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4. Questions about depression

Question: How common is depression?

Answer: Depression of one sort or another is the commonest illness of all; it’s said that 40% of all of us get this illness at some time in our lives. Nearly a quarter of all GP attendances are for some form of emotional problem; 3% of the population are estimated to be suffering from depression, and 8% suffer from mixed anxiety and depression, at any one time. Many more people, who don’t have a full-scale illness, have difficulties or disabilities owing to some depressive symptoms. There is a wide range of severity of this remarkable illness. It can range from a quite subtle loss of enthusiasm and pleasure in life, which is hardly even recognized by the person concerned or their family, to a severe condition that can need urgent hospital treatment for the patient’s safety.

Most cases of depression are in the mild to moderate range. So about 90% of people with depression will be most appropriately treated by their family doctors, generally with a combination of antidepressants and counseling.

The other 10% will need more intensive and specialized looking after by a psychiatrist – and members of their team, such as clinical psychologists, community psychiatric nurses, and other therapists. Only a very small percentage will actually need treatment in hospital. This is relatively quite rare.

Depression can have accumulated over many years and a catalyst could have set the final crumple-switch into action, to cause the breakdown to develop into severe depression. Many people do not recognize it happening to them. Others around them can also be blind to it or don’t seem able to help.

Question: Will I ever feel better?

Answer: Yes. A very common part of depressive illness is feeling negative and having a bleak view of the future. The belief that the illness will go on forever fades as the illness is treated. With treatment, people describe a feeling as if a cloud has lifted, as if the light has been switched back on, or as if the colour has come back into their lives. They often add that they never believed they could or would get better. It takes months for a complete course of treatment, often 6–9 months. You may well feel some benefit after a few days on antidepressants, in terms of sleep pattern starting to improve, and moods in the daytime becoming less variable, but a full course of treatment does require patience.

Question: What are the chances of becoming depressed again?

Answer: If you have already had a depressive illness you have an increased chance of it happening again – but it is by no means inevitable. The rate is approximately 10 times higher than in somebody who has never been depressed before. If there has been more than one previous episode, the rate is about 15 times higher. This does not, however, mean that the severity of the illness is as great. After experiencing depression, people always learn about their illness – they tend to spot it much earlier and seek treatment earlier. The people around them also tend to be quicker to spot depression developing. Having had a depressive illness, you will have coping strategies that the experience will have taught you. Remember that depression is a very common illness and affects 3% of the population a year. A very large number of those people are functioning both at home and at work, despite being ill.

Question: Will my depression come back?

Answer: About 50% of people who have depression never experience it again. The older you are when you become depressed, and the more episodes of depression you have had, the greater is your likelihood of further spells of depression. People who have had several spells of illness may need to consider long-term medication. This sort of decision needs careful thought and advice from a specialist.

Question: What makes relapse more likely?

Answer: Risk increases if mood is fairly constantly low or dysthymic – in other words a truly normal mood pattern has not been reestablished and your mood remains consistently below par. If there is a concurrent physical illness (especially if painful), the risk of relapse is higher. Relapse of depression is more likely if you are drinking alcohol to excess, or if you have a second psychiatric illness in addition to depression. Relapse is more likely if difficult and painful problems have not been addressed. The feeling of being trapped in a difficult situation is a very stressful position to be in and increases the chance of further trouble. People can, and do, cope with great adversity. If, however, you feel powerless, and as though you have no choices, then stresses are much greater to bear. We can live in difficult situations, including problematic marriages or a very demanding job, if we feel that we ourselves have made a conscious decision to do this.

Question: Does depression get better on its own?

Answer: Yes. Even very severe depressive illness can get better on its own, but there is always the risk in untreated serious depression of death by suicide, or sometimes (especially in the elderly) by self neglect.

Question: How long does it take to get better?

Answer: About half of the people who become depressed will recover within less than 6 months, but about 1 in 10 seriously depressed people may take up to 2 years to recover fully.

Question: Why are some people slow to get better?

Answer: This is a complicated question. One of the most important reasons for not getting better is stopping treatment before advised. Fewer than half the people prescribed antidepressants will still be taking them after three months’ treatment. They may stop taking the tablets for a variety of reasons, including:

 

  • Unacceptable side-effects;
  • The fact that they are feeling better;
  • Pressures from family members to stop taking tablets, or
  • Fear that antidepressants are addictive (they aren’t!).

 

Remember to tell your doctor if you have stopped taking the tablets prescribed – he or she needs to know. Otherwise the doctor might think that you are not responding to the tablets rather than the fact that you are not taking them. Not all tablets will work in everyone. A quarter of depressed people will respond to the first antidepressant that the family doctor prescribes. You cannot tell by just looking at someone which type of antidepressant will suit that particular person best. Overall about 60% of depressed people will respond to an antidepressant taken in adequate doses for an adequate length of time.

Question: Our daughter developed severe depression as a teenager. We can’t help feeling it’s our fault. Could we be to blame?

Answer: It is always painful to see a loved one depressed – particularly so a child or adolescent. There is often a tendency in parents to blame themselves and believe that any professionals involved in trying to treat will be critical of parents. Professional help is not

about blaming but enabling people to deal with their difficulties in a different way. Most children and adolescents who become depressed will get better with time and care (both of which parents can provide). Expert intervention will also help and a wide range of agencies are used for this, including health visitors, child guidance clinics, educational psychologists, nurses, social workers and doctors, as well as resources from the voluntary sector and churches.

Question: Can you be depressed and not realize it?

Answer: Looking back on my life I see that there were spells of time when I switched off from things and stagnated. I wasn’t happy or unhappy, but I just couldn’t take much interest in anything.

Question: I let things slide – my job, my social life, even my appearance. Would you call this depression?

Answer: It probably was, although hindsight is a wonderful thing. Few people’s moods are constant, level and settled; some people do have times in their lives when their enjoyment of life may wax and wane. There is a fine line between unhappiness and mild to moderate depressive illness. Loneliness and boredom at some stages are routine experiences for many people, but when you lose the ability to do something about your life, take charge of things and make some good changes so that you are no longer lonely and bored, then illness may be appearing. Broken sleep with early morning wakening, loss of appetite and sex drive, mood swings, loss of insight and concentration, and loss of pleasure in life are signs of illness, as opposed to just plain misery.

Question: Some of my family members have had depression. Does this mean I’m going to wind up like them?

Answer: The late Anthony Storr, psychiatrist and writer, has said, ‘It’s not your psychopathology, it’s what you do with it that counts.’ What he meant was that we all have a set of personality characteristics, some influenced by our inherited genes, but nothing is inevitable, and everybody has choices in how they use their own personality and character – for better or worse. Of course, we all have a mixture of strengths and weaknesses in our personalities. If you do have a family tendency towards depression or alcoholism, it does not mean that your life is going to be overwhelmed by these illnesses. It does mean, however, that you may face more emotional challenges, be more vulnerable than some other people, and that you will have to face up to looking after yourself carefully in this particular area. Having good friends around you is a great help. Remember, nothing is inevitable.

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