Depression

Overview

More than just a bad day

Depression isn't the blues or feeling glum. Rather, depression is a clinical term referring to an illness of the central nervous system that actually alters brain chemistry. Depression is agonizing, debilitating, and potentially fatal. One study shows that depressed patients are socially and physically impaired at the same level as patients with chronic heart disease.

A depressed person struggles with intense sadness and feelings of helplessness and hopelessness. He or she may find it difficult or impossible to enjoy anything that was once pleasurable. Working, eating, or sleeping may be hard. While such feelings may have their roots in a sad event — a death or job loss, for instance — the symptoms may grow out of proportion to the event or last beyond a normal recovery period. Some types of depression are not spurred by a traumatic event. Others result from different illnesses, certain prescription drugs, or substance abuse.

However, depression — even in severe cases — is treatable.

Although even severe depression is quite treatable, it often goes untreated. Many of those suffering depression are uninformed or misinformed about the disease and do not know they can be helped. Others fear the stigma of mental illness and feel they should be able to "snap out of it." Yet a depressed person is no more capable of snapping out of it than a person with diabetes is capable of suddenly having normal blood sugar levels.

Detailed Description

It's normal for brain chemistry to change in response to life's disappointments, traumas, and grief. At such times, the levels of the molecules that act as messengers to your brain and nerves (neurotransmitters) drop. Since these brain chemicals relate to our feelings of happiness and well-being, depression may occur. Normally, when the event that caused the depression passes, brain chemistry returns to normal. In depressive illness, however, the altered brain chemistry persists.

Fortunately, several drugs can successfully treat depression, such as the newer selective serotonin reuptake inhibitors (SSRIs), Prozac being the most well known. Psychotherapy alone is often successful in treating certain depressions. At other times, psychotherapy is best used along with antidepressant drugs.

Depressive illness is the fourth most likely reason for visiting one's family physician. It is usually diagnosed when five or more symptoms persist throughout the day for at least two weeks. Some symptoms include feelings of hopelessness, loss of interest in previously pleasurable activities, and fatigue.

The following are some principal features of the five major types of depression:

• Situational depression (exogenous depression). Results from an understandably upsetting event, such as a death, divorce, or job loss. Sadness and fretfulness often characterize such depressions. They are considered mild to moderate depressions and usually last a few weeks — a few months at the most.
• Dysthymia. A chronic, mild form of depression that leaves people with the disorder feeling persistently sad or down in the dumps. Dysthymia sufferers also lose interest in their daily affairs and/or activities they once found pleasurable. It is diagnosed only when symptoms have persisted for two or more years. Dysthymic disorder, despite its "mild" characteristics, can be as debilitating as major depression, because of its chronic, persistent nature.
• Seasonal affective disorder (SAD). Mild to moderate depression caused by a disturbance of our body's internal waking-and-sleeping clock (circadian rhythm). This disturbance occurs from lack of enough exposure to the sun's full-spectrum light, usually in the winter months.
• Major depression. The most severe form of depression. It may cause extreme impairment and even death, in some cases. This form of depression has its roots in biology rather than external events. It is marked by a profound lack of energy, a distorted, negative self-image, and deep sadness or hopelessness. It can be moderate to severe and pass in months or last for years without treatment.
• Bipolar disorder (manic-depression). People with this illness alternate between the "highs" of mania and the "lows" of depression. Either extreme may be severe.

How Common Is Depression?

More than 19 million American adults suffer from depressive illnesses. At some time in their lives, about 10% of all people will have a depressive disorder serious enough to require medical attention, with an average age of 40. Twice as many women are affected by depression than men.

What You Can Expect

Many depressive episodes can pass without treatment, usually within six to nine months. However, in 15% to 20% of depressed people, the illness may linger for two years or more. Depression tends to come back an average of four to five times during a lifetime.

