Depression

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Depression

We all have days when we feel down, but when days turn into weeks & it becomes difficult to cope with day-to-day living, then you may be suffering from the illness known as clinical depression.

The word depression has become mis-used as a description for anything from a grief reaction, to being down in the dumps, or just having a bad day.
– This misuse makes depression seem trivial
– when in reality it is common, & as serious as diabetes or heart disease
– research: Australia’s most debilitating illness (one million Australians experience an episode per annum)

Hope:
– depression is an illness which does get better & you will feel well again in time
– it is not a weakness, a personality flaw or a sign of failure
– it is not due to laziness/not trying hard enough
– it is not under your control – nobody chooses to feel depressed.

How do you know if you have clinical depression?
[if you have experienced many of the following symptoms much of the day, nearly every day over the past 2weeks or more]
– feeling sad/in low mood
– reduced interest in daily activities/ loss of pleasure in things
– a significant change in appetite or weight (up or down)
– trouble sleeping, or sleeping too much
– feelings of constant fatigue & low energy
– changes in your energy level – either restlessness or agitation, or being slowed down in your movements or thinking
– being disturbed by feelings of worthlessness or guilt
– trouble concentrating or making decisions
– Thinking a lot about death, or thoughts about suicide.
[others: irritability; loss of confidence & self-esteem; reduced interest in sexual activity; lose sense of humour; lose interest in other people/relationships; worry more; cry more; constipation; menstrual dysregulation; affect change – looking sad; appears agitated; appears to be slow]
[other symptoms can include: headaches, abdominal pain; tiredness, aches/pains – the body’s way of signalling it is not well][often why people report to the GP]

How does Depression affect the body?
– depression is associated with changes in hormonal & neurotransmitter function (responsible for automatic body & brain responses – may cause the mental & physical changes above)
– people with depression can think they are working too hard/getting old

Who gets depression?
– anyone irrespective of age, religion, race, upbringing, relationship status, gender, sexual orientation, socio-educational status

What causes depression?
– not exactly known
– we all have vulnerabilities (genetics, personality style, world view)
– more common at particular stages of life such as:
– post-natal period following the birth of a baby
– around the menopause [women experience depression 2x more than men]
[people who experience it once, are likely to re-experience depression]
– life stressors [chronic pain; social isolation; following bereavement]
– less commonly:
– some types of medication
– medical problems such as under-active thyroid [important to have a medical check-up]
– AOD use
– personality style (pessimistic, perfectionistic, low self-esteem – increases risk
– negative thoughts are very common as part of the illness

Getting Better
– when depressed, it is hard to imagine ever getting better again
– RECOVERY from DEPRESSION is the rule NOT THE EXCEPTION
– without treatment, an episode of depression can last typically 6 to 13 months (or longer)
– with treatment, an episode of depression can last up to 3 months

