DEPRESSION - Full extract 

Heather had been in to see me a couple of times about back pain and a general feeling of fatigue. A full examination and several blood tests were normal. After we had discussed her results she stood up to leave. " There is something else" she said. " I know it sounds silly with so many sick people out therein the waiting room, but I just feel sad."

Apparently she had been teary for some weeks and had almost completely lost confidence at work. "For some reason I don't feel good about myself any more. I ought to be able to snap out of this, but I can't. I feel lousy and I don't know why." 

Like most GPs I see many people with depression. Yet only a few people actually say they are depressed initially. More commonly they come in with symptoms like tiredness, back pain, headaches, not sleeping or weight loss. It may even be a parent who continually brings in a child for a check-up.  

Depression is a major problem in our community. It is very common; in any one year about 5% of people become either moderately or severely depressed. It can be long-term and disabling and have a huge toll on people's work and personal relationships. The rate of suicide in our community is also of great concern, particularly the incidence in younger men. 

Depression can  be regarded more accurately as a range of conditions rather than a specific illness. We all get feelings of sadness, especially at times of personal loss, such as relationship break-ups, death of a family member or losing a job. However, some people have a very prolonged and severe response to these situations. This is called reactive depression. The condition can also appear out of the blue; in its more severe form this is called endogenous depression or major depressive illness. Postnatal depression occurs after the birth of a baby and can be quite profound. Depression that alternates with periods of elevated mood is called manic-depressive illness or bipolar disorder. 

The actual cause of depression is not fully understood. It can certainly be triggered off by stressful experiences, especially if there are other factors like social isolation and alcohol abuse. We also know that it has a genetic tendency and tends to run in families. Various studies have shown that it can be due to a disturbance in neurotransmitter metabolism, particularly that of serotonin and noradrenaline. Many people do not appreciate that a biochemical imbalance can be responsible. The medications used for depression actually correct this imbalance. 

Aside from a generally flat mood there are several other features of depression of which the person may or not be aware. Chronic tiredness and fatigue is very common, as is loss of interest in activities like sport, work and social outings. Loss of concentration and feelings of worthlessness, guilt and self-blame may also be present. Irritability, disturbed sleep pattern and early morning waking are fairly common. Sometimes there is a change of appetite with either weight loss or gain. There may also be a pre-occupation with death and ideas of suicide. 

The diagnosis of depression can only be made if it is thought about by the person or the doctor, and preferably both. Some general practices can be so busy that people may not feel comfortable bringing the subject up. This is more likely if there are guilt feelings about having a mental illness. 

Some people still worry that being depressed is a sign of weakness, something to be ashamed of. Hopefully the stigma of having any sort of mental illness will soon be a thing of the past. Likewise, the doctor has to be open, tuned in to the possibility of depression and prepared to bring people back to discuss their problems in more detail. For every one person with depression there are several others who have not sought treatment. 

There are several other illnesses that the treating doctor has to keep in mind when depression is being considered. Conditions such as anaemia and an underactive thyroid gland can cause a similar picture and may need to be excluded with a careful examination and some specific tests. 

The treatment of depression has become more streamlined in recent years. Many cases of milder depression can be successfully treated with counselling, discussion and support. More severe cases may require a course of antidepressant medication, or referral to a psychiatrist. 

Several new and improved medications have become available in recent years. These medications are not addictive. In very severe cases electro-convulsive therapy (ECT) may be suggested. This is a safe and effective form of treatment that can quickly reverse the symptoms of severe depression, especially when there is a high risk of suicide. Another important aspect of treatment involves improving the person's social supports, not only from the community but wherever possible from within the family as well. 

Health tip:
 * Depression is very common and readily treatable. People should feel comfortable talking to their doctor about it. The most important step is making that decision to seek help.

Dr. Andrew Pattison: Common Consultations
North East Valley Division General Practice, Melbourne, Australia.   Disclaimer
  - Last modified: August 18, 2001