The evidence is bleak: more women are unhappy than ever before. There’s still a lot we don’t understand about depression, but we do know that when the treatment fits the patient, it can lighten – and even save – lives.

Description: “It’s the psychological equivalent of the common cold,”

“It’s the psychological equivalent of the common cold,” says Joburg psychologist Amber Mahony, though she certainly doesn’t mean it lightly.

The World Health Organization (WHO) estimates that in developing countries, like South Africa, as many as one in five people with access to healthcare suffer from depression. It seems this figure is on the rise.

Linked to everything from the pressures and pace of modern life to – more recently – the flailing global economy (“recession depression”), the condition is heavy with stigma and sticky controversy. What we do know, however is that women are twice as susceptible as men.

One recent study, from the University of Pennsulvania’s Wharton School shows that something’s been eating at our sense of satisfaction since the 1970. The worst part? While theories abound, researchers can’t say sure why this is the case.

Women are generally more ready to admit they're not coping," offers Zane Wilson, founder of the South African Depression and Anxiety Group (SADAG).

"This adds to the perception that depression is a ‘women's illness’. But it's more than that. Female hormones can significantly affect mood patterns. Women also juggle many, sometimes clashing, roles — caregiver, professional, homemaker — leaving them little or no time for themselves or their own health."

“Depression is a complex interaction of psychological, environmental and biological factors,” explains Cape Town clinical psychologist Denise Grobbelaar. “Medication is often vital initially, but using medication alone is akin to putting a plaster on a festering wound without treating the underlying cause.”

We asked the experts to outline the major themes and devise a plan of action.

Happy pills

Description: Happy pills

Antidepressants have long been the cause of controversy, which has done nothing to dent their ever increasing popularity. For the most, debate has focused on their side effects and the risk of over-prescription.

Then, in 2010, the Journal of the American Health Association published an article (“Antidepressants drug effects and depression severity”) that shifted the discussion. The paper, which whipped up something of media frenzy, suggested that most people taking antidepressants would fare no better on sugar pills.

To be clear (and many spin-off reports were not), the authors concluded that drugs do seem to be effective in cases of severe depression. But most of the people who take antidepressants don’t qualify as severely depressed, which could mean millions of people are tolerating loathsome side effects, at considerable expense, for no good reason. Only, it’s not quite so straightforward...

Wilson notes that the placebo effect is a factor in all clinical research. As such, it isn't reason enough to write off the drugs.

It's certainly no reason to bin the contents of your medicine cabinet. "For illnesses like bipolar and schizophrenia, medication is essential," says Wilson. "While not everyone reacts the same, people do get better on treatment. When people feel they're being listened to and taken seriously, their symptoms often improve."

Simply put, there's no reliable way of untangling the effectiveness of the drugs from the relief that comes when a professional takes your pain seriously. It's an issue that scientists are likely to grapple with for decades to come.

"I've been on and off antidepressants since I was 16," says Kim*, 29, a law student from Durban. "When I first read about the 'Prozac myth' — that I could just as well have been taking jelly beans all this time — I got really angry. Am I supposed to believe that I've imagined the improvement in my symptoms? This, even when no other treatment — everything from extensive psychotherapy to hypnosis – has had such clear results?

"I find it impossible to believe that this is all in my head. And if it is, I don't care... Bring on the jelly beans, if that's how well they work!"

Geneye Starling, 35, a health-store owner from Pietermaritzburg, took her first course of antidepressants when she was 17. She's been off and on them ever since.

"The last time I took them was in March last year, for about six months. The side effects were gruesome. For the first week, I felt paranoid and my body trembled constantly; I was nauseous and couldn't eat. At about 10 to 14 days, I started feeling fantastic. This lasted for about three months until I felt like I needed to up my dose and I started gaining weight rapidly.

"I'm still unsure if I'd go on them again. If I was desperate enough, I probably would... In my experience, GPs are very quick to medicate and not very open to, or knowledgeable about, the alternatives."

"Antidepressants are, in my opinion, only helpful for severe depression and then only in conjunction with psycho-therapy and lifestyle treatment. Where appropriate, more natural and conservative options should be considered first."

Of course, few react quite as strongly as Gen eye. For some, the side effects barely register. Most subside within six weeks and the dose can be built up gradually to allow the body to adjust. If the symptoms do persist, decreasing the dose or switching to a different medication might do the trick. For someone in the depths of despair, this might seem like an exhausting prospect without guarantees. But the right formula can be life-changing, says Wilson. "Often, someone who's very depressed doesn't have the energy or concentration necessary for psycho-therapy. They need to stabilize their symptoms before they can then focus on other treatment."

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