Depression and its management

What is Depression? How does it differ from sadness?

Feeling sad is a normal human experience and in most cases, an appropriate emotional response to something disturbing. Sadness can also arise in response to a loss or a perceived loss. The degree of sadness experienced can vary based on the seriousness of the event and our ways of coping. With time, sadness tends to diminish as we begin to cope with the situation and/or find a way out.

On the other hand, Depression is a medical condition that is more serious than normal sadness. It can last for weeks and have significant impact on our daily lives, our work and our relationships. It can affect our ability to enjoy things and lead to fatigue and loss of motivation. Depression can affect our sleep pattern and appetite. It can leave us feeling bad about ourselves and often we can develop a bleak view of the world. Hopelessness about the situation and the future can lead to thoughts of suicide and self-harm.

What causes Depression?

There is so single cause for Depression. In most cases, it is a combination of factors. Genes can play a role as can Adverse Childhood Events (traumatic experiences in childhood such as experiencing violence, abuse or neglect). Significant life events can trigger Depression and the lack of social support can also be a risk factor. Some people find ways to cope with Depression and whilst these may work in providing short term relief, they can become unhelpful and maladaptive in long term. Examples of unhelpful coping mechanisms include use of alcohol and drugs and social withdrawal.

How is Depression treated?

The treatment of Depression starts with a good comprehensive assessment which can help to understand the severity, associated risk and any other co-existing conditions (such as Anxiety and Post Traumatic Stress Disorder). Treatment options include medication, psychological therapy and social/lifestyle intervention. Often, a combination of different strategies is important and as Depression can be a recurrent condition, preventive strategies are equally important to reduce the risk of a relapse in the future.

How do Antidepressants work?

Antidepressants have different mechanisms of action. The ones that are often used as first line options are called Selective Serotonin Reuptake Inhibitors (SSRI) and they work by blocking the ‘reuptake’ of Serotonin and this allows for more Serotonin to be available in the space between neurons. Other types of antidepressants block both Serotonin and Norepinephrine uptake. Not everyone will respond to first line medication and may need to switch to another class of antidepressant or ‘augment’ with a different kind of medication.

How long should I continue medication?

Antidepressants don’t work immediately and usually can take 4 to 6 weeks for the full benefits to be realised. However, the initial benefits can start within a couple of weeks. It is important to take the medication on a daily basis. Based on the response and tolerability, the dose may need to be increased.

The duration of treatment can vary and depends on many factors. One important factor is whether you have had a single episode or multiple episodes (called recurrent depression). For a single episode, the recommendation is to continue the medication for at least 9 to 12 months from the point of recovery. For recurrent episodes, the recommendation is to continue the medication for at least 24 months from the point of recovery. In people with a high risk of relapse, medication for longer durations may be recommended.

Can I be treated for Depression without medication?

Psychological therapy is an important treatment option for Depression. There are different models of therapy available based on individual requirements. Cognitive Behavioural Therapy has a good evidence base for Depression and can help in challenging negative thoughts and behaviour. Cognitive Analytic Therapy can be helpful if there are particular relational difficulties (the way we relate to ourselves and other people). Eye Movement Desensitisation and Reprocessing (EMDR) is a helpful therapy model to manage traumatic memories that are recurrent and intrusive.

Lifestyle interventions can include a range of strategies. Managing stress levels and workload along with taking time to recharge can go a long way. Building social networks and being able to talk to people is helpful. Avoiding drugs and alcohol is crucial as these can directly affect brain function and limit the benefits from medication. In particular, alcohol is a mood depressant. Exercise has been shown to have positive effects on mood.

Why do people with Depression struggle to seek help?

Seeking help can be difficult for some people because they may be worried about being seen negatively by others. Lack of understanding about the condition can unfortunately lead to stigma and discrimination. People with Depression can keep things to themselves and suffer in silence. Depression is often invisible and the person can look fine on the outside. Another consideration is that Depression by nature can give rise to a sense of hopelessness and pessimism and these can become barriers to help seeking. Recognition of the condition and awareness that effective treatment is available are important.