Are you struggling with depression?

Everyone occasionally feels sad or blue, but these feelings pass within a couple of days. However, when a person is experiencing depression, the condition interferes with daily life and normal functioning. Centre for Addiction and Mental Health (CAMH) estimates that 1 in 5 Canadians have depression in any given year. Depression is a serious mental disorder, and most people who have it need treatment to get better.

The most common types of depression include:

Major depression. Also known as clinical depression; characterized by a combination of symptoms that interfere with the ability to work, sleep, eat, and enjoy life. An episode of major depression may occur only once or twice, but more often, a person has several episodes (recurrent depression). If the pattern is seasonal, it will be what is commonly known as seasonal affective disorder.

Persistent depressive disorder (dysthymia). Involves chronic symptoms that last for two years or more. The symptoms are not disabling, but they keep a person from functioning at “full steam” or from feeling good. Sometimes people with persistent depressive disorder also experience major depressive episodes.

Premenstrual dysphoric disorder. Is experiencing a significant change in mood, with depression and anger that begins a week before a menstrual period which resolves a week after the bleeding has stopped.

Postpartum depression. Is diagnosed when a new mother has a major depressive episode within one month to year of giving birth.

Symptoms of depression

People who are depressed may not have all symptoms of the condition. Some people experience a few symptoms, and some have many. The frequency and severity of symptoms may vary from one person to the next.

Symptoms of depression include the following:

• persistent sad, anxious, or “empty” moods
• feelings of hopelessness or pessimism
• feelings of guilt, worthlessness, or helplessness
• loss of interest or pleasure in hobbies and once-enjoyable activities, including sex
• sleeping difficulties, such as trouble falling asleep or staying asleep or excessive sleeping
• eating too much or too little
• fatigue, lack of energy, or feeling “slowed down”
• thoughts of death or suicide, or suicide attempts
• restlessness or irritability
• difficulty concentrating, remembering, or making decisions
• persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain

Causes of depression

Depression has no single cause. It may result from a combination of genetic, biochemical, environmental, and psychological factors.

Depressive illnesses are disorders of the brain. Brain-imaging technologies, such as magnetic resonance imaging (MRI), have shown that the brains of people who have depression look different from those of people without depression. The parts of the brain involved in mood, thinking, sleep, appetite, and behaviour appear different. But these images do not reveal why the depression has occurred and cannot be used to diagnose depression.

Some types of depression tend to run in families. However, depression can occur in people with no family history of depression. Scientists are studying certain genes that may make some people more prone to depression. Some genetics research indicates that risk for depression results from the influence of several genes acting together with environmental or other factors.

Going through a painful experience—such as the death of close relative, the loss of a job, or serious difficulties in a relationship—may trigger a depressive episode. Certain types of chronic or severe illnesses can also cause or contribute to depression, either because of the effects of the condition itself or the medications used to treat it. These health concerns include stroke, cancer, AIDS, heart disease, diabetes, hormonal disorders, Parkinson’s, and Alzheimer’s disease. Some depressive episodes may occur without an obvious trigger.

Treatment options

Most people with depression—even those with severe disorders—can be helped with treatment. Effective treatment begins with visiting your GP to rule out medical causes of the problem. If they find no disease or other medical condition that may be causing the depression, the next step is a psychological evaluation. The physician may refer you to a mental health professional, who will talk further with you about your symptoms.

Once you have a diagnosis, treatment can proceed in several ways. The most common types of treatment are medication and psychotherapy, or both.

Medication. A doctor may prescribe antidepressants or other medications that may be helpful. Many people have concerns about taking medication. Having a low level of neurotransmitters is one of several biological factors that can contribute to depression, and medication can help with it. Taking medication for depression is no different from someone with diabetes needing insulin or someone with high blood pressure taking medication to lower blood pressure. There is often a stigma around taking medication for depression. It is important to work with your doctor to determine the best medication for you and your specific needs. You may need to try a few medications in the beginning, all while working with your doctor until you find the one that works best for you.

Some people do best with medication and some with psychotherapy. Other people need a combination of both.

Psychotherapy, or “talk therapy.” Psychotherapy is a form of treatment that can help a person enhance problem solving skills, reduce feelings of anxiety and depression, build relationships and social skills, and even improve job performance. Research shows that psychotherapy is effective in treating most common mental health problems.

Antidepressant medications

Antidepressants work with natural brain chemicals known as neurotransmitters, such as serotonin, norepinephrine, or dopamine. Antidepressants include:

Selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs). SSRIs affect a brain chemical called serotonin, and SNRIs affect two chemicals, serotonin, and norepinephrine. SSRIs are often the first type of antidepressant that a doctor will recommend, in part because they often cause fewer side effects than other types.

Atypical antidepressants. Some antidepressants are called “atypical” because they work differently than SSRIs or SNRIs. One commonly prescribed atypical antidepressant is bupropion, which is used both to treat depression and to prevent depression in people with seasonal affective disorder. Other medications in this category include trazodone and mirtazapine.

