lundi 3 décembre 2012

The ABCs of Clinical Depression

Recent statistics suggest that about 11 per cent of Canadian men and 16 per cent of Canadian women will experience some form of clinical depression during their lifetime. Looking specifically at the Canadian workforce, it is estimated that as much as 20 per cent of workers will experience depression in any given year.

Clinical depression has become a widespread medical condition in North America and around the world. Women, people with a family history of depression and those suffering from chronic illnesses are most at risk of developing this disorder.

Simply defined, depression is an illness that is characterised by a persistent feeling of sadness and loss of interest in activities. Depression has a variety of bio-psycho-social determinants that lead to physical, emotional, cognitive and behavioural problems.

Most commonly called major or clinical depression, it affects how people feel, think and behave. Depression can cause different emotional and physical problems that impair significantly an individual's ability to function daily. Some may experience extreme fatigue, concentration and memory problems, and have trouble doing even the simplest day-to-day activities. As depression persists and the experienced sadness remains and even increases; those affected may start to lose interest in living all together, with some even contemplating suicide. Other typical symptoms of depression include memory and concentration problems, extreme fatigue, insomnia, significant weight gain or loss, different unexplained aches, and feelings of despair and worthlessness.

In many individuals, major depression is often a long-standing chronic condition that requires long-term treatment, just like diabetes. So, in most cases, individuals suffering from clinical depression are unable to simply "snap out" of it without seeking professional help.

Even nowadays, with increased public knowledge of mental health disorders such as depression, many individuals are often unaware that they are clinically depressed. They generally discover it by consulting their family doctor, often because they are suffering from physical symptoms such as lack of energy, insomnia or different unexplained physical aches and pains. Others may suspect that they are depressed but often underestimate their condition and may see it as not requiring treatment or as just an "untreatable" part of their personality. Many do not really understand their condition nor the effort or actions needed to treat its symptoms and causes. And many more remain unaware of how common depression really is. They often worry what others will think of them and consequently chose to suffer silently rather than seek help. In fact, some surveys suggest that less than 25 per cent of those suffering from depression will seek professional help.

Different depression treatment options are available and have proven to be effective. Medications and psychotherapy are considered the most effective for the majority.

In the following section, I will provide information on the most common medical and psychological treatments:

Medical Treatment: Common Antidepressants

Antidepressants are generally grouped by how they affect the naturally occurring chemicals in a person's brain to positively alter mood. There are various types of antidepressant medications with the newer types (such as Selective serotonin reuptake inhibitors (SSRIs) and Serotonin and norepinephrine reuptake inhibitors (SNRIs)) having fewer side effects. Among the most common SSRIs, we find Paxil, Zoloft, Prozac, Celexa and Lexapro. On the other hand, Cymbalta, Effexor and Pristiq are the most common SNRIs. And many other antidepressants exist.

Following a careful analysis of a patient's existing medical conditions, a physician will determine which antidepressant (or combination of antidepressants) will best work for any given individual.

Antidepressants have been proven to be particularly effective in relieving symptoms especially in those individuals suffering from severe clinical depression. It's important to remember that each individual responds differently to any given medication and, as such, it may take some trial and error to find the one that best works and to adjust it to the appropriate dosage. Lastly, patience is a virtue as many antidepressants take several weeks before they take full effect, and for the side effects to ease and a person's body to adjust.

Psychological Treatment: Psychotherapy

Many people suffering from depression benefit from seeing a mental health practitioner such as a psychologist, psychiatrist or a counselor. Today, most experts agree that the most effective treatment for depression is a combination of medication and psychotherapy. This is particularly true for severe clinical depression. Those suffering from mild or moderate depression and unwilling to take antidepressants should definitely consider psychotherapy at the very least.

Psychotherapy involves talking about your condition and related issues with a mental health expert. Through several one-on-one or group sessions, the objectives are to help the individual to better understand what he/she is suffering from, to identify what the main causes of the depression are, and to devise a treatment plan that will alleviate and, if possible eliminate, not only the symptoms of depression but the root causes of the psychological disorder. Psychotherapy often involves a deeper analysis of the individual and tackling the causes of his/her psychological distress.

There are different psychotherapeutic approaches used to treat depression: Cognitive Therapy, Behavioural Therapy, Interpersonal Therapy, Rational Emotive Therapy, Psychodynamic Psychotherapy, etc.

The type that is the most commonly used nowadays and often considered as the most effective is that relying heavily on cognitive behavioural principles. It is often referred to as Cognitive Behavioural Therapy (CBT) and it helps to identify how an individual's thoughts/beliefs and behaviours impact his/her emotions. It's based on the premise that our thoughts/beliefs determine how we feel or behave. Simply stated the objective becomes one of replacing our negative thoughts, beliefs and behaviours with more positive and healthier ones. The expected outcome being that more positive emotions will then be experienced.

Some individuals suffering from severe clinical depression that does not respond well to traditional treatment may need to consider hospitalization and residential treatment programs. Although other less frequent and sometimes controversial treatment options exist (e.g. Electroconvulsive therapy, Electromagnetic Therapy, Vagus nerve stimulation), these will not be addressed in the current blog.

It's important to point out that this article is not intended as a guide to help individuals self-diagnose or self-treat. It was written to provide some basic information to individuals wanting to know what clinical depression is, to help them understand that several treatment options exist, and to encourage them to seek professional assistance.

If you are considering psychotherapy, our group of mental health professionals at Y2 Consulting Psychologists is available to help you.

We are also interested in hearing your comments or questions about this blog on clinical depression.

Yaniv M. Benzimra, Ph.D.
Clinical & Work Psychologist
Y2 Consulting Psychologists

If you have any questions and/or comments, don't hesitate. Thank you!

Resources used and interesting links for additional information about depression:

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