What is Depression?

In your mind, you may:

• Feel unhappy, miserable, down, depressed. This feeling just won’t go away and can be worse at a particular time of day. Often it is first thing in the morning.
• Be unable to enjoy anything.
• Lose interest in seeing people and lose touch with friends.
• Be unable to concentrate properly and find it harder to make decisions.
• Lose your self-confidence.
• Feel guilty and unworthy.
• Become pessimistic.
• Start to feel hopeless, and perhaps even suicidal.

In your body, you may find that you:

• Feel restless, nervous or agitated.
• Feel exhausted and without energy.
• Can’t get to sleep, or sleep too much.
• Wake early in the morning and/or throughout the night.
• Have a headache or stomach upset.
• Lose interest in sex.
• Can’t eat and lose weight, or ‘comfort eat’ more and put on weight.

Others may notice that you:

• Make mistakes at work or can’t focus.
• Seem unusually quiet and withdrawn, or are avoiding people.
• Worry about things more than usual.
• Are more irritable than usual.
• Are sleeping more or less than usual.
• Complain about vague physical problems.
• Stop looking after yourself properly, like not washing your hair or your clothes.
• Stop looking after your home properly, like not cooking, not tidying or forgetting to change the sheets on your bed.

These symptoms must be present for at least two weeks before clinical depression can be considered as a possibility.

An episode of depression can be characterised as either mild, moderate or severe. This depends on the number and intensity of symptoms that are being experienced.

• Some people may only suffer a few symptoms.
• Some may misidentify their symptoms as being due to physical illness, especially if they are feeling tired, unmotivated or are having sleep difficulty.
• Some people feel very anxious when they are depressed. This can cause feelings of intense worry, fear and feeling on-edge. People often describe physical symptoms of dry mouth, sweating, palpitations and breathlessness.

Symptoms of depression can have a major impact on all aspects of person’s life, including their work, social life and personal life.

Depression is common.

• It occurs in around 1 in every 7 people.
• In 1 in 20 people, it can be severe.
• It can affect anyone, at any age.

Some people are more likely to become depressed than others. For example, women are almost twice as likely than men to suffer from depression. Also, if your life circumstances mean that you live alone or have no family or friends around, you are more likely to become depressed.

While we do not fully understand what causes depression and other mood problems, we are learning more every day.

We do know that several factors play a role in someone developing depression.

• Depression is more common after a stressful event, such as the breakup of a relationship, the loss of a loved one or the loss of a job, for example.
• However, depression may also occur for no clear reason in someone who appears to live in ideal circumstances.
• Depression is more likely to occur if you have a close relative that has depression. Children with a parent who suffers from depression have a 1-in-3 chance of developing a major mental illness.

Other causes include:

• Alcohol and drug abuse
• Serious physical and mental illnesses
• Childhood trauma
• Lack of good coping skills in dealing with stress or ongoing problems or conflicts.
• Certain medications. Some drugs, such as isotretinoin (which is used to treat acne), the aniviral drug interferon-alpha, and corticosteroids can increase your risk of depression.

Is Depression caused by a chemical imbalance?

While it is often said that depression is due to a “chemical imbalance”, this figure of speech does not capture how complex depression is.

Yes, chemicals are involved in this process. However, it is not simply one chemical being too low and another too high. Many chemicals are involved, working both inside and outside nerve cells.

• For example, serotonin is just one of many brain chemicals (known as neurotransmitters) that allow communication across regions of the brain that are involved in processing emotions.
• In the brain itself, the hippocampus is vital to the storage of memories. The hippocampus appears to be smaller in some people with a history of depression than in those who have never been depressed. We do not know why people with depression have a smaller hippocampus. Some scientists suggest that it is because depressed people have higher levels of the stress hormone cortisol, and this might have a toxic effect on the hippocampus. Other scientists suggest that people with depression might be born with a smaller hippocampus, and that this can lead to depression.

While we are learning more about depression every day, there are many factors and processes that are still unclear.

Depression can be treated with both psychological and pharmacological (or medication) approaches. Often, people will be treated with both.

The first time you experience depression you may be offered just psychological therapy.

• There are many different types of psychological therapy.
• Psychological therapy is tailored to your needs as much as possible. You may be offered one or more types of therapy depending on the problems that you identify.
• For example, relationship trouble might lead to a referral for couples therapy.

If your illness is mild, support might be offered through:

• Self-help leaflets or books based on cognitive behaviour therapy.
• Apps that can be downloaded to your mobile phone or device that guide you through CBT or other psychological therapies.
• You may be offered group therapy.

If your illness is moderate to severe, as well as psychological intervention, you may require treatment with anti-depressant medication:

• These are usually SSRI (serotonin reuptake inhibitors) medications or other medications targeted towards different neurotransmitters in our brain. Neurotransmitters are the brain chemicals that are responsible for regulating our emotions.
• We know that levels of these chemicals can be lower in people who are depressed.
• We also know that these brain chemicals are broken down very rapidly.
• Medications work by helping our brains to hang on to the neurochemicals that we produce for a little longer than normal. This gives them more time to do their job.
• Medications do not change our personality.
• They do not change the structure of our brains permanently.

