Depression

We seem to be experiencing an epidemic of depression. According to 'Beyond Blue' one in five Australians will experience depression at some point in their lifetime. Around one million adults and 100,000 young people live with depression each year and it is the leading cause of non-fatal disability in Australia.

Depression is a common experience. Most of us have felt 'depressed' about various events in our lives - sometimes we feel 'down' for no reason at all.

It is wise to seek professional help if the mood state is severe, if it lasts for two weeks or more and it interferes with our ability to function at home or at work.

Signs of a depressed mood include:

` Feelings of low self-esteem or self-worth

Change in sleep patterns, that is, insomnia or broken sleep

Changes in appetite or weight

Less ability to control emotions such as pessimism, anger, guilt, irritability and anxiety

Varying emotions throughout the day, for example, feeling worse in the morning and better as the day progresses

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.

Reduced pain tolerance: you are less able to tolerate aches and pains and may have a host of new ailments

Changed sex drive: absent or reduced

Poor concentration and memory

Reduced motivation: it doesn't seem worth the effort to do anything, things seem meaningless

Lowered energy levels.

Signs of depression may include insomnia, weight issues, emotions such as pessimism, anger, irritability and anxiety. Enjoyment in activities decreases and concentration and memory suffers. They are less able to tolerate aches and pains and may have a host of new ailments. Their sex life can change and be absent or reduced. They have poor concentration and memory, and may feel it doesn't seem worth the effort to do anything. Often their friendships drop off due to the lack of energy to maintain contact.

Feelings of guilt, worthlessness or death may start to predominate and some sufferers may attempt suicide. Some may 'self-medicate' using alcohol or other drugs. Being told to 'get over it' or ''pull yourself together' just makes the person feel worse, increasing his/her feelings of isolation and guilt.

It is normal to feel 'down' sometimes and usually these feelings go away, but if they persist for more than two weeks or if they stop us from coping at work and home, then it is time to seek professional help.

DepressioNet states that the theory that depression is either 'reactive' or 'endogenous' in origin is losing support and that it is now more commonly believed that both environment and genetic history play a part. 'Reactive' depression is the term used for depression thought to be caused by a specific event or circumstance, such as relationship problems or loss of someone you love either through death or the end of a relationship, losing or changing jobs, or anything else that you find traumatic. This doesn't refer to grief, which is normal and healthy and temporary, but to depression, which lasts well past the time that you would expect to start recovering from grief, and is therefore unhealthy.

'Endogenous' depression is the term given to depression that has no obvious cause - that is, was not brought on by a specific life event or circumstance, but rather appears to come from nowhere. Both are related to chemical changes in the brain, but differ in terms of which came first - i.e. did the depression come first, making life's problems seem far greater than they are, or did life's problems bring on the depression?

‘Postnatal’ Depression may be more common than many people realise. The feeling of the 'baby blues' often passes within two days, but if it continues then this is what is known as postnatal depression. It usually occurs within the first 12 months of having a baby, often within the first few weeks or months. The severity of the depression can range from very mild and almost non-existent, to very severe and long-term and tends to be most common after the first pregnancy. On the other hand some women can experience depression during pregnancy, this is called antenatal depression.

Andrew Miller, MD, and Christine Heim, PhD, of The Emory University Health Sciences Center conducted a study which suggests that the inflammatory response to stress may be greater in depressed people. The findings indicate that increased inflammatory responses to stress in depressed patients may be a link between depression and other diseases, including heart disease, as well as contributing to depression itself. People in the study who suffered from depression also had higher rates of early life stressful experiences. "We have found that this kind of personal life history may make people more likely to develop major depression and is actually common in depressed patients," stated Heim.

The results of a study by Johns Hopkins Phd; and James B. Potash, M.D. showed that siblings, parents or children of people diagnosed with chronic major depression before the age of 31 have a 2-to-1 chance of also having the disorder. Moreover, first-degree relatives of patients diagnosed with chronic major depression before the age of 13 have a 6-to-1 chance of having it. However they caution that the results also could point to environmental factors, such as loss of a parent at an early age or physical and/or sexual abuse.

In the 1980s improved knowledge of brain chemicals led to the belief that a shortage of serotonin was the cause of depression and a whole new generation of anti-depressants that boosted serotonin, such as Prozac and Seroxat, were developed. These were much less toxic than previous antidepressant drugs, and quickly became the treatment of choice for everything from mild anxiety to suicidal depression. However some doctors are now expressing concerns that too many people - particularly those with only mild depression - are on anti-depressants. (In a U.K. study, eight out of ten GPs admitted they were probably handing out more anti-depressants than they should).

