Depression

The diagnosis of depression is usually based on clinical assessment by your doctor (GP or Psychiatrist) after excluding any possible medical conditions which could present in a similar way to depression, e.g. Hypothyroidism (under active neck gland) and anaemia, or medication causing depression like steroids and B-blockers ( blood pressure tablets). Sometimes even excessive alcohol use or illicit drugs can cause depression. Once all these possibilities are excluded, the diagnosis can be made if the person satisfies the Diagnostic and Statistical Manual V (DSM) criteria (or other classification systems like ICD-10) which needs the person to have five criteria from the ones numbered 1-9, and to include either criteria one or two. These five symptoms need to be present most days for at least two weeks and to cause significant distress or impairment in social, occupational or other important areas of functioning.

Depression is usually the consequence of many factors. Genes inherited from parents with family history of depression can increase our chance of getting depression. Being a female could double your chance of becoming depressed especially if staying at home and looking after young children. Also troubled upbringing, adverse life events, lack of support, unemployment, low income, separation, illicit drugs, excessive alcohol use and long standing medical conditions, in particular chronic pain could all make us more vulnerable to depression. Sometimes, depression can happen without any obvious reasons.

Depression can cause us to feel hopeless and helpless, but, effective treatments are definitely available including:

• Lifestyle changes: healthy diet, regular exercise, social support and reducing alcohol use
• Problem solving and supportive counselling
• Structured psychotherapies: Cognitive Behavioural Therapy (CBT), Interpersonal  psychotherapy (IPT), Mindfulness and others
• Antidepressants: serotonergic (SSRI), serotonergic and noradrenergic (SNRI), Tricyclic (TCA) and others. The Psychiatric Medication Information – A Guide for Patients & Carers booklet provides appropriate information about medications use for treatment of depression.
• Electroconvulsive therapy (ECT)
• Others: St John’s wort, S-adenosyl-methionine, Folic acid (Folate), Selenium, Vitamin D and Omega-3 fatty acids

Treatment of depression should be individualised specifically for each person. In general, a mild form of depression can be treated with life style changes, increasing support, problem solving counselling or structured psychotherapies / antidepressants if previously mentioned approaches did not work. For the moderate to severe form of depression, either structured psychotherapies or antidepressant can be used for treatment based on availability and personal choice. Combining both psychotherapy and antidepressants is more effective than using either alone. In cases of more severe depression threatening the life of the person or in depression with psychotic symptoms, ECT is the most effect method of treatment.

Depression is more likely to resolve if treated and more than half will recover and stay well. The other half may have a recurrence and about 15% will have chronic recurrence. Current guidelines recommend continuing antidepressants for one year after full recovery for the first episode of depression and three years in case of recurrent depression.

The symptoms of depression are thought to be caused by an imbalance in certain natural chemicals in the brain such as noradrenaline and serotonin. Antidepressants work by increasing levels of these chemicals in the brain.
 

 
Common groups of antidepressants
 
View the antidepression medication pdf file

Antidepressants are NOT addictive!

Care should be taken in combining antidepressants with other medications, alcohol, over-the-counter or complimentary products that you obtain without a prescription from the community, health food shop or supermarket.

Antidepressants need to reach a certain dose before they begin to work. For most people a response occurs within about two to three week before reaching the required dose and it can take up to eight weeks or a little longer before they feel better. Hence, it is important to continue taking the prescribed antidepressant, even beyond the time you begin to feel better. If treatment stops too early, there is a high risk of depression returning and antidepressant discontinuation reaction such as agitation, headache, fatigue, and dysphoria may occur with some antidepressants such as paroxetine, venlafaxine, desvenlafaxine and duloxetine.

All medicines have side effects even the ones you can buy without a prescription at a pharmacy, supermarket or health food store. It is important to be aware that not everyone experiences side effects and it is vital to balance unpleasant side effects against the distress and pain caused by depression. Side effects usually occur early in the treatment, many of them will settle down after a few weeks, when the body has adapted to the medications.

HELPFUL HINTS & GENERAL PRECAUTIONS:

• Taking SSRI with food or after food will assist with gastro-intestinal discomfort
• Most side effects are early onset and time limited (about 1-2 weeks)
• Benzodiazepines may be useful for short-term treatment (1-2 weeks) for pronounced insomnia or anxiety.
• Care should be taken in combining antidepressants with other sedative drugs or alcohol as the sedative effects additive.
• Care should be taken when driving or operating machinery as reaction may be slowed.

The new medication can take some time to start working. In the meantime, you may experience some side effects that you are not used to. Discuss these with your doctor and within a few weeks they should settle and your treatment will be back on track.

Source: St Vincent’s Psychiatric medication information: A guide for patients & carers 4th Edition, 2017.