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#AskADoc: How Do I Know if I Have Depression?

‘It’s not in your head.’

Meet Dr Natasha Dole, our resident doc. She’s here to answer all your health-related questions.

It’s time to bust another medical myth with #AskADoc!

Dr Natasha Dole

Dr Natasha Dole

Depression is one of the leading causes of disease around the world. People with this condition suffer tremendously and all their activities of daily living are severely disrupted. Some patients have such severe and disabling symptoms that their entire life is completely interrupted.

Despite this being such a common illness, there are many myths and misconceptions about this particular mental condition or medical disease. It is not in your mind. It can happen to anyone – absolutely anyone – all sexes, all races, all ages, all cultures, and all social classes. We see it occur even among the most intelligent people and even in academic or medical professionals.

Most importantly, no one chooses to be depressed. It is beyond their control. The stigma around mental health disorders needs to be broken and addressed. It does not need to be hidden and is definitely not something you should be embarrassed about.

Depression in the 21st century is a treatable condition with an excellent response rate provided that treatment is strictly adhered to at all times. According to World Health Organization (WHO), by the year 2020, depression will be the number two cause of disability worldwide. Recent studies estimate that at least 2 in every 100 children will suffer from this disease and at least 20% of the general population will have depression at some point in their lives.

What Exactly is Depression?

Depression is due to a chemical imbalance in the brain. It is an illness caused by changes to the neurotransmitters that are found in the limbic system of the brain. These changes are triggered by multiple factors. Serotonin is an important neurotransmitter found in the brain. It enables the impulses to be transmitted from one nerve to another nerve across a tiny gap otherwise known as a “synapse.” In patients suffering from depression, studies have shown that their synapses have too little serotonin. Hence, the mainstay of treatment is with medication that increases the serotonin levels in their brain.

A major depressive syndrome or episode manifests with five or more of the following symptoms, which persists throughout most of the day for a minimum of two consecutive weeks. At least one symptom is either depressed mood or loss of interest or pleasure.

These Symptoms Include

  • Depressed or low mood
  • Loss of interest or pleasure in most or all activities
  • Sleep disturbances (too much or too little)
  • Weight or appetite changes
  • Low energy
  • Unable to concentrate
  • Thoughts or feelings of worthlessness or guilt
  • Suicidal thoughts
  • Slowing down of thought processes
  • Repetitive, purposeless or unintentional behaviour or movements
  • Extreme agitation or irritability often uncontrollable

Depression is most commonly seen in the late 20s but also seen commonly among the elderly or those with severe chronic medical conditions. The female:male ratio ranges from 2:1 to 3:1 in all socio-economic groups and all cultures.

As with all medical illnesses, there is a strong genetic link to depression. It is 1.5 to 3 times more common in those with a first degree relative with depression. About 80% of depressive episodes are precipitated or exacerbated by stressful events.

Risk Factors for Depression

  • Previous depressive episode
  • Family history of depression
  • Female gender
  • Multiple life stressors
  • Childhood trauma
  • Chronic medical conditions e.g. HIV or cancer or cardiac disease etc
  • Prolonged hospitalisation
  • Pregnancy
  • Postpartum (after childbirth)
  • Dementia
  • Substance abuse
  • Certain medications
  • Previous suicide attempt
  • Idealisation of suicide or harming your self

Red Flags for Depression Include

  • Sleep disturbances: either too much or too little
  • Chronic fatigue
  • Chronic pain
  • Recent life change or adjustment
  • Recent life stressors
  • Poor health
  • The lack of a support structure
  • The use of recreational drugs
  • Alcohol abuse
  • Unexplained physical symptoms
  • A low self-esteem
  • Bullying or victimisation (school, workplace or at home)
  • Adult or childhood trauma
  • Loss of a parent
  • Poor relationship with siblings or parents
  • Divorce
  • Poor support structure

Treatment includes a variety of options

Medications

  • 70-80% of patients respond to medications alone provided an adequate dose is reached and taken regularly
  • Most patients see an improvement within the first days of treatment while other respond after approximately two weeks
  • Within six to eight weeks, most patients feel that they are now back to normal – medication must not be stopped or reduced at this stage
  • These are not life-long and can be stopped in conjunction with advice from your treating doctor. There is a specific way to stop the medication and this of utmost importance. Often a combination of medication and therapy is needed. Admission to hospital is necessary in some cases and this does help.

Psychotherapy

  • Cognitive behavioural therapy – coping mechanisms are learned and specific behaviour patterns are identified and corrected
  • Interpersonal therapy – analysis of all your relationships, both personal and professional, reveal a vast amount of information
  • Family therapy – discussing your support or lack of support structures and finding a way forward despite this
  • Couple therapy – involving your partner by making them understand exactly what you are going through and how they can help
  • Group therapy – active involvement with other people experiencing the same symptoms and helping each other overcome this
  • Problem solving therapy – performing goal orientated tasks that involve problem solving and then reviewing their outcomes to modify behaviour patterns

Exercise or any form of physical therapy

  • The release of endorphins helps to stimulate your brain to be in a better mood

Avoidance of alcohol

  • To prevent you from turning to this as a source of comfort in this difficult time

The bottom line is that depression is a very real illness and can cause extremely dire consequences when left unnoticed or untreated. There is help out there and you are not alone. So, here is hoping that you can find the inner strength to reach out or speak up. Help us doctors to help you and overcome this disabling disease.

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