October 24, 2012

Good recovery prospects for those with depression

As published in The Erin Advocate

Speakers at a panel discussion hosted by the East Wellington Family Health Team (EWFHT) this month painted a hopeful picture of recovery for the many people who suffer from depression.

With presentations that included scientific, therapeutic and personal points of view, the overarching message was that this condition can be defeated or made manageable.

"Depression has many faces, changing the way it appears from one person to the next," said Kim Bell, Program Lead/Mental Health Worker at EWFHT.  "Compounding this problem is the fact that most people are unaware that depression is an illness. It's a treatable illness. People do recover every day. So there is hope."

Depression affects 10 per cent of Canadians. Early intervention can reduce its severity, but sufferers and health professionals are working against the embarrassment, fear and stigma attached to all mental illnesses. Caring support from family and others can be crucial to recovery.

Dr. Pete Anderson, a family physician who recently joined EWFHT, and has a PhD in molecular biology and genetics, described the physical changes that take place in the bodies and brains of people with depression. Some 15 per cent of people will suffer from depression at some point in their life, with a higher incidence for women, especially in the time following the birth of a child.

"There are measurable changes in how your neurons work in the different parts of your brain, and things that short-circuit it can cause depression," he said, recounting his own struggles with the illness.

"The pressures I put on myself while going through medical school put me into a spiral. Had my wife been a hair less strong than she was, we might not be together today. So I am very, very lucky to have had the support of my family and friends to get through that.

"Insidious is a fantastic word to describe it. I was just miserable. Everything I did was just coloured by this morose, blue, outlook on things. All the pleasure of small things seemed to get drained out of the activities in my life."

Losing the ability to function distinguishes major depression. Anderson suffered many of the classic symptoms, at first not knowing the cause. A diagnosis requires a combination of symptoms persisting over a period of time.

These include overwhelming sadness, loss of interest in activities, low self-esteem, weight loss or gain, insomnia or excessive sleep, lack of energy, slow movement, changes in appetite, feelings of guilt, impaired concentration and decision-making, and thoughts of suicide as a way to escape.

"Maybe it would just be easier if I wasn't here – I remember saying that to my wife," he said.  "That was a big turning point, when I actually admitted I was having these thoughts."

Research is showing that stress triggers hormones that can wither the neurons in the brain and reduce connectivity, which can lead to a self-reinforcing pattern of negative thoughts and emotions. The human brain evolved to handle the short-term stress of emergencies, not the constant stress that society now generates.

"We think depression is a maladaptive response of the body to chronic stress that you can't get resolution to," he said. "There's usually a difference between expectation and reality that you can't reconcile. The part of the brain that decides what to do is locked out.

"The good news is that there are effective therapies for depression. You have to start doing things that used to make you happy. You have to socialize – there's something protective about social interaction, having people tell us that they care about us. That helps make new connections in the brain.

"Exercise releases hormones within the body that actually help neurons grow. Our bodies are designed to move, and our brains are designed to catalogue that movement," he said, but cautioned against expecting quick results. "You are not going to snap out of it. It takes time for brain re-growth."

Counselling can help people challenge their negative thoughts, while medications can sensitize the brain to helpful hormones. Finding the best medication and dosage is often a trial and error process, with the risk of serious side effects, but it is extremely valuable for many patients.

So the strategy is to combine different therapies to fight the illness. I will touch on some variations when I outline the presentations of the other panelists in a future column.