Mental health: clinical depression
It is hard for people
who have not experienced clinical depression to understand its
emotional impact and severity.
Clinical depression is a serious, potentially lethal
disorder that impacts on a person physically, emotionally and
even cognitively - slowing your thought processes and reducing your
ability to concentrate.
Normally depression is caused upsetting or disappointing
circumstances, and it resolves over time. Clinical depression is
influenced far more by inherited body chemistry than
A diagnosis if based on one of the following two elements being
present for at least two weeks:
- Depressed mood, or
- Anhedonia (The absence of pleasure or the ability to experience
In addition, at least five of the following ten symptoms must
- Feelings of overwhelming sadness, fear or lack of emotion
- Decreased interest in daily activities
- Changing appetite and marked weight gain or loss
- Disturbed sleep patterns
- Unintentional and purposeless movements
- Fatigue, mental or physical, and loss of energy
- Intense feelings of guilt, anxiety, hopelessness and
- Trouble concentrating, making decisions or remembering
- Recurrent thoughts of death or suicide
- Fear of being abandoned by those close to one.
Treatment for depression
There are two primary modes of treatment, typically used
in conjunction - medication and psychotherapy. A third treatment,
electroconvulsive therapy (ECT), may be used when chemical
antidepressants are believed to work by slowing the removal of
certain chemicals from the brain. These chemicals are called
neurotransmitters (such as serotonin and norepinephrine).
Neurotransmitters are needed for normal brain function and are
involved in the control of mood and in other responses and
functions, such as eating, sleep, pain, and thinking.
Antidepressants help people with depression by making these
natural chemicals more available to the brain. By restoring the
brain's chemical balance, antidepressants help relieve the symptoms
Psychotherapy: This offers
people the opportunity to identify the factors that contribute to
their depression and to deal effectively with the psychological,
behavioural, interpersonal and situational causes. Skilled
therapists aim to:
- Pinpoint the problems that contribute to depression
- Identify and assist with negative or distorted thinking
- Explore learned thoughts and behaviours that
- Help regain a sense of control and pleasure in life.
(ECT): This is an extremely effective, very
fast-acting, antidepressant treatment. Where other antidepressant
medications have failed, ECT is often still effective. The
difficulty and main disadvantage for this procedure is the need for
anesthesia and the short-term confusion and memory effects
immediately after treatment.
Be aware of any signs of suicide risk. If suicidal thoughts are
present it is important to encourage the person to seek help from a
doctor or psychologist. Warning signs to look for include:
- Statements like "It would have been better if I had died"
- Making threats about committing suicide
- Suddenly becoming cheerful after a long period of depression
(this can indicate a decision to use suicide as a solution)
- Having a plan for suicide, and the means to achieve it are very
strong warning signs and must be taken very seriously.
All suicidal comments need to be addressed, but having a plan
and the means to achieve it is a sign that professional help needs
to be sought as a matter of urgency. If the situation is critical,
References and further information
References Specific to Electroconvulsive
- Abrams, R. (2002). Electroconvulsive Therapy (4th Ed.).
Oxford University Press Inc. New York.
- Datto, C. J. (2000). Side effects of electroconvulsive therapy.
Depression and Anxiety, 12, 130-134.
- Ghaziuddin, N., Laughrin, D. & Giordani, B. (2000).
Cognitive Side Effects of Electroconvulsive Therapy in Adolescents.
Journal of Child and Adolescent Psychopharmacology, 10,
- Sackeim, H. A., Prudic, J., Devanand, D.P., et al (1993).
Effects of Stimulus Intensity and Electrode Placement on the
Efficacy and Cognitive Effects of Electroconvulsive Therapy.
The New England Journal of Medicine, 328, 839-846.
- Sackeim, H. A., Prudic, J., Nobler, M. S., Fitzsimons, L.,
Lisanby, S. H., Payne, N., Berman, R. M., Brakemeier, E., Perera,
T. & Devanand, D. P. (2008). Effects of pulse width and
electrode placement on the efficacy and cognitive effects of
electroconvulsivetherapy. Brain Stimulation, 1,
- Weiner, R. D. (2001) The Practice of Electroconvulsive Therapy:
Recommendations for Treatment, Training and Privileging (2nd Ed.).
American Psychiatric Association. Washington.