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We all feel fed up and miserable from time to time. But depression is more than just a feeling of unhappiness. It's a major health disorder that causes untold suffering to millions of people.

We expect to feel sad if someone close to us is ill or dies, we lose our job, or a relationship flounders. Any event that involves loss or disap­pointment will make us unhappy.

But sometimes the misery just doesn't go away, or a sense of hopelessness Just comes out of the blue for no obvious reason at all.

Whether there's a cause for it or not, depression drains us of energy and our ability to enjoy life. It can make us feel worthless, leaving us unable to achieve anything at all.


Depression can range from a normal mood to a severe clinical disorder. Clinical depression is usually classed as major or minor.

Major depression is defined as a low mood and the inability to be interested or take pleasure in one's surroundings for at least two weeks. This is usually accompanied by a characteristically negative way of thinking, including guilt, pessimism, feelings of personal worthlessness and ideas about suicide and being better off dead.


Clinical depression is a serious medical condition that can last for years if untreated.

Change in sleep patterns

Restlessness or lethargy

Lack of energy or fatigue

Loss of concentration

Thoughts of death and suicide

Loss of confidence

Appetite or weight change

To be diagnosed as major, depres­sion must include at least four of the following classic seven symptoms: low self-esteem or guilt; loss of con­centration; thoughts of suicide; loss of en­ergy and extreme tiredness; loss or in­crease of appetite and weight; insomnia or excessive sleeping; and either a slowing down or a constant sense of agitation.


Special brain scans can show up differences in the metabolic activity in the tissues of a normal person and one who is severely depressed.

Minor depression is defined as having a low mood and also showing fewer than four of the symptoms that characterize major depression. People who have a low mood but show few of the classic seven symptoms have subclinical depression.

If left untreated, an episode of depression lasts between six and nine months, on average, However, another class of depression has recently been recognized. Called recurrent brief depression, these bouts of severe depression last one to 14 days and then vanish, but can occur up to 20 times a year.


Depression is thought to be caused by a reduction of certain chemicals in the brain called neurotransmit­ters, These chemicals affect our mood by stimulating brain cells.

But no one really knows why depression develops, Sometimes it seems to come out of the blue, and sometimes it's an obvious response to life. A range of internal and external factors can trigger changes in our mood.


Depression can affect anyone at any age, but some of us are more vulnerable to it than others.  At any one time, around five per cent of us are suffering clinical depression.

The most severe forms are more common in middle and old age, and perhaps up to a third of us will experience a milder form of depression.

Recurrent brief depres­sion is thought to affect up to one in 10 of us - men and women are affected equally, But it is not yet certain how many of us will suffer from depression at some point in our lifetimes.


Women are twice as likely as men to be depressed. This is partly because of hormonal factors, and also partly because women with young children may be vulnerable to social stress, Women are also more likely to go to the doctor and admit that they feel depressed.

Can children get depressed?

Yes they can, but the symptoms are often different than with adults. The most common symptom of depression in children is withdrawal from family and friends. Other signs include poor school achievement, truanting or aggressive behaviour. Tearfulness is unusual in children. Depression in teenagers may often be misinterpreted as moodiness, but up to one in 10 ado­lescents report episodes of depression.

There may also be link between depression and genetic makeup. Recent medical evidence suggests it may run in families.

People whose mothers were absent during their childhood, either because their mother died or was herself too depressed to adequately care for her family, are at higher risk of depression.


Your psychological profile is also significant Psychoanalysts believe that people who repress their emotions, particu­larly anger, are vulnerable to depression, People who have been bereaved and who don't weep or talk about their sadness - the classic stiff upper lip ­often get stuck in a long period of depression.


Severe illness often triggers depression. A strong support network of family and friends can make all the difference in your ability to cope.

There are also a number of external causes that are traditionally known to be a cause of depression, For exam­ple, illness or injury and any number of stressful life events, such as bereavement, job loss or the breakup of a relationship, are likely to cause an unhappy mood, Lack of family and friends as a network of support is a contributing factor.


Depression can follow a viral infection, and it may be set off by low levels of sunlight in winter (a condition called Seasonal Affective Disorder). Lack of sleep due to waking up at dawn is a common symptom of depression. It may make the person feel worse and the depression harder to resolve.

Antidepressants are extremely effective at relieving disabling symptoms, thus enabling the sufferer to cope with day to day living, But finding the right one is vital to successful treatment.  


Hormonal factors play a large part. Depression is very common among women just before their periods (PMS or premenstrual syndrome), immediately after giving birth (post-natal depression) and around menopause.

These are all times of hormonal change and many doctors believe that it is the reduction in the levels of oestrogen which is responsible for so much female unhappiness, However, other doctors believe that these types of depression may have nothing to do with hormones and everything to do with social at­titudes towards women.