PROVEN TREATMENTS [worth giving them a try]
– lifestyle changes – [while acknowledging motivation is difficult & energy is lacking]
1. experience fresh air & sunshine [acknowledging the sleep disturbance issues & the difficulties depressed people have in getting out of bed in the morning]
– sit in sun
– open curtains to let in the sun
2. Exercise (any type – acts as a natural anti-depressant)
– walk, jog, gym (latter two are more ambitious so start small)
– 10 mins
– write a plan
3. Manage your sleep (develop good sleeping habits)
– get up at same time each morning, even on week-ends
– don’t go to bed until you are tired
– try not to worry in bed (write our worries down on paper rather than take them with u)
– if you re having trouble sleeping, don’t lie there & get upset – get up & read a ok, listen to music, do something that is restful. When sleepy, go back to bed
– develop a pre-bedtime routine that helps you sleep (warm bath/shower, mug of hot milk, try a relaxation technique (or listen to music/read a book) – avoid anything too stimulating/challenging
– make the bedroom as comfortable as possible – avoid excessive heat, noise, light
– avoid things that make it hard to sleep such as alcohol, caffeine, nicotine
– don’t do aerobic exercise immediately before bed – early exercise is best
– avoid napping in the daytime – napping interferes with diurnal sleep
4. do things you enjoy each day [achieve something small each day – while acknowledging that even the smallest of tasks may seem overwhelming]
– aim is to try & find something good (however small about each day)
– schedule
– set goals (listen to music you like; do the dishes)(as you get better, increase the complexity and/or duration)
[WRITE OUT: I enjoy doing… ; Goals I plan to achieve are…]
5. Keep up some social contact even if you feel you really do not want to see or talk to anyone
– aim: try not to sit home alone; if possible – keep working unless this will make you even more depressed, anxious or stressed
6. Keeping a routine [while acknowledging that completing simple daily tasks of living are difficult to complete]
– routine is important
– a key to getting well
– awake/asleep same time each day
– time for self-care (including exercise)
– have a plan for each day (develop night before)
– depressed people are often at their lowest ebb first thing in the morning [putting clothes out the night before, breakfast things etc., may assist you get up in the morning]
[WRITE-OUT: My daily routine includes…]
[Sleep may not reset until your depression resets]
[sleeping tablets will not fix the problem]
7. Supportive people around you (family, friends, work colleagues, online forums, neighbours, community support groups)
[website at bluepages.anu.edu.au
[AOD, making big drastic changes – when depressed – not the RIGHT TIME]
[try not to be critical of yourself]
[avoid telling yourself what you should have done or should be doing]
– psychological treatment (opportunity to talk about how you are feeling)
– a psychiatrist is a medically trained doctor who has also undergone specialist training in mental illness & psychological therapy
– a clinical psychologist has undergone extensive training in psychological problems & talking treatments, but is not medically trained & so does not have specific knowledge in the use of medications or the ability to prescribe them. If your GP refers you to a psychologist, Medicare may pay for some or all of the fee for a limited number of sessions. Rebates are also available from some private health funds. If you are seeing a psychologist & taking medications you will also need to be seeing your GP or a psychiatrist to manage your medications. Mental Health Treatment Plan is also required.
1. CBT is most commonly used by psychologists. It focuses upon altering negative thinking habits, which play a role in causing depression, & also focuses upon changing the way you do things. THE AIM IS TO MAKE YOU FEEL BETTER ABOUT LIFE, ABOUT YOURSELF, & THE WORLD AROUND YOU.
2. Interpersonal Therapy (IPT) – to improve your relationships & the way you relate to others – sometimes problems in these areas may be a big factor in depression. Healthy relationships can help you get better. Helps you identify unhelpful or negative thinking or behaving that might make you vulnerable to becoming depressed.

– antidepressants (depression results in clear physical changes in the body – these changes are related to brain neurotransmitters)
– they are not a crutch or sign of weakness
– they are not addictive or uppers (happy pills)
– you need to take them daily
– may take at least 2 weeks to work & 8 weeks to get the full effect
– may interact with other medications including herbal remedies – so check with your GP or pharmacist – discuss interactions – avoid alcohol/illicit drugs
– different ones work for different people
How long to take:
– keep taking even if feeling better
– take for at least 12 months following a first episode
– number of episodes – take even longer
Side-effects:
– minor (go away after a week) – headache, dizziness, nausea, sleep disturbance, drowsiness during the day, sexual function
– serious – raised blood pressure, agitation, suicidal ideation, [see Dr]

Aim of treatment – full remission, not just a bit better
[COMPLETELY GETTING BETTER]

Suicide:
– myth – talking about it encourages it
– take seriously:
– comments such as “World would be better off without me”; “Wish I could go to sleep & not wake-up”
– behaviour such as “Destroying personal papers”; “tidying up ‘loose ends’ & unfinished personal business”
– 2000 Australians commit suicide each year
– 65,000 make attempts
– 35,000 are admitted to hospital for suicide-related injuries
– every year 400,000 Australians experience suicidal thoughts
[source: Black Dog Institute]

Get support for yourself – your health is vital
– & remember you would be there for your friends/relatives if they were the ones needing help

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