What it really means to be depressed

Source: Best Health magazine, January/February 2015

One day, Jane Webber’s life went flat. The busy mom of two and, at the time, avid runner was 40 years old when she began noticing she was always tired, unmotivated and strangely sensitive to fluorescent lights and strong smells. A coffee lover, she recalls the moment when it no longer tasted the same ‘ or appealed to her. ‘The flavour went out of food,’ says Webber, now 61. ‘The colour goes out of your world.’

Webber was in the midst of a full life ‘ a hectic job, with nights spent sewing Halloween costumes and packing school lunches ‘ when she was diagnosed with major depression 20 years ago. At first, she hoped the condition could be cured with a script for antidepressants. A good friend of hers had seen a big improvement in her mood after treatment with medication, but for Webber, who lives in Colborne, Ont., antidepressants didn’t deliver. ‘I tried many more,’ she says, ‘but I wasn’t one of the lucky ones that responded.’ Instead, she unwittingly embarked on a long journey that would have her try dozens of therapies. Meds were just the beginning.

While it’s not solely women who become depressed, more women than men are diagnosed with the illness ‘ two times as many, to be exact, says Dr. Nasreen Khatri, a clinical psychologist and researcher at the Rotman Research Institute, Baycrest, in Toronto. ‘Ten to 25 percent of women can expect to experience an episode of depression in their lifetime,’ she says.

Many factors may be at play in the development of depression, which can lead to feelings of sadness or despair, low energy, disrupted sleep, anger or irritability and the inability to make decisions. According to Dr. Khatri, many women in caregiving roles ‘ those in their 30s and 40s who are looking after both children and elderly parents ‘ are at higher risk of becoming depressed. Experiencing hormonal upheaval due to perimenopause or menopause, alongside workplace stress and the burden of being sandwiched, leaves many women feeling overwhelmed. ‘They are hit by a tsunami of environmental stressors and, possibly, biological stressors that predispose them to depression. Everything is firing on all cylinders all of the time,’ says Dr. Khatri.

A new way of thinking

The good news is, there’s been a sea change in how depression is viewed and treated today. The general consensus among mental health experts now is that depression is a chronic illness, like asthma or arthritis, that can wax and wane throughout a person’s life. Gone is the notion that short-term prescription drugs will be a cure-all, restoring a happy mood and leading to a happily ever after.

‘It’s less like breaking a leg and more like diabetes,’ says Dr. Khatri. ‘It’s chronic and it needs an effective treatment and a self-management program to maintain optimal mental health and functioning.’

While medications can certainly play a large part in mood control and ensure a person’s successful day-to-day functioning, doctors like Khatri believe that those suffering from depression also need to be taught behavioural strategies that will help them cope. Like many experts in this field, Dr. Khatri believes that cognitive behavioural therapy (CBT) should be the first line of defence when it comes to mild to moderate depression. A type of therapy administered by a psychologist or psychotherapist, CBT helps people identify and change negative thinking patterns. A therapist helps a patient confront a stressful situation in a gradual way while teaching them ways of coping with emotions that arise. ‘CBT is the gold standard in the treatment of depression and anxiety,’ says Dr. Khatri. ‘Medication and CBT are equally effective when a person is in treatment. CBT is twice as effective as medication post-treatment because people learn how to manage their mood.’

Sweating it out

Another, simpler mechanism for managing mood is plain old exercise. For those with mild to moderate depression, regular workouts can yield big changes, suggests a new study, especially if you’re a woman.

George Mammen, a PhD student at the University of Toronto, published a research review in the American Journal of Preventive Medicine in 2013 that found that, in 25 of 30 studies, women who exercised by walking an average of 11/2 hours a week had a significantly lower risk of developing depression that those who were less active. ‘Even low levels of physical exercise could help,’ says Mammen. ‘Doctors are quick to prescribe a pharmaceutical,’ he says, ‘but physical activity has no side effects.’

Treatments that really work

When treatments are required, there are more ‘ and better ‘ options than ever before. New brain-stimulation techniques are showing a lot of promise and offer far fewer side effects than more invasive treatments like traditional electroconvulsive therapy (ECT). Plus, they can help manage symptoms when antidepressants fail to perform, which happens in 30 to 50 percent of cases, according to Dr. Jeff  Daskalakis, Temerty Chair in Therapeutic Brain Intervention at Toronto’s Centre for Addiction and Mental Health (CAMH). ‘These are groundbreaking treatments ‘ there’s a tremendous amount of hope,’ he says. 

