Depression Everyone talks about depression, but what is it? How common is depression?

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1 Depression Everyone talks about depression, but what is it? Many people will say they feel they are depressed when they have a rough day or week at work and they are feeling unhappy. Everyone feels sad or down at certain times in their life such as following a work or life disappointment, loss of a loved one or a major traumatic event. For most people this sadness is temporary and the person will start to feel better after a few days. In about 10-15% of men and 15-25% of women the depressed mood sticks around and does not get better on its own. This can cause major problems with their family and work life. Some people will not be able to shake this feeling of sadness and they may have a condition called clinical depression or major depressive disorder. How common is depression? It is really difficult to estimate how many people have depression. Many people will never talk about their symptoms to their doctor and think it is just them and will suffer through the symptoms. Canadian depression experts estimate that about 4% of Canadians will suffer through depression in any 12 month period and the lifetime chance of being diagnosed with depression is 10.8%. A person with depression feels sad, but do they have other symptoms? People with depression don t just experience a sad mood but the condition will also impact other areas of their life. Canadian depression experts recommend that you should let your doctor know if you have any of the following: Depressed mood most of the day and nearly every day Decreased interest or pleasure in all or almost all activities. (Things that would normally make a person happy don t seem to do it any more) Weight loss or weight gain or changes in appetite Sleeping problems such as insomnia or wanting to sleep all the time Slowed thinking, forgetfulness, trouble concentrating and making decisions Fatigue or loss of energy Feeling worthless or having inappropriate guilt Feeling anxious or agitated Feeling suicidal

2 Do all people with depression have the same symptoms? Depression symptoms vary so much. Some people will have a depressed mood and a few other symptoms and others will have many of the symptoms listed above. Canadian depression experts classify clinical depression if a person has a depressed mood and 4 other symptoms listed above for 2 weeks or more. About how long will a person have depression for? Depression can be treated for most people. The length a person has depression depends on their willingness to start treatment. A treated person may only feel depressed for 2 to 6 weeks. An untreated person may have the symptoms for 6 to 18 months or longer. The average bout of depression lasts about 5 months. I have had one bout of depression, does this put me at higher risk of getting it again? Unfortunately depression is a recurring condition. About 50% of people diagnosed with depression will have another bout of depression at some point in their life. For this reason people that have recovered from depression should be monitoring themselves for the symptoms of depression. If they start to feel depressed they can talk to their doctor about early treatment to lower the impact of depression on their life. Does my doctor have to do tests to diagnose me with depression? Depression cannot be seen on any x-ray or by doing blood work. Your doctor will make a diagnosis of depression based on your symptoms that you discuss with him/her. This is the main reason that if you are starting to feel the symptoms of depression than you should talk to your doctor.

3 I think my wife may be depressed, but how can I be sure? You can t self-diagnose depression. If you or a family member is starting to have symptoms of depression you should talk to your family doctor about the symptoms that you are experiencing. Many people with depression will not mention their symptoms with their doctor. Two quick questions that depression experts recommend doctors ask their patients are: 1. In the last month, have you been bothered by little interest or pleasure in doing things? 2. In the last month, have you been feeling down, depressed or hopeless? If you or a loved one answered yes to either of these questions than you should discuss this with your doctor. Is there anything that puts me at higher risk of depression? Like most other conditions there are people that are at higher risk of becoming depressed. The most common risk factors for depression are listed in table 1. Table 1 Risk factors for depression Risk Factor Notes Family History Depression is more common in people with a family history of depression in a close relative If your mom or dad had depression your chance of developing depression is about 10% Genetics and family history plays a role in become depressed, but experts think other environment factors can cause depression Personality Some people develop a negative a view of the world that places them at a higher risk of depression These people believe bad things always happen to them, they are a bad person or the world is a bad place You are at higher risk of depression if you: o Have a low opinion of yourself o Worry a lot o Are a perfectionist o Expect too much from yourself or others o Tend to hide feelings

4 Times of Hormonal Depression is more common in women after delivering a baby. Change This is called post-partum depression Some women are at higher risk of depression symptoms when they reach menopause Traumatic events Stress can lead to symptoms of depression for many people. Common traumatic events that increase the risk of depression are: o Death in the family o Divorce o Losing your job o Serious financial problems o Relationship problems People with a history of a severe traumatic event are at higher risk of depression. Examples of these events are: o Domestic abuse o Alcohol or drug abuse o Rape o Robbery o Kidnapping o Child abuse Biology Factors Seasonal affective disorder (SAD) is a condition where the person has a sad mood in the winter months. It is triggered by the low light levels in the winter Treatment can be a trip to a sunny destination or the use of a special light that gives off rays just like regular sunlight Is it true that people with other medical conditions are at higher risk of depression? Yes. People with chronic medical conditions are at higher risk of becoming depressed. Conditions such as COPD and emphysema, migraine, multiple sclerosis, cancer, back problems, asthma and heart disease all put you at higher risk of depression.

