Clinical depression is also known as affective illness or affective disorder. A sub-group of depression occurs with the onset of longer nights and shorter days. It is called seasonal affective disorder (SAD) and surveys indicate four to six per cent of the population suffer with this problem. At least twice as many have some but not all of the features required to diagnose SAD.

Depression is one of the most common illnesses of mankind. About 15 per cent of the population will suffer from depression yet most people know little about it. For many, the notion of being depressed is the equivalent of being weak. To be afflicted with this illness is regarded as shameful. Yet there is absolutely nothing weak or shameful about depression. It is a physical illness that can be readily treated with medication and needless suffering can be avoided.

Close to one in every six people you know has been, or will be depressed. Many will never seek treatment, thinking they should be 'strong enough' to weather the bad spell. If depression is not treated, the average duration is about nine months but it can go on for years. All ages are affected and the illness is particularly severe and dangerous in the elderly. Sometimes depressive illness occurs in association with mania and this is known as bipolar illness or bipolar affective disorder.

What is the cause of depression?

A depressive episode can begin after a period of stress or physical illness. Sometimes it can come for no known reason. Certain medications such as cortisone can set off the illness. These factors are the triggers, not the cause. The most widely held belief about the cause of depression is that a chemical in the brain responsible for the flow of messages between nerves gets depleted. This chemical is called a neurotransmitter.

Nerves act very much like electric wires. The nerve impulse is, in fact, an electric impulse that flows along the nerves. There is one major difference in the transmission. Nerves are not continuous like electric wires. They have gaps called synapses and the nerve impulses cannot jump across the gaps. When an impulse reaches the synapse, a neurotransmitter, set loose to fill the gap, enables the current to continue across (see diagram).

In the brain, when neurotransmitters become depleted, an impulse cannot bridge the gap and depressive illness results. Research is continuing into the exact link between the depletion and a depression.

What are the symptoms?

The symptoms of depression affect the body physically as well as emotionally. The emotional changes are the ones that seem severest in most people. The person feels hopeless and assumes all kinds of imagined wrongs. Guilt for no good reason is common. Thoughts are slowed and concentration difficult. This lack of concentration can be severe enough to make some people fear they are having a memory loss. A fear of going mad is common in depression. Anxiety is very often present.

The physical symptoms cause a person to feel slow and weak, with no energy. Appetite is poor, and weight loss and constipation can be quite severe. Sleep is usually disturbed, and in a strange way. We are all familiar with the fact that if we have worries or problems, we have difficulty falling asleep. In depressive illness, the troublesome feature about sleep disturbance is that a person falls asleep with little delay but wakes very early. The more severe the illness, the earlier the waking. Usually once the person is awake, getting back to sleep is impossible.

Another change featured in this illness is that it is at its worst in the early part of the day. The depressed feeling improves as the day goes by so that by evening, the sufferer may feel considerably better, only to waken deeply depressed the next day. These symptoms vary greatly in severity. A person with a mild depression can carry on with a job or school but less efficiently and more slowly. Severe depression can be incapacitating. Some people are unable to work at all. They may not be able to perform even the most basic daily tasks.

Depression can be a very serious illness. The risk of suicide must always be considered in any person suffering with depression. Suicide risk is higher in depressed people who are divorced or widowed, elderly, white, male or living alone. The risk is also high if the person has other medical problems as well.

Is depression inherited?

A person whose parent had a depression before the age of 40 stands a higher chance of inheriting the illness. Depression occurring in someone after the age of 40 is usually triggered by some other factor and usually not passed on to children.

What treatment is available?

Family doctors can treat most depressions effectively with medication. There is seldom a need for hospitalization.

Anti-depressant medication:

As with many physical illnesses, depression requires treatment with medication. Highly effective medicines called anti-depressants are available. It is important to know that these are not tranquilizers like Valium™.

Anti-depressants have been in use for over 40 years. The first ones were effective but had unpleasant side effects (chiefly dry mouth and drowsiness). They could be given at bedtime in one dose and usually the patient became accustomed to the side effects. Later antidepressants called SSRIs (selective serotonin reuptake inhibitors) have many fewer unpleasant effects. The best known of these is Prozac™ but there are many other highly effective SSRIs on the market.

Anti-depressants are not addicting! They correct the chemical changes that cause depression by raising the level of neurotransmitters until the person's brain can maintain the balance on its own. Each person's need is different and no one can predict how long it will be necessary for an individual to take an anti-depressant.

What is known is that if a person stops taking the medication before the chemical balance has righted itself, the depression will break through again. Taking anti-depressants is a little like taking insulin for diabetes. It is a daily need, even when a person seems to be feeling better. The difference from the need for insulin is that with an antidepressant, the body eventually recovers from depression. The doctor and patient must work together to judge when medication can be stopped.

There is a time-lag of 10 to 14 days between starting anti-depressant medication and the beginning of recovery. During this interval, anyone who does not understand this wait may become discouraged and discontinue the drug. It is important to keep on with it.

There are now about a dozen types of antidepressant medications available. All are different, all are effective. There is not one antidepressant that will be effective for everyone. The doctor may decide the treatment needs to be changed to a more effective medication. This is not a reason to be discouraged.

ECT (Electro-convulsive therapy):

Rarely, when anti-depressants fail, ECT may be suggested. It is a safe procedure that usually clears up a depression quickly. Contrary to frequent concerns, and pictures conveyed by the popular media, modern ECT does not leave one with crippling side effects. Memory disturbance is slight and there may be a mild headache afterward. In severe depressions that do not respond to medications, the benefits far outweigh the disadvantages.

Group Therapy:

Group therapy and exploration of problems must be left until the depression is resolved. People see things much differently once the chemical imbalance of depression is relieved. In many cases, problems that seemed huge to the depressed person disappear or are easily resolved when the depression clears.

If you are depressed

You have a very treatable physical illness, not a weakness of character.
Do not feel ashamed.
Seek help from your family doctor who is able to treat most depressions effectively.
Co-operate with your doctor's treatment, even if you do not think you are improving. Tell your doctor your concerns.
Finally, it is wise not to make any big changes in your life while you are depressed. Wait until you are better!

Depression A treatable physical illness