By Ava Easton, Development Manager, Encephalitis Society
Why does depression occur?
Encephalitis may be an extremely serious condition, and one that may result in major
life changes for individuals and their families. Often feelings of grief and despair
occur as part of a normal reaction to the loss of previous life style and relationships.
This type of mood change should ease over time as people adjust to their new circumstances.
However encephalitis may often cause brain injury, which itself causes changes in
cognitive abilities and skills. For example there may be problems with thinking,
changes in ability to initiate activities, difficulty with reasoning, memory problems
and fatigue. Some of these changes are similar to those that occur in depression,
and so it can be quite hard to tease out what changes are due to cognitive changes,
and what are due to emotional factors. Often people who are felt to be depressed
are offered treatment (for instance medication or counselling) when in fact advice
on the brain injury and how to deal with the problems it causes might be a more
effective intervention.
Sometimes, a more marked depression begins to occur as the injured person’s
insight and awareness of the new situation grows. It results from a realisation
that life can never be the same as it was before. The depressed person may often
be unable or unwilling to talk about their feelings or seek outside help. As mentioned,
these emotional difficulties may be mistaken for cognitive problems due to brain
injury, or, vice versa; the cognitive difficulties might be mistakenly labelled
“depression”. It is important to try to get to the bottom of this, if
necessary with the help of professional advice.
The occurrence of depression, although it poses a great challenge, can be viewed
as a sign of progress: it means that the person is trying to work through the emotional
consequences for themselves.
However, if depression deepens, then it can begin to have a very negative impact
upon a person’s ability to continue to apply themselves to rehabilitation,
or to return to their former lifestyle. It is at such times that it is important
to remember that such a level of depression isn’t a normal part of recovery,
and that perhaps treatment is called for. Treatment may be either medical –
the prescription of anti-depressants, psychological – through counselling or
a “talking therapy”, or a combination of these methods.
What do anti-depressants do?
Anti-depressants may help to restore the brain to a more normal biochemical balance,
and thus help to elevate the mood back to its usual level. Some individuals find
them very helpful – others less so. Often the only way of knowing whether or
not they will help is to try them and to monitor carefully whether mood improves
during treatment
Which anti-depressant will I have?
There are many different anti-depressant tablets to choose from. Some are more potent
then others, some longer acting, and many have other effects, which may or may not
be desirable. The doctors will weigh all this up in determining which particular
antidepressant to recommend for you, and will explain to you the reasons for this
choice.
Often a relatively low dose may bring about a beneficial response.
Are the drugs addictive – will I get dependent on them?
The anti-depressants that we use these days are not, in themselves, “uppers”
or “pep pills”. Usually 6 months treatment is sufficient to restore
the normal balance of mood, and they may then be withdrawn. If you subsequently
become depressed again, another course can be given. When anti-depressants are used
in this way, people do not get tolerised (used to them) or addicted (dependent on
them) as was sometimes the case with the more old-fashioned drugs.
Are there any side effects?
The anti-depressant drugs we use today have very few side-effects and are generally
very safe. However there are some circumstances in which they are best avoided -
they should not be given to people with uncontrolled epilepsy, and the doctors must
make sure that they do not interact with any other medications you are taking. Any
drug can cause an allergic reaction, so if you experience any rash or other symptom
which you suspect may be a side-effect, you should report this to the nursing staff
(while you are in hospital) or to your GP (when at home). Minor symptoms such as
dry mouth and stomach upsets can occur, but usually resolve over time, so it is
worth persisting with treatment to see if this happens. Otherwise the symptoms will
resolve on stopping medication.
How will I know if they are working?
For many people with depression following brain injury, antidepressants are extremely
helpful, but not in all cases. Nobody wants to be on tablets that are not helping
them, so the first 4 weeks of treatment are normally regard as a ‘try-out’
period. You can see how you feel at the end of that time, and you can decide together
with your doctor whether or not it is worth continuing the full course.