5 My husband was just diagnosed with depression, I just don t understand why he can t seem to snap out of it and cheer up? Unfortunately depression can t be fixed instantly by turning on a magic switch. It takes time and support for the person to improve. People don t want to experience symptoms of depression and treating the person poorly will not help them snap out of it. The Centre for Addiction and Mental Health (CAMH) has some great tips to help you talk with a person with depression: 1. Speak in a calm, quiet voice 2. Stay focussed on one topic at a time 3. If the person is withdrawn, break the ice with a neutral statement, such as It is warm out there today 4. Be patient and wait 5. Listen, listen and listen. This can really help a person with depression 6. If the person is upset and irritable, slow down, lower your expectations of them and use a neutral approach such as comments about dinner, the weather or a safe subject Is it normal to feel this scared that other people might find out that I have depression? People with depression and many other mental illnesses are fearful that their friends, family or coworkers may think of them differently once they are diagnosed with depression. Some are worried that their employers will fire them if they know they have depression. This stigma is hurtful because it can prevent people from either getting treatment or interfere with their treatment and recovery. What is important to remember is depression is common and with effective treatment you should recover to your normal self. What are my doctor s goals for treating my depression? The target goal for treating depression is a complete elimination of your depression symptoms. Canadian depression experts feel a lowering of depression symptoms is not acceptable because it puts a person at higher risk of relapse and people with a small reduction in symptoms tend to have poorer long-term results.

6 Besides medications are there other treatments that are effective for depression? The treatment of depression usually involves either medications or psychotherapy and counselling. The most effective treatment of depression is actually a combination of counselling and medication. Some people have strong feelings about different treatment options. Working with your doctor you can help select the treatment that you feel fits best for your condition Psychotherapy Psychotherapy is a type of treatment used to help depression. This type of therapy involves the person with depression talking and working through the problems with a therapist. It helps to relieve stress because people can talk about their feelings. Psychotherapy can be done in an individual session with a therapist or with a group of other people with the same condition. Some people prefer group therapy because it helps to limit the isolation of suffering from depression alone. Some people find the support of the group of people suffering similar symptoms helpful on their path to recovery. Cognitive behavioural therapy One special type of counselling is called cognitive behavioural therapy. This type of therapy helps a person identify negative thoughts and how they affect their moods and actions. The therapist works with the person to help to find more productive thoughts to help link them with more positive moods and behaviours. Canadian depression experts feel that cognitive behavioural therapy is an effective treatment for depression. I hear that depression relapse is very common, is there anything I can do to prevent this from happening to me? Unfortunately about 50% of people with one episode of major depression will have a relapse of depression at some point in their life. Just like other conditions, people with a history of depression should monitor their symptoms and should report any major changes to their doctor.

7 CAMH has some great tips to help prevent a relapse: 1. Educate yourself about depression and the treatment options 2. Monitor changes in mood, make a list of warning symptoms and watch to make sure that you still take pleasure out of fun personal activities 3. Take your medication as prescribed and for the length of time prescribed 4. Adopt a healthy lifestyle with the right amount of food, exercise and sleep. 5. Think about negative features of your personality that may lead to depression 6. Learn to cope with stress 7. Surround yourself with good people and make strong relationships with these people What do antidepressant medications do in the body and do they really work? Antidepressant medications are commonly used to treat depression. These medications increase the concentration of certain chemicals in the brain that help to improve mood and make you feel better. Antidepressant medications improve the symptoms of depression and help the person with depression enter remission. About 60 to 70% of people will respond to antidepressants. They can be used alone or in combination with psychotherapy. Are antidepressants addictive? Antidepressants are not addictive and they are an important treatment for depression. Some people view taking these medications as a sign of a weakness of their character. Depression is a valid medical condition and taking these medications is no different than a person with high blood pressure taking a blood pressure medication. When should I start to feel better and how long should I take the antidepressant for? Antidepressants commonly take a few weeks for the person to feel better. Also your doctor may change the dose of the medication you take to make sure you have relief of your symptoms. Canadian depression experts recommend that if you have a bout of depression the antidepressant should be taken for 6 to 12 months. Some people will need to take their antidepressant for longer than 6 to 12 months.

