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Definition
Depression is a medical disorder characterized by feelings of
sadness, hopelessness, pessimism, and a general loss of interest in
life, combined with a sense of reduced emotional well-being.
Description
The three (3) most common types of depression are major
depression, dysthymia and bipolar disease:
- Major depression is manifested by a combination of
symptoms (see Symptoms below) that interfere with the ability to
work, sleep, eat and enjoy once pleasurable activities. These
symptoms occur without any apparent cause and deepen and persist
day-in and day-out for two weeks or longer.
- Dysthymia is marked by mild to moderate depressive
symptoms that last at least two years. People with this
condition have fewer symptoms than those with major depression,
but the symptoms last longer and develop more slowly. On
average, symptoms can last 16 years before there is a diagnosis.
Sometimes people with dysthymia also experience major depressive
episodes.
- Bipolar disorder, formerly called manic-depressive
illness, involves cycles of depression and elation (mania).
Sometimes the mood switches are dramatic and rapid, but most
often they are gradual. When in the depressed cycle, a person
can have any or all of the symptoms of depression. When in the
manic cycle, any or all manic symptoms (see Symptoms below) may
be experienced.
Causes and Risk Factors
Depression is caused by a combination of genetic (inherited),
psychological and environmental factors. Depression, especially
bipolar disorder, has been shown to run in families. Additionally,
having too little or too much of certain neurochemicals in the brain
have shown to be the cause of depression. The psychological makeup
of a person, such as low self-esteem, pessimism and stress, can also
cause depression. Environmental or other associated health factors,
such as a serious loss, chronic illness, pregnancy, childbirth,
difficult relationships, financial problems, unwelcome changes in
life patterns, alcohol, drug abuse and medications can also trigger
a depressive episode.
About 10 to 15 percent of all depression is
caused by medical illness or medicine. Once these conditions are
treated or the medication stopped or changed, the depression will
usually go away.
Symptoms
The symptoms of depression include:
- loss of interest in the things that the
person once enjoyed
- feeling sad, blue, or down in the dumps
- feeling slowed down or restless and
unable to sit still
- feeling worthless or guilty
- an increase or decrease in appetite or
weight
- thoughts of death or suicide
- problems concentrating, thinking,
remembering or making decisions
- trouble sleeping or sleeping too much
- loss of energy or feeling tired all of
the time
- headaches
- digestive problems
- sexual problems
- feeling pessimistic or hopeless
- being anxious or worried
The symptoms of mania are:
- feeling unusually "high," euphoric or
irritable
- severe insomnia
- grandiose notions
- increased talking
- disconnected and racing thoughts
- increased sexual desire
- markedly increased energy
- poor judgment
- inappropriate social behavior
Diagnosis
Diagnosis of depression involves a psychological/physical history
and evaluation. According to the American Psychiatric Association,
if a person experiences a loss of interest in the things they once
enjoyed and are feeling sad, blue, or down in the dumps for at least
two (2) weeks, and are experiencing at least five (5) of the other
symptoms of depression, they may have major depression. If a person
experiences euphoria, irritability, or a feeling of being "high"
with four (4) other symptoms of mania for at least one (1) week,
they may have bipolar disorder.
In addition to listing the symptoms, the
doctor will also ask when the symptoms began, how long they have
lasted, how severe they are, whether the individual has had them
before, and if so, whether or not they were treated and what
treatment was received, as well as whether or not other family
members have had these symptoms.
Furthermore, a mental status examination will
be done to determine if speech, thought patterns or memory have been
affected. The physical examination will either diagnosis and/or rule
out any medical conditions (such as thyroid disease, cancers or
neurologic diseases) that could be causing the depression.
Treatment
Treatment usually involves medication, psychotherapy or a
combination of both. Other treatments may include electroconvulsive
therapy (ECT), light therapy and alternative treatments.
Medication
There are more than 20 antidepressant drugs currently available.
Antidepressants correct the chemical imbalance in the brain. Because
a variety of drugs target different neurotransmitters and imbalances
of these neurotransmitters can vary from patient to patient, some
drugs may be more effective than others for any individual.
Sometimes a combination of drugs is best.
There are four (4) groups of antidepressant
medications most commonly used to treat depression:
- Tricyclic antidepressants (TCAs) which
include Elavil, Janimine, Tofranil, Pamelor, and Norpramin. TCAs
work by slowing the rate at which neurotransmitters (chemical
messengers) re-enter brain cells. This increases the
concentration of the neurotransmitters in the central nervous
system which relieves depression.
- Monoamine oxidase inhibitors (MAOIs)
include Nardil and Parnate. MAO is an enzyme responsible for
breaking down certain neurotransmitters in the brain. MAOIs
inhibit this enzyme and restore more normal mood states.
- Lithium carbonates, including Eskalith
and Lithobid. Lithium reduces excessive nerve activity in the
brain by altering the chemical balance within certain nerve
cells. This drug is effective is treating bipolar disorder.
- Selective serotonin reuptake inhibitors (SSRIs)
include Prozac, Zoloft and Paxil. SSRIs act specifically on
serotonin, making it more available for nerve cells, thus easing
the transmission of messages without disrupting the chemistry of
the brain.
Medication usually produces a marked
improvement by six weeks, but may require up to 12 weeks for full
effect.
Psychotherapy
Psychotherapy involves talking to family doctor, counselor or
therapist about things that are occurring in a person's life. The
aim of psychotherapy is to remove all symptoms of depression and
return a person to a normal life.
There are three psychotherapies available to
treat depression: behavioral therapy, cognitive therapy or
interpersonal therapy. Behavioral therapy focuses on current
behaviors, cognitive therapy focuses on thoughts and thinking
patterns, and interpersonal therapy focuses on current
relationships.
Although psychotherapy may begin to work right
away, it may take eight to 10 weeks to show a full effect for some
people.
Electroconvulsive therapy (ECT)
ECT, also called electroshock treatment, is used for severely
depressed patients and/or those who have not responded to
antidepressant medication and/or psychotherapy. During this therapy,
an electric current travels through electrodes placed on the
temples, causing a generalized shock that produces biochemical
changes in the brain.
Light Therapy
In light therapy, a special kind of light called a broad-spectrum
light, is used to give people the effect of having a few extra hours
of daylight each day. Light therapy is helpful in treating people
with seasonal affective disorder (SAD). SAD is a serious depression
that recurs each year at the same time, starting in fall or winter
and ending in spring.
Helpful Tips
During the treatment process try these helpful tips:
- Do not set difficult goals or take on a
great deal of responsibility.
- Break large tasks into small ones, set
priorities, and do what you can.
- Try to be with other people.
- Participate in activities that make you
feel better.
- Do not overdo it or become upset if the
treatment does not work right away.
- Do not make major life decisions.
- Do not expect to snap out of depression.
- Do not expect too much of the depressed
person.
Alternative
Light therapy, acupuncture, herbal remedies (such as St. John's Wort),
exercise, mediation and fasting are shown to help people lessen or
eliminate symptoms associated with depression.
Questions To Ask Your Doctor
Has a complete diagnostic evaluation been given?
- What type of depression is it?
- What kind of treatment should be used or
sought?
- Would an antidepressant medication be
prescribed?
- If so, what are the side effects?
- After treatment is started, how long will
it take before there is an improvement?
- Is the depression likely to return?
- If the depression is due to a serious
loss, how long is the depression going to last?
- What measures can be taken to help the
process?
- Where can the family get help to cope
with this disorder or get more information?
Healthcentral 2004
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