PANORAMA PSYCHIATRY & MEMORY CLINIC
How To Improve Your Overview
Chances of Recovery This handout provides
information on depression.
It starts oﬀ by explaining
from Depression the diﬀerence between
normal unhappiness and the
Learn more about depression and the treatments that are illness of sadness that is
available... called depression.
The symptoms of
All of us experience hap- depression are described.
piness and sadness on a daily ba- Anxiety often occurs in
sis. This natural variation in mood depression and it is also
is not the same as a disease condi- explained.
tions, such as depression, that af- Depression changes the
fect the emotional functions of the
way the brain works and
brain. Depression causes changes
in the biochemistry and structure aﬀects the levels of certain
of the brain and it is therefore ac- chemicals as well as the
knowledged as a true medical ill- binding of these chemicals.
ness. Depression is common
and occurs in approximately
An example of normal day-to-day form of self-help to get us out of 1 out of 5 women and in 1
happiness and unhappiness is the our little black hole. out of 10 men.
feelings that we experience when
we watch our favourite sport on a DEPRESSION IS DIFFERENT Seeking treatment early
Saturday. If our team does particu- In contrast, the sad, heavy, empty helps to limit the impact of
larly well and beats the opposition, feeling of depression is something the illness. Antidepressants
then it lifts our spirits and we feel that we have little control over. We and talk therapy are the best
high and happy. Our interaction may be able to feel better for a treatments for depression.
with family members is positive while after we’ve had our braai,
and we have an optimistic view of Talking about your
but soon afterwards the blackness
the present and future. However, if thoughts, especially worries,
sets in again. No matter what we
our team plays particularly poorly do, we just seem to be unable to helps to relieve the pain of
and loses then we become negative pull ourselves out of the depths of depression.
and moody. This also has an effect despair. This lack of control over
on our family and more often than the sadness of real depression is
not we may find that family mem- the first distinguishing feature be-
bers retreat to allow us to get over tween depression and normal un-
our moodiness. We may also ad- happiness. The second distinguish-
minister self-treatment in the form ing feature is that depression feels
of a braai and perhaps also drink very different. Depression is de-
alcohol. The result is that we feel scribed as an uncomfortable and
better and soon we are able to tell unpleasant feeling associated with
ourselves that our team will per- deep sadness. Normal day-to-day
form better next week, or that the unhappiness feels sad, but does not
opposition played really well and have that uncomfortable quality of
deserved to win. Ultimately, how- depression.
ever, we can make use of some
PANORAMA PSYCHIATRY & MEMORY CLINIC
THE CORE FEATURES OF 4. Suicidal thoughts. You have may not stand out at these activi-
REAL DEPRESSION feelings that life is not worth it ties.
The two central features of depres- and that things will be better if
sion are sadness and a lack of en- you are not here anymore. However, sometimes we experi-
joyment. One or both of these fun- 5. Sleep changes. Most people ence excessive anxiety that is bad
damental features must be present have difficulty sleeping at for us and this often occurs to-
in order to diagnose depression. night. Others sleep more than gether with depression. Too much
The sadness is a sad, heavy and usual as they tend to sleep dur- anxiety is characterised by three
empty feeling that is present al- ing the day to forget and to important symptoms:
most every day, for a large part of switch off.
the day, and lasts for 2 weeks or 6. Appetite changes. Most peo- 1. Tension. People with exces-
longer. Lack of enjoyment con- ple experience a decrease in sive anxiety report that they
sists of an inability to find pleasure appetite while others tend to have a feeling of tenseness in
in or enjoy things that you previ- eat more. their chest. It feels like a
ously were able to enjoy. This lack 7. Poor concentration. You tightness or knot. They also
of enjoyment is also present almost struggle to focus and to con- report an inability to relax or
every day, for a large part of the centrate on work and events. to feel at ease and calm.
day, for 2 weeks or longer. This leads to impaired mem- 2. Excessive worry. Too much
ory. anxiety causes the brain to
8. Poor energy. You may not manufacture worries. People
DEPRESSION AND YOUR have energy to work or per- with excessive worrying worry
BRAIN form duties as before. Some where there really is no reason
Depression changes the way the people report that they have for concern. They tend to think
brain works. The accompanying lead in their legs and can’t get a lot about little insignificant
sketch indicates a side view of the going. difficulties. For example, they
brain. At the base of the brain are 9. Changes in movements. Oth- suddenly start to worry exces-
two areas called the Locus Co- ers around you may observe sively about being on time or
eruleus (LC) and Raphe Nucleus that you have become restless they worry excessively that
(RN). These two areas regulate, and move around a lot. You people may not like them.
