Depression is a leading cause of disability worldwide. The condition does not discriminate
and may affect anyone at any time. Whilst depression is common in society, understanding
of the condition remains generally poor. People perceive depression as always linked with
stressful life events. Many consider depression as a fake illness. Others believe depression
only affects women, with individuals affected needing to snap out of it.
Without support, depression is unlikely to improve on its own. In the worst cases, depression
may lead to self-harm or suicide. Therefore, improving our understanding helps
us identify the warning signs in ourselves or our loved ones earlier. Thus, ensuring
prompt access to treatment and better outcomes. Want to learn more about depression? Keep
watching as we will break down here. So, let us talk about mental health.
My name is Dr Hart-Pinto. In this series, we aim to break down the social barriers to
mental health.
At JHP medical we make weekly information videos designed to increase awareness and
help you better understand your medical condition. So, if you find this video helpful, subscribe,
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Ok so what is Depression?
Many people struggle to understand what we mean by clinical depression. Everyone will
feel down from time to time, often in response to sad events. However, these episodes are
short-lived, and we can recover.
Depression is different to these natural fluctuations in mood. Clinical depression is a disorder
where people experience a persisting low mood. For those affected, symptoms do not improve
despite exposure to positive events.
Symptoms of depression may affect the ability to function during work, school or when at
home. Suicidal thoughts and attempts can emerge in the most severely affected.
Who gets depression?
20% of the population will experience clinical depression at some time in their lives. The
condition is not discriminatory, affecting people from all walks of life. Predominantly
depression presents during the ’30s for women and ’40s for men but can occur at
any age. It is common for episodes to develop following stressful life events. Several risk
factors exist that place you at increased risk of developing this condition:
• Health issues, such as a chronic illness, including other mental health conditions or
substance misuse. • Relationship issues, such as a recent
breakup, divorce, or poor social support • Low self-esteem or unemployed.
Additionally, a genetic link for depression exists. Meaning, those with an affected family
member are at an increased risk of developing the condition.
What do Clinically Depressed patients experience?
Everyone's experience of depression will vary. For the casual observer, symptoms are not
always recognisable. Therefore, identifying friends and loved ones with depression can
be challenging. Additionally, it's not uncommon for sufferers to delay seeking medical help
for some time.
People with clinical depression must have experienced symptoms for a minimum of 2 weeks.
These symptoms are distinguishable as core symptoms and additional symptoms.
The core symptoms of depression are: • A persistent low mood
o Symptoms are present for most of the day, with limited variation or response to positive
changes. • Lost interest in normal activities.
Symptoms which patients may additionally experience are:
• Disturbed Sleep - Individuals may experience insomnia, difficulty getting to sleep, or
conversely, people may sleep more than usual. • Fatigue or loss of energy - Usually described
by patients as being more tired. • Change in appetite and weight - Some experience
a reduction in appetite resulting in weight loss. Conversely, others have an increased
appetite and associated weight gain. • Agitation or slowing of movements - increased
agitation, with observable restlessness, or observable slowing down of activity
• Poor concentration or indecisiveness - Individuals may experience an inability to concentrate.
Commonly displayed during school or work, being interpreted by those close to you as
indecisiveness. • Feelings of worthlessness or excessive
or inappropriate guilt - You may have feelings of guilt, reduced self-worth, self-esteem
or even self-confidence. • Suicidal thoughts or acts of self-harm
How will my doctor diagnose my depression?
To diagnose clinical depression, your doctor must identify that symptoms have been present
for at least two weeks. Depression symptoms must be unrelated to any other medical condition,
medication, substance misuse or bereavement. Additionally, a patients distress should be
observable.
The number and severity of symptoms you experience dictate the severity of your depression.
Subthreshold depression is where you report at least two but fewer than five symptoms
of depression. Mild depression is if you have more than five
symptoms that result in little interference in day-to-day life.
Moderate depression is where symptoms or functional impairment are between mild and severe.
Severe depression is if the symptoms you are experiencing are significantly interfering
with day-to-day function. Patients may report thoughts of self-harm or suicide.
