Depression Prevention Tips
Depression
explained
Depression is a
common experience. We have all felt 'depressed' about a friend's cold shoulder,
misunderstandings in our marriage, tussles with teenage children - sometimes we
feel 'down' for no reason at all.
However, depression can
become an illnesswhen:
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The mood state is severe;
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It lasts for 2 weeks or more; and
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It interferes with our ability to
function at home or at work.
Signs of a depressed
mood include:
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Lowered self-esteem (or self-worth)
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Change in sleep patterns, that is,
insomnia or broken sleep
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Changes in appetite or weight
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Less ability to control emotions such
as pessimism, anger, guilt, irritability and anxiety
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Varying emotions throughout the day,
for example, feeling worse in the morning and better as the day progresses
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Reduced capacity to experience
pleasure: you can't enjoy what's happening now, nor look forward to anything
with pleasure. Hobbies and interests drop off.
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Reduced pain tolerance: you are less
able to tolerate aches and pains and may have a host of new ailments
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Changed sex drive: absent or reduced
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Poor concentration and memory: some
people are so impaired that they think that they are going demented
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Reduced motivation: it doesn't seem
worth the effort to do anything, things seem meaningless
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Lowered energy levels.
If you have such
feelings and they persist for most of every day for two weeks or longer, and
interfere with your ability to manage at home and at work, then you might
benefit from getting an assessment by a skilled professional.
Having one or other
of these features, by themselves, is unlikely to indicate depression, however
there could be other causes which may warrant medical assessment.
If you are feeling
suicidal it is very important to seek immediate help, preferably by a mental
health practitioner.
psychological treatment
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Cognitive Behavior Therapy (CBT)
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Interpersonal Therapy (IPT)
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Psychotherapies
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Counseling
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Narrative Therapy
CBT, IPT,
psychotherapy and counselling all provide either an alternative to medication or
work alongside medication. As always, a thorough assessment of the person is
needed in order to decide on the best set of approaches.
Cognitive Behaviour
Therapy (CBT)
People suffering from depression -
particularly 'non-melancholic depression' - will often have an ongoing negative
view about themselves and the world around them. This negative way of thinking
is often not confined to depression, but is an ongoing part of how the person
thinks about life. Many or all of their experiences are distorted through a
negative filter and their thinking patterns become so entrenched that they don't
even notice the errors of judgement caused by thinking irrationally.
Cognitive behaviour therapy aims to
show people how their thinking affects their mood and to teach them to think in
a less negative way about life and themselves. It is based on the understanding
that thinking negatively is a habit, and, like any other bad habit, it can be
broken.
CBT is conducted by trained
therapists either in one-on-one therapy sessions or in small groups. People are
trained to look logically at the evidence for their negative thoughts, and to
adjust the way they view the world around them. The therapist will provide
'homework' for between sessions. Between 6-10 sessions can be required but the
number will vary from person to person.
CBT can be very
beneficial for some individuals who have depression but there will be others for
whom it is irrelevant.
Interpersonal
Therapy (IPT)
The causes of
depression, or our vulnerabilities to developing depression, can often be traced
to aspects of social functioning (work, relationships, social roles) and
personality .
Therefore, the underlying assumption
with interpersonal therapy is that depression and interpersonal problems are
interrelated.
The goal of interpersonal therapy is
to help the person understand how these factors are operating in the person's
current life situation to lead them to become depressed and put them at risk to
future depression.
The therapy occurs
in three main phases:
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an evaluation of the patient's
history
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an exploration of the patient's
interpersonal problem area and a contract for treatment
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recognition and consolidation by the
patient of what has been learnt and developing ways of identifying and
countering depressive symptoms in the future.
Usually 12-16
sessions of IPT will be required.
Psychotherapies
Psychotherapy is an extended
treatment (months to years) in which a relationship is built up between the
therapist and the patient. The relationship is then used to explore aspects of
the person's past in great depth and to show how these have led to the current
depression. Understanding this link between past and present - insight - is
thought to resolve the depression and make the person less vulnerable to
becoming depressed again.