amongst other things, the feelings may struggle to sit still. In 3. Bodily symptoms. People
of happiness or sadness and anxi- contrast, some of us with de- with anxiety experience head-
ety. The LC/RN does this by send- pression may move slower and aches, tightness in the chest,
ing out messages to many different tend to do things slower than breathing difficulties, heart
parts of the brain and so communi- before. palpitations, excessive sweat-
cates states of feeling. 10. Pains and aches. Many people ing, shakiness, uncomfortable
with depression report that feelings in their stomach, mus-
they have more bodily aches cle aches and pains, clenching
and pains. Muscles and joints of teeth, urinating excessively
may also pain. You may also and feelings of chills or fevers.
experience more headaches
than before. A CLOSER LOOK AT BRAIN
11. Sexual function. Most people CHANGES WITH DEPRES-
report that they are not inter- SION
ested in sex and that the fre- This diagram shows two brain
quency of their sexual behav- cells connecting in the LC/RN
A change in function of the LC/RN iour has decreased. In some area.
area results in depression or anxi- instances people may report
ety. that they have an increase in
THE CHARACTERISTICS OF
DEPRESSION DEPRESSION & ANXIETY
Depression is often accompanied
1. Sadness. by unbearable anxiety. For most of
2. Lack of enjoyment. us, anxiety is a natural part of our
3. Poor self-image. You view existence. It helps to feel anxious
yourself in a negative light and about exams and going to work to The connection area between two
tend to put yourself down. earn money. If we don’t then we brain cells is called a synapse.
PANORAMA PSYCHIATRY & MEMORY CLINIC
Brain cells (also called neurones) and serotonin in the synapse. The Antidepressants target depression
talk to each other through two cell that receives the messages in a by working at the LC/RN site of
mechanisms; one is a process that synapse responds to an excess of the brain. They increase the con-
is very similar to electricity and the neurotransmitters by “swallowing” centration of noradrenaline and
other is a chemical process. The the extra binding sites. This proc- serotonin in the synapse almost
electricity moves down the neu- ess heralds the recovery of depres- immediately after you have taken
rone on the left and when it sion and the system then returns to your first tablet. However, you do
reaches the end of the cell, it how it was before the onset of de- not immediately feel better after
causes a little bladder to release pression. starting on antidepressants. Most
chemicals. The chemicals then people notice an improvement
cross the space (synapse) and bind within the first few weeks, al-
to a specific area on the next cell though most report that they feel
called a receptor. Once it binds to their old selves again only after a
this area it stimulates the neurone few months of treatment. It takes a
on the right to generate electricity. few months before the number of
The electricity then continues receptors decrease significantly
down the body of the cell. The and this is associated with what
chemicals that allow the electrical Other parts of the brain such as the can be called a cure. In the begin-
impulse to cross the synapse and frontal lobes are involved in the ning of treatment the rapid in-
thus propagate the electrical im- thinking processes that accompany crease in the concentration of
pulse from one cell to the other are depression. Negative self-talk and noradrenaline and serotonin can
called neurotransmitters. In de- thoughts of putting yourself down sometimes lead to side effects such
pression the neurotransmitters be- characteristically occur in depres- as restlessness and agitation.
come deficient and this causes the sion. Patients have given the
symptoms of depression. Specifi- name; “washing machine HOW COMMON IS DEPRES-
cally we get a decrease in the con- thoughts” to these types of SION?
centration of noradrenaline and thoughts. If you put dirty clothes Depression is a common illness. It
serotonin. This decrease causes an into an automatic washing machine occurs in approximately 1 out of 5
increased production of receptors and start the washing cycle then women. The incidence is a little bit
on the cell that receives the chemi- you are able to view through the lower in men where it occurs in
cal message (up-regulation). window dirty washing going about 1 in 10 men.
around and around in dirty water.