The 'baby blues' affects up to half of all new mothers, but this short­lived mood of tearfulness that occurs a few days after giving birth is not true post-natal depression. PND is a distinct condition which affects up to 15 per cent of women in the six months to a year after having their baby. Symptoms include a low mood, anxiety, irritability, tearfulness and tiredness. Some doctors believe PND is caused by social factors such as lack of support and social isolation after having a baby. They say that counselling is the best form of treatment. Others believe that PND is caused by a hormonal imbalance and often prescribe oestrogen (though some prescribe progesterone). Antidepressants are often prescribed, but women caring for a baby should not be given medication with a strong sedative effect. Breastfeeding women may pass some drugs into the baby's system via the breast milk.


Only about half of all people with major depression are identified as such by their family doctor, This is because anyone who is depressed may find it hard to talk about how terrible they feel.

They often consult their doctor with one of the physical symptoms of depression, such as constipation, sleep problems or weight loss, but are reluctant to specify that they feel unhappy or depressed.

A number of people don't want treatment and simply accept their low mood. But effective treatments for depression do exist.


Many people are reluctant to take drugs for depression because they think that medication will stop them sorting out their problems. But relieving the symptoms of depression means the sufferer can get on with life, instead of getting trapped in the classic downward spiral of decreasing energy and self-confidence.


There are several classes of anti­depressant drugs, all of which act in different ways on the levels of neurotransmitters in the brain. The most common are tricyclics, of which there are various types. Some improve sleep, while others are given to people who feel lethar­gic. Side-effects include drying of the mouth and blurred vision, but these usually soon wear off.

Monoamine oxidase inhibitors may be prescribed when people don't respond to the tricyclics. These can have major side-effects and interact with other drugs.

Serotonin re-uptake inhibitors have fewer side-effects but may cause nausea. Prozac comes from a new class of antidepressants known as specific serotonin re-uptake inhibitors.


Antidepressants are beneficial for treating major depressions, but less effective for milder depression.

Around three-quarters of people with depression respond to them. They are not addictive, but they have to be taken for as long as six to nine months after the depression has lifted to be successful.

Though antidepressants are effective, evidence suggests that a combination of anti-depressant drugs plus psychotherapy is the best treatment of all.


When we become depressed, we can get stuck in negative thought processes. If we lose our job, we start thinking that we'll never work again. If a relationship breaks up, we imagine that we're unlovable.

Cognitive psychotherapy, in which the therapist teaches you to identify gloomy ways of looking at life and replace them with more positive attitudes, can help.

But almost any form of talking therapy is useful. It can draw the depressed person out of their bleak world, and help them to understand their feelings and what steps they can take to help themselves.

Regular aerobic exercise has been shown to have an uplifting effect on depressed people as well as improving mood generally. The theory is that aerobic exercise triggers the release of certain chemicals in the brain called endorphins. These are the body's natural opiates that make us feel good. Depressed people seem to have lower levels of endorphins.

Studies have shown the medical benefits of laughter. It reduces stress and increases the output of hormones which can help overcome depression.


Hormonal depression in women can sometimes be relieved by taking oestrogen or progesterone.

As a very last resort, people with major depression who have not re­sponded to other treatments may be admitted to hospital for ECT (electro-convulsive therapy).

It's not known exactly how ECT works. The theory is that the elec­tric shock causes a fit, which seems to lift depression. However, it can cause confusion and short-term memory loss, and both therapy and medication should be tried first.

• Regular aerobic exercise oxy­genates the brain and raises levels of endorphins, the body's natural painkillers

• Smile at people - even if you don't feel happy, your brain doesn't know and starts to imagine that you're feel­ing well

• Laughter is good for you. Watch comedy shows on TV, hire funny films, or get a group of friends togeth­er for a good laugh

• Set yourself easy achievable daily tasks, like writing a letter or doing the laundry

• Try speaking to yourself positively, tell yourself how well you're coping during this difficult time


Taken from THE HEALTH FILE  A Complete Medical Encyclopedia, A MARSHALL CAVENDISH REFERENCE COLLECTION, NATURE’S CLINIC by DR JOHN CORMACK, WEEKLY Australia, New Zealand, Malaysia Singapore Malta RSA Other Countries Namibia.

DR JOHN CORMACK, BDS MB BS MRCS LRCP, is the medical consultant to The Health File. The senior partner in an Essex­ based practice, he is also a member of the General Medical Council and has written for numerous magazines and news­papers as well as for the medical press. He is a regular broadcaster on television and radio and has scripted a number of award-winning educational videos.


Note: Where gender is unspecified, individuals are referred to as 'he', This usage is for convenience only and not intended to imply that all doctors and patients are male. Medicheck charts are only a rough guide to diagnosis, Always seek medical advice if you have worrying symptoms.

Copyright Marshall Cavendish 1995, Printed in Great Britain, Published by Marshall Cavendish Partworks Ltd, 119 Wardour Street, London WIV 3TD  


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