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The word “depression” covers a mood which was all get, to a serious debilitating illness which causes many people to function well below their level, and others to commit suicide.

We all have days when we just feel “down”.

When these days turn into weeks and it becomes difficult to keep coping with day-to-day living, we may be suffering from the illness known to the public as Clinical Depression, or to Mental Health Professionals as Major Depressive Disorder (Depressive Illness).

Major Depressive Disorder affects 20-25% of our population at some stage in their lives.

In Christchurch, in any one year, 5-7% of our adult population have Major Depressive Disorder. This is approximately 13,500 – 18,900!

Depression comes in different forms and with variable symptoms. It is often not well understood by the individual, nor is it always easily diagnosed by your Health Professionals.

Doctors often diagnose depression when the individual may see their health changes as a physical illness and not a mental health condition.

In children and adolescents depression is often mis-diagnosed as a behavioural problem, and in the elderly as old age, or even dementia.

Symptoms:
There are 6 major areas –

Mood
Usually down, but can fluctuate with mood swings (ups and downs), irritability, anger etc.

Anxiety
Often accompanies depression. It has many forms – feelings of tension, fright, not relaxed, and maybe a sense of dread that something terrible will happen.
Phobias, fears or obsessions about specific situations may also develop, eg being less comfortable at the supermarket or among people.

Physical Functioning
There can be symptoms “from top to toe”:
Headaches and other pains
Feeling unwell, fatigued, no energy etc
Appetite and weight changes
Bowel and bladder changes
Menstrual cycle change
Insomnia – difficulty getting off to sleep – broken sleep – waking too early
Hypersomnia – over-sleeping but not waking refreshed

Mental Functioning
All of our cognitions can be affected:
Concentration, memory, focus, decisiveness
Thinking can alter and often becomes negative and repetitive, with an increased focus on past and/or future failure (s); doom, including suicide.

Changes in behaviour
Loss of interest/drive/motivation
Withdrawal

Changes in Relating
Negativity towards oneself, including guilt, hopelessness and unworthiness
Changed functioning in our usual relationships, with possible anger and irritability.

Causes:

Predisposing Factors –
“Nature and Nurture in a dance”
Nature – hereditary/genetic
Nurture – upbringing and life experiences

Precipitating Factors –
Stresses and losses in their many forms, including life’s transitions, eg leaving home or country, marriage, childbirth, promotion, “empty nest”, retirement, medical illness and accidents.

Medical Illness –
Including:
Strokes, thyroid problems, cancer
Operations and accidents.
Depression may add to the severity of these. Existing illness can be a factor in depression occurring and this adds to the severity, frequency, duration, eg asthma or migraine.

Perpetuating or Ongoing Factors –
Financial problems
Loneliness
Unemployment
Relationship problems
Other existing illnesses

Medications –
Birth control pills, steroids, prednisone/cortisone, blood pressure pills, are some that have been implicated.

Substances –
Alcohol and smoking, and other abused substances can take their toll.

Protective Factors –
These can help prevent depression:
Family cohesiveness
Good relationships
Ability to communicate
Having confidants who will listen

Bio-chemical Changes –
No matter how depression is caused (situational or genetic, or both), it becomes neuro-behavioural, where our brain neuro-chemical transmitters go into chemical imbalance.

Bi-Polar Disorder –
This is a more complicated condition. Usually there is a genetic/hereditary/family history.

Bi-Polar Disorder affects about 1.5% of our population, possibly up to 3%, depending on the strictness of the diagnostic criteria.

I may need to see other family members or partners to get a clear record of hypo-manic or manic bouts to make this diagnosis.

Treatments –
Psychotherapy/counselling (talking therapies) and medications are the two most effective treatments.

Psychotherapy is often the best treatment for mild to moderate depression, while medication is usually needed for moderate to severe depression.

Some GPs and all psychiatrists will use both, with maybe a psychologist doing the “talking therapy”. The two most frequently used methods of treatment are Cognitive Behavioural Therapy (CBT) and Inter-Personal Therapy (IPT).

Men and Depression
Men are less likely to accept depression or to seek help. Many men use diversions, rather than confront the problems, and many increase their use of alcohol/marijuana etc.
Unfortunately, when therapies are advised, men are less likely to follow advise.
These factors are partially why the suicide rate for men is higher than it is for women.

Self Help Initiatives include:
Learning new skills;
Problem recognition and problem solving;
Changes in lifestyle;
Stress management;
Doing at least 200 minutes of aerobic activity per week to improve physical functioning;
Refraining from abusively using alcohol or other drugs;
Trying to establish and continue a healthy diet;
Seeking trusting relationships where there is knowledge and understanding about depression and support for you. In the short term these may need to be with professionals. Long term, establishing confidants among your colleagues, friends and relatives could help you to stay well and avoid future relapses. This may reduce your need for professional help in the future.

Illness – Not Weakness!
No-one would ever accuse a person suffering from asthma or diabetes of being weak or lazy!
In the same way, if you are suffering from depression, it is not a personal weakness.
It is not easy to ask for help.
Unfortunately, if depression is moderate or severe, a person cannot will themselves to be better.

Remember:
Depression is common
It is not a sign of weakness
There is nothing to be ashamed of
It can be treated.

Dr Harvey Williams
M.B., Ch.B, DPM (Lond), F.R.A.N.Z.C.P

Medical Specialist (Psychiatrist)

Medical Director and Founder
of Caledonian Clinic (1986)

Caledonian Clinic
304 Papanui Road, Christchurch

Ph: 03 355 0336
Fax: 03 355 0337
Cell phone: 0274 58 78 28

E-mail: harvey@caledonianclinic.co.nz

Treatment Costs – approximately $360 (inc GST) for Assessment and a Treatment Management Plan. A course of treatment costs approximately $1,000 (inc GST) for approximately five consultations.

Contact us for Treatment Advice
We would like to be of service.

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