Depression is a common disease in our society today, but is under diagnosed and often under treated in many instances. When doctors talk about depression they usually mean major depression which affects about 5% of the population at any given time. Major depression not only has an economic cost on the island, but also has an indirect cost reflected in loss productivity, absenteeism and death due to suicide.

By: Dr. Brett Hodge

What is major depression?
Someone with major depression has symptoms nearly everyday, all day, for 2 weeks or longer. Symptoms may include the following:
• Feeling sad or empty
• Feeling numb emotionally
• No interest or pleasure in things one used to enjoy
• Crying easily or crying for no reason
• Feeling worthless or guilty
• Trouble thinking, recalling things or focusing on what you are doing
• Trouble making everyday decisions
• Problems sleeping, especially in the early morning, or wanting to sleep all the time
• Thoughts about death or suicide
• Feel confused
• Problems with sex

How common is depression?
The exact number of cases of depression in Anguilla is not known, but it is felt that this disorder is under diagnosed as many individuals fail to seek professional help due to fear of stigmatization.
It is estimated that over a course of a lifetime, some 30% of adults will suffer from depression and when left untreated 25-30% of these patients will commit suicide. Depression is commonly thought of as a disorder of young and middle adulthood. With an average age of onset in the late 20’s, depression is increasingly recognized as a common problem in the elderly.

What causes depression?
The cause of depression is not fully understood at this time. Depression seems to be related to a chemical imbalance in the brain that makes it hard for the cells to communicate with one another.
Subgroups of depressed individuals have been found to have reduced concentrations of serotonin or alterations in serotonin receptors. Depression also seems to be genetic (to run in families).
Depression is not caused by personal weakness, laziness or lack of willpower.
In some individuals depression might be triggered by an event like a divorce, death of a close one and abusing drugs or alcohol.

How is depression diagnosed?
If you have any of the symptoms mentioned above please tell your doctor. If you have a relative or friend with symptoms suggestive of major depression, try to arrange professional help, because many individuals with depression are reluctant to see a doctor and might need some encouragement. There is no single test to diagnose depression but after a detailed history and physical examination, and some tests, your doctor should be able to make the diagnosis or refer you to a specialist for further evaluation.

How is depression treated?
Depression can be treated with medications or a special type of counseling called psychotherapy, or with both. There are many antidepressants available and your doctor will discuss with you which one is best for you. How long you should take these medications will depend on your depression. Your doctor may want you to take these medications for 4 to 6 months or longer.
Physical activity seems to cause a chemical reaction in the body that may improve your mood. Regular exercise has many benefits including helping with depression.

Suicide
Individuals with depression sometimes think about suicide. This thinking is part of depression. If you have thoughts about hurting yourself please tell your doctor, relatives or friends. All thoughts about suicide or hurting oneself should be taken seriously and professional help is needed urgently.

Conclusion
Depression is a common disorder in Anguilla and many individuals are believed to be under diagnosed and under treated. The symptoms of depression might vary from one individual to another but individuals with symptoms suggestive of depression should seek professional help as the vast majority of cases of depression can be successfully treated. Left untreated depression can lasts for weeks, months or even years. The main risk of not getting treatment is suicide. Treatment of depression is available in Anguilla. Early treatment helps depression from getting worse or lasting longer. If you or a relative or friend have symptoms of major depression please get professional help.

Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. Dr. Brett Hodge is an obstetrician/gynaecologist and family doctor who has over twenty years in clinical practice. Dr. Hodge has a medical practice in the Johnson Building in The Valley.

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