More than just a bad day - written by Dr Jenni Parsons
Everyone experiences ups and downs in mood but major depression is a lot more than feeling down for a day or two. We speak about depression as a ‘mental health disorder’ but in fact it is a ‘general health’ disorder. Yes mood and psychological symptoms predominate, but depression causes many physical symptoms as well. The ‘mental health’ symptoms include lowered mood, loss of pleasure (which is actually very debilitating…imagine if you never enjoyed anything), lack of motivation, irritability and tearfulness. Depression also affects thinking functions such as concentration, organisational skills, decision making and short term memory. In older patients it can often be quite difficult to distinguish between depression and early symptoms of dementia.
Importantly, it also affects thought content. People with depression feel guilty, unworthy, incompetent, a failure and a fraud. As a result thoughts that roll around in the head are things like ‘I’m not good enough’; I’m incompetent’; I’m hopeless’; ’ If I wasn’t so useless I could overcome this’; I’m weak’; ‘things are never going to get better’; or ‘My family (or insert any other significant person/organisation) would be better off without me’. Although we all may have some of these thoughts occasionally, in depression they can become incessant and circular. Of the physical symptoms for depression, sleep disturbance is one of the most troublesome. This often involves waking very early in the morning and being unable to get back to sleep.
Often, especially if the person also has anxiety, difficulty getting off to sleep and frequent waking can also occur. Other general physical symptoms include marked fatigue, lethargy, weight loss (or weight gain), restlessness, a racing heart or a churning gut. Frequently, it is the physical symptoms of depression with which patients first present to their GPs .
So the assessment and treatment of depression is in many ways similar to the management of other significant general ‘physical’ disorders. In managing diabetes or cardiovascular disease, the patient first needs to be well informed about the disease process and the impacts it can have on them in the short and long term. There are behavioural and lifestyle changes the patient may need to make to improve their heath such as dietary change or taking regular exercise. There may be specific skills the patient needs to learn (such as checking blood glucose for someone with diabetes or meditation techniques or problem solving skills for someone with depression).
All serious health problems are confronting and may require us to change the way we think about ourselves and the world. The patient may need to see a specialist (in the case of a person with depression this may be a psychologist or a psychiatrist, rather than an endocrinologist in diabetes or cardiologist for heart disease). And some people with depression, like most people with diabetes or heart disease, will need to take medication to regain normal health. All these groups of people need to have their progress monitored to ensure things are going well and any relapse symptoms are detected early.
Fortunately, whether you have diabetes or depression, these are all things your GP can help you with. A comprehensive assessment and working out a management plan takes a little time, and depression is a very important health issue to deal with, so it is best to make a longer appointment for the initial consultation.
There is now a lot of good information and resources available about depression and treatment options. Beyondblue and the Black Dog Institute have excellent websites and are a good place to start… as is a visit to your GP.