Depression is an extremely common condition that causes much suffering across the world. In any year around one in twenty people will suffer from depression and one in six people are said to suffer from depression at some point in their life: one in four women and one in ten men. Depression is a very treatable condition with two thirds of people with depression making a full recovery within three months with the right expert treatment but many people do not seek help for depression, possibly due to the stigma associated with accepting there is a problem or seeking treatment.
‘Depressive episode‘ and ‘depressive disorder‘ are technical terms popular among psychiatrists, defined by the World Health Organization in their International Classification of Disease manual, ICD-10. These terms are defined by a number of characteristic symptoms that must persist over a certain period of time or recur in a certain way. These ‘operational` definitions allow psychiatrists to determine quickly and easily whether a patient has depressive disorder or not, and lend themselves to research to determine what works and what does not work for treating depressive disorders.
Post natal depression is simply defined as a depression that occurs within the 1st year of a woman giving birth. It is extremely common, estimated to occur following 10% to 20% of all births. It is straightforward to identify and treat but in spite of this it remains woefully under treated in many countries possibly due to stigma and cultural beliefs. Treating post natal depression is important both for the mother and for the developing baby.
There are a large number of easily accessible screening tools to check for depression. Some of the best are simple questionnaires that patients can fill in themselves. Doctors use (or should use) operationally defined criteria such as those in ICD-10.
Depression is usually diagnosed by a doctor or psychiatrist after a review of the patient`s symptoms and a general health assessment. Occasionally physical causes for depression can be found such as metabolic, hormonal or infective causes, but more commonly the symptoms occur with no clear concurrent medical illness. For patients where a physical cause is suspected, or where the condition does not respond to treatment, blood tests, urine and saliva tests and occasionally brain imaging are necessary.
Depression treatment can be divided into 3 broad areas: biological treatments, psychological treatments, and ‘social’ or lifestyle interventions. Treatment for depression is also divided into short term treatment, or ‘acute phase’ treatment, and long term treatment, also known as ‘continuation’ then ‘maintenance’ treatment. This is because following recovery from depression there is a period where patients are at high risk of relapse and often require ongoing treatment to sustain their recovery.
Biological treatment refers mainly to psychiatric medication such as antidepressant therapy. The names of the most common antidepressant medicines are probably familiar to many people, but there is a wide range of medications with antidepressant effects, and they differ significantly in their side effect profile and tolerability. This means there is a lot of choice for someone who is seeking treatment. In fact, research studies like STAR*D showed how important it is to find the right antidepressant medication for each individual person.
Psychological treatment includes familiar approaches such as counseling and psychotherapy but also new evidence-based therapies such as cognitive behavioral therapy and interpersonal therapy. Most psychodynamic psychotherapy is based upon the work of famous 19th Century and early 20th Century figures such as Freud, Jung and Adler. The counselling movement is strongly linked to the work of Carl Rogers and his model of Client-Centred Counseling. Cognitive Therapy grew out of behavioural therapy from the 1960s and the cognitive revolution in psychology that followed. Many recently developed psychological treatments such as Acceptance and Commitment Therapy and Mindfulness Based Cognitive Therapy have included and integrated ideas of acceptance and mindfulness.
Social or lifestyle intervention refers to strategies such as exercise programs, breathing exercises, meditation, healthy eating, taking part in social activities, addressing lifestyle factors such as alcohol use, and social issues such as employment problems, carer stress, and financial debt.
If you think you are depressed, or have a post natal depression, you should seek further assessment and discuss what sort of treatment might be helpful with a doctor.
Come to see us at our psychiatry clinic at American Clinic Tokyo in Akasaka for assessment. Dr Andrew Kissane, our UK-trained, British psychiatrist is a native English speaker, and holds both UK and Japanese medical licenses.
If you do not wish to take a medical approach to your depression but just wish to explore a psychological approach, such as cognitive behavioral depression therapy or psychodynamic psychotherapy for depression, then please email us requesting a therapy assessment at our Ginza 1-chome office.
Easy access from Nambuko line, Ginza line and the Marunouchi line via Tameike-Sanno station – exit 13, 2 minutes walk
Parking available nearby
Easy access from Asakusa line, Ginza line, Yurakucho line, Hibiya line, and JR Yamanote line: