What is Depression?
- a debilitating whole body illness
- when depression is an illness rather than a temporary state of mind, it can last for weeks, months, even years
- physical and psychiatric symptoms include:
- major changes in sleep patterns
- weight loss or gain
- restlessness or lethargy
- mental sluggishness
- feelings of worthlessness and hopelessness
- feelings of guilt
- suicidal thoughts
- rise in alcohol or substance use problems
- other bodily symptoms like headaches
- possible triggers or combination of triggers:
- significant loss, trauma, life change
- imbalance in brain chemistry
- hormonal fluctuations
- genetic predisposition
- lack of sunlight
- chronic illness
MYTH: People with depression should just ‘snap out of it.’
FACT: The kind of depression we’re talking about isn’t the natural lows of daily living. The illness of clinical depression is serious and often caused by chemical imbalances in the brain, and must be dealt with compassion and understanding. People with depression can ‘snap out of it’ no more easily than someone with a broken leg or diabetes could. But they can get better — with help.
MYTH: Depression has nothing to do with me.
FACT: Depression affects 1 in 10 Canadians in their lifetime, so chances are that it will affect you — if not personally, then someone you know or care about.
MYTH: People with depression won’t recover.
FACT: Although there is no ‘cure,’ depression is highly treatable with more than 80% of patients finding successful treatments. Recovery is the norm, not the exception.There is help. There is hope.
Depression affects your body, mind, thinking, emotions, social networks and habits. Therefore, research supports the idea that a combination of medicine (in herbal or pharmacological form), counselling, support groups, and lifestyle techniques is often the most effective way to treat it. In other words, depression is a whole body illness that requires a whole body treatment.
Self-help and Lifestyle Strategies
The strategies outlined below are helpful to anyone, but particularly useful for people experiencing depression.
Diet and Nutrition
- eat more carbohydrates, vegetables, fruits, whole grains, fish, and vitamin-rich foods
- drink lots of water, which helps fatigue and replenishes brain cells
- be careful around caffeine, sugars, and animal fats
- remember that alcohol is a depressant
- produces endorphines (mood enhancers) that help alleviate symptoms like fatigue, lethargy, irritability, sleep disturbances, poor appetite, etc.
- also a great anxiety and stress reliever
- can be helpful by itself for mild depression
- maintain a regular sleep-wake pattern
- don’t nap during the day
- limit your caffeine intake
- don’t eat a large meal or exercise too late at night
- keep a log of your sleeping habits to observe changes with medications or lifestyle
- yoga and deep breathing exercises
- massage therapy, acupuncture
- aromatherapy
- spiritual relaxation, such as prayer, meditation
- martial arts
- time management skills
Psychotherapy and Counselling
Cognitive-behavioural Therapy
- explores patient’s negative thoughts, emotions, and self-defeating behaviours and helps a person to learn to recognize and change negative thinking patterns
- emphasizes development of specific skills in managing relationships (e.g. assertiveness training, adjusting to transitions)
- focus on person’s identity issues, unresolved grief, and/or social issues
- enables people to meet others who can relate to their issues and compare solutions
Creative Therapies
- brief therapy models (e.g. solution-oriented), art therapy, music therapy, play therapy
Psychodynamic Therapy
- discover and resolve previous conflicts/traumas believed to be related to the present depression
Main Clinicians who Treat Depression
- Family doctor: Has generalized rather than specialized experience. Can provide a referral to a psychiatrist.
- Psychiatrist: A medical doctor who is eligible to prescribe medication and provide psychotherapy. You need a referral from your family doctor to see one.
- Registered Psychologist: Has a PhD in psychology. Can diagnose and provide psychotherapy. Not eligible to prescribe medication.
- Registered Clinical Counsellor: Addresses clinical mental health issues through assessment, prevention, and therapy. Has a Masters degree or equivalent.
- Other: Other clinicians who are often involved include social workers, mental health workers, occupational therapists, and psychiatric nurses
Antidepressant Medications
Antidepressants act on the neurotransmitters (serotonin, noradrenaline and dopamine) which act as chemical messengers between brain cells. Antidepressants come from several different families each having a slightly different effect on one or more of these chemicals. It takes about four to six weeks to know if one is working for you.
- Selective Serotonin Reuptake Inhibitors (SSRIs) e.g. Prozac®, Paxil®, Zoloft®, Luvox®, Celexa®, Cipralex®
- Tricyclics e.g. Tofranil®, Elavil®, Norpramin®, Triptil®, Aventyl®, Asendin®, Anafranil®, Sinequan®, Surmontil®, Novo-Maprotiline®
- Monoamine Oxidase Inhibitors (MAOIs) e.g. Nardil®, Marplan®, Parnate®, Eldepryl®, Manerix®
- Others e.g. Wellbutrin SR®, Effexor XR®, Remeron®, Desyrel®
- Lithium Commonly used to treat manic depression, lithium can also be effective as a mood stabilizer for unipolar depression. It is often used as an augmentation strategy, that is, used alongside an antidepressant.