Among the best-proven alternative treatments is exercise. One American study even found that three brisk, thirty minute sessions of running, cycling or swimming each week produced better results than some anti-depressants. This could be because the chemicals, which determine mood - adrenaline, serotonin and dopamine, are all produced during exercise

Dr. Edward Ernst, professor of complementary medicine at Exeter University believes the herb St John's Wort offers the best alternative treatment for depression. In Germany, where it is a prescription drug, it outsold Prozac four to one until research showed that it reacted badly with several prescription drugs, such as anti-coagulants, and stopped them working. "That aside, 30 clinical trials have shown St John's Wort extracts were extremely effective in reducing symptoms," stated Dr Ernst. St John's Wort was found to be very effective in treating mild to moderate depression. Ernst has also investigated other complementary therapies such as acupuncture (for which there are 12 studies, showing mixed results), and encouraging data on massage, music therapy, relaxation techniques and yoga, but none of them has such strong evidence as St John's Wort.

Professor Basant Puri at the Imperial College School of Medicine, in London believes that depression can be relieved by taking a supplement of an omega-3 fatty acid called EPA, which occurs naturally in oily fish such as salmon, mackerel and fresh tuna. EPA can be made by the body from the essential fatty acid alpha-linolenic acid (LNA) in flax and hemp oils. It is also found in seaweed. Four studies have since backed up Puri's work, and it has been established that people with depression have low levels of EPA in the brain-cell membrane, slowing brain activity and causing depressive symptoms. Puri stated, "It is such a simple treatment, with no side effects, and effective for mild and moderate depression as well as severe cases”.

The UK Government's National Institute for Clinical Excellence recommends the "talking therapies" like counselling and cognitive behavioural therapy (CBT) for mild depression. Research has repeatedly shown that they are more effective than drugs, yet there is a chronic shortage of practitioners and long waiting lists.

Leading psychologist Dorothy Rowe states that, "Antidepressants can relieve the pain of being depressed in some people for some of the time. They don't cure depression ... The way out of the prison of depression is to realise that you are not that bad, unacceptable person you thought you were and that we don't live in a world where good people are rewarded and bad people punished. Most people work this out for themselves, but sometimes it helps to talk things over with someone, a good friend or a good therapist or counsellor."

Dr Michael Yapko, a clinical psychologist based in California, is internationally recognised for his work in depression and outcome-focused psychotherapy and hypnotherapy. He believes that hypnotherapy is very effective in helping depression. He has, for the last thirty years, specialised in the treatment of depression with hypnotherapy.

Hypnotherapy has been directly influenced by the current push for empirically supported treatments, and in recent years substantial high-quality research has assessed the effectiveness of hypnotherapy and its contribution to improving therapeutic outcome. Yapko stated that "Hypnosis offers a way to conceptualise how human beings construct their individual realities, and how to interact more effectively with others; in clinical hypnosis hypnotic processes are employed as agents of effective communication and change. Our knowledge of depression has greatly improved in recent years, firmly establishing the essential role of psychotherapy in treatment. Whenever psychotherapy is indicated, so are specific identifiable patterns of hypnotic influence, since the two are fundamentally inseparable."

Dr Linda Edwards, in her article on Hypnotherapy and Somatic Hypnotherapy, also states the benefits of hypnotherapy as being a powerful tool for accessing the subconscious. Edwards states that the subconscious is a non-ordinary state of consciousness and that the human psyche is far more amenable to positive change, healing or beneficial reprogramming when we are in an hypnotic state compared to when we are in our usual beta state of consciousness (our thinking mode). Edwards recommends the work of psychiatrist Dr Stanislav Grof who has written numerous books and research articles on the healing power of non-ordinary states of consciousness. Dr Edwards states there is documented evidence that hypnotherapy compares very favourably with the most popular forms of therapy. Her comments are supported by Dr Alfred A Barrios,(12) who has reported the following success rates:

* Hypnotherapy - 93% recovery after 6 sessions (about 1.5 months)

* Behaviour Therapy - 72% recovery after 22 sessions (about 6 months)

* Psychotherapy - 38% recovery after 600 sessions (about 11.5 months)

USEFUL LINKS

BeyondBlue

DepressioNet

Black Dog Institute

Thanks to Bruni Brewin for much of the information in this article. Her original article can be found here.

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