i i B c . C o m

The EPA Theory

admin — Tue, 27 Jul 2010 10:46:29 +0000

Now that we have looked at all the various contributory factors that expert have long held to be triggers for depression, it is time to look at the newest and most exciting theory about why we get depressed. The story is a good one, going back millions of years in time to when our brains began developing their human characteristics, and travelling forward to the point in the last century when Professor Horrobin began to realize that high levels of certain tats, essential fatty acids (EFAs, of which EPA is one), were fundamental to healthy brain function.

We look in detail at how EPA works on depression in the next article, but before we begin the tale of the fatty acid theory, here is a brief explanation of EPA's effect on the brain: EPA is an essential fatty acid which, when it enters the cells in the brain, helps to form a fatty layer that both protects the brain and enhances its ability to function at optimum speed and efficiency. We cannot easily make EPA in our body, we have to eat it in food and then convert it, but we all have a certain amount of this natural substance in our brain. The problem is that our modern diet and lifestyle have lowered the levels of EPA at which our brains function best, leaving us vulnerable to depression. Dr Puri and his research colleagues are not saying that low levels of EPA always cause depression there are perhaps millions of people out there with low EPA levels who are not depressives but they are adding low levels of EPA as an important item, perhaps the key item, to the list of factors that, in a vulnerable person, might trigger a depressive episode.

As a natural corollary to this theory, they suggest that replacing EPA therefore has a beneficial effect on the symptoms of depression. Dr Puri', research, and extensive studies carried out elsewhere, has now shown this to be true. The team also put forward the idea that raising EPA levels either through diet or supplementation, or both, might help to avoid a depressive episode in the future.

THE GENESIS OF THE IDEA

To appreciate fully the history of the EPA theory it is important to know Something about our understanding of human evolution the path that led us from ape to human. According to established scientific wisdom, our nearest relatives in the animal kingdom are the great ape: gorillas, chimpanzees and orangutans. We aren't descended from them as such but modern techniques that can identify and decipher DNA (deoxyribonucleic acid) our genetic code show that we share a common ancestor. And in fact there are not a great number of genetic differences between us and chimpanzees, although those few differences have proved significant:

• We stand upright comfortably and consistently.

• We have a lot more body fat, even at birth, and our rat has a different distribution from that of apes, e.g. breasts and buttocks.

• We have a large, sophisticated brain characterized by creativity, imagination and speech.

• We have voluntary breathing control and a larynx developed for speech.

There is no evidence to show when some of these changes, such as increased body fat, decreased hair and changes in the structure of the larynx, came about because they leave no obvious trace, but they are thought to have happened at least 3 million years ago. Brain size, what we ate and when we walked upright, however, are more easily charted through fossil bone analysis.

So if humans and apes are descended form the same original source, why are we not still like apes, or they like us? This is the sixty-four-thousand-dollar question, and over the last century there have been two markedly different propositions to explain this evolutionary conundrum.

EFAS ARE PINPDINTED

David Horrabin first began to develop his own theory about human evolution in the 19705, while he was working as Professor of Medical Physiology in a new medical school in Nairobi, Kenya. In the process of research into schizophrenia, he came to the conclusion that we evolved into humans rather than remaining as apes because of a relatively small change in the chemical make-up of the fat inside our brain. Professor Horrabin's theory differs from both the savannah dweller theory and the aquatic ape theory.

He believes that at the time of our brain development, our ape ancestors were neither wholly savannah dwellers nor wholly aquatic dwellers, but semi-aquatic dwellers, i.e. we lived near lakes, rivers and marshes, 'thriving on the marginal interface between and land'. Although the human fossil bones of this period were discovered in savannah, the remains were almost all centred on areas that had previously contained water, such as dried-up riverbeds, lakes and, later on, the seashore. Horrobin's proposition is that our brain enlarged and developed as a result of the largely marine diet, rich in essential fatty acids (EFAs, of which EPA is one), which were available in abundance in these watery locations. He believes the serious savannah hunting came later, when the water had dried up and our brains had grown, making us mentally capable of getting our heads round the complexities of weapon-making and hunting.

A DIET RICH IN EFAS

The brain consists of mostly water, but the next most significant component is fat. The dry weight of the brain is made up of around 60 per cent fat, a fact that would surprise most people. And EFAs make up 20 per cent of that fat. The brain requires about 20 per cent of our energy intake to be maintained efficiently, although it accounts for only 2 per cent of our overall body weight. The brain controls the healthy functioning of both mind and body, so it makes sense that a well-nourished brain gives the best chance of a body firing on all cylinders, and a brain that is not depressed. To do this we need to eat a diet rich in nutrients that support brain function, particularly essential fatty acids. Professor Horrobin believed this to be particularly true where mental health is concerned, proposing that a diet devoid of or low in EFAs might be a significant factor in mood disorders that target the mind, such as schizophrenia. His proposals, back in the late 1970s, were met with derision by the medical and scientific communities. However, since others have joined him in research to support his theory, and come up with some extraordinary results, the tide has finally begun to turn.

EFA LEVELS LINKED TO DEPRESSION

If it is true that there is a deficiency of certain essential fatty acid, such as EPA in depressive illness, then a research study would expect to find a link between the intake of these dietary fatty acids and the occurrence of depression. In other words, the kind of diet we eat might be seen to influence whether or not we suffer from depression. One man's research graphically illustrates this crucial link. Dr Joseph R. Hibbeln, a research doctor in the United States navy, whom Dr Puri frist met at a psychiatry conference in the late 1990s, carried out a study designed to discover whether there was a link between the intake of fish (oily fish contains high levels of EFAs) and the occurrence of depression in nineteen different countries, focusing particularly on postnatal depression (PND).

Looking at a wide range of studies published between 1993 and 1998 that detailed the incidence of PND in these countries, he related these findings to the levels of fish consumption (see diagram, previous article). As you can see, as the line denoting fish consumption goes up, the line denoting PND goes down. So countries such as Israel, Saudi Arabia. New Zealand and Australia eat less fish and have more postnatal depression while countries such as Japan and Singapore, where fish forms a large part of the diet, have a low rate of depression. Dr Hihbeln went on to do a number of other studies which built on his previous work. One particular follow-up study found that there was a marked relationship between suicide rates ill men and seafood consumption. The higher the fish intake the lower the rate of mortality from suicide, which is, of course, linked to depression. Dr Puri was very interested in Dr Hibbeln's work. He began to look for other evidence that supported the theory of both Hibbeln and Horrobin that depression might be the consequence of a lack of vital fatty acids ill the brain. To find this evidence he would, ideally, have wanted to examine brain cells of depressed and non-depressed people and check the relative levels of EFAs. But obviously you can't dig brain cells out of living people, so researchers did the next best thing: they examined their blood.

TESTING FOR EFAS

By examining a person's red blood cells we can get a pretty good idea of what is happening in their brain cells. This is because every cell in the body is the same in structure, and the EFAs arc lodged in a double membrane, or skin, around the cell. Red blood cells, or erythrocytes, help carry oxygen in the blood to the various tissues and cells throughout the body – including the brain and to study the red blood cell membrane for essential fatty acids requires nothing more traumatic than a normal blood sample from the depressed person for testing. For this reason, this has been a key method of checking for fatty acid levels in the nerve cells of a depressed brain.

In 1998 Rhian Edwards, David Horrobin, Malcolm Peet and others published the results of a study into the fatty acid levels of people suffering from depressive illness who were not at the time taking medication for their symptoms. What they found was that the red blood cell membranes of the depression sufferers had low levels of certain EFAs. By finding a low level of EFAs in their red blood cells, they concluded that there was, in all probability, also a lack of fatty acids in the nerve cells in their brain.

They then went on to do another study, this time also taking into account the other influences that affect fatty acid levels, predominantly the quantity of fatty acids being consumed in the diet, but also the factors that might reduce existing levels, such as social class, smoking and excessive alcohol consumption. They compared the blood from the depressed group of people with blood samples taken from a group of healthy people who were not depressed, but were the same age and had the same dietary and social habits as the depression sufferers. Again the study showed that levels of certain EFAs were lower in those who were depressed and also that there was a relationship between the intake of fatty' acids and the degree to which the person was suffering depressive symptoms, i.e. the lower the intake the worse the depressive symptoms.

The exciting conclusion to both these depression studies, and to many others that were to follow, was that they pointed to a significant link between intake of fatty acids and depression which had been Professor Horrobin's contention since the late 1970s.

OPPOSITION IN THE MEDICAL COMMUNITY

Yet despite the compelling evidence supporting these conclusions, when these researchers tried to share their findings with their peers they found the same problem that Horrobin had encountered for the previous thirty years: that most of the scientific community still refused to acknowledge Horrobin's fatty acid 'model' for depression as significant. You might wonder why no one seemed to take seriously a breakthrough that might be potentially life changing for millions of people. It wasn't as if any of the scientists involved in the EFA discovery were anything but highly qualified and respected in their various fields of expertise.

The answer lies with the pharmaceutical industry in general. Drug companies are major funders of medical research, and it is simply not in their best interests to support research findings which may undermine the massive amount of money made from the sale of antidepressants worldwide. And the pharmaceutical factor affects research across the board, because it relates primarily to money. Academics are notoriously badly paid. Drug companies need them to do research, and also often pay them retainers to promote their product. As we mentioned earlier, most of the money relating to depression research in the last two decades has gone towards investigating the levels of brain chemicals such as serotonin, noradrenalin and dopamine in the brain, which the SSRI type of drugs address. So if the universities and academic community are seen to be promoting theories that might undermine this research, they arc unlikely to get the funding from the drug companies upon which they depend.

