A Health4u: Depression

Every normal person feels sad at times. There are life events - marital disputes, job loss, death of a loved one - that temporarily depress anyone. Depression refers to what may be normal feelings of sadness, despair and discouragement.

More seriously, depression may be a symptom of a variety of physical and mental disorders, or it may itself be a specific mental disorder known as major depression characterised by slow thinking, decreased purposeful physical activity, sleep and appetite disturbances, low self-esteem, loss of libido and feelings of guilt and hopelessness.

However, the good news is that it is a medical illness, like diabetes or hypertension, and can be treated with medication.

Depression is very common, affecting 20% of the population at any one time - twice as common in women as in men.

Symptoms of Depression

Feeling sad most of the day, nearly every day for 2 weeks or longer;
Loss of motivation;
Loss of interest in activities you usually enjoy;
Lack of energy;
Sleep and appetite disturbances;
Weight changes;
Feelings of hopelessness, helplessness and worthlessness;
Difficulty in concentrating and making decisions;
Death and suicidal thoughts.

What Causes Depression?

The exact cause is unknown. Doctors think it may be caused by chemical imbalances in the brain triggered by genes or more likely by events revolving in your life.

Two primary chemical messengers, serotonin and norepinephrine, are responsible for your moods but sometimes, there are not enough of these neurotransmitters in the brain.

These neurotransmitters carry messages from one nerve cell to another and when there are not enough, certain messages do not get carried to some areas of the brain, which in turn makes you anxious and distressed.

Choosing Antidepressant

Antidepressants will have side effects. The most suitable is the one with the least side effects. Here are guidelines on knowing whether you are on the right drugs:

If you are already on certain medication in the past, the same prescription is deemed suitable again;
Any medication used by family members might have the same effect on you.
Choice of antidepressants depends on your personal health. If the medication has bad side effects, then it is unsuitable;
Choice of an antidepressant depends on how often you consume it. The less often, the easier it is to take the doses you need to treat your depression;
Some antidepressants cost more than others. Your doctor will choose one that you can afford and is suitable;
Doctors choose a medicine which they have experience prescribing. They will choose an antidepressant that overcomes sleeplessness, anxiety and lack of energy;
If you are taking other medicines, your doctor will consider how an antidepressant will work with other medicines;
Some antidepressants do not work well with certain foods. If your doctor gives you one, he will let you know which food you should stop eating.

Shock Treatment for Depression

Shock therapy or more accurately, electro-convulsive therapy (ECT) consists of applying electric current via electrodes placed on the temples for a fraction of a second. The patient has a convulsion similar to an epileptic seizure.

Its use in young patients is controversial and is usually avoided, but it is generally thought safe for adults. Even so, some groups and therapists still oppose ECT, believing that other methods of depressive treatment can be as effective and safer.

ECT patients are anaesthetised and given muscle relaxants before treatment to prevent the jerky movements that in the past could cause fractures. Oxygen is also administered during treatment and new techniques used to prevent memory loss. In unilateral ECT, for instance, electrodes are not attached to each temple but one is attached to the right temple and one to the top right half of the head to avoid transmitting current through the brain's left hemisphere, where verbal memory is centred. Brief pulse therapy uses the lowest effective electrical current administered for the shortest possible time.

Curiously, doctors are still not sure how ECT works. The prevailing theory is that electrically induced seizures produce changes in brain chemistry. Despite some critics who maintain that memory loss is still possible, ECT remains, at present, the only hope for some patients with severe depression.