Depression
The
extent of the problem
Depression is among the most common psychiatric problems.
Around 60 - 70% of adults will at some time experience symptoms
of depression of enough intensity to affect their life.
Up to 50% of General Practice attenders may have some depressive
symptoms and about 5% will present with major depression.
At least one patient with depression is likely to present
at each surgery session. It has recently been estimated
that the total cost of depression to the NHS is £333 million.
Indirect cost due to lost social and economic productivity
may be three times higher than the direct cost quoted above.
Moreover, depression can be life threatening. Of the 4,000
people who commit suicide every year most have been depressed.
What
is depression?
Depression may present in various forms, and symptoms like
those listed below occur in varying proportions from one
individual to another. In some, it begins as a clear reaction
to a major event. In others, no such event is identifiable.
For some people the depression occurs as a clear episode,
for others it can be quite chronic and for others it can
alternate with ‘high’ episodes.
Mood
changes are primary, shown as feelings of persistent sadness,
of being down in the dumps, of hopelessness and helplessness.
Anxiety and increased irritability are often present.
Cognitive
changes of various degrees of intensity are experienced,
such as a lack of concentration, confused thinking, indecision
and difficulties with remembering. Typically, the content
of thought is very negative and pessimistic, people seeing
themselves as inadequate or even as bad, finding their environment
unfulfilling and their future bleak.
Biological
changes affect sleep, appetite, weight, sex-drive and the
ability to enjoy usual activities. Patients often complain
of aches and pains, or excessive fatigue and of slowness
of thinking and movement.
Behavioural
and motivational symptoms are characterised by inactivity,
unwillingness to initiate activities, avoidance of work
and social activities, crying and sighing.
Causes
No single cause of depression has been identified and the
consensus of opinion is that several factors can act together,
for example, genetic vulnerability, family history, social
vulnerability (loss of social support, isolation, socio-economic
disadvantages) and psychological vulnerability involving
a history of loss and disruptive childhood experiences.
Often episodes of depression appear to be precipitated by
major life events, such as the death of a loved one, divorce,
financial difficulties or loss of a job.
The
common pathway of these several interacting factors can
be both biochemical and psychological. In some depressions,
there is an imbalance in several brain chemicals. Psychological
changes are more universal, the main features being a striking
negative bias in the interpretation of events and in memory,
and predominance of dysfunctional or unhelpful attitudes
regarding oneself and the world.
Treatments
During the past few years very effective treatments have
been developed for depression. These include anti-depressant
medication and short-term psychological treatments. Both
these approaches can provide relief from depression within
3 to 4 weeks and long lasting relief within 3 to 6 months.
For more information on referring to the clinic please contact us on 01323 430831 or complete our online enquiry form.
Psychological
Therapies
Cognitive or cognitive-behavioural therapy has been the
most extensively evaluated. It has been shown to be at least
as effective as anti-depressant medication, but to be superior
to medication in the prevention of relapse and recurrence
of illness.
Cognitive
Therapy is structured and collaborative; patient and therapist
work together on explicitly agreed goals. Different components
of therapy focus on behaviour or on thoughts as means of
alleviating low mood. Time may be spent on reestablishing
previous activity levels. The sufferer learns to combat
the negative style of thinking which maintains depression
and to develop coping skills which help not only in acute
episodes of depression, but also to face future difficulties
and major events.
Medication
For the most severe depressions, anti-depressant medication
with or without psychological treatment should be employed.
Different types of medication are now available and the
GP’s choice of anti-depressant will depend on individuals
patient’s character.
The
combination of psychological treatment not only enhances
compliance with medication but also increases the likelihood
of long lasting treatment effects.
What
are Behavioural and Cognitive Psychotherapies?
Behaviour
Therapy, Cognitive Therapy and Cognitive Behaviour Therapy
have some common features. They are based firmly on research
findings and derive from specific theories. The focus is
mainly on the here-and-now, rather than the past, and the
main goal of therapy is to help bring about changes in the
person’s life which are measured and evaluated. Goals for
change may involve:
- A
way of acting eg. being more outgoing
- A
way of feeling eg. being less scared or less depressed
- A
way a thinking eg. learning to problem solve or get
rid of self defeating thoughts
- A
way of dealing with physical or medical problems eg.
lessening the difficulties associated with back pain.
- A
way of coping eg. training developmentally disabled
people to care for themselves
Cognitive
or Behaviour Therapists may work with individuals, groups
or families, and therapy is time limited. The approaches
can be used to help any person – irrespective of intelligence,
insight or other abilities.
For more information on referring to the clinic please contact us on 01323 430831 or complete our online enquiry form.
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