Whatever the reason for this academic opposition, the fatty acid pioneers were undeterred, and gradually they began to see the fruits of their efforts. The research has moved on to identify not just EFAs in general as a factor in depression, but specifically the essential fatty acid EPA, and more and more doctors and scientists are now recognizing the value of this breakthrough theory. This is how the EPA theory came into being, and radically changed the face of depression treatment. The other psychological, social and physical factors we outlined are still relevant contributors to making us vulnerable to depression, but the main biological trigger for depression can now be identified as low levels of EPA.

In we explain exactly what EFAs and EPA are, where they come from, how the body metabolizes them and how they are linked with depression through their interaction in the brain. We also chart Dr Puri's gathering of evidence to support the EPA theory, and find out more about the workings of the depressed brain.

No one cause of depression has been identified, just a number of contributory factors which when combined can trigger the disease. These factors are either psychological, biological, social or physical.
Medical science is still not sure why one person suffers from mood disorders and another, in apparently the same circumstances, stances, does not.
Low levels of EPA have been shown to be a strong contributory factor in depressive illness.
EPA supplementation has been proved to alleviate depressive symptoms.
Depression is an illness, and although some of the contributory factors might seem to be elements in your life for which you can take responsibility, such as diet, reaction to life events and thought patterns, the fact is that none of us knows, until we have experienced depression, which elements in our life might trigger the disease.
Think of depression as a cake, and the factors that contribute to it as the ingredients. There are many different methods, and many different ingredients, which can be used to make a cake.

PHYSICAL FACTORS

admin — Mon, 26 Jul 2010 11:51:16 +0000

These are factors that have a physical component, and affect our general body health. The problem with some of these physical contributors is that the symptoms of depression can get mixed up with the symptoms of the illness, and so no help is forthcoming to treat the depression.

Chronic Pain

Depression is strongly associated with chronic pain, i.e. pain that is experienced over a long period. A high percentage of people suffering in this way will also experience major depression. There is no definite organic link between pain and depression, but the psychological impact of pain is huge, particularly because pain is invisible. No one else can experience your pain or appreciate the degree to which it affects you.

If you break you arm or have a tumor, then others will understand more readily, but, for example, ongoing severe back pain can just seem like wringing. If you are the victim of chronic pain, the accompanying disability and the lack of hope that the pain will ever be alleviated can wear you down and precipitate depressive illness.

Malfunction of the Endocrine System

The endocrine system includes the thyroid gland, and the adrenal and pituitary glands, which are responsible for the manufacture and dispersal of stress hormones such as cortisol. Cushing's syndrome an endocrine disease causes an increase in production of cortisol, which in turn reduces the efficiency of mood chemicals serotonin and noradrenalin.

About half of all people suffering from this disease are also depressed. Studies have shown that raised cortisol levels are present in many severely depressed people, although it is not yet known whether high cortisol levels produce depression, or whether depression triggers high cortisol production. Thyroid malfunction is also sometimes responsible for depressive symptoms. Anxiety and palpitations can be a result of high levels of the thyroid hormone thyroxin; lethargy and dejection can result from low levels of thyroxin.

Stroke

Some 30 to 40 per cent of stroke patients develop major clinical depression. There is still no evidence to explain why this should occur, although you might expect reactive depression to accompany such a disabling condition. Doctors researching in this arena believe that left frontal lobe damage to the brain can trigger the rapid onset of severe depression, whereas damage to the right side of the brain seems to trigger depression more slowly, with less severe symptoms.

Parkinson's Disease

In this disease, the levels of dopamine a mood-enhancing neurotransmitter are lowered in the brain. This not only affects the person's mobility and muscle function, but also promotes depressive illness. Recent research has shown that the area of the left frontal lobe in the brain associated with Parkinson's seems also to be linked to depression. Seasonal Affective Disorder (SAD)

As we mentioned earlier, SAD sufferers experience depressive symptoms as a direct response to the reduced amount of light available during the dark winter months. This is thought to be as a result of the pineal gland producing too much melatonin, the hormone that helps us sleep.

Multiple Sclerosis

The myelin sheath the fatty layer that protects the nerve paths in the brain and the spinal column is damaged in this degenerative disease. But this does not explain why a large percentage of MS sufferers are prone to depression and mood swings, unless you take Professor Horrobin's model for depression into consideration and look at the levels of EFAs in a person with MS – research that has yet to be done.

Diet

A poor diet, devoid of vitamins, minerals and EFAs, can trigger depression. Low levels of B vitamins, vitamin C, folic acid, magnesium and potassium are particularly implicated in contributing to depressive symptoms. Equally, dietary habits that strip the body of nutrients, such as smoking, drinking alcohol in excess and eating foods rich in saturated fat, or to which you are intolerant – e.g. wheat, sugar and dairy products are strongly linked to depression. We discuss this in more depth in.

Prescription Drugs

Medication given for other conditions can sometimes produce the symptoms of depression. Here are ten of the most common prescription drugs associated with depression, but, remember, they do not have this side effect in the majority of cases, so if you are taking any of the drugs listed below, there is only a small chance that the drug might trigger depressive symptoms. Consult your pharmacist when taking a new medication to check for possible side effects.

• Carbamazepine. Used as an anticonvulsant, antipsychotic and mood-stabilizing drug.

• Chloral hydrate. Used as a sleeping drug.

• The oral contraceptive pill.

• Some beta-blocking drugs, such as hydralazine and clonidine. Used for lowering high blood pressure.

• Levodopa. Used for Parkinson's disease.

• Sulphonamide antibiotics. Used for bacterial infections.

• Benzodiazepines. Used to reduce anxiety.

• Corticosteroids. Used for rheumatoid arthritis, asthma and skin conditions.

• Pentazocine. Used as a painkiller.

• Amantadine. Used as an antiviral drug and also to treat Parkinson's disease.

Whenever symptoms of depression coincide with taking a new drug for another condition, or changing your levels of medication, your doctor should first consider whether the drug is implicated in your symptoms. Always tell your doctor what medication you are on, and whether you are taking it as prescribed.

Whatever the contributory trigger, or triggers for your depressive illness, once you have identified them you can go a long way to avoiding them in the future. Just understanding the factors that make us vulnerable to this disease can also help eliminate the common view that depression is somehow our fault.

SOCIAL FACTORS

admin — Mon, 26 Jul 2010 11:49:01 +0000

Social factors figure strongly in contributing to depression, which makes sense as we are powerfully influenced by the environment, both physical and social, in which we live. You can't help but be upset by a particular circumstance, such as someone close to you dying, or you and your partner separating or getting a divorce, or losing your job. When something traumatic like this happens to you, obviously you react. Sometimes you will go through the grieving process and carry on with your life as usual, sometimes you will get angry and be galvanized to change an aspect of your life as a result; for instance you might get a new job which you had never thought to apply for when you were in steady employment, but which you infinitely prefer. And sometimes you react by becoming depressed. This is known as reactive depression, and is not thought to have a biological component.

There are also other less specific, wider social issues that are thought to be contributory factors, which include general life stresses such as ongoing poverty, loneliness and unwelcome change. But don't forget that most medical professionals believe that depression is a result of many different factors coming together. So, looking at your own life, what social factors should you watch out for as possibly contributing to your depressive illness?

Let's take two women, Woman A and Woman B. Both women's husbands have just died. Women A's profile: she has high levels of essential fatty acids obtained through a healthy diet. She has been brought up in a nurturing family. She has a secure job. She is not in the habit of drinking or smoking to excess. She has no family history of depression. Women B's profile: she eats a poor diet, low in EFAs and high in saturated fats. She suffers from very low self-esteem because she was not properly nurtured as a child. She doesn't work and worries about money. She smokes a lot, regularly drinks large amounts of alcohol and takes recreational drugs. Her father suffered from frequent bouts of depressive illness.

Woman A, although she is devastated about losing her husband, is more likely to be able to grieve appropriately and cope with her tragedy. She will experience many mood swings in the weeks following his death, including sadness, anger, numbness and disbelief, but the moods will eventually pass into acceptance.

Woman B, however, is statistically much more likely to succumb to a depressive episode. But it is not just the fact of her husband dying that can be blamed for Woman B's depression. She might have succumbed to the illness without her husband's death. That perhaps tipped her into depression, but she was already susceptible from the accumulation of the other biological, psychological and social factors. It should also be mentioned that, given depression is such a complex, unpredictable disease, it might well happen that neither woman, or both, will experience depression, despite the probabilities. So when you look at the list of contributory social factors, don't panic and assume that if you are currently experiencing one you will necessarily fall into a depression.

Loss

We have discussed how loss in early childhood changes the way we think and feel about ourselves, but loss is also a reality for everyone. We all experience loss at sometime in our life, and so it acts as a social, reactive trigger for depression, as Woman A and Woman illustrated. The problem is that we all try to attach permanence to our surroundings the relationships, work and material possessions that lend structure to our lives because these structures give us a sense of security.

Although we know logically that nothing is permanent, and that any event can occur at any time to reduce all we have to nothing, most of us still cling to the illusion of permanence. And so when something happens to shatter that illusion, and we lose something dear to us, we can be very badly affected. What can then compound the problem is that you feel you should be able to cope with what has happened, but often you just can't.

Here are some of the loss events that might trigger a reactive bout of depression. Some, as you see, are not necessarily serious, but if they hit you at the wrong place or the wrong time, they can feel very serious:

You lose your partner, either to death or divorce.
You lose your health and mobility.
You lose a best friend, either through death, argument or geography.
You lose a parent. Even if your parent is old and their death appropriate, this doesn't necessarily make the event any less painful.
You lose a beloved pet.
You lose your material wealth.
You lose your home and community, perhaps relocating to an area where you know no one.
You lose your faith.

Whatever the loss, it is not only painful in itself, but it can also highlight other aspects of your life that in happier times you could manage to ignore. For instance, your husband leaves you, and this exposes all your long-held insecurities about being unlovable, dating back a lifetime. Or your mother dies and you finally have to face up to the fact that you had a terrible relationship with her. The combination of these powerful emotions can often send a vulnerable person into a depression.

