Depressive disorders

By Jock Matthews

Depression has been called the world's No 1 public health problem. About one in every seven people and one in every five women in New Zealand will develop a depressive disorder at some stage in their lifetime.

The word "depression" is commonly used to describe both a frequent human emotion as well as a disorder or illness. As an emotion, it is usually a normal experience, often related to things going wrong in life.

However, some people develop a depression that disrupts their ability to engage in normal activities, usually requiring professional help. In about half of all cases the depression will not be recognised and will be under-treated. This is because the initial problem may be a vague sense of distress or associated physical and mental disorder such as anxiety disorders (panic attacks, social phobias) and substance abuse.

People may not want to admit that something is wrong because they may be seen as incapable or weak.

"Depression" is a term used when a low mood persists, bringing on intense distress that interferes with a person's ability to cope with the ordinary demands of living.

People with depression often feel burned out or overwhelmed by stress. For a doctor, psychiatrist or psychologist to diagnose a major depressive episode, at least five of the following symptoms - including the first two - must be present during a two-week period:

* Depressed mood most of the day, nearly every day.

* Markedly diminished interest or pleasure in normal activities.

* Significant weight loss or gain.

* Insomnia or sleeping too much.

* Loss of energy, interest or pleasure in day-to-day activities.

* Feeling agitated or fatigued.

* Social withdrawal from family and friends.

* Change in personality, such as becoming dramatically more agitated or anxious.

* Irritability.

* Feelings of worthlessness or excessive guilt.

* Difficulty concentrating, remembering and making decisions.

* Recurring thoughts of death or suicide.

* Unexplained physical symptoms.

Depression affects women more than men, possibly because many women have been stuck in submissive, disempowering and anxiety-causing roles.

Like a number of mental illnesses, depression appears to result from an inter-action between a genetic and psychological pre-disposition towards an illness/disorder, and stressful events. A person may hold certain pessimistic beliefs and attitudes about themselves and the world.

When sufficient stresses occur, these can overwhelm an individual's coping strategies and cause depression. Factors which may prevent depression from occurring include having had parental warmth, having a good social support system, well-developed coping skills and certain optimistic personality styles.

Medications now exist that are well tolerated and very effective in assisting in the treatment of the symptoms of depression.

Rojolie Clinic staff specialise in the assessment and treatment of depression, anxiety problems, stress and burnout. Clinical research has shown that certain psychotherapy treatments (cognitive behavioural psychotherapies) and more tolerable antidepressant medications, are more effective than others in treating depression.

* Jock Matthews is a psychologist with the Rojolie Clinic.