Depression

What causes depression

Some people get depression after a bereavement or during a difficult period, where problems at work, with finances or in personal relationships can cause deep feelings of sadness. Low self-esteem can lead to depression, as can addictions and loneliness.

Another type of depression, seasonal affective disorder, comes and goes with the seasons. Winter seems to trigger depression in some people, possibly because of the lack of light.

Hormonal changes can also cause depression, and some women experience it after giving birth (post-partum depression).

Certain personality traits, namely low self-esteem or high levels of self-criticism can make you more prone to depression. A family history of depression can also make you vulnerable.

Physical illness like cancer can lead to depression, particularly if life-threatening. Head injuries are also linked to depression, as is an underactive thyroid.

But sometimes there is no obvious reason for depression.

Symptoms of depression

The symptoms of depression can include:

• despair and hopelessness
• lack of concentration
• suicidal thoughts
• crying for no reason
• feeling detached from other people and life in general

Depression can cause anxiety, too.

Depression has some physical symptoms:

• loss of appetite
• sleeping a lot more or a lot less
• abdominal pains
• feeling tired and lacking energy
• headaches
• stomach upsets

How is depression diagnosed?

A GP will use various questionnaire tools and observations to diagnose depression. It is difficult to diagnose mental health conditions and it is best to make an appointment with your GP if you are not feeling quite right. They can help you make the best decisions about your care, including choices of depression meds and therapies. Most depression meds are available only on prescription, so you need to see a GP to get them.

What should I do if I think I have depression ?

If you think you might have depression, speak with a healthcare professional, even if you think you don’t merit it.

It is common for people with depression to think their illness is not serious enough to need the attention of a GP. Here are some indicators that you need to make a doctor’s appointment for your depression:

• you have thoughts about suicide or self-harm
• you have had symptoms of depression for most of the day, every day for more than two weeks
• your depression symptoms are not improving
• your low mood affects your ability to work, go to school or to enjoy leisure activities
• your low mood affects your relationships with other people

Sometimes people with depression hesitate to seek help out of shame or for other reasons, but as with many mental health disorders, depression is easier to treat early on. Your GP can give reassurance and advice about lifestyle changes that can help. They will explore medication options for depression, and talking therapies.

Seeking help from a healthcare professional, from family and from your school or workplace is an important step in depression recovery.

Some people believe depression is a sign of weakness. But depression is an illness, just like flu or a broken leg. GPs see many people with depression and they have lots of ways to help.

Family members concerned about someone who might be depressed can support their loved one by being a good listener and by accompanying them to appointments.

How is depression treated?

There are plenty of treatment and management options for depression. The most common treatment regime for depression combines lifestyle changes, medication and therapy.

Mild depression is often treated with a wait-and-see approach combined with lifestyle changes like exercise, talking to a friend, self-help books and online CBT courses.

Moderate to severe depression is treated with antidepressants and sometimes a talking therapy.

If you have severe depression you may need the support of a wider mental health team including psychologists, psychiatrists, mental health nurses and occupational therapists.

Talking therapies for depression

There are several different types of talking therapy available for depression. The most common is cognitive behavioural therapy (CBT), which teaches skills that will reduce your depression symptoms by overcoming negative thoughts. Even if you’ve had CBT before, it’s worth having a refresher from time to time. Other types of talking therapy used for depression include:

• counselling
• interpersonal therapy (IPT)
• psychodynamic therapy

Drugs and medications used for depression

There is a range of different treatment options if your doctor agrees that medication is the best option for your depression. And if one depression treatment doesn’t work, your doctor will help you to try another. These are some common antidepressants that might be prescribed for your moderate to severe depression:

Selective serotonin reuptake inhibitors (SSRIs)

Some common SSRIs that treat depression are:

• paroxetine (Seroxat)
• fluoxetine (Prozac)
• citalopram (Cipramil)

SSRIs work by increasing the levels of serotonin in your brain.

Tricyclic antidepressants

Tricyclic antidepressants include:

• imipramine (Imipramil)
• amitriptyline

Avoid cannabis while taking TCAs as the combination can make your heart beat rapidly.

Other antidepressants

If SSRIs and tricyclics do not work your GP might treat your depression with some other meds including:

• vortioxetine (also known as Brintellix)
• serotonin-noradrenaline reuptake inhibitors (SNRIs) such as venlafaxine (Efexor), duloxetine (Cymbalta or Yentreve)
• mirtazapine (Zispin, Soltab)

Lithium

Lithium citrate or lithium carbonate are used for depression when no other antidepressants will work. People taking lithium need to have blood tests every three months to check for lithium toxicity. Lithium interacts badly with a low-salt diet, and your GP will give you dietary advice to follow while you are taking lithium.

Do antidepressants have side-effects?

Side-effects can vary from person to person and drug to drug. Sometimes the side-effects of antidepressants ease as your body gets used to the drug. But if you are struggling with your meds, talk to your doctor. You’ll need a check-up every two to four weeks to check how your meds are working. You can talk about side-effects at these appointments. You and your doctor may need to try a couple of antidepressants before you find the right one.

How long do I need to take antidepressants for?

A course of antidepressants lasts four to six months. You’ll need to go on taking the meds even after your symptoms have eased. Stopping antidepressants too early can cause you to relapse.