Repressed feelings

How we deal with a loss event is as important to our depression as the event itself. Unfortunately, we in the West are not good at dealing with loss. Many communities have forgotten the supportive rituals surrounding death, and increased mobility for economic reasons has meant that we are often not living close to family and friends who in the past might have offered consolation.

If we are not able to express our grief at some traumatic event, we can turn this sadness ill wards where it festers and can re-emerge as depressive symptoms nut it is not always easy to say how we are feeling, especially if your friends and family seem embarrassed by your grief. Here are a few tips to help you deal with a loss:

• Cry if you want to. Crying is a vital body function for dealing with strong emotion, as scratching deals with an itch. You should never be ashamed of showing emotion.

• Be honest about how you feel, both to yourself and others. It is not always appropriate to go into detail, but don't always say you are fine when you are not.

• Find someone, or a few people, who is prepared to let you talk about what has happened to you. If your friends are unhelpful, try a bereavement counselor.

• Don't be hustled out of your grief. You are entitled to feel sad for as long as you like. Obviously it is easier for those close to you if you get over your grief as quickly as possible, but it is not helpful to you. Experts say that it takes at least two years to go through the grief of a partner's death.

• Be kind to yourself if you are experiencing a loss. Don't try to carryon as normal. If you want to cancel social cngagements or avoid extra work pressures, then do so.

• Try not to use alcohol or recreational drugs in excess to dull the pain of your grief. It may seem to help in the short term, but it can make you feel worse in the long run.

• Whatever you do, don't bottle up your unhappiness. Isolation It is hard to understand how, in a world that seems to be exploding with people, modern Western society creates so much isolation. But many of us experience feelings of loneliness and isolation even within our family structure. There are many reasons why people have become isolated:

• Economic migration. Living as we used to in small towns and villages, everyone knew everyone else, and families lived alongside each other. This is not to say that the old social structure didn't have its own stresses and strains, but at least you knew your neighbors and you probably worked with them too. People looked out for each other, and this is very important when you are old, ill, or a lonely young mother stuck at home all day with a grizzling baby.

• Economic independence can, perversely, be another isolating factor. The number of people, particularly women, living alone has soared in the last twenty years, and one of the reasons is that they can afford to do so. This is not to say that living alone causes depression, it doesn't, but if you are prone to depression, being alone too much can exacerbate any tendency to introversion and low mood, and also separate you from avenues of help.

• Divorce for both the parents and the children. Children, particularly in stepfamilies, often suffer real isolation if they don't fit into the new family structure.

• Children leaving home.

• Spiritual isolation is on the increase. We live in a secular society, with only 3 per cent of Britons attending church regularly, and this can leave us feeling as if there is no larger context to our lives, no purpose beyond the pursuit of material comforts. Lack of faith also means that if we are feeling down about something, we have no spiritual counselor to whom we can turn for help and guidance.

Being alone is not the same as being lonely. You need time on your own, when you can wind down and not have to think about others, but enforced isolation can be mentally wearing. If you do feel isolated, remember that there are many others out there who feel the same way, and therefore many avenues for improving your life so that you do not feel so alone. Nowadays dating agencies have lost their stigma, with the Internet providing an easy way of contacting others, but if you are not ready to meet new people on a one-to-one basis, why not join a class, such as an exercise, dance, 3rt, cooking, writing or gardening class. You don't even have to say anything at first, but being with people who are enjoying the same thing as you will automatically create a bond.

Coping with Change

Change is good, change is challenging. We all need change to stimulate us and progress our lives, otherwise we risk getting stuck in a boring life routine. However, how you react to change is key to whether it becomes a positive or a negative experience. Answer these questions to sec how good you are at coping with change:

• Do you have a fixed routine to your life?

• Do you hate changes in this routine? For instance, it upsets you if the cafe you usually have coffee in has closed for the day, or the supermarket has moved the items you normally buy to another aisle.

• Do you get flustered if someone asks you to do something on the spur of the moment?

• Have you got the same friends you've had for years, with no new ones?

• Do you rely on other people to do the same thing at the same time, just as you do, and get upset when they are unreliable?

• Do you worry about things changing around you, for instance the local cinema becoming a leisure centre?

• Do you worry that you won't be able to cope if things change?

If you have answered 'yes' to the majority of these questions, then change is obviously difficult for you, and makes you anxious, perhaps raising questions of inadequacy. You have regulated your life as much as you can to create a feeling of security, but you might be very vulnerable if this routine were upset. Try to introduce an element of change, however small, into your daily life. Walk a different way to the Tube, buy a new variety of fruit, make a new friend, try a different newspaper. When you know yell can cope with small changes, the bigger ones become less threatening.

Addiction and Depression

The relationship between addiction to alcohol and drugs and depression is a complex one. Studies have shown, for instance, that people suffering from depression are about twice as likely to be alcohol-dependent – i.e. if you don't consume a regular supply of alcohol you suffer from symptoms of withdrawal than the rest of the population. This, again does not mean that alcohol or drug abuse causes depression, but it certainly complicates it. The difficult thing about alcohol is that we are all very unrealistic about how much we drink.

• 'I only had a couple of glasses' means you've probably had three or four.

• 'I don't drink very much' means you don't get drunk very often, but you still drink often and more than just a glass.

• 'I'm sober enough to drive' means you shouldn't!

• 'I'm a social drinker' means that you think drinking a lot is fine as long as someone else is doing it with you.

• 'Did you see how much so-and-so drank" means you're in denial about the fact that you had almost as much.

• 'I never drink on weekdays' except for the office lunch, that supper with friends, a drink with your sister ..

• He insisted I have a drink' means you're blaming someone else.

This common denial about our intake of alcohol is not usually a problem. We have times when we rein ourselves in, others when we are a bit more indulgent, but our drinking can become dangerous to ourselves and others if we are under strain from external circumstances, and we are using alcohol in a vain attempt to cope with that strain.

This is where depression comes in. If we begin to use alcohol inappropriately, then it can impact on depressive symptoms.

• A depressed person can begin to abuse alcohol or drugs in an attempt to relieve their low mood.

• Alcohol and drugs can make the symptoms of depression worse.

• Substance abuse can mean that the symptoms of depression are masked and therefore not treated.

• Drug and alcohol abuse are not compatible with the successful treatment of depression, and therefore recovery, because many antidepressant drugs interact badly with alcohol and recreational drugs, and also people drinking heavily will not take their medication reliably.

• Substance abuse raises the chances of suicide in a depressed person.

• Thirty-two per cent of people suffering from a mood disorder also show some form of substance abuse or dependency. We discuss ways to help control drink.

All these social factors linked to depression can only pose a threat to a person if for some reason they are already susceptible. Remember that different life events affect people in different ways, and any reaction should be respected. So you might feel a friend is making a bit of a meal of her old cat dying, but for the friend her animal's death seems emotionally overwhelming. Whether you understand or not, you will not help your friend by trivializing her problem.

BIOLOGICAL FACTORS

admin — Mon, 26 Jul 2010 11:38:33 +0000

As well as the psychological factors in depression, there are also factors that relate to the actual make-up of the tissues in the body. These are the brain chemicals, hormones and genes, and a disruption of the body's norm in any of these elements is thought to contribute to depressive illness. It is not always clear why these elements are disrupted although modern diet and lifestyle are thought to contribute but righting the balance of these chemicals has been the main function of antidepressant treatment over the last few decades. Dr Puri's fatty acid theory is based on depression having a strong biological component, and we discuss this later in the article. The problem for a depression sufferer is that there is no warning that our body chemicals arc out of kilter before we become depressed.

Body Chemicals

Low levels of EPA are associated with depression, but there are other chemicals in our bodies, amino acids the biochemical compounds that make up proteins which are key in the production of the mood-enhancing brain chemicals serotonin and noradrenalin. Low levels of these brain chemicals, also known as neurotransmitters have been strongly linked to depression. Like essential amino acids, eight of these am.ino acids are called 'essential am.ino acids', and are vital for healthy body function.

Two, called I-phenylalanine and I-tryptophan, are needed for the production of serotonin and noradrenalin. Your body does not make these amino acids, so you have to get them from food, such as milk products, bananas, chicken, fish, meat, peanuts and sesame seeds. Why one person has low levels of these neurotransmitters and not another is still a mystery, and whether the low levels actually cause depression, or whether depression causes the low levels, is still up for debate. However, Basant Puri's fatty acid theory goes a long way to explain how these low levels of neurotransmitters occur in a brain that is not functioning properly because of a lack of EFAs. If you support your brain, your neurotransmitter levels should right themselves.

Genes

We have discussed how depression has a generic component, but there is another interesting aspect to the gene debate: that of depression as a survival mechanism. Charles Darwin's theory that it is only the fittest genes that survive suggests that if the depression gene is hereditary, then perhaps it has some survival value. This may sound odd, since the common perception of depression is that it increases the likelihood of early death, not that it helps the race survive.

However studies with apes have shown that depressive behavior, which is by nature passive and withdrawn, could be a survival mechanism against a superior opponent, as the ape exhibiting this type of behavior appears to be nonaggressive and therefore not threatening. You might think that passive behavior has no place in our intensely competitive modern world, but it is possible that we still unconsciously use depression as a means of withdrawing from a world we are finding hard to cope with and that this withdrawal is our attempt at survival.

The Contributory Factors in Depression

admin — Mon, 26 Jul 2010 11:34:57 +0000

PSYCHOLOGICAL FACTORS

There have been a host of different theories put forward by psychologists and psychoanalysts over the years to help to explain the mindset that is present in many depressed people. They are theories that address the way we think and feel about ourselves and others in the light of our experiences. Many psychologists believe that these experiences, usually unhappy or traumatic, happened in childhood, and have set a blueprint for our thought patterns and reactions to those around us for the rest of our lives. You may recognize these theories in relation to your own life.

