Feeling flat and stuck? Hang on to the dreams you used to have before you let yourself sink into the dumps, they can safe your life and spirit.
Dr Ng Min Ching
General Practitioner
"After my baby was born, I had a lot of problems coping with a lot of expectations at work and at home. What I did was never right enough for my mother or my in-laws.I could never sleep because my baby kept waking up. I kept thinking I would get fired if I did anything that didn't please my boss. I burst into tears uncontrollably. I stopped going out. I thought I was so fat and ugly, why should I bother? I even started having thoughts like I should never have got married, never have had a child because I was so bad, wimpy and useless as a mother. It took me whole of 10 months to get out of the rut. I didn't dare see a doctor because I was ashamed of myself. What finally led me out of the dumps was my back, which was hurting a lot through looking after my child. I enrolled in a stretching class class, which slowly helped me to stop thinking about my unhappiness." - an accountant in her early thirties.
Depression is a common disorder that often goes undiagnosed and untreated. It is estimated that around one-third of patients have depression. In a recent news report, experts from Woodbridge Hospital noted that two in three sufferers are undiagnosed. In addition, the diagnosis of depression is frequently missed because it is masked by co-existing medical conditions.
This is a shame as it is a highly treatable condition. About fifteen per cent of patients with mood disorders attempt suicide and the risk is highest in untreated patients. Hence, it is very important to identify and treat these patients to avoid tragic outcomes.
Depression can be recurrent. There is a 50 percent risk of recurrence if a person has already experienced one episode of major depression. This risk increases to 70 percent and 90 percent after a second and a third episode respectively. Studies have also shown that people with a family history of depression are more prone to developing depressive symptoms themselves.
What It Means To Have Depression
The American Psychiatric Association has outlined the following criteria for the diagnosis of major depression. These symptoms must be present for two weeks or more before the diagnosis can be established. These symptoms are a sense of depressed mood, with a diminished interest in what you have enjoyed doing.
In addition, four of the symptoms below have to be present:
- Significant change in appetite and/or weight
- Change in sleep patterns (sleeping poorly or too much)
- Agitation (restlessness) or retardation (slowness) observable by others
- Feelings of worthlessness or blaming oneself excessively or inappropriately
- Fatigue or loss of energy
- Lack of concentration or indecision
- Thoughts of death or suicide
In addition, you might experience a vague pain in your body, a sense of abdominal discomfort, a decreased sex drive, giddiness and palpitations, hallucinations or delusions in cases of severe depression, and even signs of substance abuse.
Major depression may occur alone or as part of a manic-depressive psychosis. The latter is a condition whereby mania (hyperactivity with increased irritability) alternates with severe depression. If you are in a depressed state for two years or more, the depression you have is called dysthymia.
What Usually Happens When You Have Depression
Patients who are suffering from chronic illnesses are at increased risks of developing depression. Some examples of these illnesses are cancer, rheumatoid arthritis, diabetes, epilepsy, stroke, Parkinson's disease and Alzheimer's disease. Psychosocial factors may contribute to depression as well. These include bereavements, loss of job, relationship difficulties and other stressful life events
Depression may also coexist with other psychiatric disorders such as personality, obsessive compulsive, panic or manic disorders. It is well known that some medications like cimetidine, ranitidine, methyldopa and prednisolone are associated with depression.
When a doctor comes across a person who has been diagnosed as a depressive, he will try to identify whether she is at risk of committing suicide. As mentioned previously, the lifetime suicide risk in a patient with major depression is 3.5 percent. The patient can be expected to ask if she has suicidal thoughts, or if she has any feasible suicide plans. If her answers show her to be acutely suicidal she will have to be hospitalised immediately and placed under close supervision.
Forms Of Treatment
Antidepressant drugs are used in the treatment of mild, moderate and severe depression. They produce a remission in six out of ten patients. Currently, there are many antidepressant medications in the market. What drug to use depends on the side effects, overdose potential, whether the patient has previously responded to the drug, presence of other medical conditions, potential drug interactions and the cost of the drug.
These drugs vary widely in their side effects. The side effects include dry mouth, constipation, blurring of vision, difficulty passing urine, memory dysfunction, drowsiness, weight gain, low blood pressure, giddiness, palpitations, tremors, problems with erection and ejaculation, gastrointestinal upsets and movement disorders. The newer medications like Prozac and Zoloft have fewer side effects and are better tolerated by patients. Therefore, they are the preferred first-line treatment drugs.
Patience is required in the treatment of depression. The drugs work slowly. Four to six weeks may elapse before a response is evident.
Most of the time, if the drugs do not seem to work, it is because of inadequate dosage or duration of treatment. Sometimes, patients are unable to tolerate the side effects of the drugs and stop taking the medication on their own. This means that the doctor may need to review and correct his initial diagnosis of depression.
Once the cause of non-response is traced to an ineffective drug, the patient will have to be switched to a drug from a different class of antidepressants. Occasionally other medications are prescribed to augment the response to an antidepressant.
The natural course of an untreated depression is between six and 24 months. Generally, the patient continues to take antidepressant medication for a minimum of between six and nine months after remission of symptoms. However, if the patient has had three or more episodes of depression, or if the episode has been severe or prolonged, long-term therapy should be considered.
Generally, however, the patient is treated with a combination of both pharmacotherapy and psychotherapy. Psychotherapy is a method of treatment in which a close therapeutic relationship is developed between the patient and the doctor. The doctor tries to help the patient to adopt a more positive outlook by being a good listener and by being patient, understanding and empathetic.
For patients who do not respond to either drugs or therapy, they may be treated with ECT or electroconvulsive therapy. It is indicated for severe, psychotic cases. During ECT, an epileptic fit is induced by passing an electric current through the patient's head. This is usually done under anaesthesia. Even after ECT, continued therapy with antidepressant medication is still required.
How Curable Is Depression?
Depression is a curable disorder and the majority of patients recover fully. The patient is deemed to have recovered when all the symptoms of depression have disappeared and when the individual is able to work and function at pre-depression levels. It has been noted in the literature that if you exercise regularly, you can handle stress and depression much better. Jogging, swimming or biking are definitely cheaper alternatives than Prozac.
Where To Find Help
General practitioners will be able to manage simple cases of depression. Complicated cases warrant the attention of a specialist (psychiatrist) and patients with severe depression will be admitted to hospitals.
References:
- Karen E. Broquet, MD. Status of Treatment of Depression. Southern Medical Journal. 1999; 92(9): 848-858.
- Lim Y.C., Peh L.H., Tay L.K. Effective Management of Depression in Primary Care Practice. 1996. Singapore Psychiatric Association.
Date reviewed: 28 February 2005
