Ministry of Health Vanuatu April 2019 Mental Health Newsletter
What is Depression?
Approximately 1-in-5 people will experience Depression at some stage of their lives.
It is normal for people to experience short periods of sadness. Although some people may say that they are depressed if they feel sad at times, Depression, formally known as Major Depressive Disorder (MDD), is a psychological disorder of consistently lowered mood. Depression also comes with several physiological, cognitive and behavioural changes.
These changes include:
- lack of interest or pleasure in most activities
- loss of energy
- difficulties sleeping or sleeping too much
- feeling restless or slowed down physically
- increased or decreased appetite
- substantial weight gain or loss without intending to do so
- feelings of worthlessness
- excessive or inappropriate guilt
- concentration difficulties, and
- recurrent thoughts, plans or intentions towards death or suicide.
To meet criteria for Depression, an individual must have at least five of these symptoms most of the day, nearly every day for two consecutive weeks, and it must result in significant distress or functional impairment (American Psychiatric Association, 2013).
Potential Treatments for Depression
1. Antidepressant Medications:
Various antidepressant medications have been developed and prescribed over the years, including monoamine oxidase inhibitors (MAOIs), tricyclics antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), and more recently norepinephrine (SNRIs) and dopamine reuptake inhibitors and melatonin-based antidepressants. The most commonly prescribed antidepressants worldwide are SSRIs, however, only TCAs are currently available in Vanuatu. This medication is not recommended for children, and is only recommended for adults with moderate to severe depression.
2. Psychological Treatments:
Cognitive Behavioural Therapy (CBT) for Depression is a non-drug treatment that focuses on improving what people think and believe (including their expectations) and behavioural factors associated with depression. CBT has many studies supporting it as an effective treatment for Depression, with research showing comparable or greater effectiveness than treatment by medication, especially with milder forms of Depression (Butler et al., 2006).
Furthermore, CBT and antidepressants together can have additional benefits over either CBT or medication alone for severe Depression (Thase et al., 1997). Thus, effective treatment for severe cases of Depression may benefit from both medication and psychological interventions like CBT.
3. Self-Help Strategies:
Currently, the number of Medical and Allied Health staff trained in Mental Health treatments in Vanuatu is limited, especially outside of Port Vila. There are also various instances where individuals are unable to access or do not want to use any of the traditional treatments for Depression. This is where self-help strategies for Depression can potentially assist.
In 2009, Morgan and Jorm asked several Depression experts which strategies (out of 282 possible options) they thought would be most likely to be useful for individuals with sub-threshold Depression.
They came up with a final list of 25 self-help strategies that can be frequently used by people with Depression.
The 14 self-help strategies rated as most likely to be effective for Depression included:
- Make sure that you get out of the house for at least a short-time each day
- Eat a healthy, balanced diet
- Do something you enjoy
- Try to remain involved in purposeful activities for at least a small part of each day
- Engage in exercise or physical activity
- Make sure you get enough sleep at night and have a bedtime and rise time that varies little from day to day
- Engage in an activity that gives you a feeling of achievement
- Talk about problems or feelings with someone who is supportive and caring
- Let family and friends know how you are feeling, so they are aware of what you are going through
- Try methods to improve your sleep, such as not napping during the day, avoid caffeine and alcohol before bedtime, and make your bedroom as restful as possible
- Enlist a trusted friend or relative to help you get out and about or do activities
- Reward yourself for achieving a small goal
- Learn relaxation methods
- Make a list of strategies that have worked in the past for depression and use them
Seven strategies were rated by Depression experts to be less helpful but not likely to be harmful. These were:
- Take a nap
- Have a warm bath
- Take omega 3 fatty acids (fish oils)
- Get a massage
- Do yoga
- Take St John’s Wort
- Take antidepressants
Depression experts rated four self-help strategies as being potentially harmful for Depression. These were:
- Spend more time alone
- Drink alcohol
- Do something risky and exciting, such as driving a car too fast or under the influence of a substance
- Use illicit drugs, such as marijuana
A follow up study in 2012 by the same authors then compared what the Depression experts recommended to what individuals with Depression actually did.
By looking at their behaviour, individuals with Depression tend to isolate themselves way more than experts recommend, drink more alcohol than is valuable, and struggle to exercise, achieve things, talk to others, ask for help, and relax as much as they would like to.
What this means is that if you or a loved one has Depression, try out the first 14 self-help strategies listed above.
If they do not work or you are unable to do them, it may be important for you to seek extra help and support from someone that you trust or a qualified Mental Health professional such as a Mental Health Nurse or Psychologist. This is especially important if the Depression becomes severe and is affecting you or your loved one’s life at work, school or home
You do not have to suffer alone. For more information or advice, please contact:
Mind Care Clinic
VILA CENTRAL HOSPITAL
Mind Care Clinic
NORTHERN PROVINCIAL HOSPITAL
Mental Health Clinic
Mental Health Clinic
Dr Damon Ashworth