Having tried antidepressants, yoga, meditation and ECT, Webber is now benefitting from regular treatments of magnetic seizure therapy (MST), a new treatment offered by CAMH. A procedure in which a magnetic charge initiates a small seizure in the brain, it is very effective in drug-resistant depression, according to Dr. Daskalakis. Requiring general anesthesia, it is most commonly administered three days a week for four to six weeks before symptoms abate. At the moment, it is available at CAMH and at the University of British Columbia in Vancouver. ‘The seizures may have a very therapeutic effect in depression,’ says Dr. Daskalakis, adding that rates of recovery are between 50 and 60 percent and side effects are almost non-existent. (Patients are asleep and therefore do not experience the procedure but may experience a headache.) Webber, who has undergone MST for two years, saw an improvement immediately. ‘I noticed a difference from the very first session,’ she says.   

Another effective treatment is repetitive transcranial magnetic stimulation, which involves the use of a magnet instead of an electrical current to activate the brain and change the firing patterns of neurons. With most people only experiencing a mild tingling sensation, it can usually lead to improvement after daily doses for four to six weeks. It is a gentler procedure than MST and doesn’t require general anesthesia.

And while antidepressants haven’t radically changed in recent years, new ‘me-too’ drugs have emerged that have similar profiles. The big news is that augmenting agents such as Abilify (aripiprazole) and Seroquel (quetiapine) can help antidepressants work in cases where they’re losing their effectiveness. Plus, they can potentially allow a patient to take fewer selective serotonin reuptake inhibitors (SSRIs), according to Dr. Darrell Mousseau, a professor of psychiatry at the University of Saskatchewan.

‘They are effective for about half of the people who take them,’ confirms Dr. Donna Stewart, the director and inaugural chair of women’s health at University Health Network and the University of Toronto, adding that doctors are also increasingly augmenting antidepressant treatments with other medications, such as lithium or thyroid hormones, to help them work better.

Even with all these new options available, one long-time component of treating depression remains important: having a healthy attitude. It’s something that’s easier to do today given growing awareness of the illness. Celebrities like Ellen DeGeneres and Gwyneth Paltrow, who have made their personal struggles with depression public, may be doing more good than they realize. ‘There’s less of a stigma about depression than there used to be,’ says Dr. Stewart.

Webber agrees. She says that the world has changed since she was diagnosed two decades ago. ‘It was frightening at the beginning, but more and more people are getting treatment. I think it’s wonderful that depression has come to the forefront.’ Webber has resumed drinking coffee now that it tastes good to her again, and she has slowed down, spending more time focusing on staying well and centred. She has some advice for women who’ve been diagnosed: ‘Step out of your box. Move forward. Don’t be afraid. Wellness is an ongoing process.’

How to deal with depression

If you’re experiencing symptoms of depression, which can include but are not limited to difficulty concentrating, excessive sleepiness and loss of appetite, talk to your doctor right away. Treating the condition now can keep things from getting worse. ‘Depression becomes more difficult to treat the longer it lasts,’ says Dr. Donna Stewart, the director and inaugural chair of women’s health at University Health Network and the University of Toronto. Here are the top three ways you can take action today:

Talk to your GP. Don’t be shy. If your doctor only has five minutes, book a longer appointment to speak about your symptoms and concerns.

Get a referral to a mental health professional. You need someone who will listen and be respectful.

Explore all of your options. If you have a family history of dementia, talk to your doctor about exploring treatments beyond medications. If lifestyle modifications aren’t working, consider counselling or other therapies.

The connection between depression and dementia

Being diagnosed with depression in the prime of your life is one thing. What’s more troubling is that depression is increasingly being linked to cognitive issues down the road; new research highlights a connection between depression and the development of Alzheimer’s disease and dementia.

Dr. Darrell Mousseau, a professor of psychiatry at the University of Saskatchewan has studied depression and Alzheimer’s disease for just over a decade. His research suggests that a small percentage of patients with depression have cognitive issues ‘ trouble with mental math or performing daily tasks ‘ that seem to make them more vulnerable to dementia in later years. He says studies have found that ‘certain people with depression have a similar amount of plaque ‘ changes within the brain that look like Alzheimer’s.’ And women with depression tend to have much more of this plaque than men.

In no way does this mean that all people with depression will go on to develop dementia, cautions Mousseau ‘ far from it. His team is currently working to determine what gene or genes are involved in this process in order to develop drug therapies that can halt this progression. ‘We think we now know how to identify women at risk of Alzheimer’s ‘ and those who are not.’