December 2002 Volume 83 Number 12 "serving the protectors"

Depression

More than 800,000 adults and 95,000 children and adolescents in Australia experience depression each year. Depression is a leading cause of ongoing illness and premature death. It is estimated that, in the next 20 years, it will become a cause of premature death as common as heart disease.

Treatment or prevention of depression needs an increased awareness of the causes of depression and how it can be treated. It also needs a different social acceptance of the diagnosis. If this understanding occurs, it is likely people who need treatment for depression will receive it.

One of the best ways to look for early depression is to be aware that it usually occurs after a recent bereavement or stressful social events, or in situations of social isolation. All of these things are common in our society, and most of us will be at personal risk of depression.

To make people understand depression, Australia is involved in a major public awareness programme called beyondblue, and discussions were released in an October supplement of the Medical Journal of Australia.

Police work comes with a higher risk of the type of stressful events that increase the risk of depression. An attitude of acceptance of the possibility of depression will make it easier to cope with its effects.

Depression needs to be seen like any other illness so that the stigma is decreased and treatment can be effective.

If you worked in a job in which you hurt yourself through physical activity, you would just accept that that is part of the job and get it fixed. Most people wrongly think that to become depressed at work is a reflection of their own stupidity, but it is likely to be a natural consequence of a work-related experience.

Some cases on which you work have the potential to hurt you. They might be the ones in which children get hurt or die, your integrity is called into question or you see the worst of humans’ treatment of others. The resulting hurt or depression must be treated the same way in which you would treat a pulled hamstring or twisted ankle.

Today, we consider the brain as we would any other part of the body. If you get depressed, your brain, because it is injured, is not thinking like it would normally. We know from experiments – that show how people think when they are depressed – that there is slowness in the thoughts to move around. One part of the brain will be thinking and any connections with the rest of the brain are sluggish.

As the depression lifts, we can see by further brain experiments that the thoughts start to move around the brain again. These experiments – using positron emission tomography (PET) scans – show the brain activity changing when you think about different things. If you get stuck on a depressing idea or experience, activities will stick in one part of the brain, while the rest of the brain goes unused and wastes slowly away.

This is exactly what happens to the muscles in the leg if you get a knee injury and can’t use your leg for a while: the muscles in the leg start to waste away. So, to get your brain working after something has upset or made you depressed, you need to do exercises to get all the parts working again. These are “thinking exercises” which are part of counselling or psychotherapy, or similar ways to help recovery. Just like physical activities, some thinking exercises are better than others and different programmes suit different people.

Another development has been the tablets used to treat depression. PET scanning shows the brain activities improve with new medication by increasing the ability of the brain to exercise all its different parts needed to recover. This is exactly the same way an arthritis tablet would help your exercise programme for the recovery of a sore knee. The tablet would decrease the pain, make the exercise programme easier and eventually allow the recovery to continue without the medication.

The social isolation that occurs with depression also makes it hard to recover and, again, the nature of police work and the expectation that you need to deal with your problems by yourself, put you at risk.

If you are involved in cases that take their toll on your self-esteem or make you feel depressed, you must remember to get help. Treat depression like any other physical injury and approach the recovery in a pragmatic and optimistic way.

You do not need to handle the situation alone, and new medication allows treatment to proceed at a better rate than it did in the old days. Leaving treatment too long is like leaving any injury too long. Early intervention leaves less likelihood of permanent injury.

Even if it is some time since you first felt you were depressed, the new understanding of this condition has given us a chance to fix most of the problems. No matter how complicated or developed the depression might be, there is an answer. Don’t take chances with an injury. Talk to someone about fixing it.

Your questions answered

Dr Pearce will answer questions on any health issue important to you. For his response, write to or fax the Police Journal with your question. Those who write need not identify themselves.

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