You’ve had the blues before, but it’s never been quite this bad. Will your black mood blow over or could you be depressed? By Carine Visagie.

I was drained of all energy and willpower,’ recalls Nadia*, a 32-year-old woman from Cape Town. ‘My days consisted of dragging myself out of bed, painfully crawling through a day’s work, getting back home and getting back into bed. Even simple things like getting up and making a cup of tea seemed like too much effort.’

For many people, Nadia’s story may seem all too familiar. After all, she’s one of 121 million people worldwide battling the sleepless nights, the feelings of worthlessness and the all-consuming lethargy that so often accompany depression.

She also belongs to an estimated 9.8% of South Africans who have a major depressive disorder. And Nadia fits the demographic too; the South African Stress and Health study (2009) showed that depression particularly affects women and young adults in this country.

There’s no doubt depression has a significant impact on the lives of South Africans. But the dark cloud has a silver lining – medical science is working in our favour with research showing that antidepressants and psychotherapy are effective in helping 60–80% of those suffering from depression.

MANY DIFFERENT GUISES
Scientists know that certain neuro-transmitters (chemicals responsible for transferring impulses in the body) called serotonin and norepinephrine don’t work adequately in people with depression. This causes a dis- ruption in the flow of information between the nerve cells.

Chase Twichell describes the process well in Unholy Ghost: Writers on Depression (Perennial). ‘It’s like a game of [broken] telephone; the message gets lost as it travels, eventually affecting cellular metabolism, hormone balance and the circadian system, the clock that determines cycles of rest and activity.’

Depression can be very different in different people or in the same person over time, but can be widely categorised as follows:

1. Major depression
Clinical or ‘major’ depression is a term doctors use to describe a severe, persistent form of depression. This is a biological illness that affects the brain and body. ‘A person who experiences a depressed mood or a consistent loss of interest and/or pleasure in daily activities for at least two weeks on end, has major depression,’ explains Prof Soraya Seedat, co-director of the Anxiety and Stress Disorders Research Unit at the University of Stellenbosch’s Department of Psychiatry. Some people will have major depression only once in their lifetime, while others may battle with it over and over.

2. Dysthymia
This is another common form of depression. Unlike major depression, which usually lasts for weeks or months, dysthymia is a chronic, milder form of depression. Many of the symptoms are the same as those of major depression, but they’re mostly less severe or intense. Prof Seedat notes that a person with dysthymia may feel good for a few days, or even a month at a stretch. However, the symptoms will always return.

3. Seasonal affective disorder
Seasonal affective disorder (SAD) is a type of depression that occurs at the same time every year. Though it typically affects people living in countries in the northern hemisphere, it can affect those in the southern hemisphere too. One South African study, conducted in 1995, showed that mood disorders tend to peak in winter and spring. Scientists hypothesise that reduced sunlight in winter may affect the body’s internal clock and/or levels of melatonin, the ‘sleep hormone’, and that this effect may be carried over into spring. But this is still only speculation.

4. Postnatal depression
About 10% of new mothers experience postnatal depression, which is triggered by childbirth. According to the US National Institutes of Health, postnatal depression can make you feel restless, anxious, fatigued and worthless, and some new moms worry that they’ll hurt themselves or their babies. True postnatal depression doesn’t go away quickly and can be serious.

YOU MAY JUST BE GRIEVING
We often use the word ‘depro’ when we’re feeling under the weather or when we’re grieving – for instance after the loss of a loved one. But depression shouldn’t be confused with sadness and bereavement.

‘Sadness is something we all experience at some point in our lives,’ explains Prof Seedat. ‘It’s part of being human and is a natural reaction to painful or unpleasant circumstances.’ These bad feelings are usually short-lived and don’t require medical treatment. Over a period of days or weeks, the majority of us are able to return to our normal activities.

In some susceptible people, however, sadness may deepen into depression. ‘But with the help of a therapist, most people can be taught the skills to cope,’ says Ian Lipman, a clinical psychologist from Johannesburg.

THE WAY OUT
No matter what the cause of your depression, the treatment options are more or less the same: a special form of talk therapy called psycho-therapy and/or antidepressant medication. When carefully moni-tored, this combination packs a powerful punch.

According to Juané Voges, a clinical psychologist from Cape Town, cognitive-behavioural therapy is particularly useful. She explains that this form of therapy, in which a practitioner helps you to identify and change specific thought patterns and behaviours, can also decrease the risk of a relapse.

‘Other psycho-therapies, such as interpersonal therapy and psycho-dynamic therapy, are also useful,’ she says.

Many people with depression also need to take antidepressant medication to balance the chemical processes in the brain.

The medication heroes are the selective serotonin reuptake inhibitors (SSRIs), the serotonin and norepinephrine reuptake inhibitors (SNRIs), the monoamine oxidase inhibitors (MAOIs) and the tricyclics.

For Nadia, medication was a literal lifeline when she was first diagnosed with major depression.

‘Within a couple of days, my mood – which used to bear down on me like a ton of bricks – started to feel lighter.’

But healing wasn’t an instant process, Nadia recalls. ‘More than two years later, I still take my tablets and still go through bad patches.

But they definitely aren’t as bad as they used to be.’

She continues to see a psychiatrist and psychologist on a regular basis, both of whom keep tabs on her progress. And she bears witness to the fact that depression can be controlled.

*Name has been changed

MYTHS ABOUT DEPRESSION*
Myth #1 Depression isn’t a real medical problem.
Fact Depression is a serious medical illness that involves the brain. It’s more than just a feeling of being ‘down in the dumps’ or ‘blue’ for a few days.

Myth #2 Depression is something you can ‘snap out of’.
Fact Someone with depression can’t just ‘snap out of it’ any more than someone with heart disease can.

Myth #3 Depression will go away on its own.
Fact Sometimes depression will go away, but most often this isn’t the case. It can continue for weeks, even months, if not properly treated.

*Source: US National Institute of Mental Health

HAPPY THOUGHTS NOT ALWAYS ENOUGH
Depression isn’t something you can prevent or treat by trying to think more positively. ‘You need to learn to take control of the situation,’ says clinical psychologist Ian Lipman.

He uses an example: You’re having a tough time at work and your boss bullies you. As a result, your workplace becomes a negative environment and you start to withdraw in an effort to avoid your nasty boss. This behaviour becomes habitual, spreads to other areas of your life and you become depressed.

With the help of a good therapist, you can learn how to assert yourself towards your boss, and feel better as a result. Alternatively, a therapist can help you to take the bold step of applying for another job. ‘In the end, it’s all about learning skills,’ Ian says.

Clinical psychologist Juané Voges agrees: ‘A psychotherapist can help you to change negative, self-defeating beliefs to more adaptive alternatives. Part of this process may entail identifying which thoughts are self-defeating and challenging these beliefs by evaluating whether they’re based in fact.’

’WHAT ARE THE TRIGGERS?
Depression sometimes doesn’t have a trigger at all and can come out of the blue, says psychiatrist Prof Dan Stein. However, it can be triggered in usceptible people by one of a broad range of losses and stressors. The list of possible triggers includes death or illness in the family, interpersonal violence, financial difficulties, retrenchment and divorce.

USEFUL CONTACTS
Sadag Mental Health Line
011 262 6396

Suicide Crisis Line
0800 567 567
SMS 31393

Mental Health Information Centre
021 938 9229
mhic@sun.ac.za
www.mentalhealthsa.co.za

DID YOU KNOW?
Club has qualified medical professionals available to assist with any medical queries you may have, free of charge. Call 0861 424 789. Club members outside South Africa should dial +27 11 991 8330.