MYTH: Antidepressants are addictive
FACT: No. Unlike sleeping pills and some anxiety medications, antidepressants are not addictive. However, you should never just stop a course of antidepressants on your own without the supervision of a treating physician; while your body will not crave the medicine, it will be affected by a sudden stop, particularly at higher doses.
MYTH: Antidepressants are “happy pills”
FACT: Antidepressants are often called “drugs” in slang but they have no relation to amphetamines (“uppers”) or euphoria-inducing recreational drugs. Antidepressants are designed to correct imbalances in certain brain chemicals and get you back to feeling like yourself, not merely a happier self. A person without those imbalances, who is not depressed, will feel no effect from antidepressants and may even feel ill.
MYTH: Pills will change your personality or prevent you from feeling “normal” moods
FACT: Many people are nervous when taking medication for a mental illness because they feel anything affecting the brain — the very heart of our humanity — may interfere with their identity and feelings. Actually quite the opposite: antidepressants are designed to return you to your former demeanour, not create a different one.
MYTH: I’ll be on antidepressants for life
FACT: A general rule clinicians use is that a person should be treated with antidepressants at least one-and-a-half times as long as the duration of the depressive episode before they can begin to be weaned off. Half a year is around the minimum duration for brief episodes. Longer-term antidepressant usage is considered for a smaller percentage of people who have one or more relapses of major depression in their life or who have episodes of depression that last months or years.
MYTH: Antidepressants have horrible side effects
FACT: Like other medications, antidepressants carry the risk of side effects. These range from fatigue to dry mouth to sexual side effects. Fortunately, newer brands of antidepressants have relatively few or mild side effects. Many of these lessen or disappear with time, or can be corrected in other ways. Talk to your doctor and pharmacist to learn more about what to expect.
MYTH: Antidepressants act the same on everyone
FACT: Everyone’s body is unique — including the way our brains are wired. Medication targeted at chemical messengers works differently in each person. Trial and error is still the best process to find out which medicine will work for someone.
MYTH: Pills don’t get at the root of the problem
FACT: While it is true that antidepressants won’t do much to alleviate the environmental circumstances that cause situational depression, they can be “enabling” medicine that alleviate symptoms of major depression enough to enable a person to pursue and receive more benefit from lifestyle changes, support groups, and counselling.
Light Therapy
Research has shown that many patients with Seasonal Affective Disorder (SAD) — clinical depression only during autumn and winter seasons — improve with light therapy which is exposure to bright, artificial light for as little as 30 minutes per day. Light therapy leads to significant improvement in 60% to 70% of SAD patients. For more information, visit the Society for Light Treatment and Biological Rhythms at www.sltbr.org.
Alternative Remedies
Some people prefer to use herbal products for mild symptoms. It should be noted, however, that the benefit claims of most herbal formulations or alternative rem-edies are not as well supported by empirical research as antidepressants, counselling or light therapy are.
- St. John’s Wort (Hypericum)
- most researched herbal remedy
- recommended for mild/moderate depression
- may have side effects; do not use with several other medications or if you are an organ transplant recipient. Check with your doctor.
- Ginkgo Biloba
- believed to enhance memory, energy, and vitality
- Other herbs indicated for mood
- e.g., ginger, licorice root, oat straw, balm peppermint, Siberian ginseng, SAM-e*
- Fish Oil & EFAs (essential fatty acids)
- e.g. flax, sunflower, pumpkin, borage oils
- omega-3 fatty acids in fish believed to be helpful for bipolar disorder
- Homeopathic remedies
- consult a trained homeopathic physician
- Vitamins
- B (B1-12, Inositol, Bioton), C, Folic Acid
Check with your treating physician and pharmacist when considering the medications. Do not use in conjunction with other antidepressants unless directed.
* Note: Some restrictions may apply in obtaining these medications in Canada.
Getting Help
- Your family doctor
- If you don't have one, see the website directory of the College of Physicians of BC at www.cpsbc.ca
- Your workplace benefits
- Employee Assistance Programs
- Extended health benefits which often cover short-term psychotherapy with a registered psychologist.
- Your local mental health centre
- You can find it in the Blue Pages under ‘Health Authorities’ or call 1.800.661.2121
- Referrals to counsellors or psychologists
- BC Psychological Association Referral Line at 1.800.730.0522
- BC Association of Clinical Counsellors Referral Line at 1.800.909.6303
- A depression support group in your area
- Contact the Mood Disorders Association of BC at 604.873.0103 or
- BC Mental Health Information Line
- 604.669.7600 or 1.800.661.2121
- Internet resources
- Crisis lines
- In the front cover of your phone book or call 1-800-SUICIDE for 24/7 support