When people are depressed, it can be difficult to cope with difficulties in their lives. Medications help us to cope better so that we can address these difficulties. However, it is vitally important that we work to identify the things in our lives that are causing us difficulty. Then we can address these things and reduce their negative impact.

Your GP should be the first person that you attend if you are feeling down or think that you may be suffering from depression. They will be able to treat milder illness.

• GPs can signpost you to local psychological services that might be appropriate to your needs.
• GPs will refer you to your local community mental health team (CMHT) if they feel that this is necessary.

Sometimes, GPs may refer you straight to the hospital if they feel that you require it. Most people do not require hospital admission and will manage their illness by engaging with the local CMHT. A hospital admission might be recommended if a person is not getting better in the community, or if they are so unwell that they are a risk to themselves.

It is uncommon for an episode of depression to be so severe that it does not respond to usual treatments like medication and psychological therapy. In these rare cases, electroconvulsive therapy (ECT) can be used.

• ECT is a treatment that has a lot of negative attention in media. It has often been portrayed very negatively and frighteningly in movies and on television. These are not true representations of how ECT is given.
• ECT is actually a very safe and effective treatment.
• If ECT is recommended for you, your consultant psychiatrist and multidisciplinary team will give you all the information you need so that you can make a fully informed decision about your treatment.

There are many lifestyle changes you can make to help you cope with your depression and which may help prevent another episode of depression from occurring:

• Stress management may help if your depression is being triggered by stress or pressure, for example in your job.
• Try to get regular exercise and eat a well-balanced diet.
• Avoid alcohol and illegal drugs. These substances can worsen depression.
• Make sure you get enough rest and maintain a regular sleep schedule.
• Improve your social outlets e.g. hobbies, meeting with friends, evening courses, etc. This may be difficult when you are unwell, but it is important that you don’t isolate yourself. Isolation can make depressed feelings worse.
• Confide in trusted friends or family about how you are feeling. Don’t keep things bottled up. Sometimes just talking can lighten the load a little.

Talk to your doctor or CMHT early and follow through on any advice you are given. Do not be afraid to ask for more help if you feel you need it. Remember, it is never too late to ask for help.

Listen

• Listening can be harder than it sounds. You may have to hear the same thing over and over again.
• It is usually best to not offer advice unless the person you are listening to asks for it, even if the answer seems perfectly clear to you.
• If depression has been brought on by a particular problem, you may be able to help find a solution, or at least a way of tackling the difficulty.

Spend time with them

• It’s helpful to just spend time with someone who is depressed.
• Letting the person know you are there for them can help encourage them to talk and keep going with doing things that will make them feel better.

Reassure them

• Someone who is depressed may find it hard to believe that they can ever get better.
• You can reassure them that they will get better. You may have to repeat this over and over again.

Support their self-care

• Make sure that the person is buying enough food and is eating regularly, with a good amount of fruit and vegetables in their diet.
• You may be able to help them to get out and do some exercise or other enjoyable activities. These are a better alternative than using alcohol or drugs to cope with their feelings.

Take them seriously

• If the person is getting worse and they start to talk of not wanting to live, or even hinting at harming themselves, take them seriously.
• Make sure they tell their doctor about these thoughts.

Encourage them to accept help

• Encourage the person to see their doctor, take their medication, or talk to their therapist or counsellor.
• If they are concerned about their treatment, courage them to discuss these with their doctor.

Look after yourself

• Depression can make people lethargic, irritable and self-focused. This can be emotionally draining for a person who is supporting them.
• Make sure you look after your own mental health and wellbeing.
• You may need to take breaks from the depressed person from time to time. These breaks will help both of you in the long run.

Depression is a health condition that affects many people in the old age population. It is not a normal part of aging.

When older adults become depressed, they are at risk of being misdiagnosed and not receiving proper treatment for their depression. Some of their symptoms can look like normal age-related issues. Symptoms of depression may be mistaken for symptoms of other illnesses, medication-use, or life-changes.

Medical problems, including chronic conditions, can trigger or worsen symptoms of depression in older people.

Any medical condition, especially those that are painful, debilitating, or life-threatening can result in symptoms of depression. These conditions include: cancer, Parkinson’s disease, stroke, heart disease, Diabetes Mellitus, Dementia and Multiple Sclerosis.

Certain medications are associated with depression in older adults. These medications include: cardiovascular drugs, chemotherapeutics, antipsychotic drugs, antianxiety medications, sedatives, anticonvulsants, anti-inflammatory and anti-infective agents, stimulants, hormone drugs, and other drugs. Older patients who experience depressive symptoms when taking medications should report these symptoms to their General Practitioner.

Older people may be reluctant to talk about their feelings or fail to understand that physical symptoms can be a sign of depression. For some older people, isolation can make it difficult to reach out for help.

As mentioned above, the main feature of clinical depression is:

1. a period of at least two weeks
2. when a person experiences depressed mood or loss of interest or pleasure in nearly all activities
3. most of the day, nearly every day

According to the American Association for Geriatric Psychiatry, the most common symptoms of depression in older people include:

• Persistent sadness
• Feeling slowed down
• Excessive worries about finances and health problems
• Frequent tearfulness
• Feeling worthless or helpless
• Weight changes
• Pacing or fidgeting
• Difficulty sleeping
• Difficulty concentrating
• Unexplained physical pain or stomach problems
• Withdrawal from social activities