Everything you need to know about depression

Everyone gets sad sometimes. It’s all part of being human. But if you're one of the 10 million Canadians with true depression, you know the difference. Today, promising treatments are revolutionizing the course of this potentially devastating illness.

For generations, depression was stigmatized as a personal weakness. Even friends would exhort the sufferer to "snap out of it." Then, in the 1980s, scientists started using cutting-edge imaging techniques to take a closer look at what happens in the brain when a person feels depressed. They found that the condition has a lot more to do with brain chemistry and genetics than it does with willpower.

• When you're fine with the world and not feeling depressed, plentiful stores of neurotransmitters zip effortlessly around your brain. They leap critical gaps between the brain’s millions of nerve cells and keep communication flowing. When you're depressed, this easy interchange breaks down.
• The key mood neurotransmitters — chemicals such as serotonin, norepinephrine and dopamine — become unbalanced, and neurons then have problems conducting impulses back and forth.

Depression can take many forms, and its causes are complex.

• In some people underlying brain chemistry is all-important, and in others a single upsetting event can trigger a downward spiral, but in most people it’s a complex interaction of internal chemical imbalances and external factors.
• Generally, you will be formally di­a­g­nosed with depression after you've had at least two consecutive weeks of sadness, sleeplessness, poor appetite and concentration, or a loss of interest in normally pleasurable activities.
• More severe forms of clinical depression can be acutely distressing and debilitating, with symptoms lasting for months, even years.

• Antidepressants to correct brain chemistry imbalances and improve mood.
• Psychotherapy to unveil and help you cope with sources of your depression.
• For severe depression, shock therapy (ECT) to dramatically reset brain function.

• Steel yourself for a search. The odds that the first anti­depressant you take will lift your depression are only 65 percent. So don't be surprised if you have to try a few before settling on one (or a combo). The good news: increasingly sophisticated antidepressants are becoming available.
• Investigate what’s worked for family members. If a parent or other close relative with depression improved by taking a certain antidepressant, mention this to your doctor. Often the same drug will work best for you, too.
• Tell your doctor about herbs you take. Many herbs and supplements interact with prescription antidepressants.
• Stick with it. The longer you stay in treatment — medications or therapy — the less likely you are to endure another depressive episode.
• Ignore drug company ads. Try as they might to convince you otherwise, there’s no good evidence that one SSRI antidepressant is superior at easing depression. So says a 2001 research study.
• Write a list of questions for a prospective therapist: What kind of experience do you have? How will you treat me? What will this approach do to help me? Are there any risks?
• Take suicidal feelings seriously. This is an emergency. Talk to someone. Call your doctor. Go to the hospital. Sign a contract promising not to hurt yourself. Have guns removed from your home. And don't drive.

• Friends, family or your primary-care doctor may be able to recommend a good therapist.
• The Canadian Mental Health Association maintains a comprehensive website on mental health and well-being, with the latest research, practical tests and online publications (416-484-7750 or www.cmha.ca).
• For additional information about depression online, log on to the Mental Health Support Network of Canada (www.cma.ca).

Depression is a serious illness, not to be taken lightly. Keep this guide in mind and contact your doctor for more treatment options.