Studies have emphasised the importance and therapeutic efficacy of counselling in the management of the depressed patient. 13 The most practical approach by the general practitioner to the depressed patient is empathy, support and a logical explanation of their malaise. The author gives the following explanation to the patient.
Depression is a very real illness that affects the entire mind and body. It seriously dampens the five basic activities of humans, namely their energy for activity, sex drive, sleep, appetite and ability to cope with life. They cannot seem to lift themselves out of their misery or fight it themselves. Superficial advice to 'snap out of it' is unhelpful because the person has no control over it.
The cause is somewhat mysterious but it has been found that an important chemical is present in smaller amounts than usual in the nervous system. It is rather like a person low in iron becoming anaemic.
Depression can follow a severe loss such as the death of a loved one, a marital separation or financial loss. On the other hand it can develop for no apparent reason although it may follow an illness such as glandular fever or influenza, an operation or childbirth.
Emphasising the 'missing chemical' theory really helps patients and family come to terms with an illness that tends to have socially embarrassing connotations. It also helps compliance with therapy when antidepressant medication is prescribed.
Ongoing contact, support and availability are an important component of counselling with appropriate referral to someone with more expertise, should that be required.
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