MANAGING DEPRESSION LOOk to the future

Transcription

1 MANAGING DEPRESSION Look to the future 1

2 Contents About this guide 3 What is depression? 4 Why do I need a Depression Action plan? 5 Signs and symptoms of depression 6 What can increase the risk of developing depression? 8 What to discuss with your doctor 10 How can depression be managed? 11 Psychological therapies 12 Medical treatments 14 Other types of therapy 17 Where can I find help? 19 Where can I get further information? 20 Mood and Sleep Diary 21 The Depression Action plan 23 We ll help find a healthier you It s our purpose that makes us different we want our members to live longer, healthier, happier lives. We offer more than health cover. Our expertise extends to health assessments and health coaching, wellness programs, optical care, aged care and international health cover. We offer information and tools to help you manage your health. And as a member, you ll enjoy access to great value travel, home, car and life insurance. A commitment to our members We re part of a global family, who reinvests our profits to provide better services for our members. We proudly offer affordable, highquality health cover to more than three million Australians. 2

3 ABOUT THIS GUIDE This guide offers practical advice, current research and information to help people living with depression. It may also be a useful resource for family and friends who want to know more about depression and how they can help. Inside this guide, you ll find the following: information about depression and how you can help to reduce its impact on your health and everyday life a Depression Action Plan that you can prepare together with your doctor a Mood and Sleep Diary to help you and your doctor monitor your progress a personal Medication Record to help you keep track of your medications Take this guide with you when you next visit your doctor so you can get started on making your Depression Action Plan together. 3

4 WHAT IS DEPRESSION? At some point in life, we can all feel down. Depression however, is more than just a low mood it s a serious illness that often goes unrecognised. Sometimes sparked by a traumatic event like a break-up, bereavement or illness, or often without any apparent reason at all, depression is a sustained period of low mood that can affect your enjoyment of life and your motivation to participate in family, work, and other activities you once enjoyed. Depression is very common. According to beyondblue, the National Depression Initiative, around one million Australian men and women and 100,000 young people live with depression each year. The most common affective disorder is unipolar or major depression, where a significantly lowered mood lasts for more than two weeks. The impact on people living with depression can be severe and it s the leading cause of non-fatal disability in Australia. Currently, one in six people experience depression at some stage of their lives. However, the good news is that it s treatable. If you re worried you might be depressed, talk to your doctor about how you might be able to address your symptoms and start to feel better again. 4

5 WHY DO I NEED A DEPRESSION ACTION PLAN? Good management of depression helps to reduce the frequency and severity of symptoms. There are plenty of positive actions you can take now to minimise the way depression affects you and your daily activities. A combination of medical advice, psychological treatment, medication (if your doctor thinks it s right for you) and physical exercise can all help. Looking after yourself and regular visits to your doctor can decrease the risk of short and long-term complications. Having a written Action Plan to record important information in can help you and your doctor to clarify medication and other treatment regimes and assist you in monitoring symptoms and managing your depression so your health and lifestyle can benefit. 5

6 SIGNS AND SYMPTOMS OF DEPRESSION There are five main types of depression. Although these often have slightly different symptoms and may require different treatments, two main features of depression are a lowered mood and loss of interest or pleasure in activities that used to be enjoyable. Your doctor may make a diagnosis of depression if you have had symptoms for at least two weeks which include both depressed mood and loss of interest or pleasure plus at least five of the following symptoms: significant change in weight loss of energy sleeping too much or not being able to sleep decreased interest in daily activities feeling restless or slowed down feelings of worthlessness or guilt difficulty concentrating or indecisiveness recurrent thoughts of death or suicide. For most people, the most common symptom is low mood. In addition to feeling sad, you may also feel irritable and have a tendency to lose your temper more easily than usual. Some people notice that they feel worse either first thing in the morning or last thing at night. You may find that you don t get pleasure from events or activities that you d normally enjoy and you may also feel separate from the rest of the world. Lack of energy, tiredness and poor concentration are also common symptoms. You may find that you aren t sleeping well waking up unrefreshed from a long sleep, waking up early in the morning or waking frequently throughout the night. Some other common symptoms include a loss of sex-drive (libido) and disturbed eating patterns either losing your appetite or eating too much. 6

