Depression

What is Depression?

Depression is a medical disorder with a biological or chemical basis. It affects more than 18 million Americans of all ages and races. Depression affects your moods, feelings, thoughts, behavior, and physical health.  It was once believed that depression is “all in your head”.  However we now know that depression is not a weakness, and cannot be treated without help.  Depression is more than greiving or having an emotional episode. It can be a normal reaction to loss, life’s struggles, or an injured self-esteem.

Depression can occurr only once in someones life, however it usually occurs as episodes are repeated over a lifetime, on and off with periods in-between. For some, it is a chronic condition requiring continued use of medicine over a lifetime.   A stressful life can trigger depression, other times it happens spontaneously with no specific cause.  Medication available to treat depression are generally very safe and effective. Those undergoing proper treatment can improve within weeks and return to their normal daily life.

Depression Signs and Symptoms

According to the DSM-IV (a key used to diagnost mental disorders) depression occurs when you have at least five of the following symptoms at the same time:

• A depressed mood during most of the day, particularly in the morning
• Fatigue or loss of energy almost everyday
• Feelings of worthlessness or guilt almost everyday
• Impaired concentration, indecisiveness
• Insomnia, or hypersomnia (excessive sleeping) almost everyday
• Diminished interest or pleasure in almost all activities nearly every day
• Recurring thoughts of death or suicide
• A sense of restlessness — known as psycho motor agitation — or being slowed down — retardation
• Significant weight loss or weight gain (a change or more than 5% of body weight in a month)

Other symptoms of Depression include:

• Low self-esteem
• A loss of interest in sexual activities
• Irritability or restlessness
• Feeling no pleasure in life
• Overeating or appetite loss
• Feelings of “emptiness”

Physical symptoms of depression include things like generalized itchin, blurred vision, excessive sweating, dry mouth, gastointestinal problems, headache, and backache.  Children and teens may react differently to depression.  In these groups, symptoms may take different forms or may be masked by other conditions.

What causes Depression?

There is no single distinguished cause of depression.  Often, the illness runs in families.  Experts believe a genetic vulnerability combined with enviornmental factors like stress or physical illness may trigger an imbalance in brain chemicals serotonin, norepinephrine, and dopamine (all neurotransmitters), resulting in depression.  Scientists have yet to fully understand how imbalances in neurotransmitters can cause signs and symptoms of depression.  It is not certain whether changes in neurotransmitters are a cause or result of depression.

Some factors that contribute to depression and may increase the chance of depression include:

• Abuse – Past physical, sexual, or emotional abuse can cause depression later in life.
• Certain medications – Some drugs used to treat high blood pressure, like beta-blockers, can increase your risk of depression. Long term use of certain medications such as sleeping pills, or birth control pills, may cause depression in some people.
• Stress – Stressful life events such as a loss of a loved one or a job, can trigger depression.  Personal conflicts or disputes with family members or friends may also cause depression.
• Major Events – Events like moving, losing a job or income, getting divorced, or retiring can lead to depression.  So can good events such as starting a new job, getting married, or graduating.
• Heredity – Researches have identified genes that may be involved in bi-polar disorder, and they are looking for genes linked to other types of depression.  Not everyone with a family history of depression develops the disorder.
• Illness – Having a chronic illness puts you at higher risk of developing depression.  Researchers have revealed an unexplained link between depression and heart disease.  Depression occurrs in may people who have had heart attacks. Having an under-active thyroid (hypothyroidism) can even cause depression.
• Alcohol, nicotine, and drug abuse – Many people feel that drugs and alcohol are ways to ease depression, however by using these substances, you may actaully contribue to depression and anxiety disorders.
• Death or loss – Sadness or grief from the death or loss of a loved one can also increase the risk of depression.
• Personality – Certain personality traits, such as having low self-esteem, or being overly dependent, self-critical, pessimistic, and easily overwhelmed by stress, can make you more vulnerable to depression.
• Postpartum depression – It is common for new mothers to feel a form of distress that usually occurs a few days after giving birth.  During this time you may have feelings of sadness, anger, anxiety, irritability, and incompetence.
• Diet – Deficiencies in folate and vitamin B-12 can cause symptoms of depression.  In addition, low levels of these nutrients can prevent anti-depressant medications from working properly.

