DEPRESSION - Part 2

Hickie stresses that physiology and biology are closely linked in depression.

"Poor physical health and poor mental health tend to go together," he said.

"There is also feedback between mood on the one hand and hormones and the immune system on the other. In addition, there is evidence that long term depression can also actually change The structure of the brain. Depression also has a sociological dimention." Hickie said.

"Social disconnection is a risk factor for depression, particularly in young people. Young people need access to a whole bunch of functioning adult role models. The community bonds are much weaker nowadays people are reluctant to leave their kids alone with a sports coach or a minister.

"But children and adolescents need guidance from lots of different adults if they are to develop into mature adults who can cope with the world."

While rates of depression have gone down among the elderly due largely to reduced smoking, better diets and improvements in medical care the incidence of depression among young is continually rising." Hickie said.

"Depression has been increasing in every decade since World War 11," he said.

"People born in the 1960s have higher rates than people born in the 50s did at the same age. People born in the 70s have higher rates than people born in the 60s. The 80s are worse than the 70s, and so on."

Young people are also more prone to obesity and less likely to exercise than in the past. They binge drink more and are more likely to abuse cannabis, amphetamines and the other that have been linked to depression, rates are already markedly higher among the young.

However, head of physiological medicine at the Adelaide Women and Children's Hospital Jon Jureidini argues that clinical depression is over-diagnosed and drugs are too often used as the first resort when other treatments would be more appropriate.

Dr Jureidini is concerned that the diagnosis and treatment of depression is being driven too much by the availability of drugs.

"Depression used to regarded as relatively rare, but as drugs have become available it is being more commonly diagnosed," he said.

"There are cases when extreme sadness and all the emotional and physical symptoms associated with clinical depression can be best explained by something bad having happened to a person, for instance bereavement.

"In such cases you will help that person more by addressing the cause of their symptoms through psychological therapy rather than by giving them drugs designed to treat clinical depression. Our first line should be to try to understand the meaning of what people are going through rather than just categorising it as an illness."

He says doctors should try to recognise when depressive symptoms are linked to grieving or stress over specific events and are likely to be temporary. In such cases no treatment may be necessary.

When treatment is appropriate, psychotherapy should be the first line of treatment according to Jureidini. Such therapy can not only treat depression but can also help patients develop better coping mechanisms and make other helpful changes in their lives.

Jureidini says drugs do help some people and will always be necessary for some people, but if they must be used they should be an interim measure, given as part of a rehabilitation approach.

"There should be two phases of responding to distress," he said.
By James Charles

Click here for Part 3