That depressions may pass doesn't minimize the depths of despair a depressed person may feel. Depression is a serious, treatable illness that left untreated can result in suicide. About 15% of severely depressed people commit suicide.

ALERT! Any person who talks of making a specific plan for suicide is at great risk for carrying it out. This is an emergency. If you or someone you know is considering suicide, contact your local suicide prevention hotline and your doctor immediately. Help and hope is available for those with even the most severe depression.

Conventional Treatment

Goals of Treatment

Currently there is no cure for depression, but researchers are looking for better treatments, as well as for the cause of the illness. Depression — even the most severe forms — can be treated effectively in 80%-90% of people suffering from it. If you are depressed, your doctor's immediate goal will be to relieve the symptoms of your depression and return you to your normal mood. In addition, you and your doctor can work together to prevent the depression from happening again.

Treatment Overview

Current treatment methods — such as new drugs, exposure to bright light, psychotherapy, and physical exercise — have done wonders for the treatment of depression. Your treatment probably won't require a hospital stay; you'll be treated in your doctor's office and go home the same day. But if you suffer from severe depression, you may need to stay in the hospital at some point during the illness.

Your treatment can vary widely depending upon the type of depression you are diagnosed with:

• Situational depression. Your doctor may not prescribe drugs to treat your depression. This is usually mild and responds well to counseling. Should depression persist, your doctor may look for progression to a major depression and then prescribe an antidepressant drug for treatment.
• Dysthymia. Your doctor may suggest psychotherapy alone or in combination with an antidepressant.
• Major depression. This illness is often treated effectively with an antidepressant drug. If you have had depression before, your doctor may suggest a maintenance dose of the drug once the episode has passed, to protect against future relapses of the illness.
• Seasonal affective disorder (SAD). Your doctor may suggest light therapy in addition to an antidepressant. In light therapy, you spend from 30 minutes to several hours a day in front of special, extra-bright, full-spectrum fluorescent lights.

Drug Therapy

Antidepressant drug therapy is remarkably successful for treating depression. The chances that any given antidepressant will work for a particular person are about 65%, while the chances that at least one antidepressant will work for a particular person are 80%-90%.

Selective serotonin reuptake inhibitors (SSRIs)
Celexa
Lexapro http://www.nmihi.com/e/escitalopram.html
Luvox
Paxil http://www.nmihi.com/p/paroxetine.html
Prozac
buy Sertraline
Serotonin�norepinephrine reuptake inhibitors (SNRIs)
Cymbalta
Effexor http://www.nmihi.com/u/venlafaxine.html
Tricyclic antidepressants (TCAs)
Anafranil
Elavil http://www.nmihi.com/a/amitriptyline.html
Pamelor
Sinequan
Tofranil
Monoamine oxidase inhibitors (MAOIs)
Eldepryl
Others
Zyprexa
Desyrel
Seroquel
buy Atomoxetine
Zyban http://www.nmihi.com/b/bupropion.html

Psychotherapy

Psychotherapy and drug therapy in combination often produce the best results. In mild cases, psychotherapy alone can be just as effective as drug therapy. Forms of psychotherapy for relieving depression include:

• Interpersonal therapy. Supporters believe that depression results from flawed personal relationships, which in turn perpetuate the depression. Interpersonal therapists focus on relationship issues, helping the patient to understand his or her feelings about them and finding ways to address them.
• Cognitive/behavioral therapy. This helps depressed people recognize and change the negative thinking and behavior that may lead to and perpetuate depression.
• Psychodynamic therapy. This focuses on resolving deep internal conflicts that depressed people may have carried from childhood to adulthood.

Electroconvulsive therapy (ECT)

ECT, previously known as "shock treatment," is reserved for severe depression, such as when a patient becomes suicidal or psychotic. Doctors place electrodes on the patient's head and deliver a mild shock, inducing a brain seizure. Doctors give the treatment under general anesthesia, in five to seven treatments, one treatment every other day. It may cause temporary memory loss, but it can deliver almost immediate relief from a severe depressive episode. Why ECT works is still a mystery.

