Continuing on from last week, it is also important to remember that Geraldine was being treated with a combination of cytotoxic drugs, which have, in some cases, been reported to be associated with chemically-induced depression; although it should be stressed that it was by no means certain that this was the definitive cause, if at all, However, it was suspected of having caused or exacerbated a kind of depression, somewhat different to that observed in and experienced by Stephen, especially concerning those key dimensions of clinical or major depression referred to in last week’s blog.

(Perhaps I might briefly add here that those antidepressant drugs most widely prescribed in general practice, are ‘designed’ to counter serotonin depletion (also referred to earlier) by blocking its reuptake and dispersal into surrounding neurons, thus prolonging its effect at key synaptic sites• within the brain. However, there is, it has to be added, invariably something of a “cost-benefit” aspect to such treatment, which requires to be discussed, understood and negotiated with and by both prescriber and prescribee).

Though often successful where appropriately prescribed, such medication is not in some cases, not altogether without cost to some patients, in the form of unpleasant and sometimes bothersome side effects. So much is true of the very latest and ‘state of the art’ drugs, even if (as is certainly claimed for them) to a lesser extent. This said, I shall make scant further reference to anti-depressant medication, since any such detailed review would fall well outside the scope of this form of correspondence. Furthermore, my point in commenting upon them at all, is solely in order that it can be viewed within the context of a need to differentiate different aetiologies (causes) of depression and their treatment set out in these last two blogs and the one to follow.

To return then to my account concerning Geraldine: in the event, anti depressant therapy proved to be extremely helpful and effective and after only a few weeks of regular treatment, things began to improve mood-wise that is. Moreover, the knowledge that what was happening to her did not in fact indicate the presence of some deep-seated inadequacy and failure on her part to cope with her illness and/or its implications, also had an important therapeutic role to play in her undoubted improvement. On the other side of things, it needs to be clearly stated that unpleasant and sometimes quite toxic treatment side-effects of such treatment, can and do test patients’ ability to cope. However, in Geraldene’s case, both she and her family members gradually came to terms, or so it appeared, with all the impositions and changes brought about by her cancer and its treatment.

So far then, we have briefly considered something of the causes of depression; what it is and how, for the most part, it may be effectively treated. In the remaining blogs specifically concerned with depression, I hope to lay specific emphasis on the obvious (one might think) need for accurate diagnosis and appropriate treatment.

* A synapse is a minute gap between neurones of the brain and of the body. At precisely the right moment, a chemical impulse is made to enter and ‘trigger’ an electrochemical response, which in turn, ‘fires’ the next neuron and so on. The complexity of this is apparent in that there are instances of as many as 15’000 synapses per cell.