Depression

What is it about ?

Key symptoms and other manifestations

Depression is a mental illness. The key symptoms of depression are sad mood or a loss of interest or pleasure vis-à-vis (almost) all activities. These symptoms appear almost every day, for most of the day. Complaints last at least 2 weeks and key symptoms may be accompanied by other manifestations:

• weight gain or weightloss involuntary;
• decreased or increased appetite;
• sleep disturbances (insomnia Where drowsiness);
• restlessness or slowing down of activity;
• a tired or a lack of daily energy;
• a feeling of worthlessness or guilt;
• a decrease in the ability to think or concentrate;
• from morbid thoughts or suicidal thoughts.

In total, 5 symptoms must be present to diagnose depression, including one of the key symptoms (sad mood or loss of interest or loss of pleasure). These symptoms interfere with daily functioning and cannot be explained by other physical ailment or one substance abuse. You may have some of these signs, but they are transient in nature. These are then depressive symptoms. Almost all of us suffer from it at one time or another, such as the death of a loved one. But to talk about depression, the above criteria must be met.

There is a link between hereditary factors and personality traits and the onset of depression, with psychosocial stress often acting as a trigger.

Forms of depression

Depression is ranked in order of severity by mild, moderate and severe form. The doctor will determine a person’s degree of depression by evaluating the symptoms and their consequences. Its not always easy. Other factors may intervene, such as other physical ailments Where psychic, taking medications, a substance abuse, risk factors, etc. The doctor must also take into account a potential suicide risk.

There are also particular forms of depression :

• the postpartum depression, in which a woman suffers from depression after childbirth;
• the dysthymic disorder, a mild to moderate but chronic form of depression in which symptoms persist for at least two years;
• winter depression, in which a person develops depressive symptoms in the fall before regaining morale in the spring, for at least two years in a row;
• psychotic depression, characterized by disturbed sense of reality and generally unrealistic and pessimistic thoughts.

What is its frequency?

Depression is a common condition, affecting about 8% of the population. It is 1.5 to 2 times more common in women than in men.

How to recognize it?

Depression can be expressed in different ways. But it is necessarily manifested by at least one of the following two signs:

• You have a sad mood most of the day.
• You have less interest or less pleasure for things that normally interest you.

During depression you can also have other complaints:

• You no longer have a taste to eat or you overeat, causing you to to lose or gain weight.
• You sleep badly or you sleep too much.
• You feel sluggish and tired or, conversely, restless.
• You have more difficulty concentrating, eg. ex. to read or watch television. Every decision, including the simplest, is harder to make.
• You feel guilty or worthless.
• Life may seem too heavy to carry, and sometimes you even want to die.

If many of these symptoms persist for a long time, it is called depression. Depression can interfere with your daily life, household chores, free time, and work activities.

Often you are unaware of your depressed mood and you are not able to put the word “depression” on your unhappiness. It is often helpful to go through the list of potential symptoms to find out.

What can you do ?

Depression is a very common condition. You should neither be ashamed nor feel guilty. Do not get caught up in your dark thoughts or other psychic symptoms; ask for help.

Talking about your depression

• Talking about it, with your GP, but also with family and friends, is often good. Explain to them how you are feeling and what depression means.
• You may develop negative thoughts about yourself. Disappointment, sadness and anger can reinforce this negative feeling. Talk about your feelings without shame. It takes time to digest such emotions.

Realistic goals

Don’t be too demanding of yourself. For example, avoid imposing on yourself a quick recovery or an early return to normal in your professional activities. In the beginning, focus instead on the simple and practical tasks of everyday life. Set realistic goals.

Rhythm your life

Try to maintain a normal rhythm in your life by going to bed, getting up and eating at regular (normal) times.

Alcohol and drugs

Do not consume alcohol or drugs. These substances temporarily calm or hide negative feelings, but they prevent a good long-term recovery.

Distraction

Try to distract yourself by doing activities that you find enjoyable or relaxing. Don’t stay home alone. The great outdoors and physical activity will already make you feel better.