Loss

Loss is a recurring theme in psychoanalytic theory. You may have experienced loss in your childhood. This does not mean losing a material object, but rather the loss of proper emotional support when you were a child and most vulnerable; for instance not being nurtured properly by your mother. The psychoanalysts believe that if you did not have this reliable support when you needed it, you can find it hard to make successful relationships with others later in life, and you may become prone to depression as a result. It is not always easy to know how we were looked after when we were small, but you might remember not feeling predominantly safe and happy, or being frightened, neglected or criticized by the person caring for you. This sort of treatment might leave you with the feeling that you are not a person worthy of love and respect.

Helplessness

This is another strand to this same theme of loss. Perhaps you were brought up by a mother who, for whatever reason, was not able to make you feel safe and loved, but, being a child, you had no control over the way you were treated. Some psychoanalysts believe that you will react to this unhappiness by giving up and becoming passive and withdrawn. You feel there is nothing you can do to change things, and no point in struggling against what you have found to be the way of the world.

Then if, as an adult, you are faced with a similar feeling of helplessness and grief, such as when someone close to you dies, or your spouse leaves you, or you lose your job, then you react in a similar way, believing that all action is futile, and you withdraw into depression. This mindset can also be brought about by the death of a parent when you were young, especially if the death 'was never properly discussed and explained.

Lack of Positive Reinforcement

This is a theory that addresses how you were treated in childhood too. Perhaps the people close to you never praised you or made you feel that there was anything to look forward to. If this was the case, you might eventually just give up and stop bothering to make any effort, and again become vulnerable to a depressive episode. Maybe every time you attempted something, like painting a picture at school, your mother would laugh at it, or ignore it, or tease you about it. Perhaps your efforts to learn to swim were ridiculed, or your ability to make friends was mocked. You can see how after a while you, as a child, would just stop bothering. You might then unconsciously carry that same pattern into adulthood, making you negative, lacking in ambition, unable to experience pleasure, and therefore vulnerable to depression.

Negative Thought Patterns

These are key to the theory of the cognitive psychologists, who believe that it is the way you think about yourself and your environment, more than what is actually going on in your life, that affects your happiness and the likelihood of you developing depression. They developed what they call the 'cognitive triad', which is made up of three fundamental mindsets. Look at these statements and see if they relate to the way you see the world.

• You have a negative view of yourself; i.e. you have low self-esteem.

• You have a negative view of events that occur in relation to yourself; i.e. you always think the world is against you, even if this has no bearing on the truth.

• You have a negative view of the future; i. e. you don't believe it will ever get any better, something will always go wrong.

Is this how you think. If you do, then the cognitive therapists believe you could be the victim of inadequate nurturing when you were a child. Perhaps your mother or father constantly told you that you were stupid, clumsy, lazy, ugly, generally unlovable, and you believed them. Now you have absorbed this distorted information and it colors everything you do and the way you deal with everyone you come in contact with as an adult. So you are always waiting for the insult, you then overreact and treat your friends and acquaintances with paranoia and suspicion, which in turn alienates them, and this distorted thought pattern becomes a self-fulfilling prophecy, because people then don't find you lovable. The end result? Depression again.

Trying Too Hard to Be Good and Perfect

Doing this because you believe that you are intrinsically worthless and bad is another mindset that can lead to depression. Trying to be perfect is inevitably doomed to failure, no matter who you are, but many of us do this in an attempt to negate the horrible feelings we have about ourselves inside. So perhaps you are always charming and helpful and there for everyone, always the one who does the extra school run or takes the difficult project, makes all the costumes for the school play and gives everyone presents for no reason. Nothing wrong with that, you might say, and no, there isn't, except if you are doing it in a desperate attempt to be what you consider a 'good' person because your childhood careers have instilled in you how bad you really are. This 'trying to be good' mindset is a terrible strain and will often lead in the end to depression.

These different mindsets identified by psychoanalytic theory can be very hard to live with, not least because so many of us are unaware that we think and feel this way. You might know that you don't feel good about yourself, bur it is another leap to understand why you feel this way or how it is affecting your life. If you think that there are issues here that you relate to, it may be a good idea to get professional help from a qualified therapist because our internal messages about ourselves and others seem to be of prime importance in mood disorders such as depression.

The theories all point to our childhood blueprint as key to the way we feel about ourselves. A perfect childhood may be something of a myth, but the majority of us received nurturing that was good enough. Psychological research suggests that for the rest of us, however, it is the lack of proper safety and respect during childhood that might tip us towards depression in adult life.

Why Do We Get Depressed?

admin — Mon, 26 Jul 2010 11:10:39 +0000

It seems from ancient texts that human beings have always suffered from depression. Saul, it appears, suffered a bout of it when the Philistines were being uppity and he had lost his faith in God; and Hippocrates, the famous ancient Greek physician who is considered to be the father of medicine, described what he called 'melancholia' in the same terms as modern-day depression. Yet even after thousands of years the definitive cause of depression is still something of a mystery to scientific researchers worldwide. There does seem to be agreement on the fact that there is no single cause for depression, but rather a number of contributory factors which come together and trigger a depressive episode in people who are vulnerable.

This consensus is only a jumping-off point, however, because no one is sure which combination of factors is needed, or why one person reacts to one set of contributory factors and another does not. And it is even true that a person who is vulnerable one time might not be so vulnerable the next. So unfortunately there is no single formula that states A + B+C=depression, as, for instance, you have in equation low immune system + flu virus = bout of flu. It is best to think of depression as a cake, and the factors that contribute to it are the ingredients. There are many different methods and many different ingredients that can be used to make a cake. The tiniest inconsistency in temperature or ingredients can change the outcome. Not to mention the fact that you can make it exactly the same way twice and get a totally different result.

Even if there is no simple formula, there is still a lot you can learn about the roots of your depressive symptoms. Depression ingredients include various biological, psychological, physical and social factors, and this article outlines all these factors in detail, and also describes how they might interact with each other, so that you have a clearer idea about how you might have become vulnerable to this disease. But remember, no one factor can be said to cause depression every time and in every case. If this were true, then, say, everyone who was socially deprived would be expected to contract depressive symptoms, and this is certainly not the case.

The good news is that most of these depression triggers are open to change. For instance, if your life reflects psychological factors such as childhood neglect and negative thinking, then you can find help in facing up to these problems and so reduce the number of factors in your life that might make you prone to depression in the future. Or if stress is a contributory factor you can identify what is causing you to be so stressed and go about modifying these elements. Or if low levels of EPA arc a factor – which Basant Puri has shown them to be then you can increase your EPA levels and help alleviate your depression. We explain this biological factor Basam Puri's fatty acid theory about low levels of EPA in the brain in detail in this article; it is one that he believes is crucial in triggering depressive illness, and which challenges the current thinking about the biochemistry of depression. We go back millions of years to the beginnings of human brain development, and chart the EPA theory through the years of research and trials to the point Dr Puri has now reached, where he can put it into practical application in the treatment of depression. So to answer the question 'Why do we get depressed" let's first look at the various contributory factors and see to what extent your life might reflect these elements.

Problems Accessing Help

admin — Fri, 23 Jul 2010 12:33:47 +0000

One of the snags in getting treatment is that a depressed person finds it particularly difficult to access the help that is offered, or even find the motivation to take the antidepressant medication. One of the side effects of depressive illness is that when someone tries to help a depressed person perhaps talking to them, hugging them, generally caring for them the depressed person can see the help is being offered, but somehow can not take comfort from it. The kind words mean nothing, the embrace doesn't soothe, in fact often exactly the opposite: the help only makes you irritable, and guilty at your lack of responsiveness.

Who Gets Depressed?

No one knows exactly why, but some of us are more vulnerable to depression than others. Even with reactive depression, where a person is depressed following a life trauma, another person might experience the same trauma and not get depressive symptoms. They might be sad and miserable for a while, and go through a normal phase of reaction to the event, but it will not be followed by depression. And a person who does experience reactive depression after one upsetting event might not do so when faced with another equally distressing circumstance.

There have been many theories put forward by doctors and scientists over the years in an attempt to explain this complex disease, covering biological, psychological and social factors. And it is thought that often a person's depressive illness is triggered by a combination of these factors rather than one particular villain.

Professor Horrobin's research, followed up by Dr Puri and his colleagues, sheds more light on what might be a large factor at the root of mental illness, indicating that depression might have a mainly biological genesis, specifically the lack of EPA in our diet. However, there is still the fact that gender, age, our genetic inheritance, and marital and social status have so far been highlighted in statistics as playing a significant role in depression too.

WOMEN AT RISK

Women, it appears, are two to three times more likely to suffer from a major depressive episode than are men. Is this to do with women's hormonal make-up? If so, there is as yet no research to back lip this theory. Given that women tend to eat roughly the same food as men and live in the same environment, why should they be more susceptible? Married men, for instance, have lower rates of depression than single men, but married women arc no better off than single widowed or divorced women when it comes to depression.

There have been various hypotheses some rather improbable bandied about concerning women's increased vulnerability, such as the idea that come are more likely to have been sexually abused as children, again not backed up by research. Or that modern women have a more stressful, more complicated life trying to raise families, run homes and have full-time careers, and that many are failing to cope. Or the theory that women are more sensitive than men, making them more likely to react badly to trauma sadness.

The Depression Alliance, a mental health charity, suggests that men and women may in fact suffer the same amount of depressive illness, it's just that women are twice as likely to seek help and be diagnosed as their male counterparts. They also suggest that doctors, faced with a man complaining of depressive symptoms, are less likely to diagnose them with depression than if the patient were a woman. However, the truth is that we just do not know which of these possibilities is the most likely contributor to the higher incidence of depression in women.