How will I know when to stop?
If the treatment is effective and you agree to continue the full course, it is normally
recommend you remain on the tablets for 6 months. At the end of that time, you should
see your GP and arrange to end the course. Rather than stopping suddenly, your doctor
will normally recommend tailing the tablets off gently. As the brain re-balances
itself off the medication, it is quite common to feel a bit low for the initial
3-4 weeks after stopping the tablets. However, this is not a sign that you need
to re-start the treatment. Usually the mood stabilises after 1-2 months, but if
it does not you should consult your GP.
Treatments in addition to Anti-Depressants
Effective psychotherapies (talking treatments) may enable people to recover from
depression. They also help prevent recurrences. If given proper care, people with
depression can achieve recovery and lead productive and enjoyable lives . It can
take time for a doctor or psychiatrist to find the correct tablet or dosage. Patience
and persistence may be needed.
How to help yourself:
- Avoid alcohol as it is a depressant, and also interacts with many drugs.
- Eat fresh meats, fruits, vegetables, brown breads and rice and plenty of water.
Avoid processed foods, and drinks with high sugar content, such as fizzy pops and
sodas.
- Set goals that you can achieve in a short time: Break large tasks into small ones,
set some priorities and do what you can as you can. When setting goals, start small
and go for a quick win. Then use the achieved goal as evidence of the progress being
made.
- Refrain from assuming too much responsibility for the time being.
- Don’t turn your house into a tomb. Get out, be with other people, find someone
with a friendly ear, and participate in activities that help you feel better.
- Take control by exercising, going to movies, events or doing other activities –
but don’t overdo things!
- Even with medication, your mood will improve gradually, sometimes over 4 to 6 weeks.
Don’t expect a quick fix.
- Postpone big decisions until the depression has lifted. This may include significant
transitions, such as changing jobs, getting married or divorced. You might want
to talk these things over with a counsellor or other therapist.
-
Try to think good thoughts. Depression often manufactures bad thoughts, whether
or not something bad is actually going on.
If you are a carer…..
Acknowledge the uniqueness of the person’s loss, and help them identify their
own strengths and assets, no matter how small. Validate how they are feeling while
at the same time offering support and encouragement for their future. This can be
done by listing concerns on paper and setting goals to overcome them. It is also
important to focus on the positive aspects of the recovery and keeping a diary and
reflecting back on the progress made, which on a day-to-day basis may be virtually
unnoticeable, can do this.
Be aware of the strain that taking care of someone who is depressed can produce,
and take care of your own reactions and feelings.
Suicide
Coming to terms with a depressive illness is not easy, although research shows that
many people can benefit quickly when they ask for treatment. People with depression
may well benefit from anti-depressant medication, but they also need to talk, as
this can act as a good “safety valve”.
If you suspect someone may be considering suicide, give them the opportunity to
talk and encourage them to tell you about their fears. Don’t be afraid to
mention the word suicide in asking how they are feeling. This is not likely to put
the thought into their head, but on the contrary, they may be extremely relieved
to hear that you understand the severity of their depression. Listen closely and
show that you are listening by paraphrasing key points and feelings. Validate how
they are feeling. Also, clearly state the options for help that are available to
the person with depression. Treat thoughts or talk of suicide very seriously, and
quickly seek professional help via the GP. They may recommend counselling from a
qualified counsellor.
Who do I ask if I have any other questions?
If you have any questions, you should consult with your doctor.
This factsheet was completed with the help of information provided by Professor
Lynne Turner Stokes and Dr Frances Clegg, Northwick Park Hospital
Further sources of information:
The Samaritans
www.samaritans.org.uk
Tel: 08457 909090
Depression Alliance
www.depressionalliance.org
Tel: 020 7633 0557
Depressives Anonymous
Tel: 01702 433838
Aware (Republic of Ireland)
www.aware.ie
Tel: 1890 609090
Last modified: November 2004