Counselling
Counselling encompasses a broad set
of approaches and goals that are essentially aimed at helping an individual with
problem solving - solving long-standing problems in the family or at work; or
solving sudden major problems (crisis counselling).
Narrative Therapy
Narrative Therapy is a form of
counselling based on understanding the 'stories' that people use to describe
their lives. The therapist listens to how people describe their problems as
stories and helps the person to consider how the stories may restrict them from
overcoming their present difficulties. It sees problems as being separate from
people and assists the individual to recognise the range of skills, beliefs and
abilities that they already have (but may not recognise) and that they can apply
to the problems in their lives.
Narrative Therapy differs from many
therapies in that it puts a major emphasis on identifying people's strengths,
particularly as they have mastered situations in the past and therefore seeks to
build on their resilience rather than focus on their negatives.
physical treatment
The main physical
treatments for depression comprise
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Drug treatments
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Electroconvulsive therapy
A third physical
treatment with as yet narrow application is
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Transcranial magnetic stimulation.
Drug
Treatments
There are three
groups of drugs most likely to be used for depression:
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Antidepressants
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Tranquillisers
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Anti-manic drugs or mood stabilisers
Antidepressants
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There is a large number of
antidepressants - they have a role in many types of depression and vary in their
effectiveness across the more biological depressive conditions.
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Selective Serotonin Reuptake
Inhibitors (SSRIs), Tricyclics (TCAs) and Irreversible Monoamine Oxidase
Inhibitors (MAOIs) are three common classes of antidepressants. They
each work in different ways and have different applications.
-
At the Institute we believe that they
are not, however, equally effective and that it is necessary to find the right
antidepressant for each person.
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If the first antidepressant does not
work, it is sensible to move to a different kind of antidepressant. For the
biological depressive disorders, more broad action antidepressants are usually
more effective.
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A well-informed health provider
should be able to use their assessment of the type of depression, its likely
causes and their understanding of the person to identify the medication most
likely to benefit.
Finally, being able to decide not to
use medication is important too.
Tranquillisers
These medications are usually called
'minor' or 'major' tranquillisers.
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Minor tranquillisers (typically
benzodiazepines) are not helpful in depression; they are addictive and can make
the depression worse.
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Major tranquillisers are very useful in people with a
psychotic depression and in melancholia where the person is not being helped by other
medications.
'Anti-manic' drugs
or 'mood stabilisers'
These drugs are of great importance
in bipolar disorder.
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Their use in treating mania makes them 'anti-manic',
while their ability to reduce the severity and frequency of mood swings makes
them 'mood stabilisers'.
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Lithium, valproate and carbamazepine
are the most common.
It is important to
remember that the anti-depressants and mood stabilisers are often necessary both
to treat the depression that is occurring now, and to make a relapse in the
future less likely. So people sometimes need to continue taking medication for
some time after they are better.
Electroconvulsive
Therapy (ECT)
Because of its
controversial past many people feel the need to think carefully before having
ECT or allowing it to be given to relatives.
Clinicians at the
Institute firmly believe that ECT has a small but important role in treatment,
particularly in cases of
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Psychotic depression
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Severe melancholia where there is a high risk of suicide or the
patient is too ill to eat, drink or take medications
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Life-threatening mania
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Severe post-natal depression.
While there are some
short-term side-effects, ECT is a relatively safe and, because an anaesthetic is
used, not too unpleasant.
Transcranial
magnetic stimulation (TMS)
A possible alternative to ECT is
transcranial magnetic stimulation (TMS).
Transcranial magnetic stimulation is
a procedure used by neurologists, both as a treatment and as diagnostic
procedure. A coil is held next to the patient's head and a magnetic field
created to stimulate relevant parts of the brain. Unlike ECT, there is no need
for a general anaesthetic nor is a convulsion induced.
In our view, the evidence in favour
of this treatment is not yet in, but it is a major area of research at the
Institute and elsewhere. If TMS is shown to be as effective as ECT this would be
a distinct advance in the treatment of many mood disorders. No clear evidence
about its utility is expected for a number of years.