Depression: the way forward

Have you ever felt "depressed"? Have outside events beyond your control spiralled into what feels like a tunnel of darkness, a feeling of drowning in sorrow and sadness, almost a state of panic, worry and deepest blackness of mood?

Over the centuries, there have been many theories about what makes a person suffer from what was once called melancholia and is now called depression. The weather, hormonal imbalance, grieving, one's habits or diet, heredity, social class, as well as many other reasons have been variously quoted as causing depression.

However, it is important to remember that each and every one of us is unique and that one rarely fits perfectly into this explanation or that one; however, it is the explanations that are inadequate, not you.

When people are feeling really depressed, they suffer a number of physical symptoms, which may end up almost seeming to paralyse them. There is also the risk of attempted self harm or even death through suicide.

In medical terms, depression is an illness. It is believed that depression causes alterations in the brain's chemistry and that anti-depressant drugs, designed to restore the imbalance to normality, have a high level of effectiveness. However, this only suggests that the brain's chemistry is altered during depression; it does not prove that this change caused the depression.

In fact, some people, who simply take anti-depressant medication and do not change themselves or their environment in any way, will often find themselves depressed again if they stop taking the medication prematurely (before the doctor's orders).

People describe their depressed feelings in a variety of ways; some feel an emptiness, which they attempt to fill with alcohol, vast quantities of food or, symbolically, by spending money.

Others feel a great weight dragging them, a great feeling of being alone, almost a sense of drowning. Apart from the primary sign of this intense sadness and sense of sorrow, depressed people are often filled with intense self-dislike, a lowering of self-esteem and a feeling that they are to blame for all the events that are going wrong about them.

Furthermore, the depressed person can see no end to the misery he/she is experiencing. In technical terms, they feel "hopeless and helpless".

Physical signs are such that mild feelings of depression may contribute to 'comfort eating', but more serious depression introduces a definite loss of appetite and weight.

People suffering from anxiety may have trouble sleeping but those with depression find they wake much earlier than usual and that those hours of early dawn are the worst in the day. They are constantly exhausted, lose interest in sex, have memory problems and difficulty in concentrating and making decisions.

If you are suffering from these symptoms, it is natural that you must seek professional help. In Malta, patients suffering from various forms of depression present themselves frequently at medical surgeries.

It is usual for such patients to complain of a variety of symptoms, seemingly unconnected with depression, for example headaches, sleeplessness, various aches and pains.

Over a number of such visits, the experienced GP will observe that there is an underlying cause for these symptoms, which become increasingly intrusive into the daily life of the patient.

In such cases, the course of action usually followed is for the GP to prescribe appropriate doses of anti-depressants. Nowadays, medical expertise recommends the SSRI and SNRI groups of medicines, which work on Serotonin, a chemical receptor in the brain. Depression alters the balance of the neuro transmitters and these particular medicines redress the balance.

However, drugs alone should only be used as a partial measure not as an exclusive, everyday long-term solution to the problem of depression. In fact, in the US, this modern group of medicines was so successful in altering people's moods that people began to misuse them as recreational, mind-altering drugs!

It is worth noting that, in Malta, all members of society have the facility to avail themselves of the services of the Maltese psychiatrists and psychologists. The system of referral via the polyclinics is such that, ultimately, rich and poor alike can be successfully treated for their depressive illnesses, mostly on an outpatients basis.

In diagnosing depression, psychiatrists make two distinctive divisions - one is called reactive depression where there is a clear external cause, such as bereavement or unemployment. The other is identified as endogenous depression, which is seen as an illness caused entirely by the changes in the brain's chemistry, but the distinction is hardly valid.

It is known that there is a relationship between our mood and our brain chemistry; for example, drugs and alcohol have direct physical effects on our mood but there is no longer clear evidence that changes in brain chemistry actually cause depression.

In contrast, within psychology, there are a number of theories which attempt to explain why people become depressed. Although such claims can be substantiated by good evidence, each individual has to be diagnosed in his/her own unique way.

In psychoanalysis, theories on happenings in the first years of one's life (such as relationships with parents or careers) are put forward to explain the depression which strikes the individual in later life.

It is possible that events in adult life reawaken their earlier traumas and cause the mind to spiral downwards into a depression. In certain cases, these explanations can help the depressed individual understand the root cause of his/her depression and contribute towards recovery and happier times.

Other sources of help come via the family GP or a psychiatrist, both of whom will probably prescribe a course of antidepressant medication, as outlined earlier. A cognitive psychotherapist will give the patient exercises to change the thought patterns that produce depression and a behaviour therapist will help by introducing new rewards into his/her life and removing the aspects which threaten peace of mind.

The two methods are usually combined (Cognitive-Behaviour Therapy) and coupled with anti-depressants produce excellent results.

In conclusion, the path along which one can travel if one suffers from depression can be a long and arduous one. If one were able to confront painful feelings, share sadness and grief with those willing and experienced at listening to such experiences, then there is hope for the future.

The first step towards identifying and acknowledging one's depressive illness is the best way forward. This applies also for the attending physician, who must always keep in mind that physical disease may kill the patient if not diagnosed. Depression may make the patient kill himself if missed!