Lundbeck South Africa (Pty) Ltd.252 Montrose Avenue, North Riding 2194PO Box 2171, North Riding 2162Telephone +27 11 699 1600Facsimile +27 11 795 2252

Depression is a common illness that affects many people through-

out the world. About 10-15% of the population will suffer from

depression during their lifetime, and it occurs more frequently in

women and the elderly. A number of treatments are, however,

available for depression, and it can be successfully treated in the

majority of people.

No doubt you are already familiar with at least some of the

symptoms of depression, and have experienced its debilitating effects

on your life.

This booklet contains information about the causes of depression

and its treatment, to help you and your family and friends to under-

stand your illness. By knowing more about the disorder you will be

able to get maximum benefit from your treatment.

1

Depression is an illness that can seriously impair all aspects of a

person’s life, including personal relationships, performance at work

and enjoyment of leisure activities.

One of the features of depression which can make it difficult to

diagnose, is that no two people will have exactly the same symptoms

associated with the illness. A number of symptoms are, however,

commonly seen:

� irritability

� feelings of guilt and/or helplessness

� feelings of anxiety

� inability to concentrate or make decisions

� reduced appetite

� loss of interest in personal appearance

� loss of interest in favourite activities

� difficulty in sleeping (either in falling asleep when first going to

bed, or waking during the night and being unable to get back to

sleep)

� difficulty getting up in the morning

� constant feelings of tiredness/lack of energy

� changes in weight

� physical symptoms, such as headache or backache.

These symptoms will, typically, develop over a period of several

weeks or months, and several will be present at the same time.

There are many myths and misconceptions about depression. It

is important to know that depression is not:� just feeling ‘a bit down’

- depression has a profound effect on your everyday life

� a sign of weakness

- depression is ultimately caused by an imbalance of special

chemical substances in the brain, called transmitters, though

personality and life events resulting in stress may have contributed

to the imbalance

� a ‘punishment’ because you are a bad person

- depression is an illness that can affect anyone

� something to feel guilty about

-remember, it is not your fault.

Many people think that depression will go away if the sufferer

just makes an effort to think positively or to go out and enjoy him

or herself. Unfortunately, they do not understand that depression

is an illness that requires specific treatment, just as every other illness

does. This lack of understanding can itself make the depressed person

feel even more helpless and isolated. It also means that people with

depression are often reluctant to tell their friends and colleagues

about their condition.

Sometimes, people become depressed following a particularly

stressful period in their lives, such as the death of a close relative or

friend, or after losing their job, and there is evidence that some

people inherit an increased risk of becoming depressed.

Fortunately, a number of effective medicines and psychological

interventions are available to treat depression, and the illness can be

successfully treated in the majority of people. By visiting your doctor

and having your depression diagnosed, you have already taken the

first step on the road to recovery. Read on to see how you can get

the most from your treatment.

3

Treating depression

4

Effective treatment of depression usually requires a combination of

medication and counselling or psychotherapy.

A large number of effective medicines are available for the treatment

of depression, but they can be subdivided into four main categories:

� monoamine oxidase inhibitors (MAOIs)

� tricyclic antidepressants (TCAs)

� selective serotonin re-uptake inhibitors (SSRIs)

� serotonin-norepinephrine re-uptake inhibitors (SNRIs).

Your doctor will have given careful consideration to choosing the

individual medication that will be the most appropriate for your

treatment.

It is important to realise that antidepressants do not act immediately,

in the way that, for example, antibiotics do. It may take about 4-6

weeks of treatment

before you will notice a

significant improvement in

your symptoms. In addition,

you will have to continue

taking your medication

for 6-12 months or possibly

longer, to ensure your

recovery is complete.

Professional healthcare workers, including your general practitioner

(GP), a counsellor or psychotherapist or a psychiatrist, will be involved

in/with your treatment but you are also an important member of your

care team.

The most important thing you can do is to remember to take your

medication regularly, following the directions from your doctor.