Diagnosing Depression

In order to diagnose depression, a doctor may perform a physical examination.  This may include tests that rule out the conditions that cause symptoms that mimic depression.  If your doctor notices signs of severe depression or suspects the possibility of suicide, they may refer you to a psychiatrist who specializes in mental illness. Your doctor may diagnose depression based on the important signs and symptoms of the disorder, plus the presence of other signs and symptoms.

How is Depression treated?

The treatment of depression has improved with the development of newer antidepressant medications and mood-stabilizing drugs.  Medications can alleviate symptoms of depression and have become the main form of treatment for most types of depression.  In addition to medication, psychotherapy may be used to help you cope with ongoing problems that can trigger to depression.  A combination of medicines and a brief course of psychotherapy is usually effective for those with mild to moderate depression.

If you are severely depressed, initial treatment is usually medications with electroconvulsive therapy.  When you improve, psychotherapy is more effective.  Depression is treated in two stages.  Acute treatments with medications help relieve symptoms until you feel better.  Once your symptoms of depression ease, maintenance treatment continues for 6 – 12 months to prevent a relapse.  Depression usually recurs in the majority of people who have one episode. If you continue taking treatment for at least six months after you feel well, it reduces your risk of rapid relapse.  If you have had more than two previous episodes of depression, your doctor may recommend long-term treatment with anti-depressants.

What Medications are used to treat Depression?

Selective serotonin reuptake inhibitors (SSRIs). Doctors often consider selective serotonin reuptake inhibitors, such as fluoxetine (Prozac, Sarafem), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa) and escitalopram (Lexapro), as the first-line treatment for depression because they have fewer serious side effects.

They seem to work by increasing the availability of the neurotransmitter serotonin in your brain. Drugs similar to SSRIs include serotonin and norepinephrine reuptake inhibitors (SNRIs), such as nefazodone (Serzone), trazodone (Desyrel) and venlafaxine (Effexor), and dopamine reuptake inhibitors, such as bupropion (Wellbutrin, Zyban).Tricyclic and tetracyclic antidepressants. These medications also affect neurotransmitters, but by a different mechanism than SSRIs. They may be used for any type of depression, be it mild or severe. Among tricyclic antidepressants are amitriptyline (Elavil), desipramine (Norpramin, Pertofrane), nortriptyline (Aventyl, Pamelor), protriptyline (Vivactil), trimipramine (Surmontil) and a combination of perphenazine and amitriptyline (Triavil, Etrafon). Tetracyclics include maprotiline and mirtazapine (Remeron). Monoamine oxidase inhibitors (MAOIs).

These drugs, which include phenelzine (Nardil) and tranylcypromine (Parnate), prevent the breakdown of neurotransmitters. The drugs have potentially serious side effects if combined with certain other medications or food products. Doctors rarely use them unless other options have failed. Your doctor may prescribe them if you have chronic depression and eat or sleep excessively. Stimulants. If you’re severely depressed, your doctor may initially prescribe a stimulant such as methylphenidate (Ritalin, Concerta), dextroamphetamine (Dexedrine, Dextrostat) or modafinil (Provigil) in addition to an antidepressant because most antidepressants are slow to work. After one to four weeks, your doctor may then switch you to just an antidepressant.

Lithium and mood-stabilizing medications – Doctors prescribe lithium (Eskalith, Lithobid), valproic acid (Depakene), divalproex (Depakote) and carbamazepine (Epitol, Tegretol, Carbatrol) to treat bipolar depression. Medications called atypical antipsychotics such as olanzapine (Zyprexa), risperidone (Risperdal) and quetiapine (Seroquel) were initially developed for treatment of psychotic disorders. Doctors sometimes also use them to treat bipolar disorder.

Most antidepressants are slow to work. You may see a response in two weeks, but many people don’t see a full benefit for six to eight weeks. If your response to medication hasn’t resulted in satisfactory progress after six to eight weeks, your doctor may suggest either adding another antidepressant or replacing the first medication with another drug from a different chemical family.One person’s body may break down drugs faster or slower than another person’s body. Scientists are developing techniques to measure this. If you’ve taken several medications and your condition hasn’t improved or you’ve experienced side effects, tell your doctor. He or she may order blood tests for you to determine how rapidly your body breaks down your current medications.