Additionally, your doctor will be keen to assess for any risk of self-harm or suicide.
They may ask the following questions: • Have you experienced thoughts about death
or suicide? • Do you feel that life is not worth living?
• Have you made any previous suicide attempts? • Has there ever been anyone in your family
who has attempted or committed suicide?
If any concerns regarding the risk of harm exist, your doctor may request the support
of the psychiatry team. Further assessments may involve reviews and support at home or
a voluntary admission to the hospital. If you pose a significant risk to yourself or
anyone else, compulsory hospital admission may be required.
Treatment
The recommendation for treatment will vary based on the severity of your symptoms. The
best treatment decisions are shared between you and your doctor. Commitment is required
as it can take time for symptoms to improve.
For patients with subthreshold symptoms or mild depression, your doctor may recommend
a period of observation, usually lasting two weeks.
Should no improvement in symptoms occur the doctor will offer:
• Self-guided self-help therapy - This therapy consists of supportive media in either a written
or online form and is available at home. Additionally, you will gain support from a therapist as
face-to-face or telephone sessions over three months.
• Computerized cognitive behavioural therapy (CCBT) - This self-help program, completed
over twelve weeks, helps you regain control of your symptoms. Here you will develop techniques
to address how you think and feel about your depression. Consequently,
If self-help therapy isn't for you, an alternative would be group therapy. Here you will meet
with other people with similar symptoms, supported by a therapist. Group weekly sessions are
usually weekly.
Your doctor may offer a combination of more intense psychological therapy plus an antidepressant
if:
• If you are experiencing moderate to severe symptoms of depression
or • Your mild symptoms have not improved with
previous treatments
Therapy sessions conducted face to face with a therapist will help you address your feelings,
providing support to regain control of your depression. Various therapy types are available,
such as: • Cognitive behavioural therapy
• Interpersonal therapy • Behavioural activation
and even • couples therapy.
Choice of antidepressant is dependent on your number of depressive episodes.
For initial episodes, your doctor will prescribe an SSRI. These medications are also known
as selective serotonin reuptake inhibitors. Examples include:
• citalopram • fluoxetine
• paroxetine or
• sertraline.
Recurrent episodes amongst individuals with proven experience of SSRIs are prescribed
an additional course of this medication.
Amongst patients where SSRIs haven't worked for prior depressive episodes, a tricyclic
antidepressant (TCA) can be trialled. The most commonly prescribed is sertraline.
Should despite the best efforts of your GP or primary care physician, your depression
remains poorly controlled, referral to specialist care will take place.
Amongst the most resistant cases, ECT, electroconvulsive therapy can be helpful. ECT, a treatment that
creates a controlled seizure, has shown to be beneficial in the most challenging patients.
Herbal remedies
St John's Wort, a herbal antidepressant, can be purchased over the counter. It is a popular
herbal medication, often used in Chinese medicine, demonstrating effectiveness in managing mild
depressive symptoms. However, taking St John's Wort is not advisable.
Whilst many consider St John's wort a natural alternative to modern antidepressants, it
remains a potent medication with many side effects. Significant interaction with other
medications can occur, specifically with anti-epileptic drugs, anticoagulants, antidepressants and
the contraceptive pill, resulting in serious health issues.
Additionally, inconsistencies in the manufacturing process mean the quantities of active ingredients
present in St John's Wort vary vastly between brands and batches, making its effects unpredictable.
Prognosis
Everyone's experience of depression is different and will experience varying responses to treatment.
You should be aware that symptoms usually take a few weeks to improve. Prescribed medication
is continued for at least six months following symptom improvement to prevent relapse.
After the 1st depressive episode, around 90% will experience complete resolution of their
symptoms. However, many will experience further episodes of depression in the future.
Suicide rates for depression can be as high as 15%. So, if you are experiencing thoughts
of suicide or self-harm please confide in someone you can trust, your doctor or the
Samaritans. You are not alone.
I hope you have enjoyed this video.
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purposes only. Do not consider this as a substitute for professional
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