By Ava Easton

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 – 15/11/2006