Other forms of depression treatment in addition to medications might include: 

Psychotherapy – Involving a short-term, goal-oriented approach aimed at helping you deal with specific issues. The success of therapy depends on finding a doctor, psychiatrist or psychologist you’re comfortable with. Both medications and psychotherapy can take four to eight weeks to have an effect. Specialized and supervised group therapy, such as bereavement groups, stress management classes, marital counseling and family therapy, also may help.

Electroconvulsive therapy – This is a safe and effective way to treat severe depression.  In this form of therapy, you receive a light general anesthetic and a muscle relaxant.  A current is passed through your brain for one to three seconds.  The stimulus causes a controlled seizure which lasts for 20-90 seconds.  You wake up in 5 – 10 minutes and should rest for about 30 minutes.  Most people generally require 6 – 10 treatments.  The seizures are said to affect the levels of neurotransmitters in the brain.  The most common side effects of this treatment is confusion that lasts between a few minutes to several hours.  A few people have some memory loss for several weeks.  This therapy is usually used for people who don’t respond to medications or are at high risk of suicide.

Light therapy – This therapy helps those who have seasonal affective disorder (Seasonal Depression). This form of depression involves periods of depression that recur at the same time each year, usually in the winter.  Researchers believe that fewer hours of sunlight may increase levels of melatonin, a brain hormone that induces sleep and depresses the mood.  The treatment is in the morning with a specialized type of bright light which prevents production of melatonin.

Alternative Medicine

Herbal and dietary supplements sold in stores have become increasingly popular. People take them to help prevent or treat a number of health conditions. Some of these alternative therapies are being studied to determine their effectiveness in helping depression. Within the next few years, researchers may know more about these products, how effective they are and if they can cause other health problems or interfere with medications.

In the meantime, talk with your doctor before taking any herbal or dietary supplement. The downfall of herbal and dietary products is that they aren’t regulated. The Food and Drug Administration doesn’t test them for safety, purity or effectiveness. You can’t always be sure of what you’re getting and if it’s safe.Some popular supplements marketed or taken for treatment of depression include:

St. John’s wort is an herbal preparation from the Hypericum perforatum plant. It has long been used in folk medicine, and today it’s widely prescribed in Europe to treat anxiety, depression and sleep disorders. In the United States, it’s sold in health food stores and pharmacies in the form of tablets or tea. European studies suggest that St. John’s wort may work as well as antidepressants in mild depression and with fewer side effects. Adverse reactions include dry mouth, dizziness, digestive problems, fatigue, confusion and sensitivity to sunlight. In most cases, signs and symptoms are mild. Of concern is that St. John’s wort can interfere with the effectiveness of prescription medications, including antidepressants, drugs to treat human immunodeficiency virus (HIV) infections and AIDS, and drugs to prevent organ rejection in people who’ve had transplants. There’s also a risk of serotonin syndrome if St. John’s wort is used with an SSRI or another serotonin-active antidepressant.SAM-e. Pronounced “sammy,” short for S-adenosyl-methionine, this chemical substance is available in Europe as a prescription drug to treat depression. In the United States it’s sold as an over-the-counter dietary supplement. SAM-e is a chemical substance found in all human cells and plays a role in many body functions. It’s thought to increase levels of serotonin and dopamine, but this is unproved. The pills are expensive, especially considering their effectiveness is unproved. Too much of this product could be harmful, boosting serotonin to dangerously high levels.5-HTP.

One of the raw materials that your body needs to make serotonin is a chemical called 5-HTP, which is short for 5-hydroxytryptophan. 5-HTP is prescribed in Europe to treat depression and other conditions, including obesity and insomnia. In the United States it’s available as an over-the-counter supplement. In theory, if you boost your body’s level of 5-HTP, you should also elevate your levels of serotonin. But there’s not enough evidence to determine if 5-HTP is effective and safe. Larger studies than have been conducted to date are needed. Omega-3 fatty acids are found in fish oil and certain plants. They’re being studied as a possible mood stabilizer for people with bipolar depression and other psychiatric disorders. Some studies have suggested that people with depression have decreased amounts of an active ingredient found in omega-3 fatty acids. Fish oil capsules containing omega-3 fatty acids are sold in stores. The capsules are high in fat and calories and may produce gastrointestinal problems. Another way to get more omega-3 fatty acids is simply to eat more fish.