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Mental Health Information Centre - Southern Africa

Depression

What is depression?

It is natural to feel sad or down at times. This is a normal part of everyday life. When someone experiences sad or negative feelings that interfere with normal functioning and that last for at least two weeks, they could be suffering from depression. The first sign of depression is often a change in the person’s usual behaviour. Common symptoms of depression include:

  • Persistent sad, anxious, or “empty” mood
  • Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
  • Feelings of hopelessness and pessimism
  • Feelings of guilt, worthlessness, helplessness, self reproach
  • Insomnia, early-morning awakening, or oversleeping
  • Appetite and/or weight loss or overeating and weight gain
  • Decreased energy, fatigue and feeling run down
  • Restlessness, irritability, hostility
  • Difficulty concentrating, remembering, making decisions
  • Persistent physical symptoms such as headaches, digestive disorders, and chronic pain
  • Thoughts of death or suicide; suicide attempts

It is important to note that different people experience depression differently (e.g. children may display unusual behavioural problems). In some people depression is characterised not so much by a sad mood, as by increased irritability, unexplained pain, or other symptoms.

Different kinds of depression

  • Major depression: A period of deep depression when most of the symptoms of depression are experienced.
  • Dysthymia: Only some depression symptoms are present over a long period of time.
  • Bipolar disorder: Alternating periods of deep depression followed by extreme highs. This kind of depression is also known as manic-depression.
  • Seasonal affective disorder: Depression may occur only during specific seasons of the year.
  • Post-natal depression: Feelings of sadness, anxiety, irritability and fear of not being able to cope that occur after childbirth.

Who gets depression?

Depression is a medical disorder that may result in significant distress, and affects people of both sexes, all ages and races, cultures and social classes. Large international studies have shown that about 10% of the general population will suffer from a depressive illness in any given year. Women are twice as likely as men to have depressive symptoms.

What causes depression?

A number of different factors may contribute to the onset of depression. Very often, a combination of these factors play a role in precipitating a depressive illness:

  • Vulnerability to depression is likely to be at least partially genetically inherited.
  • Psychological make-up and environmental factors, such as increased stress or personal losses.
  • Medical conditions such as thyroid problems, strokes, cancer and Cushing’s disease.
  • Certain medications, such as steroids, birth control agents and high blood pressure tablets.
  • The symptoms of depression are mediated by levels of chemicals, such as serotonin and/or noradrenaline, changing in the brain. Like other medical illnesses, depression can be treated.

What to do and where to go for help

In most cases the best treatment for depression is a combination of medication and psychotherapy.

Medication

Antidepressants are not addictive or habit-forming, and can be safely used over an extended period.

There are different types of antidepressants which treat depression symptoms but have different side-effects, such as nausea, blurred vision, drowsiness, dry mouth, and sexual problems. Inform your doctor if these side-effects are excessively irritating or disturbing or do not go away after a while.

Some improvements may be experienced immediately but the full beneficial effects may only be achieved over a period of weeks or months.
Medication must be taken regularly according to your doctor’s instructions and advice.

The medication should not be stopped or substituted by another without prior consultation with your doctor.
Always inform your dentist or any other prescribing medical professional that you are taking antidepressants, as it is possible that combining drugs can cause severe side-effects.

Benzodiazepines (tranquillisers) may sometimes be prescribed for the short-term control of anxiety symptoms that often accompany depression. These run the risk of dependency though.

Psychotherapy or “talk therapy”

May help you gain self-insight, change negative thoughts and feelings, and learn new behaviours and coping strategies. Talking about your emotions and depression with a trained professional can help reduce, and in some mild to moderate cases, treat symptoms. The different therapy approaches most often used in depression are cognitive behavioural therapy (CBT), interpersonal psychotherapy and psychodynamic psychotherapy.

Self-help techniques

In addition to conventional treatment strategies, these can be beneficial. Reading and learning more about your condition will help you to understand your symptoms and treatment and enable you to make informed decisions about your own well-being. Joining a support group can help you to share ideas and experiences as well as gain reassurance that you are not the only person with depression. Relaxation techniques, exercise and lifestyle changes have been noted as beneficial in managing depression.

Depression is a serious medical illness that may result in significant distress and interference in daily functioning. Nevertheless, the vast majority of people with depression respond well to treatment. The first step in fighting depression is to discuss your symptoms with an experienced professional. So, consult your family practitioner, local clinic or day hospital.

Further resources/ references

Bipolar Association
Tel:  +27 12 348 6057
www.bipolar.co.za   

SA Depression and Anxiety Group
Tel: +27 11 783 1474/6
Fax: +27 11 884 7074
www.sadag.co.za

Download pdf for more information: Mood Disorders

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University of Stellenbosch
South African Medical Research Council
University of Cape Town