Antidepressants can, however, produce a range of side-effects, including

dry mouth, blurred vision and altered bowel function (diarrhoea or

constipation). If any of these are a particular problem, or if you think

you have developed any other symptoms as a result of your medication,

do not stop taking your medicine, but tell you doctor as soon as

possible about your symptoms. He or she can then decide upon the

most appropriate action to take (e.g. reducing the

dosage, switching to a different product).

Even if you are feeling much better, you should

continue to take your medication and attend regular

follow-up consultations with your doctor. At these visits

you can discuss the ways in which your symptoms have

changed and assess the effectiveness of your treatment.

It is important that you discuss honestly all your feelings and

concerns with your doctor or counsellor. They will not be shocked if

you tell them, for example, that you have had thoughts about suicide,

as these are not unusual in people with depression. There are no

physical measurements, such as temperature or blood pressure, which

give the doctor any clue about your symptoms of depression. Only

you know how you are feeling, and the doctor and counsellor need

this information to ensure that you receive the most effective treatment.

5

Your GP will make the initial diagnosis of depression, and will start

treatment with one of the antidepressant drugs. The choice of

medication will be influenced by the particular types of symptoms

that you have described, the side-effects of the different medication

available, and also your GP’s knowledge of other aspects of your

health (e.g. whether you are already taking medication for another

condition).

It is important that you take your medication regularly, and that you

discuss any concerns about your illness or its treatment with your GP.

6

It is only by knowing exactly what your

needs and concerns are that your GP can

ensure that you will receive the most

effective treatment.

Your GP may provide you with

counselling or you may be referred to a

specialist counsellor. Your GP may also

refer you to other healthcare professionals,

such as a psychotherapist or a psychiatrist,

depending upon your symptoms and your

response to treatment.

Your doctor will want to see you

regularly throughout your treatment.

During these consultations you may:

� discuss how you are feeling and whether

your symptoms are improving

� review any problems you may have as

a result of side-effects of your

medication

� consider whether any changes in your

treatment are needed

� discuss any other concerns that you

may have about your illness or its

treatment, including aspects of your

life that may be influencing your

response to treatment

What your counsellorcan do

Many people with depression find that a course of counselling can

help them to identify why they have become depressed. Counselling,

used in addition to antidepressants, is an important part of the

treatment of depression. Counselling will help your recovery and

reduce the chances of the illness coming back.

Just as no two people have exactly the same symptoms of depression,

their needs for counselling will also differ. Your counsellor will want

to build up a detailed picture of your life, including information

about your employment and your family, as well as your symptoms

of depression and how they started. This will help him or her to

decide upon the most appropriate counselling approach for you.

9

Counselling may take many different forms. For example, someone

who has become depressed following the death of a loved one may

need help to come to terms with their feelings of loss and grief, while

someone with feelings of anxiety may be taught relaxation techniques.

Contrary to what many people believe, counselling is not always

a ‘soft option’. It can often be difficult to admit to some of the

feelings you may be experiencing, or to relieve a past trauma.

However, many people find that they feel better once they have

discussed these things. It is important that you attend your counselling

sessions regularly so that you can work through such experiences

together with your counsellor, helping you to recover as quickly as

possible from your illness.

Depression can be a difficult illness for your family and friends

to understand. It is confusing and distressing for them to see someone

they love become withdrawn and irritable, and show no interest in

activities that he or she previously enjoyed. If they do not realise

that you are ill, they may feel hurt or rejected when you refuse their

invitation to join in social activities.

It is important for your family and friends to understand that

depression is a serious illness, but that it can be treated successfully.

They also need to be aware that it take some time for you to make

a full recovery and that, contrary to popular belief, depression is not

something that you can just ‘snap out of ’.

If you have difficulty talking about your illness to family and

friends, you may decide that you would like your doctor to explain

your condition and its treatment to them. Once they understand

the nature of your illness, your family and friends can help by

reminding you to take your medication and encouraging you to go

to your counselling sessions. As you begin to recover, you will want

to start building up your social activities again, but your friends

should realise that you need to do things at your own speed, and

should not feel hurt if you turn down some of their invitations.

They will understand this better if you talk to them openly about

your illness and the way you feel.