Are antidepressants addictive?

Antidepressants aren’t addictive, but coming off them suddenly or missing a dose can cause unpleasant withdrawal symptoms which can include stomach upsets and anxiety as well as vivid dreams and flu-like symptoms.

To avoid this, patients coming off their medication gradually reduce their doses. This is known as tapering. You should wait until your doctor says it’s time to stop taking your meds before starting to taper.

What should I do if I miss a dose of my antidepressants?

Missing a dose of your antidepressants can give you withdrawal symptoms. The patient informational leaflet with your meds will have instructions for what to do if you miss a dose. Or you can ask your doctor for advice.

If you find you keep missing doses, ask for help. There are devices, apps and techniques that can support you in remembering to take your meds.

Will I get generic or branded antidepressants from NX Pharmacies?

Branded and generic versions of a med are bioidentical. But we know it takes time and care to get the correct regime for your depression, and many people prefer to stick with the same version of their meds each time. Be assured that NX Pharmacies will do their best to ensure you get the right meds delivered to your door.

Can I get antidepressants over the counter?

Drugs that affect the brain need to be handled with care. They are available only with a prescription and even experienced, knowledgeable patients benefit from the support of a doctor or pharmacist in managing their anti-depression regime. So keep in touch with your doctor, and ask for advice if something doesn’t seem right, or if you think you need to stop taking your depression meds.

Most medications used to treat depression are prescription only medications (POMs). You will need to see a doctor about your depression. They will prescribe the right meds to relieve your depression and give advice on lifestyle changes that will help you recover.

In Canada you can depend on NX Pharmacies for your anti-depression drugs. We serve Western Canada and can fill your prescription of depression medication and deliver it next day to major towns and cities. We can help with renewals and refills. Our discretion is assured, and you can depend on us for authentic Health Canada-approved medications to treat your depression in the most effective way.

How to prevent depression

Some lifestyle changes recommended for depression can be helpful in preventing a recurrence. You can always ask your GP for help in implementing them.

Take your anti-depression meds and attend follow-up appointments

Antidepressants are powerful drugs so it’s important to take them as prescribed. Ending the course too early can cause you to relapse into depression. Your doctor or pharmacist can answer questions about your meds and can advise on reducing the impact of side-effects. They can also tell you if your meds are likely to interact with any medication you are taking for another condition, or nutritional supplements.

While you are recovering from depression your doctor will want to see you every two to four weeks. This is to check that your meds are working as they should and to ensure that your recovery is progressing as expected. Keep these appointments, even if you feel better. It is important to your recovery from depression.

Eat a healthy diet to reduce depression symptoms

Regular meals of healthy food will keep your energy levels stable and ease depression symptoms. Reducing your intake of foods and drinks that contain caffeine can also relieve depression. A healthy diet has a good effect on low mood, and eating healthily will also help prevent physical health problems.

Physical activity helps depression

Exercise can improve general wellbeing and improve mood, so acquiring an exercise habit is a good idea if you have depression. Even a ten-minute walk around the block a couple of times a week can make all the difference. Physical activity causes your body to release feel-good chemicals known as endorphins. It can also improve self-esteem, and distract you from negative thoughts associated with depression. Joining a class or exercise group, or just getting out and about in your neighbourhood can provide positive social interactions, too, which will help you recover from depression.

Smoking, alcohol and recreational drugs when you have depression

Some people with depression also use alcohol or other substances such as cannabis. They do appear to lift your mood, but they can also lead to more anxiety and depression. Some recreational drugs interact with antidepressant meds so they work less well or give unpleasant side-effects. And the aftereffects of alcohol and recreational drugs can bring on depression, so healthcare practitioners recommend abstinence or moderation.

If you need support in abstaining from or moderating your use of tobacco, alcohol and recreational drugs, talk to your GP.

Therapy can teach skills to prevent depression

Therapy, such as cognitive behavioural therapy (CBT), can help you to manage the symptoms of depression. This is available privately, or it may be included in your health plan. Your GP can advise you about accessing talking therapy for depression.

One skill that is particularly beneficial for people with depression is mindfulness. It is the skill of paying more attention to the present moment, to the world around you and to your own thoughts and feelings.

Talking can also help, or if it is too difficult to share your experiences of mental distress with others then expressing them through art or writing can be beneficial for depression, too.

Work and depression

You may need to take time off work to recover from depression, specially if overwork caused your depression in the first place. Prolonged time off work can make depression worse, and a supported return to work will help your recovery.

Know about barriers to recovery

Talk with your doctor about any barriers to your recovery from depression. They can support you in getting appropriate help.

Addictions to gambling, drugs and alcohol can make it harder to recover from depression. Ask for professional support with your addiction.

Unsafe living conditions make recovery from depression difficult. You may need to distance yourself from friends and family members who make poor, dangerous choices or who are cruel. It can be very hard to remove yourself from an abusive living situation, so seek support.

Living in poverty, or alone, or having difficult working conditions make it harder to get better from depression. Therapy can help you change what can be changed, and develop coping strategies for what cannot be changed.

People who experienced abuse or neglect as children may find it harder to recover from depression. Therapy for past trauma can help with recovery from depression.