Depression FAQ

What about premenstrual syndrome (PMS), menopause and depression?

Changes in the hormonal cycle of women have been linked to symptoms of depression. During the premenstrual stage, women can experience changeable moods, irritability, anxiety and sleep difficulties. For women with premenstrual tension, these symptoms may last for a few days and then go away. Symptoms of premenstrual syndrome are more severe and disrupt routine activities. During menopause, women must adjust to the effects of reduced levels of estrogen; hot flashes and profuse sweating may make it harder to function on a daily basis. Many women may also have to deal with other life events, such as children leaving home and aging spouses or parents. The physical and emotional stressors associated with menopause may contribute to the onset of depressive symptoms.

Can depression occur secondary to a physical illness?

In the medically ill, depression can occur in three different ways: as a result of another illness that shares the same symptoms (lupus or hypothyroidism); as a reaction to another illness (cancer or a heart attack); or caused by an illness where neurological changes have occurred (stroke).

Is depression treated differently in the elderly?

Generally, elderly patients are given lower dosages because they are more sensitive to medication, prone to confusion and may have more trouble tolerating side effects. Potential drug interactions must be considered, because elderly patients are often taking medication for other medical problems.

How do alcohol, street and prescription drugs influence depression?

Alcohol, street drugs and some prescription medications can provide a temporary break from some of the symptoms of depression; however, this simply masks and sometimes worsens the symptoms of depression. Depression can be triggered by abuse of alcohol and other drugs. Substance abuse can lead to further health problems and affect the ability to function.

Can people diagnosed with depression also suffer from anxiety?

Two-thirds of people with depression also struggle with anxiety (also known as apprehensive expectation, or excessive worry that is hard to control). The person may feel restless, tired, irritable, tense and have difficulty concentrating and sleeping. The combination of depressive and anxiety symptoms can severely impair a person's ability to function. If a person has symptoms of both depression and anxiety, a thorough assessment will determine which of the two is the primary problem and influence the course of treatment.

Why do so many depressed people choose to increase their isolation by avoiding other people?

Most depressed people want to be left alone. Symptoms of depression make social interaction difficult. Depressed people often feel guilty about being depressed, and assume their presence is intolerable to others. Often, this social isolation simply reinforces their depression. Part of recovery involves encouraging people with depression to gradually reintroduce themselves to social situations.

Should depressed people force themselves to continue with routines and activities?

Those who are mildly depressed but able to carry on with regular activities should do so. If you are severely depressed and physically and emotionally unable to carry on with your normal routine, treat the depression as you would a severe physical illness: set small goals each day and rest when your body needs it.

Can I return to normal after being depressed?

Most people are able to return to their previous level of functioning. For people who have suffered severe depression, recovery can be a much slower process. Setting small, achievable goals is an important first step in recovery. Develop a graduated plan for returning to work, school or volunteer activities.

What should I do if I feel suicidal or harming other people?

If you are contemplating harming yourself or others, tell your doctor immediately, call a local Distress Centre or visit the emergency department of the nearest hospital. It is important to talk to someone with an objective point of view.

Can I be kept in the hospital against my will if I am suicidal?

Most people who are suicidal recognize hospitalization as a way to stay safe until their mood stabilizes. However, if you do not recognize the need for professional help or want to harm yourself or others, you can be legally certified by a doctor and prevented from leaving until your safety is ensured. In most hospitals, patients may consult a rights advisor or have access to an appeal process to challenge this involuntary hospitalization.

Will I be completely well when I leave the hospital?

Most patients are kept in the hospital in order to get acute symptoms, such as suicidal thinking, under control. Follow-up treatment with medical professionals is then arranged. Because it is important for patients to resume normal routines, hospital stays are kept as brief as possible.

Can antidepressants interact with other medications?

Ask your doctor about potential drug interactions. If you are prescribed MAOIs, you should not take nasal decongestants, painkillers or other antidepressants. If you are taking blood pressure medication or are scheduled for surgery where you will receive an anesthetic, tell your doctor that you are on an MAOI.

What about medications and driving?

Ask your doctor whether your medication may cause drowsiness. Depression itself can lead to fatigue and concentration problems, affecting your ability to drive.

Do medications interact with caffeine?

Some MAOIs and SSRIs may have a mild interaction with coffee. Even if you are on a different class of medication, it is better to drink decaffeinated coffee and beverages. Caffeine itself can cause problems if you struggle with depression or anxiety. Depression disrupts sleep and caffeine can make the problem worse.

Are medications safe during pregnancy and while breastfeeding?

Each woman's situation is individual and should be discussed with her treating physician. Research has found newer antidepressants to be generally safe during pregnancy. Studies on the effects of older drugs are not as extensive, so prenatal risks are unknown. Anti-depressants are not necessarily contra-indicated while breastfeeding; the body filters out many impurities in breast milk, so only about 30 percent of medications can be detected. Given that an infant's organ systems are still immature, however, it may be wiser to bottle-feed the baby, or supplement breast milk with bottle-feeding. The issue of taking antidepressants while pregnant comes down to a risk-benefit analysis. If not taking an antidepressant during pregnancy means a high risk of relapse and a serious depressive episode, then the benefits of continuing to take medication may outweigh the risks. Women who feel uncomfortable remaining on medication may choose to be medication-free while monitoring their mood. This is an individual choice for each woman to make in consultation with her doctor.

What about medications and the treatment of depression during menopause?

Depression in menopause can be the result of both hormonal and psychological factors. Antidepressants can help to ease the symptoms of depression, and hormone replacement therapy may also be effective. Support groups and talk therapy can also help women to understand the changes taking place.
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