Winter-2014

Mental health issues are very commonplace in our society and they are on the rise. In fact, depression continues to be the fastest-growing diagnosis in Canada. According to the Centre for Addiction and Mental Health (CAMH), 1 in 5 people in Ontario experiences a mental health or addiction problem. Specifically 16% of adults will experience depression or anxiety at some point in their life, yet, sadly only 20% of those dealing with depression or anxiety will receive adequate treatment. Furthermore, the lifetime recurrence rate of major depression after one episode is 50%, after two episodes 70%, and after three episodes is 90% after three years if the depression is untreated. The reasons for not seeking help and for not getting appropriate treatment can be attributed to the stigma and misconceptions about depression. As with other mental health conditions, depression carries a stigma. To encourage people to seek help, many recent campaigns about depression have been successful in helping debunk

There are several common misconceptions about depression. Many people think that depression is ‘just temporary’ and that a depressed person can ‘just snap out of it’. Unfortunately, depression can be chronic and very debilitating. It is a complex condition that requires treatment and support. Next, depression as being a ‘sign of weakness’ is a pervasive stigma that should be addressed. Depression is unrelated to the strength of someone’s character; again, it is a serious medical condition like asthma or diabetes. Interestingly, the pharmacological approach to treating depression is also a misconception. Many people think that antidepressant medication does more harm than good because of their side effects but on the flipside, many also think that a pill will cure depression entirely! Although antidepressants do have side effects such as: dry mouth, weight gain, insomnia, and sedation, to name a few, there are several different classifications of antidepressants that can be used to help minimize the side effects. Keep in mind that all drugs have side effects so antidepressants are no exception to the rule. Unfortunately, some people come off anti-depressants because of their unpleasant side effects before its full benefit can be achieved, which often takes 4-8 weeks. That being said, although antidepressants are effective, depression’s complexity warrants other supportive measures, such as counseling. Fortunately, there are treatment options for depression. For mild depression, depending on the patient’s preference, one can consider psychotherapy/counseling (such as Cognitive Behaviour Therapy/CBT) alone, medication alone, or a combination medication and counseling. However, for moderate to severe depression, antidepressant medication (ideally with counseling) is recommended. For other types of depression such as psychotic depression, other types of medications and treatments are highly required. The choice of specific antidepressant is determined by anticipated side-effect profile, safety and tolerability, patient preference, and cost. There are several classifications of antidepressants including Selective serotonin-reuptake inhibitors (SSRIs), Selective norepinephrine-reuptake inhibitators (SNRIs), Monoamine Oxidase Inhibitors (MAOIs), and Tricyclics (TCAs). Medications are often started at a low dose and increased to a full dosage within the first few weeks of initiation of medication and if there is no significant improvement after 6 weeks, the medication regimen is altered. Monitoring for severe or adverse side effects is also an important part of medication management. In conjunction with medication or as a treatment option alone, there are many forms of counseling available for depression. Psychoanalysis, Solution Focused Brief Therapy (SFBT), and Cognitive Behaviour