Depression

Depression's exact cause is unknown, but various factors contribute:

• Genetic predisposition
• Chemical imbalances in the brain
• Traumatic or stressful life events
• Chronic illnesses
• Certain medications

Symptoms may vary but commonly include:

• Persistent sadness or hopelessness
• Loss of interest or pleasure in activities
• Sleep disturbances (insomnia or oversleeping)
• Fatigue and lack of energy
• Difficulty concentrating
• Changes in appetite and weight
• Feelings of guilt or worthlessness
• Suicidal thoughts or attempts

In Australia and around the world:

• Selective Serotonin Reuptake Inhibitors (SSRIs): Fluoxetine (Prozac), Sertraline (Zoloft)
• Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs): Venlafaxine (Effexor), Duloxetine (Cymbalta)
• Atypical Antidepressants: Bupropion (Wellbutrin), Mirtazapine (Remeron)
• Tricyclic Antidepressants: Amitriptyline (Elavil), Imipramine (Tofranil)
• Monoamine Oxidase Inhibitors (MAOIs): Phenelzine (Nardil)

• SSRIs: Nausea, insomnia, sexual dysfunction, weight gain
• SNRIs: Increased blood pressure, dry mouth, constipation
• Atypical Antidepressants: Seizures (Wellbutrin), weight gain (Mirtazapine)
• Tricyclics: Dry mouth, blurred vision, constipation, urinary retention
• MAOIs: Hypertension, dietary restrictions due to interaction with certain foods

Approximately 264 million people worldwide suffer from depression. 

In Australia, an estimated 1 million adults experience depression annually.

• Cognitive-Behavioral Therapy (CBT): Proven effectiveness for depression.
  • Reference: Hofmann SG, et al. Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials. The Journal of Clinical Psychiatry. 2008.
• Mindfulness-Based Cognitive Therapy (MBCT): Helps prevent recurrence in those with chronic depression.
  • Reference: Segal ZV, et al. Mindfulness-Based Cognitive Therapy for Depression, Second Edition. The Guilford Press. 2012.
• Exercise: Regular physical activity can improve mood and energy levels.
  • Reference: Cooney GM, et al. Exercise for depression. Cochrane Database of Systematic Reviews. 2013.
• Dietary Intervention: Nutrient-dense diets may positively impact mood.
  • Reference: Jacka FN, et al. Nutritional psychiatry: the present state of the evidence. Proceedings of the Nutrition Society. 2017.
• Herbal Remedies: St. John's Wort has some evidence of effectiveness but should be used with caution.
  • Reference: Linde K, et al. St John's wort for major depression. Cochrane Database of Systematic Reviews. 2008.

De-prescribing in depression requires caution, and often a gradual reduction of medication under professional guidance, along with complementary therapeutic support.

• Depression Relapse Prevention: Programs involving psychological support can help in medication reduction.
  • Reference: Bockting CL, et al. Continuation and maintenance use of antidepressants in recurrent depression. Psychotherapy and Psychosomatics. 2008. Link
• Integrated Care Models: Combining medical care with therapy and lifestyle interventions can be effective.
  • Reference: Archer J, et al. Collaborative care for depression and anxiety problems. Cochrane Database of Systematic Reviews. 2012. Link

Treating and managing depression requires a comprehensive approach that might include pharmacological treatments, therapy, lifestyle changes, and ongoing support. Careful consideration of de-prescribing must always be based on individual needs and performed under professional guidance.