7 One of the most serious aspects of depression is the thoughts you may have about yourself and your life Depression is often accompanied by anxiety. Symptoms of anxiety include fearfulness, palpitations and even panic attacks. Often these feelings subside when the depression is treated. One of the most serious aspects of depression is the thoughts you may have about yourself and your life. You may judge yourself too harshly or critically, and think of harming yourself or feel that life is not worth living. Some people may turn to alcohol or illegal drugs to try and blot out their difficult feelings. Unfortunately, this tends to make things worse. Alcohol, for example, lowers the mood further and is harmful to physical health when taken in excess. Along with periods of low (depressed) mood, a person living with bipolar disorder will also experience intervals of high (manic) mood. In occasional cases, major depression may become so severe that a person living with depression loses touch with reality and may experience disturbing hallucinations, delusions and/or feelings of paranoia. This is termed psychotic depression and requires urgent treatment. 7

8 WHAT CAN INCREASE THE RISK OF DEVELOPING DEPRESSION? While a bout of depression can be set off by a stressful event, often involving some form of loss such as when somebody dies or when a relationship breaks down, depression can often be brought on by a mix of recent life events and long-term or personal risk factors. Research suggests that ongoing stressors, such as financial worries, a stressful job, redundancy or fear of unemployment are more likely to trigger a depressive episode in vulnerable people than oneoff events in life. Long-term or serious illnesses such as diabetes or cancer can also lead to a bout of depression. Depression can also run in families and some people may be at increased genetic risk of the condition. However, researchers have yet to find a simple genetic explanation and this doesn t mean that you will automatically develop depression if a parent or a close relative has it. Life events and your personal risk factors are as likely to determine your chance of developing depression. Other biological factors for depression include illnesses, ageing and gender. A personal risk factor that can be an important influence in whether or not you develop depression is your personality. Some people tend to always look on the darker side of things. According to beyondblue, personality traits that may put you at higher risk of developing depression include: perfectionism unassertive self-critical sensitive to personal criticism shy, socially anxious low self-esteem. 8

9 There are certain medical conditions that can make you more likely to develop depression. These include: low thyroid function brain injuries and disease (eg stroke, heart disease, head injury, epilepsy) some forms of cancer some steroid and hormonal treatments chronic pain. 9

10 WHAT TO DISCUSS WITH YOUR DOCTOR If you think you might have depression, seek the advice of your regular doctor. Left untreated, depression can become more severe and have greater impacts on the quality of your life. Your doctor will want to discuss your personal story and symptom pattern. Your story may have important clues such as a family history of depression, anxiety, other mental health conditions, recent life events or long-term personal risk factors. Your doctor may order some tests to try to investigate possible causes of your symptoms, or to eliminate other conditions that could be causing symptoms similar to that of depression. These tests may include: full blood count and biochemistry thyroid function tests urine tests for sugar and protein a brain scan, if necessary. It may not always be possible to find the cause of your depression and at other times it may not be possible to change the difficult life circumstances that have brought on an episode of depression. The important thing is to recognise the signs and get help to manage them. 10

11 HOW CAN DEPRESSION BE MANAGED? Depression may interfere with the way you want to live your life. Many people living with depression may feel unable to go to work or do any of the things they used to enjoy and yet, many don t seek help for their problems. You may feel embarrassed about your feelings, considering them a sign of weakness or you may blame yourself for your misfortune. But it s important that you seek help for depression. Your brain is an organ just like your heart or lungs. Sometimes, organs need medicines or other treatments to function as effectively as they can. Fortunately, a number of treatments are available for depression and talking to a qualified medical professional is the first step. The two main approaches to treating depression are psychological therapies such as counselling and medical treatment with antidepressants. 11

