Clinical depression

What is it? one in six Australian men suffer depression at any given
time. Teenagers and elderly men have higher rates of
Feelings of depression may be described as feeling sad, depression.
blue, unhappy, miserable, or down in the dumps. Most Depression in men is associated with destructive
of us feel depressed at some stage, but this is not clinical behaviour, alcohol and drug abuse, and numerous
depression. medical disorders such as cardiovascular disease and
True clinical depression is a mood disorder in which diabetes.
feelings of sadness, loss, anger, or frustration interfere The true rates of male depression may be underestimated
and impede upon one’s everyday life for an extended because many males are reluctant to seek medical advice.
period of time. Depression has commonly been thought of as a disease
of women, although the ratio is increasing in favour
Who gets it? of men. The increased rates of depression in men may
be attributed to changing social roles. Fewer men are
Feeling low or sad is something that everyone experiences.
becoming the sole fi nancial provider in a family, leading
Depressive symptoms are common, affecting 10-40%
to a loss of social status, and to isolation. In addition,
of people who see their GP. Feeling temporarily down is
the increased rates may refl ect changes in diagnosis and
different to clinical depression, however, and only half of
admission criteria, or greater health seeking behaviours
these patients actually meet the specifi c criteria used to
by men.
diagnose a patient with a major depressive disorder.
High rates of depression are refl ected by the tripling of
Still, depression remains the most common psychological
suicide rates for males aged 15-24 over the last three
disorder that a GP sees, and the rates of depression
decades, making suicide the second most common cause
appear to be increasing even further. It is thought that
of death in this age group. This is an alarming statistic.
depression will become the second most important
Elderly men have the highest suicide rates in the country.
disease in terms of disability and premature death, second
Depression in these patients may stem from loss of
only to cardiovascular disease.
spouse, isolation, fi nancial diffi culties and physical illness.
Women
Children and Adolescents
Female gender is considered a risk factor for depression.
Depression in children is actually far more common than
Studies suggest that 20-25% of women will be affected
many people realise. It is estimated that one in 10 children
by major depression at some time in their life.
and adolescents are suffering depressive symptoms at any
The reason for this is not completely understood but one time. This equates to over 95,000 Australian children
several factors may contribute, including the high and adolescents who are affected by depression. Studies
incidence of post-natal depression, social factors (e.g. have shown that the most common time to be affected
history of childhood abuse, low self-esteem), and gender by depression is in mid to late adolescence, though it can
differences in the breakdown of chemical messengers in occur at any time.
the brain.
Similarly to depression in adults, depression amongst
Men adolescents is greater in females than in males. Some
studies show that up to 25% of female teenagers
True depression, characterised by low mood and reduced
report depressive symptoms. In prepubertal children, the
pleasure, is becoming more common in men, affecting
incidence of depression is thought to be about 2.5%.
7-12% of men during their lifetime. It is estimated that

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The actual rate might be even higher, as it is hard to Children and Adolescents
diagnose children, since they do not display the same
Genetic:
symptoms. Many children fi nd it diffi cult to speak about
20-50% of children with depression have a family
their feelings very clearly, and may often present with
history of the illness, and children of depressed
behavioural changes that can be diffi cult to identify as
parents are up to three times more likely to experience
depression.
depression

Predisposing Factors Environmental:

The home and school environment in which a child is
Genetic cause of depression: brought up can infl uence the chance of experiencing
The risk of developing depression is increased three- depression. Factors such as high levels of confl ict
fold when an immediate relative is affected by within the home, or an early death of a family
depression. If you have had depression in the past, you member, increase the chances of a child experiencing
are also more likely to develop it again depression. Sexual, physical and emotional abuse can
also contribute
Physical causes of depression:
Virtually all chronic diseases (including diabetes and Negative life events:
obesity) and chronic pain syndromes are associated Events such as parental divorce, poor social
with depression. This is partly due to low moods relationships, death of a family member or friend,
over having a disease, and partly due to the disease and other negative experiences are reported more
disrupting the normal balance of chemistry within commonly in adolescents suffering from depression
the body. Depression associated with chronic diseases Personality characteristics:
can be problematic, as it can remove your desire and Some personality types are particularly prone to
motivation to pursue treatment and take medications adolescent depression. Those with attributes such
as prescribed as high levels of anxiety, low self-esteem, high self-
criticism and poor school performance are more likely
Hormonal causes of depression:
to have depression
There is a greater incidence of depression in patients
with hormonal disorders
Progression
Poor sleep as a cause of depression:
Patients with poor sleep quality are more likely to Unlike feeling gloomy or having a bad day, as happens
develop depression to all of us from time to time, the symptoms of a severe
clinical depression usually occur in episodes that last for
Psychological causes of depression: months. During this time, the symptoms of depression
Physical or sexual abuse in childhood may predispose will be more pronounced, with the sufferer becoming
adults to depressive illness. Certain personality traits socially withdrawn and personally feeling depressed. At
are also risks for depressive illness. If you have any these times, patients are more vulnerable to acts of self-
other psychological problems such as anxiety, you are harm and suicide attempts. Sometimes patients suffering
also at higher risk to develop depression depression will need to be observed more closely to
prevent these events from occurring.
Social causes of depression:
Traumatic life events are closely linked with the
Children and Adolescents
development of depression. Separation, divorce,
bereavement and redundancy are all associated with There are a few long-term consequences associated
depressive illness. If you are from a lower social class with major depression, especially in children. There is
or are unemployed, you may also be more likely to some evidence, though not conclusive, that depression
develop depression during early and late adolescence is associated with later
obesity, especially in females, and that the more episodes
Drugs that cause depression: of depression there are, the higher the level of obesity.
Chronic alcohol consumption and other substance Depressed adolescents are more likely to be involved in
abuse, has been linked with depression unsafe sexual practices and other risky behaviours. It can
lead to some negative outcomes such as:

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 Poor school performance stages you may feel like hurting yourself, or you may have
thoughts of suicide.
Substance abuse
However, depression does not always present so
Early pregnancy
obviously. You may notice you feel tired, run-down or
Social isolation have other vague symptoms such as abdominal pain or
Poor physical health headaches. It may not be until your doctor asks several
detailed and specifi c questions about your specifi c
This does not mean that all depressed children will
symptoms, mood and lifestyle that you realise you are
experience these things; it just highlights the fact that
depressed.
depressed children need to be treated and monitored
very closely, to prevent these kinds of problems from Children and Adolescents
occurring.
Symptoms in children and adolescents are the same as
in adults, but because some children react to emotional
Probable Outcomes states differently than adults, they may seem different.
Some symptoms that appear to be more common for
Most patients with depression will recover from their
children and adolescents include:
condition after 6-12 months, depending on the severity.
About a quarter of patients attending hospital with Mood changes: increased irritability, anger, or hostility
depression symptoms will experience depression again Boredom
within a year of treatment, and three quarters will
experience it again within 10 years of treatment. Reckless behaviour

If you suffer from recurrent episodes of depression, Outbursts of shouting, complaining, unexplained
you may be recommended treatments to help prevent irritability, or crying
depression. Poor school performance
This may involve: Fear of death

cognitive behavioural therapy – which is a short term Alcohol or substance abuse

form of psychotherapy which focuses on correcting Frequent nonspecifi c physical complaints such as
incorrect beliefs which profoundly infl uence a person’s headaches, muscle aches, stomach aches, or fatigue
feelings and actions, and concentrates on relapse
prevention Clinical Examination
other forms of psychotherapy
Your doctor will perform basic tests to determine your
antidepressant medication mental state and mood. It is also likely he or she will
perform some examinations to exclude other diseases that
Children and Adolescents
can present with depression. In particular, your doctor will
About 40% of depressed adolescents will continue to do a general examination, and examine the thyroid, chest,
have depressive symptoms after 4 years, and up to 70% stomach and perhaps the nervous system to look for any
will have a relapse of depression by adulthood. For this related diseases.
reason, it is important that all children with depression are
closely monitored so that they remain adequately treated. How is it diagnosed?
How will it affect me? Many doctors use screening tools for depression, which
are usually questionnaires that help identify people who
The two most classical features of depression are a low have symptoms of depression.
mood, and reduced pleasure from activities that were
Depression may be caused by a variety of physical
previously considered pleasurable.
problems within the body (this is called “organic”
In true clinical depression, these feelings will have lasted depression). Such problems include electrolyte
a while and are now starting to impact your life in disturbances, thyroid disease, anaemia, chronic infection
negative ways. If depression is severe you may develop a and cancer. You may need to have a series of baseline
very grey view of the world, and overwhelming feelings blood tests to exclude other problems that may be
of worthlessness, hopelessness and guilt. In advanced contributing to your depression.