To move

• Regularly participate in a sporting activity, such as cycling, walking, running or the like. Half an hour of physical activity, three times a week, could already help you feel less depressed and fitter. Pick a sport you love.
• If you are suffering from sleeping troubles, regular exercise can help you get a good night’s rest.

Job

If possible, try to continue working (part-time), eg. ex. two half-days per week. Discuss it possibly with the occupational physician.

What can your doctor do?

Multidisciplinary treatment plan

Treatment is always multidisciplinary. He involves collaboration between the depressed person, the general practitioner, the psychologist and, possibly, the home nurse, physiotherapist, family and informal caregivers.

In case of mild and moderate depression, a treatment plan is established, with a daily structure and an activity plan, and is supported by a psychological support. The preferred method is the cognitive behavioral therapy, which emphasizes changing ways of behaving. The goal is to get you back to meaningful activities on a specific schedule. In doing so, you break out of your moodiness and depression, and you revert to ordinary daily activities, which you relearn to enjoy. The doctor and / or psychologist will follow you closely and regularly, for example every two weeks, depending on the severity of the depression.

Drugs and psychotherapy

• A mild to moderate depression does not generally require no drug treatment. Psychotherapy will preferably be offered. In some depressed people with a lot of anxiety disorders and of sleeping troubles, a sleeping pill is sometimes prescribed for a short time at the start of treatment. If possible, this intake should be limited to a maximum of one week, taking into account the risk ofhabituation.
• In case of severe depression, an antidepressant is almost always offered.
• The psychotherapy and antidepressants should preferably be combined.

Antidepressant treatment

The goal of medication is to make the symptoms of depression go away.

• You may have to wait up to 6 weeks to really notice the effect of antidepressants. If there is no improvement, the dose is usually increased or another type of antidepressant prescribed.
• Once depression is under control, drug therapy should be continued at the same dose for 6 to 9 months.
• The dose is defined on a case-by-case basis: if it is too low, it will have no effect; if it is too strong, it will have no more effect but will instead cause more side effects.
• If you have had depression in the past and responded well to treatment at the time, disease-modifying treatment may be necessary and may even need to be continued for several years, especially if you have had multiple depressions. The doctor will discuss with you the need for continued treatment.
• Stopping drug treatment is always done gradually, decreasing the dose as and when. During this process, symptoms of a relapse to depression will be watched closely. If you cannot take the medicine, the dose will be increased again.

Specialist orientation

The doctor will refer you to a psychiatrist in the following cases:

• if he doubts the diagnosis;
• in the event of treatment difficulties (eg insufficient effect);
• in case of suicide risk ;
• in the event of long-term incapacity for work.

In very serious situations, for example if you have suicidal tendencies or if you are no longer able to take care of yourself on a daily basis, the doctor will have you hospitalized.

Regular

The quality and thoroughness of the follow-up provided by the doctor and other healthcare providers are very important. Make sure you feel confident with your healthcare providers and that you can talk to them about everything. A good relationship of trust is essential.

Want to know more?

• Depression – let’s talk about health
• Fall energy loss – Christian Mutuality
• Physical activity – Eat Move – Health question
• Depression: drugs or psychotherapy? – mongeneraliste.be – SSMG – Scientific Society of General Medicine

• Cognitive Behavioral Therapy (CBT) – AEMTC – Association for the Study, Modification and Therapy of Behavior

• Alcohol, the point on your consumption – Stop or else?
• Sleeping pills or tranquilizers, an update on your consumption – Stop or else?
• Sleeping pills and sedatives, think before consuming – FAMHP – Federal Agency for Medicines and Health Products

Are you looking for more specialized help?

• Mental Health Services – The Social Guide
• Find a therapist – AEMTC – Association for the Study, Modification and Therapy of Behavior
• Find a psychologist – Commission des psychologues
• Alcohol aid – Le Pélican & Le center ALFA
• Infor-Drogues – Another listen

Sources

• Belgian practice guide ‘Depression in adults’ (2014), updated on 24.03.2016 – To find on this page of the SSMG – Scientific Society of General Medicine (put the direct link on the whole reference)
• Intego database