Depression: recognising it and getting through it

People expect depression to look like crying and sadness. Often it does not. It frequently shows up as flatness — nothing feels like anything, good or bad — or as irritability, exhaustion and an inability to start things.

• Low mood, or a numbness where feeling used to be, most of the day and most days.
• Losing interest or pleasure in things you used to enjoy. This one is particularly telling.
• Sleeping far more or far less than usual, and waking in the early hours unable to get back to sleep.
• Appetite and weight changing noticeably in either direction.
• Fatigue that rest does not fix.
• Difficulty concentrating, remembering, or making even small decisions.
• Feelings of worthlessness or guilt that are out of proportion.
• Thoughts of death, or that people would be better off without you.

Depression also shows up physically — headaches, stomach problems, body pain with no clear cause. In many South African settings people present to a clinic with these physical complaints rather than mood, which is a completely normal way for depression to arrive.

• ambulance10177Emergency Medical Services
• local_police10111South African Police Service
• sos112Universal Emergency (mobile)
• psychology0800 029 999SADAG Mental Health Crisis Line
• science0861 554 911Poisons Information Helpline

Depression responds well to treatment. Talking therapy, medication, or both together are all effective, and which one to start with depends on severity, on what is available to you and on what you would actually engage with.

Antidepressants such as fluoxetine (Prozac), sertraline (Zoloft) and escitalopram (Cipralex) are commonly used first. There are several practical things worth knowing before you start.

• They take time. Two to four weeks before much shifts, six to eight for full effect. The first fortnight can feel like nothing is happening.
• Side effects usually come before benefits — nausea, headache, disturbed sleep in the first week or two, often settling.
• Energy sometimes returns before mood does, which is a period to be aware of and to have support around.
• They are usually continued for months after you feel well. Stopping as soon as you improve is the most common reason depression returns.
• They are tapered, not stopped suddenly.

None of this replaces treatment for moderate or severe depression, and being told to exercise when you cannot get out of bed is unhelpful. But when you have a little capacity, these are the things with real evidence behind them.

• Do one small thing, then another. Depression removes motivation, and waiting to feel motivated before acting is a trap — action usually comes first and motivation follows.
• Keep sleep and wake times regular, even on bad days.
• Get outside in daylight early in the day.
• Movement, at whatever scale is possible. A short walk counts.
• Stay in contact with people even when you do not want to. Withdrawal deepens it.
• Be careful with alcohol. It is a depressant and it interferes with treatment.