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 How is it treated? Social treatment for depression:
Depending on your circumstances, there are a variety of
The treatment of symptoms of depression involves ways that your doctor and agencies can try to help to
physical, psychiatric and social interventions. An initial reduce the stressors in your life. This may include:
step in the management of depression is educating
the patient about the condition and its implications. 1. F inancial assistance, such as eligible benefi ts and debt
Often just knowing that self-loathing, guilt and suicidal counselling
thoughts are caused by the illness can help you take the 2. E mployment assistance, such as helping you attain a
fi rst step in pursuing treatment for depression. job or change career
Many men do not seek medical advice for depression 3. H
ousing assistance, such as ensuring an adequate and
because they think it is a sign of weakness. However, it secure tenancy, and safe, social neighbours
is important for all depressed patients to see a doctor.
4. A
ssistance with young children, such as child-care
Friends and family may need to encourage and persuade
support
men to see a doctor to avoid the depression getting out
of hand and, in the worst scenario, leading to suicide. Overall, the most effective treatment for depression is
a combination of psychotherapy and antidepressant
An overview of treatment principles for depression is
medication.
provided below.
Physical treatments for depression: Children and Adolescents
1. S top the use of drugs which can cause depression Treatment in children and adolescents is much the same
(such as alcohol or steroids) as for adults. Education is especially important, as patients
often enter treatment thinking of the stigma associated
2. K
eep co-existing medical conditions under control
with depression. Discussing the very common nature of
with their recommended treatments
depression in childhood and adolescence can be useful,
3. R
egular exercise (this can help mild to moderate as can carefully explaining that it is in no way a character
depression) fl aw but rather a medical condition. Encouraging patients
4. I f excess weight is contributing to your low mood, it to engage more in school and increase activities with their
may be helpful to lose some weight friends can also help treatment, and physical activity can
decrease depressive symptoms.
5. A
ntidepressants can help to elevate your mood. Your
doctor will decide the best agent based on side- Treatment of children and adolescents with medication
effects, any other illnesses and interactions. Patience has been controversial, but antidepressant medications
is required because the treatment of depression takes can be highly effective in reducing depressive symptoms.
time, and it may take 6-8 weeks to see full benefi t In choosing an appropriate medication, the doctor
from the medication. Sometimes, the doctor will need will assess the patient for potential risks, explain the
to try a variety of antidepressants before fi nding the side effects in detail and the patient should be closely
medication or combination of medications that is most monitored.
effective for the patient
Treatments used in
6. E lectroconvulsive therapy (ECT) is a treatment option
for patients with severe life-threatening depressive this disease
illness, particularly when psychotic symptoms are
present Pyschotherapy (including cognitive behavioural
therapy)
Psychological treatment of depression:
Antidepressants
1. E ducation and regular follow-up by a psychiatric
professional
Drugs used in the treatment
2. C
ognitive behavioural therapy (this is the most of this disease
effective psychotherapy for clinical depression)
3. O
ther relevant psychotherapies, such as couple, family Citalopram hydrobromide (Cipramil)
and interpersonal therapies Escitalopram oxalate (Lexapro)

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 Fluoxetine hydrochloride (Prozac) Doxepin hydrochloride (Sinequan)
Fluvoxamine maleat (Luvox) Dothiepin hydrochloride (Prothiaden)
Mirtazapine (Avanza) Imipramine hydrochloride (Tofranil)
Paroxetine hydrochloride (Aropax) Mianserin hydrochloride (Tolvon)
Reboxetine mesylate (Edronax) Nortriptylline hydrochloride (Allegron)
Venlafaxine hydrochloride (Efexor, Efexor XR) Trimipramine (Surmontil)
Mirtazapine (Remeron) Phenelzine sulphate (Nardil)
Sertraline hydrochloride (Zoloft) Tranylcypromine sulphate (Parnate)
Moclobemide (Aurorix) It is possible that there are other generic brands of the
medicines listed above. Please discuss any questions
Amitriptylline hydrochloride (Endep)
you may have about the medication/s you have been
Cloimipramine hydrochloride (Anafranil) prescribed with your doctor or pharmacist.

Notes

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