TEENAGE AND YOUNG ADULT MALES AT RISK

Young adult males, you might think, given their high rate of suicide the highest, certainly, of any group are more prone to depression than their girlfriends. In fact, post puberty they are less likely to suffer a depressive episode. The discrepancy is partly explained by the methods of suicide that young men tend to choose. Young women most commonly opt for pills, which are less predictable in outcome, whereas boys go for the more violent and unfortunately more successful methods.

But there is still the alarming 85 per cent increase in young male suicides over a recent ten-year period to be explained. Are they also finding the pressures of the modern world too difficult to cope with? Or, with illicit drugs and alcohol increasingly available to young people are they more likely to succumb than their girlfriends, making them vulnerable to violent mood swings and endangering behavior? Again, we don't know.

OLDER PEOPLE AT RISK

Old people are particularly vulnerable to depression. Research in the US suggests as many as one in twelve Americans aged sixty-five or over are suffering from major depression, although it seems their symptoms often go unrecognized. You might think it reasonable that old people, particularly if they are lonely ill or in care, might suffer from an increased incidence of depression. And much of this increase may be explained by the prevalence of diseases in the elderly that are associated with depression, such as dementia, stroke and Parkinson's. Also, old people are twice as likely to be on medication, some of which is linked to symptoms of depressive illness, such as some beta-blockers used to lower blood pressure. But it is still important that the disease is recognized so that they can receive appropriate treatment to alleviate their symptoms. Or perhaps take preventative measures in the form of a daily EPA supplement

GENETIC INHERITANCE

There is good evidence that a genetic factor plays a role for some people who suffer from clinical depression. One route the research scientists have taken is to look at whether or not a depressed person has a first-degree relative who has suffered from the disease. Unfortunately, a study that follows this route has also to take into account the 'nature versus nurture component. For example, a parent who is suffering from a depressive illness while raising their child might treat the child differently to the way in which a non-sufferer relates to their offspring.

Twin Research a better way of studying genetic factors is to examine twins. We know that identical twins share the same DNA; the genetic code in their chromosomes is identical. In contrast, non-identical twins share on average only 50 per cent of their genetic material. But of course twins, whether they are identical or not, will receive roughly the same parenting and the same environmental messages, from diet, schooling economic and social factors.

A study of this kind will first have to find pairs of twins, both identical and non-identical, in which one twin has become depressed. It then needs to establish whether, and if so how often, the other twin in the pair also suffers a depressive episode. If genetic factors are important, then the study would expect to find that the identical twins had a higher incidence of both twins suffering depressive episodes than the non-identical. A 1996 study into depressive illness at the University of Wales College of Medicine in Cardiff studied 177 pairs of British twins where at least one twin had a diagnosis of major depression according to the American DSM-IV criteria. They found that the incidence of both twins suffering a major depressive illness ran at 20 per cent in the non-identical twins, but in the identical twins that rate was more than doubled at 46 per cent. This is strong evidence that there is a genetic component ill the causation of depression.

So far, however, no specific 'depressive gene' has been identified. Scientists working in this burgeoning field of research believe that there are perhaps a number of genes responsible, not just one, and that they act together to produce depressive illness. But until a gene or genes is identified, no one will understand how exactly they change the person's brain patterns to create depression. The fact that there is a genetic component in depressive illness does not mean that if you have a close relative who suffers from depression you will automatically become depressed. As we have said earlier, genetics are just one of the factors that are now seen to be linked to depression. But when scientists finally crack the disease's genetic identity, it will tell us a great deal more about the origins of depression and why one person suffers and not another.

SOCIAL DEPRIVATION

Social deprivation has long been thought to be a precipitating factor in depressive illness. If you live with the stress of unemployment or low-paid work where you are not properly valued, the humiliation of benefits, and the worry about whether you will have enough money to pay the bills and feed the children, it is hardly surprising that you might be more vulnerable to depressive symptoms than your more well-off-counterparts. However, as with all depression factors, it isn't as simple as 'If you're deprived you're depressed.' There is debate about the statistics that show that people suffering socioeconomic deprivation have a higher rate of depressive illness, some experts saying that severe depression naturally inclines a person to drift into poverty, as they can no longer hold down a job or relationships. The other side of the argument is that the stress of poverty causes depression, combined with the likelihood that a person who has a miserable life is more vulnerable to the abuse of alcohol and illicit drugs, which in themselves can promote depressive symptoms.

A recent study at Cornell University in America linked inadequate food intake and a poor diet with depression, which supports Professor Horrobin and Dr Puri's contention that a brain starved of sufficient fatty acids is vulnerable to mental illness. The study found that 60 per cent of adolescents who lived with inadequate food intake had at least one suicidal symptom – i.e. they had considered committing suicide and 20 per cent had attempted suicide. Whether it's chicken or egg, there is a significant link between social deprivation and depression, but, again, just because you are poor does not mean you will necessarily suffer from the symptoms of depression.

RICH PEOPLE GET DEPRESSED TOO

Although we have mentioned groups of people who might be more vulnerable to depression, that does not mean that depression only strikes these groups. Anyone can get depressed, even celebrities, eminent scientists, politicians, writers, artists and people who have, to the casual observer, the most perfect lives. Winston Churchill, a famous depressive, called his depression 'Black Dog'. Other well-known sufferers include Van Gogh, Ernest Hemingway, Marx and Caroline Aherne. No category of person is immune, and although a person who has once suffered a major depression will possibly fall victim to another bout, equally they may not. And now, with the new discovery about the brain-supporting properties of EPA, there is the real chance that those who have been prone to depression in the past can take a daily supplement of EPA to ward off any further attacks.

Are You Depressed?

We have listed some of the types who alight be particularly vulnerable to depression, but it is important to remember that anyone can fall prey to the illness, not just the ones mentioned above. You might recognize a trigger for your symptoms in the categories above, but equally you might not fall into any of these groups, yet you are still experiencing what feels like depression.

With so many cases of depression unrecognized and therefore untreated, you may be one of those suffering depressive symptoms but still wondering what exactly is wrong with you. You may feel foolish bothering the doctor, worried they will think you are wasting their time and convinced all they will say is, 'Pull yourself together.' But not knowing what the matter is can be unnecessarily frightening, and obviously the sooner you know the reason for your symptoms, the sooner you can get treatment. Use the questions listed below as a quick guide to how you might be feeling if you are suffering a depressive episode:

• Has your mood changed over the past few weeks from your normal, day-to-day pattern to become more pessimistic and dark? This does not mean just having a bad day it means a more sustained lowering of mood. Some people are naturally quieter and more introverted than others, but it is the change you should be looking for.

• Are you feeling hopeless about life for no particular reason? Obviously if you have just suffered a personal tragedy, or even a less major emotional trauma, you will not be feeling full of the joys of spring, but this is a generalized despair about everything around you which is not justified by the actual circumstances in your life.

• Are you exhausted? Again, this is not the normal tiredness you might feel after a busy day, or a period of high stress; this is a more fundamental tiredness, a deep bone-tiredness which seems to settle over your mind and body and make you feel incapable of even the smallest effort.

• Do you find nothing makes you smile any more? Not even the prospect of a holiday, a new dress, or seeing your favorite friend for a drink? Do you find yourself constantly making feeble excuses to get yourself out of work and social engagements?

• Are you having trouble sleeping? Do you wake up horribly early in the morning and lie there feeling exhausted and miserable at the prospect of another day?

• Are you feeling ashamed of your low mood and think it is all your fault?

• Have you experienced panic attacks or feelings of high anxiety about everyday situations you would normally find easy to deal with? For instance, going alit, meeting friends, taking a meeting at work, going down a high escalator, driving.

• Are you finding it's hard to concentrate, are you having difficulty getting through your daily tasks, is it impossible to Blake decisions?

• Have some of your family or friends begun asking you what is the matter' Do you get angry and irritated when they do?

• When people try and cheer you up, do their efforts fail to comfort you and seem utterly pointless?

• Do you spend a lot of your day with negative, despairing thoughts churning about in your brain?

• Have you started drinking or smoking an abnormal Amount?

• Do you just want to give up? Does everything seems too difficult and you simply haven't the energy to cope any more?

If you have answered 'yes' to three or more of these questions, you should go and see your doctor because you are showing the classic symptoms of depressive illness. Write a list of the symptoms you are experiencing before you go, so that you can give them a clear picture of your problem. It is easy to forget what you meant to say when GP consultations are so short, particularly as you are finding it difficult to think straight. If your doctor doesn't listen or understand, make an appointment with a different doctor, and take a friend along to back you up. It's important to get a diagnosis for your symptoms, and eliminate other medical conditions, so that you can begin treatment.

Being Close to Depression

The person suffering from depression is not the only one who is affected by this disease. Everyone who comes into contact with someone who is even moderately depressed will feel the impact. There are three main problems to consider in coping with a person, either at work or at home, who is in the throes of a depressive illness recognizing the problem, understanding the problem, helping them to get treatment.

RECOGNISING THE PROBLEM

First we have to recognize that the person in question is depressed. This, as we have already discussed, is not easy. But it might be easier for you to spot it in someone else than it is for the sufferer them self to identify their problem. This is because their perceptions will be clouded, their normal reality distorted. If you notice a marked and prolonged mood change in someone close to you, which may be accompanied by general tiredness and lack of enthusiasm, negative thinking, disturbed sleep and eating patterns, perhaps an increase in alcohol consumption and loss of libido, then you should consider depression as the cause.

Because of their distorted perceptions, they may resist any suggestion of depression as a diagnosis for their mood disruption. They will be trying valiantly to be 'normal' again, and may feel ashamed of the way they are feeling and behaving, particularly if they are harboring suicidal thoughts. They will be hoping that it will pass, that tomorrow they will wake up and feel different.