Tricyclics. Tricyclics are an older group of antidepressants and are named for their chemical structure. They may be prescribed for people who can’t take SSRIs or SNRIs or for whom those medications don’t work well.

Monoamine oxidase inhibitors (MAOIs). MAOIs are the oldest class of antidepressants, and for some people they work better than other medications. But people who take them must avoid certain foods and drinks, such as cheese, fermented foods, and red wine.

A doctor may need to try a variety of antidepressants and adjust the dosage to find one that works for you.

If antidepressants are prescribed for you

Take these steps if an antidepressant is prescribed for you:

Ask about the side effects. Also find out about any testing that may need to be done to monitor the effects of the medication on your body.

Be patient. Finding the right medication can take time. Work closely with your prescriber, and report any side effects and benefits that you experience.

Always talk with your health professional before you stop taking a medication, even if you feel better. Some medications must be stopped gradually to give your body time to adjust. If you have bipolar disorder or chronic major depression, you may need to take medication daily to avoid disabling symptoms.

If you are taking MAOIs, remember that you will have to avoid fermented foods, including cheeses, wines, and pickles. Get a complete list of foods to avoid and always carry the list with you.

Never mix medications—prescribed, over-the-counter, or borrowed—without talking to your GP. If your dentist or any other medical professional prescribes a drug, tell them that you are taking antidepressants. Some drugs that are safe when taken alone can be dangerous if taken with other medications.

Avoid alcohol, including beer, wine, and spirits. Alcohol can make antidepressants less effective. Talk with your GP about how to plan for situations in which alcohol may be served.

Call your GP if you have a question about any drug or if you are having a problem, you believe is drug-related.

Antidepressants may also increase the risk of suicidal thoughts in children, adolescents, and young adults. People in all three groups need to be monitored closely by health professionals if they take antidepressants, especially in the first weeks of treatment.

Psychotherapy

Several types of psychotherapy can help with depression, including:

Cognitive behavioural therapy (CBT). This is a form of short-term therapy that has been found to help with some types of depression. Cognitive behavioural therapists help clients change the negative styles of thinking and behaving that are often associated with depression.

Interpersonal therapy (IPT). This type of therapy helps people understand and work through difficulties in their personal relationships that may cause depression or make it worse. Therapists may help you explore the causes of your actions, such as past experiences.

Therapists often draw on different forms of psychotherapy, tailoring treatment to the needs of a client. No one form of psychotherapy is best for everybody. The level of comfort and trust between the client and the therapist is more important than the type of psychotherapy used.

Depression that is severe or keeps coming back will generally require both medication and psychotherapy, but a combination of holistic treatments will help overall wellbeing.

Steps to take in finding help and support

If you may be suffering from depression, try to see a professional as soon as possible. Some research suggests that the longer you wait, the more problems you may have later. You can also help yourself by taking these steps:

Try to stay active or exercise. Do things you’ve enjoyed in the past, like going to the movies or a sports event or walking in your favourite park. Take part in social, religious, and other activities that have had meaning for you.

Set goals you can achieve. Focus on what’s realistic for you to accomplish, not on what you or others think you “should” accomplish.

Break large tasks into small ones and set priorities. Do what you can, as you can. Tell yourself you will work at the task for 10 or 15 minutes. Then if you want to work longer, that’s great.

Keep your expectations realistic. Expecting too much too soon may increase feelings of failure if you fall short. Give yourself credit for what you have accomplished, even if that seems small.

Try to spend time with other people. Talk with a trusted friend or relative, and try to avoid becoming isolated.

Put off making major life decisions, such as whether to change jobs or get married or divorced, until you feel better. If you need to make a big decision, talk about it with people who know you well.

Expect to improve gradually, not overnight. Don’t assume you can “snap out of” depression or see progress right away. You can call a WarmLine. A warmline is a free peer-run line staffed by people who share coping strategies, provide support, and listen.

Remember that you can replace your negative thinking with positive thoughts. Negative thinking is part of depression. It will ease or disappear as your depression responds to treatment.

Join a support group. You can join online or face-to-face support groups such eMental Health, or Depression Hurts. You can also ask your GP for suggestions or organisations that could help you.

Finding professional help

If you aren’t sure where to turn for help with depression, start by talking with your health care provider. Others who can provide help or referrals include:

Mental health professionals, such as psychiatrists, psychologists, social workers, and religious advisors who have special training in counselling.

Community resources, including family and social service agencies and mental health centres, programs, and clinics.

National organizations and agencies. Search online or ask your GP for a list of reputable organizations in your region.

If you feel suicidal

Seek help right away if your depression is causing you to think of hurting yourself or someone else. For immediate help:

Call 911 or go to a hospital. Ask a friend or relative to help you do these things if you can’t do them yourself. Hospitals and emergency rooms have psychiatrists on staff. If you need an immediate evaluation, this is the quickest way to be seen by professional.

Call your GP. Be honest and upfront. Your GP can only help you based on the information you share. You should tell them how you have been feeling and what you have been thinking.

Call the crisis line. You can call Talk Suicide Canada 24/7 at 1 855 484 8255.