Introduction
Depression is more than just feeling sad or experiencing a temporary bout of negative emotions. It is a serious mental health disorder that can profoundly impact a person’s quality of life. It is essential to recognise the signs and symptoms and understand the available treatment options to manage this condition effectively. This article aims to demystify depression and provide a comprehensive overview of its diagnosis and treatment, with a focus on practical resources for anyone needing help.
Understanding Depression
At the heart of depression are feelings of intense sadness, hopelessness, or lack of interest in activities that a person once enjoyed. It’s crucial to know that depression is not a sign of weakness or something somebody can merely “snap out of”. It can be a chronic condition that requires long-term management and care.
Diagnosis of Depression
According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) major depressive disorder is:
Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful).
- Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation).
- Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day.
- Insomnia or hypersomnia nearly every day.
- Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).
- Fatigue or loss of energy nearly every day.
- Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
- Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).
- Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
For a diagnosis of major depressive disorder (MDD), the DSM-5 requires the presence of at least five of these symptoms during the same two-week period and represent a change from previous functioning. At least one of the symptoms must be either a depressed mood or a loss of interest or pleasure in activities.
It is important to note, however, that DSM-5 was developed as a research tool and not necessarily as a hard diagnostic criteria. You may not exactly fit the criteria for any of the psychiatric conditions but may be diagnosed by a clinician, or you may have symptoms that fit the criteria but depending on the severity of the symptoms you may not be formally diagnosed with a psychiatric condition.
Practical questions to ask
Identifying depression begins with asking the right questions. In primary care two screening questions known as the PHQ-2 can be asked:
During the past month, have you often felt down, depressed, or hopeless?
During the past month, have you had little interest or pleasure in doing things?
If the answer is yes to either of these questions, further exploration is warranted. This is where the Patient Health Questionnaire (PHQ-9) comes in providing a more detailed look at the severity of symptoms and serving as a tool for ongoing monitoring.
Recognising the Symptoms
A comprehensive review of the individual’s history of symptoms, any functional impairment, and signs of self harm and suicidality are essential elements in diagnosing depression. In older adults, symptoms can be different from those in younger individuals. They are less likely to show emotional symptoms such as sadness and guilt, and more likely to display cognitive changes and physical symptoms such as sleep disturbances, agitation, and general loss of interest.
Factors like personal and family history of mental health disorders, substance and alcohol use, and presence of other mental or physical health conditions also play a crucial role in diagnosis.
Blood Tests
Basic blood tests should be done to check for a potential explanation for depression.
- Full Blood Count (FBC): Looks for abnormalities in blood components that might indicate inflammation or nutrient deficiencies related to depression.
- TSH (Thyroid Stimulating Hormone): Evaluates thyroid function, as thyroid problems can contribute to depression.
- Ferritin: Assesses iron stores, as iron deficiency has been linked to depressive symptoms.
- LFT (Liver Function Tests): Checks liver health, as liver dysfunction can affect brain function and increase the risk of depression.
- Creatinine: Evaluates kidney function, as kidney problems have been associated with depression.
- Sodium and Potassium: Measures electrolyte levels, as imbalances can impact mood regulation and contribute to depression.
- B12 and Folate: Tests for deficiencies in these vitamins, as they are important for neurological function and low levels can affect mood.
Available Treatments for Depression
Once a diagnosis of depression is established, the focus shifts to effective management. This typically involves a combination of psychological therapy, medication, and lifestyle changes.
Depression Helpline (0800 111 757): A New Zealand helpline that offers free, 24/7 support from trained counselors.
Lifeline (0800 543 354): Another New Zealand helpline providing 24/7 access to confidential support from trained counselors
Therapy
Counseling, especially cognitive-behavioral therapy (CBT), can be a powerful tool in managing depression. ‘Talking Works’ is a counseling network that can be accessed here. If you’re a Southern Cross member, you can access up to three online mental health sessions every policy year with a counselor or wellbeing coach here.
Online CBT is another option, which can be accessed either through GP-referred platforms like Beating the Blues or freely accessible platforms such as Just a Thought.
BetterHelp and TalkSpace are platforms that offer online therapy with licensed therapists. These can be useful for those who prefer virtual sessions or cannot access in-person therapy.
Medication
Medications, particularly selective serotonin reuptake inhibitors (SSRIs), are often the first line of treatment for depression. The SSRIs citalopram, escitalopram, sertraline, and fluoxetine, along with mirtazapine, are commonly used. If there is no response within three weeks, a switch in medication may be needed.
Each of these SSRIs has different characteristics and potential side effects. Careful monitoring is necessary to manage these side effects effectively, which can include sexual dysfunction, nausea, change in bowel habits, (exacerbation of) anxiety, insomnia, and in rare cases, worsening depression or suicidal thoughts.
There has been wide interest in the use of psychedelics such as LSD and psilocybin in treating various mental disorders including depression but more research is needed to prove their effectiveness.
Wrapping Up
Depression can be a debilitating condition, but with proper diagnosis and treatment, individuals can manage their symptoms and lead fulfilling lives. The journey to recovery may be challenging and long, but it is crucial to remember that help is available. Reach out to health professionals, engage in counseling or therapy, and utilise resources such as helplines MHERC for support and assistance.
Remember, seeking help isn’t a sign of weakness; it’s the first step towards recovery.
Conclusion
Depression is a complex and challenging mental health disorder, but understanding its symptoms, diagnoses, and treatment options is a significant step towards managing the condition. With the help of professional medical advice and treatment, along with supportive resources, it is possible to navigate the challenges of depression and move towards recovery.
Remember, it’s okay to reach out for help, and there’s no shame in seeking treatment. If you or someone you know is dealing with depression, consult with a healthcare professional and explore the resources listed in this article. You are not alone on this journey.
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