Thus, in depression, your brain has Similarly, these negative thoughts IS TREATMENT NECES-
a deficiency of noradrenaline and of depression keep on turning in SARY?
serotonin, and an increased num- your mind and it leaves no space It is important to distinguish de-
ber of binding sites or receptors. for optimistic or positive thinking. pression from normal unhappiness
Most happy people tend to think which is a part of life, as it is un-
about happy events that have oc- necessary to treat normal unhappi-
curred or perhaps they look for- ness. We provided distinguishing
ward to happy events in the future features above in the introduction.
such as birthdays, anniversaries or It is important to treat depression
even a holiday. Washing machine when it interferes with your ability
thoughts may project back to the to function optimally at home and
LC/RN to worsen the abnormali- at work. If it affects your quality
ties that have been described of life and makes you unable to
Neurotransmitters are usually ab- above. Psychotherapy works on enjoy life, treatment will help you
sorbed back into the cell that re- these washing machine thoughts to to feel better and to enjoy life
leases them. This re-absorption improve your thinking. again.
process can be blocked by certain
medications. Antidepressants can In many instances depression is a
either block the re-uptake of sero- self-limiting condition. It usually
tonin or of noradrenalin, or in takes 9 to 12 months for depres-
some instances the antidepressant sion to improve on its own. More
will block the re-uptake of both. severe forms of depression will not
Blocking the re-uptake of neuro- improve and may even lead to
transmitters causes an increase in death through suicide or starvation
the concentration of noradrenaline
PANORAMA PSYCHIATRY & MEMORY CLINIC
and general deterioration of bodily person drives his car down the rejected, which worsens their de-
functions. In the era before anti- road and approaches a traffic light pression.
depressants most people had to which turns red. The person thinks
endure the illness and wait for it to nothing of this and stops his car. A melancholic depression is a par-
subside. In today’s modern society On the other hand, somebody with ticularly severe form of depression
we don’t have the time to wait for depression may think that even the where patients report a significant
depression to get better. Depres- red traffic light is against him/her worsening of their depressive
sion interferes with your ability to and that like everything in life, symptoms in the morning. The
earn an income and look after nothing is working out well today. symptoms usually improve during
yourself and your family. It is This is perhaps the final straw that the course of the day.
usually not worth it to wait for an confirms that he/she is a failure
extended period until you get bet- and that sadness is a way of life. Postpartum depression is a type of
ter. In the end most patients agree Even though this is an extreme depression that develops in women
that it is more sensible to get example, it illustrates the effect after giving birth. This is not the
treatment so that you can carry on that depression can have on your same as the “blues” that occur in
with your life. thinking. the first week after giving birth.
Postpartum depression is a particu-
WHAT CAUSES DEPRES- Some medical illnesses cause de- larly severe depression that occurs
SION? pression. A decreased production within the first 3 months after giv-
There is a strong genetic compo- of thyroid hormone (hypothyroid- ing birth. It can sometimes be so
nent for the development of de- ism) is often accompanied by de- severe that the mother may have
pression. Depression occurs more pression. Metabolism of the neu- thoughts of harming her baby or
commonly in certain families and a rones slow down and the result is herself. This is a medical emer-
positive family history predisposes the symptoms of depression. gency and should be reported to
you to the development of depres- Other illnesses that are associated your doctor immediately.
sion. with depression are strokes, head
injuries and dementia. Substance The last type of depression that is
Relationship difficulties, financial abuse and dependence are also as- often described is called a cata-
stress and chronic illness are sociated with depression. Alcohol tonic depression. This type of de-
common factors associated with suppresses brain functioning and pression is characterised by a vir-
the development of depression. prolonged use often results in de- tual sensation of all movement.
However, these stress factors are pression. Patients are immobile, refuse to
part of life and cannot always be move and also refuse to take in any
held accountable for the develop- TYPES OF DEPRESSION fluids or food. This is also a medi-
ment of depression. See below The most common type of depres- cal emergency and these patients
for more information on this. It is sion is the one where people report may require special care in order to
also possible that stress from sadness and a lack of interest in improve.
childhood may result in the devel- enjoyable activities. This is called
opment of depression in later life. a major depressive disorder. Depression may also occur as part
of a bipolar disorder. In bipolar
Stress from our surroundings is an An atypical depression is another disorder patients experience the
easy scapegoat for causing depres- type that is associated with pro- two extreme poles of emotions
sion, but the situation is often more nounced feelings of a lack of en- namely depression and mania.
complex. Some people experience joyment, increased sleep, increased Mania is a condition of euphoria
normal life stress and go on to de- appetite and profound loss of en- accompanied by racing thoughts,
velop depression. They then, be- ergy. Patients describe this lack of increased energy and decrease
cause of the depression, interpret energy as typically a leaden or need for sleep.