8 My friend told me I should stop my antidepressant when I start to feel better, is this right? Most people will start to feel better after a few weeks of taking an antidepressant. Stopping an antidepressant early increases your chance of a relapse of your symptoms. Even with experts recommending treatment for 6 to 12 months, about 30% of people stop their medication in 30 days and close to 40% in 90 days. How does my doctor choose which antidepressant to use for me? There are many different antidepressants available. When your doctor selects an antidepressant he/she take into consideration: Expert recommendations for the treatment of depression Other medical conditions you have Other medications you take If you have responded to any of them in the past The safety of the product How easy it is to take The cost of the product Do we still use some of the older antidepressants to treat depression? There are two classes of medications known as tricyclic antidepressants and MAO inhibitors that have been around for a long time for the treatment of depression. Canadian depression experts do not recommend the use of these drugs first, because they have many side effects and do not work any better than newer treatments. Tricyclic Antidepressants How do tricyclic antidepressants work? Tricyclic antidepressants increase the level of the brain chemicals serotonin and noradrenaline. Raising these chemicals help for mood. The most common tricyclic antidepressants are amitriptyline, clomipramine, desipramine and nortriptyline.

9 What are the common side effects of tricyclic antidepressants? This class of medications has many side effects that make them hard to take. These side effects include: Drowsiness Dry mouth Blurred vision Constipation Sweating Changes in heart rate Weight gain What are some of the important things to know about tricyclic antidepressants? Even though some people will find them very helpful, these medications have a fair number of side effects. Canadian depression experts don t recommend them to be used first in a person with depression. MAO Inhibitors How do MAO inhibitors work? MAO inhibitors increase the level of the brain chemicals serotonin and noradrenaline. Raising these chemicals help for mood. The most common MAO inhibitors are phenelzine, tranylcypromine and moclobemide. What are the common side effects of MAO inhibitors? The most common side effects are: Drowsiness Insomnia Headache Dizziness

10 What are some of the important things to know about MAO inhibitors? This class of medications are effective but are rarely used because they have many drug interactions Phenelzine and tranylcypromine can be a problem with certain foods such as aged cheese, smoked meat and some beer. What are the newer drugs used for depression? The newer antidepressants are now recommended to be used first for people with depression because they work just as well as the older medications but have fewer side effects. The most common newer antidepressants are SSRIs, SNRIs, bupropion and mirtazapine. SSRIs How do SSRIs work? SSRIs increase the level of the brain chemical called serotonin. The increase in serotonin improves mood. The most common medications in this class are fluoxetine (Prozac ), fluvoxamine (Luvox ), paroxetine (Paxil ), sertraline (Zoloft ), citalopram (Celexa ) and escitalopram (Cipralex ). What are the common side effects of SSRIs? The medications in this group are slightly different and some drugs have slightly different side effects than the others. The most common side effects are: Drowsiness Headache Constipation Stomach upset Dizziness

11 What are some of the important things to know about SSRIs? One of the most commonly used group of medication for depression They are tolerated well and Canadian depression experts recommend them to be a firstchoice option for a person with depression There are slight differences in the side effects of the specific SSRIs. So if you have any side effect mention it to your doctor because they may want to consider changing you to another medication Each of the medications in this class work well and the key is finding a medication that you can tolerate and works well for you. SNRIs How do SNRIs work? SNRIs increase the level of the brain chemicals serotonin and noradrenaline. Raising these chemicals help for mood. The most common medications in this class are venlafaxine (Effexor ), duloxetine (Cymbalta ) and desvenlafaxine (Pristiq ). What are the common side effects of SNRIs? The most common side effects of SNRIs are: Drowsiness Headache Stomach upset Dizziness Constipation What are some of the important things to know about SNRIs? One of most common groups of antidepressants They are tolerated well and Canadian depression experts recommend them to be a firstchoice option for a person with depression There are slight differences in the different drugs in this group so you may tolerate one better than another

12 Bupropion How does bupropion work? Bupropion increases the level of the brain chemicals dopamine and noradrenaline. Raising these chemicals help for mood. Bupropion is also known as the brand name Wellbutrin What are the common side effects of Bupropion? The most common side effects of bupropion are: Insomnia Headache Dry mouth Stomach upset What are some of the important things to know about bupropion? A common medication used for depression It is tolerated well and Canadian depression experts recommend bupropion to be a firstchoice option for a person with depression Mirtazapine How does mirtazapine work? Mirtazapine increases the level of the brain chemicals serotonin and noradrenaline. Raising these chemicals help for mood. Mirtazapine is also known as the brand name Remeron What are the common side effects of mirtazapine? The most common side effects of mirtazapine are: Weight gain Drowsiness Dry mouth Constipation

13 What are some of the important things to know about bupropion? This medication commonly causes drowsiness and is many times used in people with depression that have trouble sleeping Canadian depression experts recommend mirtazapine to be a first-choice option for a person with depression