Scientists have discovered a link between disturbed circadian rhythms and depression and it could all be down to re-setting the body’s internal clock which makes us sleep at night and be awake in the day.

Circadian rhythms are physical, mental and behavioural changes that follow a 24-hour cycle. Our master biological clock in the brain governs our circadian rhythms or biorhythms, which are affected by environmental signals such as eating and drinking patterns, social interactions and stress, among others. They are also responsible for the regulation functions such as body temperature, hormone release, variations in mood, energy and alertness.

Recent research has linked the dysfunction of biorhythms to the symptoms of depression, including disturbed sleep-wake cycles, daytime mood swings and changes in the intensity of the depressed mood. In fact, research has shown that the more “out of synch” a patient's circadian rhythms are, the more severe their depression.

Current treatments of depression generally focus on controlling the brain’s chemical pathways and increasing the activity and availability of these chemicals or neurotransmitters. But a drug that re-synchronises the body’s circadian rhythms is on the way and will be in South Africa in the next few months.

Psychiatrist Dr Franco Colin says nobody should underestimate the severity of depression, which he describes as an “illness of the brain”, one that is severe, recurrent and disrupts the patient’s life.

“Depression is serious and it can become chronic,” he said at a briefing in Johannesburg .

“People who have depression are three times more likely to die if they have a heart attack than those who do not have depression. It is a ‘whole body’ disease. Depression also damages the brain on a physical level, increases cardiovascular risk, impairs the immune system and affects relationships. If you were to leave depression untreated for 40 or 50 years, you would end up in an Alzheimer’s-like state.”

The new drug, agomelatine, has been widely prescribed in Europe for several years and tested on a small number of patients in South Africa, with success.

It has the potential to establish a new approach to the treatment of the condition, says Colin.

Psychiatrist Dr Rykie Liebenberg says she has prescribed the drug to several patients with success, and a big plus is that there are fewer side effects than with many of the current drugs in use to treat depression.

“Adherence to treatment is often a problem and patients stop taking medication because they cannot bear the side effects like nausea, weight gain, sexual dysfunction and disrupted sleep patterns. Patients report few side effects with this drug.”

Another plus is that patients have reported an improvement in symptoms, as early as in one week in some symptoms. You can take it in conjunction with other therapies too, under guidance of your doctor.

Liebenberg points out that depression will only occur in genetically predisposed people and that is also why not everybody who is stressed or bereaved will become clinically depressed.

Agomelatine is suitable for all depressed patients, not just the ones with sleep disturbances. Many rhythms are disturbed in depression – energy, libido, appetite, diurnal mood variation, to name a few – and sleep is only one of them.

Colin stresses that drug therapy is only one component in the treatment of depression and a holistic approach needs to be taken. Other treatments include psychotherapy, family and couples therapy, occupational rehabilitation (helping the patient get back to work), supplements (folic acid has been shown to increase effectiveness of anti-depressants) and in some cases electro-convulsive therapy.”

Forget what you saw in the Jack Nicolson movie One Flew Over the Cuckoo's Nest.

“Treatments today are far more refined and, when used correctly, for the right patient, it is a good therapy,” he says.

Symptoms

Not everyone who is depressed experiences every symptom listed. Some people experience a few symptoms, some people experience many. Also, the severity varies between individuals.

Symptoms include:

* Persistent sad, or “empty” mood.

* Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex.

* Feelings of hopelessness.

* Feelings of guilt, worthlessness, helplessness and self-reproach.

* Insomnia or hypersomnia, early morning awakening, or oversleeping.

* Appetite and/or weight loss or overeating and weight gain.

* Decreased energy and feeling run down.

* Increased use of alcohol and drugs, may be associated but not a criteria for diagnosis.

* Thoughts of death or suicide; suicide attempts.

* Restlessness, irritability, hostility.

* Difficulty concentrating, remembering, making decisions.

* Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, chronic pain.

* Deterioration of social relationships.

Depression by numbers

The average age of onset is 45, with women of childbearing age outnumbering men by two to one. After menopause the incidence in men and women is the same.

The average number of depressive episodes experienced by sufferers over a lifetime is four. Studies show that people with depression spend one-fifth of their lives in a depressed state. One in three people recover with current treatment and one in eight will have a lifetime of chronic depression.

Self-help for depression

* Make sure to get out of bed and dress every day – even if you are not doing anything. Staying in bed all day will make you feel worse.

* Get adequate sleep.

Avoid non-prescription sleeping pills or alcohol, because they can make your sleep restless and may interact with your depression medications

* Try to establish a routine that is easy to follow and not stressful. This will keep you engaged with reality and help you cope.

* Eat a balanced diet. If you lack an appetite, eat small snacks rather than large meals.

* Avoid drinking alcohol or using illegal drugs or medications that have not been prescribed to you.

They may interfere with your medications or make your depression worse.

* Try to do the things you remember enjoying before the onset of your depression. Reading, listening to music, sewing, woodwork, painting, watching TV.

* Even if you don’t feel motivated, try to participate in religious, social or other activities.

* Get regular exercise, even walking around the block.

* Keep a journal and write your feelings down. This is cathartic and will help put things into perspective.

* Let your family and friends help you.

* Surround yourself with positive influences, avoid negativity.

* Try to share your feelings with someone. It is usually better than being alone and secretive.

* Set realistic goals for yourself and take on a reasonable amount of responsibility even around the home such as cooking, shopping, or ironing.

* Break large tasks into small ones and set priorities. Do what you can when you are able.

* Postpone major life decisions such as changing jobs, moving or getting married or divorced when you are depressed. Read as much as you can about your illness. This will help you not let it take control of your life.

* Be patient and kind to yourself. Remember that depression is not your fault and is not something you can overcome with willpower alone. Treatment is necessary for depression, just as for any other illness.

* Try to maintain a positive attitude – remember that feeling better takes time, and your mood will improve little by little. Try to focus on the positive aspects in your life and do not dwell on the negative aspects. If you are always thinking about the negative aspects in your life it will make you more depressed.

* Surround yourself with positive people and don’t necessarily live for the moment, think of the future and of things you would like to accomplish – tomorrow – “today” will be gone for ever.

* Always keep yourself occupied and do not allow yourself to think about negative and upsetting things.

* Remove yourself from places and people that do not bring out the best in you or make you feel good.

* Start or join a support group and talk to people who have overcome depression to find out what they did to beat it. If there is no group in your area speak to your doctor, or friends about the two of you starting a group in your area, with help from Sadag.

* Do volunteer work. Help others, go to an aged home, hospital, church, school and see what help they need.

* For help call the South African Depression and Anxiety Group (Sadag) helpline on 0800 205026. - Daily News

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