normal life stress as especially heavy feeling in their legs. Atypi-
stressful and this may even trap an cal depression is also accompanied TREATMENT
inexperienced therapist to focus on by a heightened (sensitivity to be- Depression can be treated with
the stress rather than the depres- ing rejected in relationships) sense psychotherapy, medication or other
sion. Therefore, you should not of rejection sensitivity in relation- forms of therapy such as electro-
only focus on events around you ships. Patients report that they convulsive therapy.
that upset you but also understand require constant reassurance that
that depression causes you to in- relationships are working out well Psychotherapy involves talking
terpret normal things as stressful. and if they don’t get this they feel and usually occurs between a pa-
Consider the following example: A tient and a trained therapist. The
PANORAMA PSYCHIATRY & MEMORY CLINIC
therapist will analyse the thinking synapse. An example of this class
patterns of the patient and point of drug is Wellbutrin. Sometimes we are not fully aware
out thinking that worsens depres- of the impact that depression has
sion. Through this process the pa- Receptor blockers on our way of living. We feel the
tient will also gain insight and un- Some medications block binding pain, but also try to press on with-
derstanding about him/herself and sites on the cells that release out getting treatment. Be aware
how he or she relates to people chemicals. This results in an in- that depression affects your brain’s
around them. Cognitive behav- crease of serotonin and noradrena- ability to correctly interpret the
ioural therapy (CBT) and interper- line in the synapse. Examples in- influence that depression has on
sonal psychotherapy (IPT) are the clude Remeron and Molipaxin. your life. The impact may be far
two types of therapy that have the greater than you are aware of and
best results in depression. These Electroconvulsive therapy you should find help for your own
therapies have been well re- Electroconvulsive treatment (ECT) sake and also for those around you.
searched and have proven to be as is also called “shock therapy”. If you are in doubt then rather go
beneficial as medication in mild to This type of treatment is usually for an assessment. The doctor who
moderate depression. CBT works only used in instances of more se- examines your brain for the symp-
by helping patients to identify and v e r e d e p r e s s i o n , t r e a t m e n t - toms of depression will be more
correct negative thought patterns resistant depression, or where the objective as he is not trapped in-
and beliefs. IPT helps the patient person cannot participate in other side your mind.
to understand depression and how treatments due to, for example,
it is worsened by interpersonal pregnancy or major illness. ECT is WHO TREATS DEPRES-
conflict. administered in an operating thea- SION?
tre under general anaesthetic and a A number of professionals are in-
Numerous research studies have muscle relaxant is also given. volved in the treatment of depres-
shown that the combination of During the procedure a small elec- sion. Often your general practitio-
psychotherapy and medication is trical current is administered to the ner is the point of first contact.
the best treatment available today. brain. In most instances the de- Your GP may be the one who made
These two treatments work on dif- pression recovers quickly with this the diagnosis and started initial
ferent aspects of brain functioning, treatment. treatment. If you respond to
as described above, and the com- treatment then often no further in-
bination probably gives you the IMPACT OF DEPRESSION tervention is required. In cases of
best chance of not suffering from a Depression has a tremendous im- a non-response or troublesome side
relapse. pact on family and work life. It effects your GP may refer you to a
affects all your relationships at specialist such as a psychiatrist. A
ANTIDEPRESSANTS home and it is important to be psychiatrist is a medical practitio-
SSRI aware of this so that you can limit ner who received a further four
Selective Serotonin Re-uptake In- the impact. You may feel with- years of training in working with
hibitors work by blocking the re- drawn and less interested in recrea- depression and other mental condi-
uptake of serotonin. The result is tional activities. Your significant tions. Your psychiatrist may order
high levels of serotonin in the syn- others may interpret this as rejec- blood tests or brain scans to exam-
apse. Examples of these kinds of tion and feel that you dislike them. ine further for other causes of de-
medications include Cipralex, Pro- Discuss this with them and make pression. Your treatment may be
zac and Cipramil. them aware of the symptoms asso- adjusted to cater for a more resis-
ciated with depression. tant type of depression and some-
SNRI times more than one medication is
Serotonergic and Noradrenergic Your performance at work will prescribed.