Depending upon the nature of your symptoms and their response

to treatment, your GP may decide to refer you to another healthcare

specialist, such as a psychotherapist or a psychiatrist.

A psychotherapist will work with you to identify particular areas

in your life that may have contributed to the development of your

depression. He or she will then help you to address these problems,

possibly by learning new patterns of behaviour, or by confronting

specific fears or anxieties.

You should not be alarmed if your are referred to a psychiatrist.

Just as your GP would refer you to a cardiologist if you had heart

disease, he or she may decide that you would benefit from treatment

by someone who specialises in the care of people with mental illnesses.

As a specialist, the psychiatrist will have access to a wider range of

treatment options than are available to your GP.

Some people find it helpful to talk to others with depression. It can

be reassuring to know that you are not the only person to experience

the feelings of hopelessness that have troubled you recently. You can

also exchange ideas about techniques that can help you to feel better

about yourself during your treatment.

Your doctor or counsellor should be able to provide contact

details for self-help groups in your area, if you are interested in

joining such a group.

If you have access to the Internet, you will find that there are a

number of sites devoted to depression. Many of these have been

developed by people with depression, and they may provide you

with useful information about your illness and helpful hints on how

to manage it.

For further information on depression visit:www.depnet.co.zawww.lundbeck.comwww.firstsupport.co.zaSADAGSouth African Depression and Anxiety Support Group:Tel: 0800 567 567www.sadag.orgAlzheimer’s/Dementia Support Services:Alzheimer’s SA:Help Line 0860 102 681National office 011 478 2234www.alzheimers.org.zaDementia SA:021 421 0077/8021 418 5888E-mail: info@dementiasa.orgwww.dementiasa.orgParkinson’s Disease:Parkinson Association011 787 8792www.parkinsons.co.za

Use this page to fill in useful addresses and telephone numbers. For

example, you may like to include your doctor, counsellor and support

group. You could also include appropriate Internet addresses.

Name _______________________________________________

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Name _______________________________________________

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Conversion of Raw Scores to SDS Index(Index = Raw Score Total x 100)

Maximum Score of 80Raw SDS RAW SDS Raw SDSScore Index Score Index Score Index

20 25 40 50 60 7521 26 41 51 61 7622 28 42 53 62 7823 29 43 54 63 7924 30 44 55 64 8025 31 45 56 65 8126 33 46 58 66 8327 34 47 59 67 8428 35 48 60 68 8529 36 49 61 69 8630 38 50 63 70 8831 39 51 64 71 8932 40 52 65 72 9033 41 53 66 73 9134 43 54 68 74 9235 44 55 69 75 9436 45 56 70 76 9537 46 57 71 77 9638 48 58 73 78 9839 49 59 74 79 99

80 100

The SDS Index can be interpreted as follows:

SDS Index Equivalent Clinical Global Impressions

Below 50 Within normal range, no psychopathology

50-59 Presence of minimal to mild depression

60-69 Presence of moderate to marked depression

70 and over Presence of severe to extreme depression

© W.W.W. Zung, 1974, 1989

The mySupport Programme:There for you during yourrecovery from anxietyand depression

Everybody needs supportduring difficult times

Ask your doctor about the mySupport programmeand get connected

Major sponsor of the SA Depression and Anxiety Support Group (SADAG) Tel: 0800 567 567. www.sadag.org

Brought to you by Lundbeck in the interest ofpatient well-being

The mySupport programme is an online, confidential, secure, anxiety anddepression support programme with the following benefits:

Information :

Health library on depression and anxiety

Podcasts eg: what to expect from antidepressants

Ask the expert – disease related questions

Monthly professionally qualified guest speakers on various topics

Videos on different psychiatric disorders

Self rating scales to monitor your progress

Support :

Forum to share thoughts

Coping tips e.g.: diet, exercise

Appointment reminders

Go to www.firstsupport.co.za to see all thebenefits of the mySupport programme

MO/09/11

Lundbeck South Africa (Pty) Ltd.252 Montrose Avenue, North Riding 2194PO Box 2171, North Riding 2162Telephone +27 11 699 1600Facsimile +27 11 795 2252