12 PSYCHOLOGICAL THERAPIES Psychological treatment is very important as it may not only help you recover from an episode of depression but it may also help to prevent a recurrence. There is a wide range of psychological and counselling services available in the community and these are not all the same or equally helpful. Depression should be treated with a specific type of psychological treatment developed for this purpose and provided by a psychologist or psychiatrist with specific training in the treatment of depression. The common type of psychological treatment for depression is Cognitive Behaviour Therapy (CBT). The way you think affects the way you feel, so CBT attempts to change the way you may think about your moods and how you react to life situations. People who are depressed may often think negatively about themselves, the world around them and the future. CBT helps you to recognise negative thoughts you may be having, teaches you how to replace them with more realistic thoughts and helps you find new, more positive ways of going about your daily life. Learning to manage stress can be another important factor in the prevention and treatment of depression. Stress is a highly individual experience as we all have different things in our lives that cause frustration or unhappiness. You need to be aware of how you react to and feel about certain pressures in your life, and develop positive ways of coping with those stressful situations. This may simply mean making more time to relax or get some exercise, and learn to talk more openly with people you re close to. 12

13 For mild forms of depression, psychological treatments are often the first thing recommended by health professionals to try to help you manage your condition. For more severe depression, a combination of psychological treatment and antidepressant drugs may be recommended by your doctor. 13

14 MEDICAL TREATMENTS Medications called antidepressants are also used to treat depression. These medicines can only be prescribed by your GP or psychiatrist. Antidepressants can help treat moderate to severe depression as well as some anxiety and related conditions. While these medications are effective in some people with depression, most antidepressants take at least two weeks to start working and their effects begin quite gradually. It may take six to eight weeks until they take full effect. You may be required to take them for six to twelve months to treat an episode of depression, even if the symptoms seem to clear up sooner. This is because it s been shown that a longer course makes a relapse of depression less likely. Selective serotonin reuptake inhibitors (SSRIs), selective serotonin and noradrenaline reuptake inhibitors (SNRIs) and noradrenaline reuptake inhibitors (NARIs) are the most commonly prescribed antidepressants in Australia. Although most antidepressants are known to be effective in treating depression, SSRIs and SNRIs are more widely used because they have relatively fewer and less troublesome side effects. The medication information outlined is for general explanatory purposes only and is not medical advice. You should always check with your doctor prior to taking any medications as they may cause side effects. If you are experiencing side effects or symptoms from your medication, contact your doctor as soon as possible. You may also have to be careful about mixing the medication/s you are on with other medications and/or alcohol. 14

15 Below are descriptions of the different classes of antidepressants. Selective serotonic reuptake inhibitors (SSRIs): work by raising levels of the natural chemical serotonin in the brain, which in turn tends to lift the mood. They are generally best taken in the morning as they can interfere with sleep. Medications in this class include sertraline, citalopram, escitalopram, paroxetine, fluoxetine and fluoxamine. SSRIs may cause some nausea and mild dizziness but these symptoms are generally short lived. Some people who take SSRIs have lowered libido or some alteration in sexual function. This may dissipate over time and clears up when the medicine is stopped. Less common side effects include persistent sweating, weight changes, and headaches. SSRIs are not considered to be addictive. If any of the side effects are bothering you, it s important to discuss them with your doctor. Your doctor may decide to alter the dose or even change the medication. If treatment is to be stopped, it needs to be done with the guidance of your doctor. Reducing the dose gradually may help to reduce the risk of temporary withdrawal effects such as anxiety, stomach upset or flu-like symptoms. Selective serotonin and noradrenaline reuptake inhibitors (SNRIs): are similar to SSRIs but they work more broadly and may be effective in some patients where SSRIs haven t worked. Side effects and withdrawal symptoms are similar to those of the SSRIs. Medications in this class include venlafaxine, desvenlafaxine and duloxetine. Noradrenaline reuptake inhibitors (NARIs): are designed to affect one type of brain chemical called noradrenaline, which is associated with improving mood and increasing energy. NARIs are less likely to cause drowsiness than some other antidepressants. A medication in this class is reboxetine. 15

16 Noradrenaline-serotonin specific antidepressants (NASSAs): are relatively new antidepressants that are generally less likely to cause side effects such as lowered libido, but are more likely to cause weight gain. A medication in this class is mirtazapine. Reversible inhibitors of monoamine oxidase (RIMAs): are relatively non-sedating. They can be helpful for patients who are experiencing problems with anxiety or having difficulty sleeping. A medication in this class is moclobemide. Tricyclic antidepressants (TCAs): increase noradrenaline and serotonin levels in the brain to help lift mood. However, TCAs are less selective and work on several other neurotransmitters, so they often have more side effects than newer antidepressants. For this reason TCAs are not recommended if you have prostate problems, glaucoma, hyperthyroidism or epilepsy. TCAs are also commonly used to treat pain in people without depression. Medications in this class include nortriptyline, amitriptyline, imipramine, dothiepin, and clomipramine. Common side effects of TCAs include dry mouth, blurred vision and dizziness although they should mostly disappear after the first seven days or so. HOW LONG WILL ANTIDEPRESSANTS BE NEEDED? For most people, treatments for depression should be used for as long as necessary for the person to stabilise, and it can be different for everyone. Studies show that if antidepressants help a person to treat depression, they should be taken for at least twelve months to get the most benefit from their treatment and decrease the chance of a relapse. 16

17 For most people, treatments for depression should be used for as long as necessary for the person to stabilise OTHER TYPES OF THERAPY St John s wort (hypericum perforatum): a popular complementary medicine for low mood available from health food stores and pharmacies. Some research studies have shown some promising results in treating mild to moderate depression. However, if you are also taking prescription or over-the-counter medicines from the pharmacy, ask for advice from your doctor or pharmacist before taking St John s wort as there can be harmful interactions with many other medications such as the contraceptive pill and warfarin. Regular physical exercise: may also be helpful for treating symptoms of mild to moderate depression. It s believed to boost production of mood-lifting chemicals in the brain, including serotonin and endorphins, as well as improving sleep, increasing energy and providing a distraction from anxiety. Both aerobic exercise (eg brisk walking, jogging, cycling or swimming) and resistance exercise (eg lifting weights) appear to help in treating symptoms of depression. 17

18 Repetitive transcranial magnetic stimulation (rtms): a newer treatment for depression that has been developed in Australia and overseas in the past 15 years. It uses magnetic pulses from an electromagnet placed on the scalp to stimulate small areas of the brain. Clinical trials suggest it does help some patients in whom medication has not been successful. It has been approved for use in a number of countries including the USA and Australia, while research into its use continues. Electroconvulsive therapy (ECT): is a medical procedure that has long been used to treat severe depression. It involves giving a brief electric current to the brain while the person is under general anaesthetic. ECT is generally used in severely depressed people when other forms of treatment have failed and is also the treatment of choice in lifethreatening situations, such as in patients at high risk of suicide. ECT is effective, relatively safe and the main side effect is memory problems that tend to improve after a few months. 18

19 WHERE CAN I FIND HELP? Visiting your GP is a good first step in getting help for a mental health problem. Some GPs may manage your mental health themselves, while others may refer you to a specialist such as psychologist or psychiatrist. Medicare rebates are now available for the treatment of many chronic mental disorders including depression. You can find a GP or other health professional in your area that has had extra training in mental health through the Find a doctor or other mental health practitioner service on the beyondblue website. There are also a number of 24-hour telephone support services such as Lifeline that are available to help you. These details can be found overleaf. Occasionally, people with depression may need to go to hospital for treatment if their symptoms are severe or they are in danger of hurting themselves or others. Major general public hospitals have psychiatric in-patient units attached to them while there are also private hospitals dedicated to psychiatric problems. In addition to hospital-admitted or out-patient services, many regions have a crisis team that can be contacted 24 hours a day. They are designed to give urgent, short-term help. Crisis services provide intensive treatment and support, usually in the person s own home. Crisis teams are attached to psychiatric inpatient units and specialist community health services. To find the nearest local crisis team, call your local public hospital or Community Mental Health Service. 19

20 Where can I get further information? For more information and support, contact: Your local doctor or public hospital Beyondblue at beyondblue.org.au or on Black Dog Institute at SANE Australia at or on Helplines: Lifeline on (local call cost) Suicide helpline (Victoria only) on (local call cost) Kids Helpline on (free call) MensLine Australia on (local call cost) 20