UNDERSTANDING THE PROBLEM

There are a few facts that are important to understand when you are trying to cope with a person in a depressed state:

You cannot cheer up someone who is experiencing a serious depressive episode.
The depression sufferer cannot cheer themselves up, nor can they 'snap out of it'.
They cannot take in what you say or react usefully to your help and advice in the way they normally would.
Their depression is not your fault and hardly ever even related to you.

• Likewise, there is no shame or blame attached to being depressed. You can contract depression like any other illness, such as cancer or heart disease.

• Teenagers and children can also experience depression.

• Depressed people are more likely to be a danger to themselves than to anyone else.

• There are very successful treatments for alleviating the symptoms of depression. And now, with EPA, they do not involve side effects.

It is vital that you, as a person close to depression, understand these facts, because a lot of the anguish surrounding the disease is caused by frustration engendered by misunderstanding. There is no doubt that dealing with a depressed person who is not responding, whose behavior is strange and erratic and who is refusing to seek help is frustrating and extremely daunting. The subsequent impact on relationships, both at home and at work, if depression goes unrecognized can be devastating.

HELPING THEM TO GET TREATMENT

So you have recognized that someone close to you is depressed, but either they won't admit to it, or they admit it but are adamant that they don't want treatment. What do you do' The answer depends very much on the degree of severity of the depressive symptoms. Unless they are very severely affected, it should be possible to talk to them about seeing a doctor. They may not respond at once, but keep trying, or get someone else close to them to try. Let them know that you understand how they are feeling, and that they have your full support. Nagging won't work. If it is a work colleague affected, contact a close friend or family member and tell them your concerns. If they continue to refuse to get medical help, see their GP yourself and ask them to drop round and talk to the person about their symptoms.

Depression in children and teenagers is notoriously difficult to spot, not least because you don't expect them to get the illness so young. And how are you supposed to tell the difference between a normally sulky, monosyllabic teenager who refuses to eat what you cook or get out of bed or function in a way that you consider appropriate, and a depressed teenager? The answer is that often you can't, but signs to look for are marked changes in mood, within the context of teenager behavior. For instance, a stroppy teenager who has lots of friends, and then suddenly becomes lethargic and has no interest in seeing their mates. Or a teenager who begins to drink excessively and regularly. Or a teenager who seems to get absolutely no pleasure from a treat, such as some extra money for clothes.

If you think someone you know is in danger of harming themselves, you must seek help immediately by contacting their GP and explaining the problem. Don't rely on the problem going away. Someone intent on suicide will find a way, and you are not responsible for their actions; but a person may still be at the stage where they are just desperate and confused. Don't forget, this is a difficult illness and there are no hard and fast rules to play by. But understanding is certainly the key.

Points to Remember

• Depression is an illness just as cancer and heart disease are illnesses.

• Two-thirds of those suffering a serious depressive episode do not seek professional help. This is because there is still a strong stigma attached to depression. Many sufferers, and the people close to them, feel ashamed of their condition, thinking it shows mental and emotional weakness.

• Depression is not just a normal low mood which the sufferer can 'snap out of' by 'pulling themselves together'.

• Depression is now classified as mild, moderate or severe, with diagnosis relying on the number and severity of symptoms present over a period of two weeks or more. The key identifying symptom present in all people suffering from depression is an overwhelming feeling of hopelessness and despair which will not go away.

• Diagnosis is hampered by the fact that depression sufferers can have such a variety and degree of symptoms that it can be hard for the doctor to pinpoint. Depression can sometimes be confused with other illnesses. Sufferers might find it difficult to articulate their problem clearly.

• Depression can have several different associated contexts. These include seasonal affective disorder (SAD), postnatal depression, bipolar disorder (manic depression) and schizophrenia.

• Groups most frequently affected by depressive illness include women, older people, those with a family history of depression and those who are socially and economically deprived.

• No one is guaranteed in immunity from depression.

• Those close to a person suffering from depression need information and support to cope with the problem too.

• EPA offers an alternative, side-effect-free treatment to antidepressant and antipsychotic drugs for depression and related mental disorders.

How is Depression Diagnosed?

admin — Fri, 23 Jul 2010 09:35:15 +0000

Faced with this bewildering array of symptoms how is a doctor to decide that their patient is definitively depressed and not just going through a stressful period in their life which is affecting, say, their sleep patterns' It is easy for a time-pressed GP to treat individual symptoms instead of spotting the wider problem. For instance, a patient may present with sleeping difficulties and be prescribed sleeping pills, which will do nothing to alleviate their depression. There are, however, various physical changes in a person's appearance that may point to depression, and which a doctor can be alert to at the first examination. These include:

Facial changes such as downturned eyes, sagging at the corners of the mouth and a furrow between the brows.
The patient may avoid looking the doctor in the eye.
Changes ill overall appearance, for instance weight loss, poor self-care and general neglect such as grubby clothes and poor personal hygiene.

Changes in speech patterns. Speech is typically slow, with long delays before questions are answered and poor concentration on any task.

Diagnostic Classification

Apart from listening to the symptoms described and observing the patient, there have also been specific diagnostic criteria created by experts to help doctors define depression. The two most important are those produced by the American Psychiatric Association (APA) and the World Health Organization (WHO). The APA classification is known as the Diagnostic and Statistical Manual of Mental Disorders (DSM), current edition DSM-IV -TR. It states that a person suffering a major depressive episode will present with at least five of the symptoms numbered 1-15 in the previous section during the same two-week period, and that these must be different from the person's usual mood. At least one of the symptoms must be an ongoing depressed mood or loss of pleasure in life. The sufferer will be showing an inability to function normally in a social, relationship or work environment, and their mood will not be as a result of inappropriate use of drugs, alcohol, Indication or a medical condition.

The WHO classification is known as the International Classification if Diseases and Related Health Problems, abbreviated to lCD, the latest edition known as ICD-10. This is the one used by many National Health Service hospitals in the UK. It is more complicated than the APA system but broadly speaking it divides depression into the three categories of mild moderate and severe and then further divides the symptoms into an A and B list. List A includes: ongoing depressed mood loss of interest and enjoyment in life tiredness and lethargy (numbers 1-3 listed above on pages 24-25). List B includes: all the other symptoms of depression listed above (numbers 4-13). There is also a C list which is concerned with whether the general symptoms of depression are accompanied by psychotic symptoms such as hallucinations and delusions.

MILD DEPRESSION DIAGNOSED

A person with mild depression has at least two symptoms from list A and two from list B. None of list B should be too severe and the symptoms should have been ongoing for at least two weeks. The person affected will still be working and functioning at home but with reduced usefulness and they will be experiencing no enjoyment in their daily tasks.

MODERATE DEPRESS ION DIAGNOSED

A person with moderate depression has at least two symptoms from list A and at least three preferably four from list B. with several of the symptoms present to a marked degree, or a large number of symptoms present. The symptoms will have been experienced for at least two weeks. The person affected will be finding work very difficult, or may even have given it up, and will have become isolated from their family and normal social network.

SEVERE DEPRESSION DIAGNOSED

A person with severe depression has all the symptoms from List A and at least four from List 13, which will be severe in intensity, lasting at least two weeks. The person affected will be unable to function normally any more. They will be suffering from marked low self-esteem and feelings of hopelessness and guilt. They might be experiencing psychotic symptoms such as hallucinations and delusions and be at a serious risk of committing suicide.

Problems with Diagnosis

The diagnostic criteria above, although sound when applied professionally, can only be put into practice if the person presenting with depression is able to articulate his symptoms. Many cannot. Another problem is that a depressed person, as the statistics show, will more than likely not seek professional help at all. In addition, the symptoms of depression can seem similar to the symptoms of certain medical conditions, such as anaemia, thyroid disorders and cancer, or may be masked by already existing medical problems, such as irritable bowel syndrome (IBS), chronic fatigue syndrome (CFS) and chronic migraine. Patients don't want to be diagnosed with depression.

They would rather be told they were suffering from what they consider a more presentable' disease, such as anaemia, which has a more predictable outcome and does not involve feelings of shame and inadequacy. Let's look at the symptoms and causes of the illnesses often confused with depression and see how similar they are to those of depression themselves.

ANAEMIA

There are many different causes for anaemia, which is a blood disorder where hemoglobin, the oxygen-carrying component in red blood cells, is deficient, but the most common is iron deficiency. Lack of iron can be the result of excessive bleeding from heavy periods a poor diet, a bleeding stomach ulcer or injury, pregnancy, and less commonly from malabsorption in the gut the symptoms of tiredness, pallor, faintness and shortness of breath on exercise are universal with all anaemias. Also brittle nails and skin breakdown particularly in the sides of the mouth. Treatment includes blood tests and iron tablets, plus dietary advice.

HYPOTHYROIDISM

Thyroid hormones arc essential for body metabolism – i.e. our temperature and how we but fuel and the smooth functioning of the nervous system. They also affect sexual function. The thyroid gland can malfunction on two levels, either producing too much of the thyroid hormones, known as hyperthyroidism, or too little, known as hypothyroidism.

Hypothyroidism is the thyroid malfunction most commonly associated with depression and has many possible causes hypothyroidism causes many of the body's functions to slow down and can product symptoms in all parts of the body such as extreme tiredness, weight gain, depression, anxiety, sensitivity to cold slow heart rate and speech, palpitations, fluid retention, constipation, a hoarse voice, heavy periods, dry, coarse skin, hair thinning or loss, ridged nails. Goitre, a swelling in the front of the neck caused by thyroid gland enlargement, is also a symptom. These symptoms may develop slowly over weeks or months, and it is sometimes difficult to diagnose because of the insidious onset of potential signs. If you have three or more of the above symptom over a sustained period, then consult your doctor. Treatment includes thyroid hormone (thyroxin) replacement, or nutritional supplements of iodine.