Re-uptake Inhibitors are medica- decrease because of depression.
tions that increase the concentra- Not all employers understand this A psychologist is a mental health
tion of serotonin and noradrenaline and you may have to educate your professional who received special
in the synapse. Examples include colleagues at work. Tell them training at University for psycho-
Cymbalta and Efexor. about the symptoms of depression therapy (talk therapy). It is benefi-
and the impact that it has on your cial to see a psychologist at any
DRI life. Tell them that you will im- stage of your illness. Mild and
Dopamine Re-uptake Inhibitors prove and that you will be back to moderate forms of depression are
increase the amount of dopamine your old self again. It sometimes treated with psychotherapy. Se-
in the synapse. These medications takes a few weeks or months, but vere depression is usually treated
also increase noradrenaline in the recovery is the rule.
PANORAMA PSYCHIATRY & MEMORY CLINIC
with a combination of medication difficult to talk about their is an emergency then go to
and psychotherapy. feelings. Sometimes you have your nearest hospital emer-
to force yourself to verbally gency unit. Or phone the SA-
There are many individuals who express the thoughts that you DAG (South African Depres-
receive training in counselling and are having. Literally just start sion and Anxiety Group) at
these persons can also help to by saying what you are think- 011 783 1474 right now.
manage milder forms of depres- ing. Do not be put off by
sion. Most church ministers are thoughts like “what I am TIPS FOR FAMILY AND
trained in counselling and they thinking is not worth it”. Start SIGNIFICANT OTHERS
often have many years of experi- communicating your thoughts 1. Provide unconditional support
ence in working with depression. now and with time you will and love.
see that it is beneficial and Give your depressed family
Hospitalisation is usually indicated easy to express your thinking. member unconditional support
for moderate to severe depression. and love. Tell them that you
It is a useful intervention to re- You can also write your are there for them and that no
move a depressed person from a thoughts down in a diary or matter what happens you will
stressful environment. It is also other place. Writing and read- not change your support.
possible to provide more intensive ing what you have written
therapy during hospitalisation. will help to lessen the pain 2. Don’t take is personally.
associated with depression. People with depression may
SUICIDAL THINKING appear to be less interested in a
Thoughts that your life is not 2. Do the basics right. relationship and it may be dif-
worth it and that you may want to Make sure that you sleep well ficult for you to accept this.
end it all are often part of depres- and eat well. Learn about the Know that it is a temporary
sion. Tell your doctor or psy- principles of sleep hygiene so thing and that the person will
chologist about these thoughts. that you can sleep without get better.
Remember that depression can medications. But, if it doesn’t
convince you that the only way out work then contact your doctor. 3. Look after your own needs.
is to take your own life. These Also, try to schedule some Caring for somebody with
thoughts are part of depression and form of exercise into your more severe forms of depres-
are not an objective assessment of daily routine. Stick to the sion can be very tiring. Make
reality. These thoughts are caused routine that you may have had sure that you have time for
by the biochemical and structural when you were feeling better. yourself so that you can re-
changes in your brain. Call your It is important to force your- cover and build your strength.
doctor at any time of the day or self to live as if you are get-
night if you experience suicidal ting better. 4. Obtain help.
thoughts. You may also call the Always make sure that you are
South African Depression and 3. Walk with it. not on your own when looking
Anxiety Group on 011 783 1474. Sometimes you just have to after somebody with more se-
tell yourself that you are suf- vere forms of depression.
TIPS FOR COPING fering from depression and Make sure that you have help
Initially it may feel as if nothing is that there is nothing you can and that other family members
working for you and you may feel do right now. Just walk with or friends understand what is
that you are rapidly loosing control the depression and try to get going on.
of your brain and life. Below are on with things. You will even-
strategies that may help you to tually get better even though FAMOUS PEOPLE WITH
cope. Read this carefully and see if right now it may be difficult to DEPRESSION?
you can apply them right now: imagine that it will ever be
better. Just try to carry on with A number of very famous people
1. Talk about your feelings. your day to day routine even have struggled with depression.
It is important to talk about though you are carrying these These include: Billy Joel, Jim Car-
your thoughts and feelings. heavy feelings inside. rey, Sheryl Crow, Brooke Shields,
Numerous research studies Terry Bradshaw, Princess Diana,
have shown that we are able 4. Get help. Harrison Ford, Abraham Lincoln,
to handle and decrease nega- If these steps are not helpful Boris Yeltsin, Buzz Aldrin, Kurt
tive thinking just by talking and things are getting worse Cobain, Vincent van Gogh and
about it. Many patients find it then contact your doctor. If it Winston Churchill.