21 MOOD AND SLEEP DIARY Name Date / / Monitoring your mood and sleep can help your doctor keep an eye on your progress and help you manage your symptoms. Use this diary to rate and record your average mood daily on a scale from Place a check mark in the box that most corresponds to your day s experiences, where 0 = worst (you are significantly impaired by depression symptoms and can t work) and 10 = best (you are not significantly impaired or impaired at all by depression symptoms). Note down how many hours of sleep you had the night before as well. There s also room to add comments about your day (eg any activities out of the ordinary). day Daily mood rating 10 (best) WITHOUT SIGNIFICANT IMPAIRMENT SIGNIFICANT IMPAIRMENT ABLE TO WORK SIGNIFICANT IMPAIRMENT NOT ABLE TO WORK (worst) number of hours of sleep other comments Medication Record List all the medications you take in your medication record, including over-the-counter medicines, vitamin supplements and natural remedies. Take your medication record with you when you visit your doctor so that you can monitor your progress together and keep track of your medication. Medication Dosage How often/ when Instructions Comments 21 22

22 DEPRESSION ACTION PLAN Name Take this Action Plan with you when you visit your doctor. Together, you can fill in dates, actions required and any goals discussed. Use it to help keep track of your progress when you go in for a check-up. Date / / For a medical or psychiatric emergency, call 000 or go to the nearest hospital. Or if you re unsure call your doctor or local hospital. Checks or reviews By doctor or health professional Doctor to fill in: Date/ Action/Goal Doctor to fill in: Date/ Action/Goal Doctor to fill in: Date/ Action/Goal Doctor to fill in: Date/ Action/Goal Doctor to fill in: Date/ Action/Goal Monitor your medications and make sure you take them (if you have any) Monitor your sleeping patterns Review stress management techniques Review physical activity Review diet Review general health Review information needs Record mood daily (in diary provided, as required) Rate your average monthly mood: in the last 4 weeks, about how often have you felt: (mark as all / most / some / a little / none of the time)* so sad nothing could cheer you up? nervous? restless or fidgety? hopeless? that everything was an effort? worthless? * adapted from the K6 scale from Kessler, R.C., Barker, P.R., Colpe, L.J., Epstein, J.F., Gfroerer, J.C., Hiripi, E., Howes, M.J, Normand, S-L.T., Manderscheid, R.W., Walters, E.E., Zaslavsky, A.M. (2003). Screening for serious mental illness in the general population Archives of General Psychiatry. 60(2),

23 Sources Anderson I Piling S Barnes A et al. Depression: the treatment and management of depression in adults (updated ed). National Institiute of Health and Clinical Excellence (NICE), The British Society and the The Royal College of Psychiatrists American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th ed, text revision (DSM-IV-TR) Australian Institute of Health and Welfare (AIHW). Key indicators of progress of chronic disease and associated determinants: data report. Cat no PHE 142. Canberra: AIWH beyondblue. Depression [online] [accessed 12 Jul 2012] Available from: Maerov P. Demystifying CBT: effective, easy-to-use treatment for depression and anxiety. Current Psychiatry. 2006; 5(8). Available from: Malhi G Adams D Porter R et al. Clinical Practice Recommendations for Depression. Acta Psychiatr Scand. 2009; 119(Suppl 439): Rossi S (ed). Australian Medicines Handbook Adelaide, South Australia: Australian Medicines Handbook Singh S. Cognitive behavioural therapy in general practice. BMJ careers Timms P Kumar R. Alcohol and depression. [online] 2010 [accessed 12 Jul 2012]. Available from: The information in this brochure has been developed and reviewed for Bupa Australia Pty Ltd and its related entities ( Bupa ) by health professionals. To the best of their knowledge it is current and based on reputable sources of medical research. It is intended to be a guide only and should not be relied upon as a substitute for professional medical advice. The mention of specific products, services, tests, doctors, specialists or other health care professionals, procedures or opinions does not constitute or imply a recommendation or endorsement by Bupa, unless specifically stated as such. Bupa makes no warranties or representations regarding the completeness or accuracy of the information and is not liable for any loss or damage you suffer arising out of the use of or reliance on the information, except that which cannot be excluded by law. We recommend that you consult your doctor or other qualified health professional if you have questions or concerns about your health or wish to discuss your individual symptoms or circumstances. The information in this brochure does not represent which products and services may or may not be covered under your level of cover. 25

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