ADDISON'S DISEASE

This are disease occurs when the adrenal gland is making too little of the adrenal hormones known as corticosteroids, and as a result the body's metabolism is upset. There are various causes, such as autoimmune disease, where the body attacks its own cells, adrenal cancer and certain drugs.

Symptoms: tiredness and weakness, loss of appetite and weight loss, general feeling of ill health, skin pigmentation like a suntan, particularly in the creases of the palms, knuckles, elbows and knees. Treatment includes addressing the underlying condition and taking long-term oral corticosteroid drugs.

Contexts for Depression

For some, depression comes about as the result of vulnerability to a particular circumstance, such as seasonal lack of light, hormone changes after childbirth, or a chemical imbalance which promotes manic episodes or schizophrenia.

SEASONAL AFFECTIVE DISORDER (SAD)

One group of depression sufferers it is easier to diagnose is the one in which the depressive illness is triggered by light deprivation during the long hours of darkness in the winter months. None of us likes the lack of light in winter, and we all feel our spirits lift as the spring brings longer days, but for some the problem is a lot more serious. Those affected by SAD become clinically depressed on a seasonal basis. As soon as October (in the northern hemisphere) comes round, these sufferers begin to slide into a downward spiral of depression, and without treatment they will stay depressed till spring. SAD has many of the same symptoms of other forms of depression, including fatigue, low mood, lethargy, difficulty in waking and carbohydrate craving, the distinguishing mark being the cyclical nature of the depression. Treating SAD Luckily for SAD sufferers, light therapy is successful in alleviating depressive symptoms in up to 85 per cent of cases. This therapy requires the person to be exposed, open-eyed, to bright, broad-spectrum light at a minimum strength of 2500 lux (the unit in which we measure light) for up to two or more hours a day. The light is delivered via a light-box, and can be used at home or during a visit to a therapist. However, it is important to have your condition diagnosed professionally before using light therapy at home.

POSTNATAL DEPRESSION

Another context for depression is the hormonal flux that affects women after they have given birth. There are three types, the most common being the short -lived emotional disturbance that usually starts between the third to the fifth day after childbirth known as the 'baby blues'. The woman feels tearful and exhausted. It only lasts around two days and seems to be more common among first-tune mothers and in those with a history of premenstrual syndrome (PMS).

The next most common is postnatal depression itself, which occurs in around out in five to one in ten mothers and begins within two to three days of childbirth. The symptoms the mother might experience include despondency, tearfulness and irritability, often accompanied by fatigue, anxiety and phobias.

She might also have difficulty sleeping, poor concentration, decreased libido and feelings of inadequacy, particularly in relation to her role as a mother. The symptoms may be worse at night, and the depression can last for a few weeks to more than a year. What is particularly distressing about this type of depression is that the bond between the mother and her child is threatened and can affect their relationship in the future. The third type is a very severe form of depression known as puerperal psychosis and is comparatively rare.

Treating Postnatal Depression

The best scenario in postnatal depression is an early recognition of the condition, so that mother and baby can be given the support that they need. Unfortunately this depressive illness is often put down to the baby blues and no treatment is forthcoming. Treatment has so far been with antidepressants, but Dr Puri's research suggests that EPA is now also a treatment option.

BIPOLAR DISORDER (MANIC DEPRESSION)

This depressive condition combines depression with mania, the two mood states usually occurring in different, distinct phases. To be diagnosed with bipolar disorder, a person needs to have suffered at least one episode of mania. Mania can take various forms, depending on its severity, but during a manic phase a person will experience an elevated mood which is extreme and pathological. They often speak very loudly and quickly and won't stop, jumping from one subject to another without apparent connection, as if they had been 'fast forwarded'.

They can become delusional believing things that are not true and acting on this belief, so that, for instance, they might spend huge amounts of money they don't have, or think that they are God. Their perceptions can change, so they might fail to notice that they have injured themselves or that they arc not eating and drinking adequately. They can act completely out of character, often engaging in highly flirtatious behavior and sexual promiscuity. They might also suffer hallucinations. And they believe all the while that their behavior is normal.

In general, patients with bipolar disorder have a history of mood swings, with episodes of both mania and depression. But they are diagnosed with the condition as soon as a man is phase has been identified, even if a depressive episode has not yet occurred. Treating Bipolar Disorder The most common treatment for manic depression is a long-term maintenance course of the drugs lithium carbonate and carbamazepine, although it is not clear how these drugs work to reduce the symptoms, and both drugs have potentially troublesome side effects. A common problem with manic-depressive patients is keeping them on their medication long term, as they can reach a stage where they believe they no longer need the drugs. However, EPA and high EPA essential fatty acid supplements appear to have mood-stabilizing properties which make them potentially therapeutic in bipolar disorder.

SCHIZOPHRENIA

This disease is strongly associated with clinical depression, meaning that schizophrenics also commonly suffer the symptoms of depression. Schizophrenia is often first manifest in teenage years, which makes for problems in diagnosis as normal teenage moods can seem quite severe and alienated.

Symptoms of the disease are many and varied, and, like depressive symptoms, can also vary in number and intensity and have a genetic component. In its mildest form, the exceptional thought patterns can push boundaries in art and science. They might include: an increasing need for solitude; a lack of response to those close to the sufferer, or a cold, blank response; disrupted sleep patterns where the sufferer can end up sleeping during the day and staying awake all night; bizarre thought patterns and connections which confuse both themselves and others; agitation and restlessness; delusions and paranioa, where they come to believe that they are the victim of hostile forces which are trying to control and persecute them; hallucinations, where the schizophrenic hears voices, sometimes commanding them to perform totally irrational and often destructive tasks; general hostility to those close to them.

An interesting feature of the disease is that its distribution worldwide is absolutely consistent. All populations have the same level of incidence, between 0.5 and 1.5 per cent over a lifetime. Culture, race, social circumstances and so on make no difference. This is not true of any other illness. However, once the disease had developed, the countries whose diet had a high intake of saturated fat which is thought to be destructive to essential fatty acids and therefore the production of EPA – had worse results in controlling the course of the disease than the countries whose diet contained little saturated fat.

Treating Schizophrenia

Schizophrenia can be difficult to treat successfully over the long term. Antipsychotic drugs such as chloropromazine, which control symptoms of hallucination and help to stabilize mood, are the main treatment option, combined with general support in dealing with the disease. However, schizophrenia is the disease which is in the forefront of the research done by David Horrobin, Krishna Vaddadi, Malcolm Peet, Basant Puri, Jan Mellor and Alex Richardson which has led to the discovery of EPA as a treatment for depression. Their studies have also shown that a high-dose EPA supplement alleviates the symptoms of schizophrenia considerably, with none of the unpleasant side effects that have traditionally plagued the long-term users of antipsychotic drugs. If you are currently taking antipsychotic drugs, do not stop taking them without first consulting your doctor, who will advise a gradual reduction of dose. If there is a particular context for your depression, such as one of those mentioned above, it is important that it is recognized. not only so that the appropriate treatment can be started and help given, but so that you can be aware of your possible vulnerability to the illness in the future. For instance, if you are diagnosed with SAD, you will know that the approach of winter is a time to be starting light therapy and making sure your levels of EPA are high.

What Happens if Depression Goes Untreated?

This obviously depends on the nature and severity of your depressive episode, but it is a fact that a large number of depression sufferers just fight it out by themselves with no professional help. This can have disastrous consequences if the person becomes suicidal, not to mention the fact that a prolonged, undiagnosed bout of depression can wreak havoc with families and career prospects. Where a boss might be sympathetic to an employee taking time off to be treated for depression, they might not look so favorably on a person whose concentration, people skills, speed and efficiency suddenly deteriorate for no apparent reason. And someone living with a depressed spouse will find it a lot easier to be tolerant and sympathetic if they feel their partner is taking the appropriate steps to speed recovery.

This is why it is so important to diagnose and treat the condition as soon as possible. Depression, however, is not necessarily progressive. You may experience a mild or moderate episode which remains just that, mild or moderate, regardless of whether it is treated or not.

The Symptoms of Depression

admin — Thu, 22 Jul 2010 09:43:38 +0000

The symptoms of depression vary widely from person to person in their number severity and duration, making it hard for the sufferer, the people close to the sufferer and the practitioner faced with the sufferer to make a firm diagnosis. This is further complicated by the fact that certain diseases can mimic depressive symptoms, thus throwing the doctor off the scent. Depression symptoms might present suddenly or they might creep up on you gradually, and during the course of a depressive episode the symptoms might vary. Here is a list of the possible symptoms a person suffering from depression might experience.

1. Persistent low mood

This is the number one depression symptom. We have discussed the difference between a low mood and a low depressive mood, but the best way to describe this depressed feeling is by imagining a mood scale of one to ten. Happiness is ten. A low mood is five. A serious trauma such as bereavement is two. A low depressive mood is zero. In its severest form it is off the scale of feeling because what the sufferer feels is nothing, just a persistent deadness, as if the world were going on in a separate place. And unlike a normal low mood, the feeling doesn't go away.

2. Feelings of despair and hopelessness

These feelings are a corollary to the persistent low mood and can often be frightening. It seems as if there is no hope of anything ever being any better. The future is bleak, the present unbearable, there seems to be no point to your life, yet at the same time you know that the reality of your life does not merit this despair. You may in fact have what others, and indeed you yourself, would consider a good life, but when you are depressed you just can't see it as good. And, worse, you cannot e" "plain why you feel this way, so guilt is added to the mix of feelings. You can burst into tears at the smallest thing, or even for no apparent reason at all.

