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What is depression?

DepressionDepression is more than simply feeling unhappy or fed up for a few days. Most people go through periods of feeling down, that Monday morning feeling, but when you are depressed you feel persistently sad for weeks or months. Unfortunately, some people think depression is trivial and not a genuine health problem – it is a real illness with real symptoms and left untreated can lead to premature death.

According to Dr Tim Cantopher, a Consultant Psychiatrist in the UK, in his very readable book “Depressive illness – The Curse of the Strong”, says “depressive illness is not a psychological or emotional state, and it is not a mental illness. It is not a form of madness. It is a physical illness. It is a deficiency of two chemicals that are normally present in the brain – serotonin and noradrenaline. The chemical dopamine and the hormone melatonin are also thought to be involved.”

The structures concerned are spread around various parts of the brain, but are linked in the form of a circuit called the limbic system. One of the important functions of the limbic system is to control mood. When the limbic systems malfunctions, a characteristic set of symptoms arises which define clinical depression and separate it from sadness, disgruntlement or stress.

Limbic system malfunction can be caused by hormonal conditions, illicit drugs, excessive alcohol, some prescribed medications, too many life changing events, too many loses (bereavement, divorce, illness, redundancy), or facing choices involving conflicting needs. The commonest trigger is stress.

Depression isn’t a sign of weakness and it is not something you can ‘snap out of’ by ‘pulling yourself together’. It is a treatable illness and asking for help is a sign of taking responsibility. Depression is fairly common and affects about one in 10 people at some point in their life. It affects men and women, young and old. Depression is an affliction of the good and the great including Oliver Cromwell, Abraham Linciln, Isaac Newton, Ludwig van Beethoven, Vincent Van Gogh and Winston Churchill who called his depression his ‘black dog’.

The typical symptoms in clinical depression are:

Feeling worse in the morning and better as the day goes on and the following losses:

*sleep (usually early morning waking) *enthusiasm
*appetite *concentration
*energy *memory
*confidence *self-esteem
*sex drive *drive
*enjoyment *patience
*feelings *hope
*love *almost anything else you can think of

Sometimes both appetite and sleep can increase rather than decrease.


Eighty per cent of people with depression get better without any help but it can take between four and six months and sometimes longer. The illness is however very debilitating and may damage your relationships, affect your ability to work and certainly destroy any enjoyment of life. The worst-case scenario is premature death through suicide. But why wait for the depression to lift when there are effective treatments available?

There are some self-help tips that might help:

• Talk about any difficulties, bad news or painful experiences.
• Exercise regularly.
• Eat a good balanced diet – there are a number of foodstuffs that are good for mood.
• Moderate your alcohol consumption. Alcohol is classed as a depressant and will certainly adversely affect your mood if drunk in large quantities
• Address the issues behind the depression if you can identify them
• People do recover from depression – remind yourself repeatedly

But there is no substitute for getting professional help from your doctor. If the diagnosis is of mild depression it may be suggested that treatment should start with talking therapy and Cognitive Behavioural Therapy (CBT) or Mindfulness Cognitive Therapy are now considered the talking therapies of choice for depression.

If the depression is diagnosed as being severe it may be suggested that you start on an anti-depressant medication. Depressive illness involves a lowering of the levels of the transmitter chemicals in the limbic system and the nerve fibres becoming less sensitive to the chemicals that are left. Antidepressants work by bringing the levels of the chemicals back to normal and making the nerves more sensitive, so that the limbic system starts running again.

The most common prescribed antidepressant medications are from a group known as Selective Serotonin Reuptake Inhibitors (SSRIs). They are a lot safer than the older medications and often you are put straight on a dose that is suitable for you with no need for the medication to be cranked up over time. There are side effects but they usually go away after the first one to two weeks. The major side effect is some nausea and/or headaches. There are six frontline antidepressants:

• Fluoxetine (Prozac) – Ever so slightly stimulant and decreased appetite
• Paroxetine (Seroxat) – Slightly sedative; useful in depression with anxiety or phobias
• Sertraline (Lustral) – usually slightly stimulant
• Citalopram (Cipramil) – Neither sedative nor stimulant
• Escitalopram (Cipralex) – Updated Citalopram
• Fluvoxamine (Faverin) – Fewer sexual side effects

Not all medications work on everybody and there may be some people who do not recover using a medication that works solely on the serotonin system alone. Since the introduction of SSRIs, there have been a number of further drugs that have become available and your doctor will advise when a medication different from an SSRI is needed. Unfortunately, this is often not until it has been shown that the SSRI is not working.

When prescribed antidepressant medication there are three important points to remember:

1. Antidepressants usually taken a minimum of two weeks before any relief from the depression is felt
2. You should continue to take them for 3 – 6 months as advised by your doctor even if you are feeling well again.
3. The best treatment for depression is a combination of prescribed medication and talking therapy.

The journey to recovery from depression is not always a smooth one. It usually takes a while before any improvement is felt and then there can be bad days as well as good days. But the bad days get shorter and less often and the good days longer and more frequent.

There are several advantages of therapy and in particular CBT which has proven to be very effective in the treatment of depression (alongside medication). It is a therapy that predominantly looks at the ‘here and now’ – the problem today rather than looking too far back into history or childhood. It helps the client to understand the origin of the depression and by challenging the client’s thoughts and beliefs, new coping strategies for dealing with the triggers to depression can be learned and the client can begin to enjoy a new life with ‘normal’ levels of mood.

The next step …

If you are concerned about depression or are concerned about someone close to you, or you are struggling with another emotional disorder such as anxiety or stress, please don’t delay. A comprehensive free assessment is exactly what it says. It may confirm what you already know or give you some relief from expectation of the worse. Whatever the outcome of the assessment if often feels good that the first step has been taken. Where the clinical Team feel a further assessment by a medical doctor, psychologist or psychiatrist is necessary then this will be advised.

Start the process by booking an appointment with our Admissions Team on:

T: [+351] 919 357 186
E: sallyvincent@novavidarecovery.com


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