, but never all of the following symptoms:-
- Fatigue, Tiredness, Lassitude. Or as the patient puts it: ‘I’m tired all the time’ or ‘I’ve just got no life in me’ or ‘I feel permanently drained’….tired even after a good nights’ rest, tired even after a weekend off or even after a good holiday.
- Sleep Disturbance. Sometimes just seeming to need more sleep than normal, sometimes not being able to get off to sleep or waking in the early hours but always a feeling that the sleep has not been of the right sort and has failed to refresh and restore.
- c. Irritability. Friends, relatives and work-mates are often the first to notice this, the patient ‘flying off the handle’ in a most uncharacteristic way….the patient is often the last to notice that something is sadly awry.
- Anxieties, worries and even panics, often over trivial matters.
- Sadness and an inability to cope. Often a feeling of helplessness and hopelessness, of guilt and worthlessness. These feelings can be so powerful that a loved and valued member of society may even believe that the world would be a better place without them …..often even moving them to consider suicide as the best solution to their problems.
- Pains, real pains which really do hurt. These pains are not ‘all in the mind’ but caused by the chemical deficiency in the persons’ brain. The most common ones are: pains anywhere in the head and face, gut-aches (various), chest and pelvic pains. When X-Rays, Barium Studies, Endoscopies and scans all come back negative, the patient becomes convinced they have some mysterious dread disease beyond medical understanding. However, once antidepressant treatment is established, the pains mysteriously disappear.
- Digestive Problems. Constipation, diarrhoea, bloating and flatulence, indigestion and heartburn are all recognised symptoms; weight gain and weight loss are also common.
- Anhedonia. This means an inability to experience pleasure and the patient often loses the ability to enjoy the things they most valued – music, laughter, golf, sex etc.
- Poor Concentration. Even reading a book or watching TV can become a real chore, decision-making extremely difficult and general judgement atrocious; this is not a good time to make major life decisions!
- Generally Unwell. A feeling that there is some serious disease going on, eating away at ones vital reserves; the patient often becomes convinced that they have cancer or HIV.
- Can a person fight this disease alone?
No, absolutely not! Advice such as ‘pull yourself together’ or ‘Try to snap out of it’ although well-intended is useless, and will-power for Depression is about as effective as will-power in the control of diarrhoea!
- How is Depression best treated?
With antidepressant medication. This medicine is almost always in the form of pills and helps the body to replenish those vital chemicals which have gone into short supply. If you do not have depression, then they do no good at all, nor can they give you a ‘high’ or ‘pep you up’.
They NEVER cause addiction.
- How long do I need to take them?
Usually a minimum of six months. However, they are so safe that they may be taken as long as your body needs them.
- Do they cause side-effects?
Yes, but these are more of a nuisance than a serious problem and the newer antidepressants cause very few indeed. If you do experience any, do discuss them with your doctor, but the side-effects do tend to gradually disappear with time anyway.
- How do I start treatment?
Some antidepressant help you sleep and are best taken at night, while others give you more energy and are taken in the morning. Often we start on a low dosage to ensure that the medication suits you before we increase the dose to full effect; occasionally, the medication needs to be altered or combined with another medication to completely cure your symptoms. Therefore, early on in treatment you may have to see the doctor more frequently – even every week or two. However, once you are feeling fully well again, the successful treatment can be put on repeat prescription so you need not see the doctor for 3 months or sometimes even longer. Note that once you are on the “right” medication, it may take 4 weeks to achieve the full effect, even though significant improvement happens within the first 2 weeks.
9….and how do I come off the treatment?
Easy, but reduce the dosage gradually over 3 or 4 weeks. Tell your spouse or someone close to you what you are doing and instruct them to let you know if the depression is coming back as you, yourself, are often the last one to notice.
- Surely it is better to talk through problems than use mind-altering drugs?
These are not ‘mind-altering drugs’; they simply restore your brain chemistry to normal. Do confide in a friend or professional your problems, worries and secret fears, but the problem and the solution both lie in the realm of the brain’s chemistry. The use of antidepressant medication is totally compatible with all forms of psychotherapy including counselling and CBT (Cognitive Behavioural Therapy), but restoring the brain chemistry back to normal is the logical first step back to health.
- Is there a wide choice of antidepressant medication? How does the doctor chose which one will be best for me?
Each patient with depression is unique and there is no single antidepressant to cure everyone! If the patient has no energy, then we would tend to choose an antidepressant which gives her more “pezaz” such as Prozac (fluoxetine) or venlafaxine or duloxetine. However, if the patient is already anxious and “strung out” a more calming antidepressant such as paroxetine or mirtazipine would be appropriate. If he is exhausted during the day, but can’t sleep at night, we may use two medications such as trimipramine or mirtazipine at night and prozac or venlafaxine during the day. If the patient is neither agitated nor fatigued, then citalopram or sertraline might be the best choice. Some antidepressants can help with a patient’s pain – such as duloxetine, venlafaxine or trimipramine; others are helpful with allergies such as doxepine; for snoring protriptyline can be helpful, for premature ejaculation paroxetine and for bed-wetting imipramine. You may be confident, then, that just because one antidepressant doesn’t work or doesn’t suit you, there are still many options!!
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REMEMBER!
Don’t be afraid of the tablets; the side-effects may be annoying, but they are very safe and very effective.
Be patient in the early stages; they do take time to take effect.
Don’t stop the treatment too soon – just because you feel well; the depression will almost certainly return with a vengeance.
Don’t drive or work with hazardous machinery until you know how the tablets affect you.
Be very careful of alcohol while taking the tablets; the effects may be more marked than usual – especially in the early stages of treatment.
They NEVER cause addiction – NEVER!
Bernard Shevlin b.shevlin02@gmail.com
Hope you find this explanation helpful; if you get chance send me a quick comment by e-mail – please!