3. Loss of interest and pleasure in it

Things that previously gave you pleasure, and which you know should give you pleasure, no longer do. You usually love taking your children to the park, or going to a movie, or even just making your first cup of coffee of the day. But now you feel no sense of enjoyment or anticipation for any of these events.

4. Lack of energy

The torpor that falls over you like a blanket when you are depressed is extraordinary. You just cannot be bothered to do anything. Under the duvet seems the safest place, and even the smallest task, such as writing a letter or washing your hair, seems almost insuperable. Your sleep patterns are probably disturbed, but this does not entirely explain this overwhelming tiredness.

5. Disturbed sleep patterns

These vary; some depressed people, particularly those experiencing seasonal light deprivation depression or those with chronic depressive illness, tend to sleep too much. But the most common complaint with an acutely depressed person is that, although they have no problem falling asleep, they tend to wake very early in the morning 4 or 5 a.m. and then can't get back to sleep. This is particularly distressing, not only because you feel alone and isolated when no one else is awake, but also you face the day already tired, with the knowledge that by the end of the day you will be exhausted. And this form of sleep disturbance is not cured by staying awake longer at night to make yourself extra tired.

6. Difficulty concentrating and making decisions

When you are depressed you find it hard to think clearly. Part of the problem is that you cannot concentrate on what is being said or what you are reading. You might read a paragraph over and over again and still have no idea what it means, or you might be talking to someone and suddenly be aware that you haven 't heard a word of what they have just said. This is obviously very hard to cope with in a work situation, where you may appear flustered and incompetent to your colleagues, take longer to complete work assignments and find making decisions just too difficult.

7. Feeling worthless

This crisis in personal confidence leads on from the tiredness, lack of concentration and hopelessness. You begin to blame yourself. This is all my fault, you tell yourself. If I was cleverer, prettier, thinner, more successful I wouldn't be feeling this way. You begin to think that everyone is looking down on you, from your family to your work colleagues and even the waiter in the coffee shop. They can see you are a worthless person and nothing anyone can say will change your mind. In fact you might even think that your friends' attempts to console you are hollow and insincere. These feelings of worthlessness can increase your isolation, because day-to-day events such as getting together with friends, attending important work-related meetings, or even picking up your child from school become almost impossible to face.

8. Anxiety and panic attacks

You can be anxious without being depressed, but depressed people often manifest a high degree of anxiety. You might even experience panic attacks, when your heart starts racing, you break out in a sweat and find it difficult to breathe. You may become frightened to go out for no reason, or become oversensitive to your environment; for instance a crowded room can unexpectedly make you nervous. Or you may experience sudden phobias, such as agoraphobia (a fear of going out in public places or travelling by public transport) or of heights a steep escalator in a station can present a real problem for you .

Or you may adopt what is known as obsessive/compulsive behavior, where you wash yourself and your surroundings continuously, or you find you need to follow a specific ritual to complete tasks. These anxiety symptoms are not always experienced in depressive illness, but they are very common.

9. Appetite changes

Your eating habits sometimes change when you are depressed. You may eat too much and put on weight treating food as the only reliable comfort in your life. Then as soon as you've eaten the food you become disgusted with yourself, and your added weight further reduces your self-esteem. Alternatively you may go off food and lose a lot of weight. You are still hungry, but as soon as the food is in front of you your appetite disappears and the thought of eating it makes you feel nauseous.

10. Impatience and irritability

You might feel like screaming at everyone and it's hard to stop yourself from doing so. And the more others try and reason with you and encourage you, the more they drive you mad.

11. Loss of libido

Like everything else, sex suddenly seems completely uninteresting. Whatever your sex drive previously, now you feel no desire for anyone. This can be problematic in a relationship, as the other person may not understand that your lack of desire has nothing whatever to do with them.

12. Persistent negative thoughts

This is a general feeling of negativity towards the whole world. You may begin to feel that your friends are selfish, that your partner doesn't love you any more, that your work colleague is being favored by the boss, that your clothes are all gross. Everything and everyone is against you, but this negativity is not based in any reality.

13. Self-destructive behavior

It is easy when faced with these bewildering mood alterations to seek some way of distancing yourself from your distress, and many people suffering from depression turn to excessive and uncharacteristic use of alcohol or drugs in the mistaken belief that they will find respite, or simply to get through the day. In the short term your despair may be forgotten, but when you return to reality the depression is still there and might feel even worse when mixed with the toxic residue of a hangover. You may also increase your nicotine intake, or take up smoking again.

14. Psychotic symptoms

This is a term used to describe a feature of severe depression when a person suffers from strange illogical, false beliefs. You might hear voices that are not heard by others, or hallucinate – i.e. see things that are not there or smell odors that no one else can smell. For instance, you might believe that a voice is telling you to burn all your possessions, or you might believe that your partner is trying to murder you.

15. Suicidal thoughts

You may trunk of suicide a lot, even planning the best way to kill yourself. Part of you wants to die because there is no point in living; another part is sure that you will be doing everyone a favor by removing your useless presence from the world. And yet unless you are suffering from a severe form of depression, another part of you knows this isn't true and that your family and friends would be devastated if you were to kill yourself.

What is Depression?

admin — Wed, 21 Jul 2010 12:41:42 +0000

The importance of the medical breakthrough outlined in this article is borne out by some of the statistics we have listed below which currently relate to depressive illness. Statistics are notoriously difficult to read and should always be taken with a pinch of salt, but they are none the less an interesting indicator of the trend in depressive illness as a worldwide problem.

The findings may seem alarming, first because we are not used to seeing depression as a killer disease in the way we have been taught to regard cancer and heart disease in the Western industrialized world, and second because the diagnosis and treatment of depression still seem to be rather a hit-and-miss affair, with so many people undiagnosed, and others not responding to the treatment on offer, either because the drugs don't work, or they don't take them properly, or they cannot tolerate the unpleasant side effects of antidepressant medication.

• Approximately one in five people in Britain suffers from depression at some time in their life, but nearly two-thirds do not get help or treatment either because it is not recognized, or they are so disabled they cannot access help, or they are blamed for personal weakness or they are misdiagnosed and wrongly treated for a medical problem.

• As many as 2.9 million people in Britain are diagnosed as having depression at anyone time.

• Some 20 per cent of patients visiting their CPs have depressive symptoms, but nearly half of these may go unrecognized.

• In a recent survey, 23 per cent of the British public thought that a depressed person was dangerous to others.

• With diagnosis and appropriate treatment, over 50 per cent of depressed people can fed better within weeks.

• At least 30 per cent of people on antidepressants don't take their drugs properly, or prematurely discontinue their medication, often suddenly rather than gradually.

• More than half of the people who have had one episode of major depression will have another at some point.

• Suicide is the third leading cause of death among young people aged 15-24. Young men have the fastest rising suicide rate, up 85 per cent between 1980 and 1990. More than two young people commit suicide every day in Britain and lreland.

• Depressed men are more than twice as likely to develop coronary heart disease as their non-depressed counterparts.

Faced with these statistics, it seems vital that we finally get to grips with depression by being as informed as possible about the symptoms and progress of this difficult disease. The more understanding we have, the better the chances of removing the taboo that hangs over the condition, and the more likely that a climate will grow where depression sufferers no longer feel ashamed about their symptoms, allowing them to access the help they need. Especially now, when there is a real chance that their symptoms can be alleviated with a natural, side-effect- free alternative to antidepressant medication.

Defining Depression

Depression is a term med to describe a wide range of mood disorders that create psychological distress in the sufferer. The illness can ebb and flow, the severity of symptoms can be erratic, being sometimes mild, sometimes very bad, sometimes almost bearable for a while during which time the symptoms appear to recede then often returning even worse than before. It can last for just a few weeks, or for months and even years.

There are broadly two categories of depression: the reactive type, which comes on as a result of some external circumstance, such as the death of someone close to you, losing a job, divorce or chronic illness; and clinical depression, which is depression that is mainly biological in origin. The origins of clinical depression are still not clear, but Dr Puri's research throws new light on the doctors previously thought to trigger depressive illness. Within these two broad categories there are more specific classifications for depression which are used by doctors to facilitate diagnosis and treatment: mild, moderate and severe. The classifications are based on the number and degree of symptoms of which there are many present in a patient at anyone time. These are only guidelines, and many patients spill over from one category to another or progress from, say, moderate to severe depression. Few fit neatly into one classification and no depressions are identical.

As well as the type of depression and the degree to which the patient is suffering, there is often a context in which the person is depressed, such as those affected by seasonal light deprivation (SAD), postnatal depression and bipolar disorder, or manic depression.

What Does It Feel Like to Be Depressed?

As we said earlier, depressive illness is very different from the sort of low mood that you might experience when something difficult or unpleasant is happening in your life, or you are merely going through a boring, uneventful period where there seems to be nothing exciting to look forward to. These low moods are part of everyday life; it is not the human condition to be in a state of perpetual happiness, despite what some magazines would have you believe. But for most of us these low moods are fleeting, and can be easily dispelled by such strategies as talking the problem through with a friend or family member, finding a new job, a new relationship, or taking a break from routine. And a low mood still allows you to get enjoyment from simple things, like seeing your child laugh, or trying on a new pair of shoes. In fact you can 'snap out of' a low mood, you can even 'pull yourself together' if need be.

Depression is different. You might not even realize that you are depressed, because the feeling is so utterly alien to a normal mood, and can sneak up on you insidiously and without warning, changing your ability to see things clearly. You might feel bewildered, mad even, and blame your deep reluctance to get out of bed, or to do anything, or to speak to anyone, on the fact that you are undisciplined, weak and useless. You might convince yourself that you have a terminal disease which might explain your extreme symptoms. You might just think that the world as you know it has come to an end, and that no one else has noticed. You will almost undoubtedly feel hopeless, exhausted and ashamed. These feeling; as you can see, are not the feelings we so often get from a passing low mood.