Healthcare Professionals Who May Be Involved in Treatment

Many types of doctors treat depression, including:

• Family physicians
• Internists
• Pediatricians
• Psychiatrists
• Neuropsychiatrists
• Neurologists
• Psychologists

Considerations When Selecting Treatment

Some types of depression medication may be less suited for those with other health problems. For instance, if you have heart rhythm disturbances you should generally avoid tricyclic antidepressants (TCAs). These drugs may also cause blurred vision, dry mouth, and constipation. Another class of antidepressants, selective serotonin reuptake inhibitors (SSRIs), may decrease your sex drive. Ask your doctor about side effects of any medication you're prescribed.

Activity & Diet Recommendations

People who are depressed do best when their routine is as normal as possible. Even if you don't feel up to it, continue daily personal care, work, normal meals, and outings with friends and family. Also, get regular exercise, which can greatly improve your mood.

Even if your appetite is suppressed, you should make sure you get enough calories, protein, and nutrients. Avoid alcohol because it may interfere with the effectiveness of certain antidepressants as well as worsen depression. Some nutritional therapists promote a sugar-free diet high in complex carbohydrates and protein.

Monitoring Depression

Your physician will probably want to see you within two weeks of starting your medication and every two weeks thereafter until you feel an improvement. He or she will also want to evaluate side effects and effectiveness of the treatment. If the medication works for you — at the right dosage — you should see results within a month or so. You will probably want to see your doctor once every three months after you improve. Your treatment may last anywhere from six months to two years.

Possible Complications

The complications of depression include continuing misery and other symptoms. If a person does not respond to medication, suicide is a possibility in some cases. Ongoing depression occurring simultaneously with another major or chronic illness can make recovery from the second illness more difficult.

Quality of Life

Living with depression can profoundly affect the quality of your life. Even mild depression can steal months — or years — of happiness from your life if it goes untreated. And sadly, many depressed people struggle through their depressions without medical help. If you have friends or family members who are depressed, you would do them a great service by letting them know about their treatment options.

Considerations for Women

Pregnancy

You should avoid many antidepressant drugs during pregnancy. Check with your physician about treatment alternatives.

Nursing mothers

Most antidepressant drugs are passed through breast milk. Talk to your doctor about any medicines you may be taking if you are considering breastfeeding.

Considerations for Older People

Nearly one in six Americans over age 65 — more than five million — has serious symptoms of depression. Another one million have clinical depression. But other serious physical problems that an older person may have often overshadow the depression. Also, the usual symptoms of depression may not show up in older people. Instead, the person may be irritable and apathetic, have difficultly concentrating, memory lapses, and decreased energy — symptoms that are often mistaken for normal signs of aging. Because adverse reactions to antidepressant drugs are more common in older people, doctors start their medications at a low dosage.

Considerations for Children and Adolescents

Some perfectly healthy children and teens are, on occasion, moody, withdrawn, and sullen. Such behavior is normal. When a child is clinically depressed, symptoms such as these become exaggerated, persist, and do not respond to parental counseling or intervention. In addition, children and adolescents may not appear "depressed" as an adult would, but instead may be more angry, irritable, or complain of vague physical symptoms. Depressed children need medical help and can benefit from the same treatments as adults. Here's what to look for if you are worried that your child may be depressed:

• Social isolation
• Anger and irritability
• Poor school performance
• Withdrawal from parents and family
• Unexplained crying
• Insomnia or excessive sleepiness
• Guilty feelings
• Unexplained physical pains
• Loss of appetite or overeating
• Neglect of personal appearance

ALERT! Children who ponder suicide, threaten it, or make a suicide plan should be taken seriously. Suicide rates among the young have increased and such threats represent a true emergency. Contact your suicide prevention hotline and your primary care doctor immediately if you worry that your child is at risk. Hope and help are available for anyone who is depressed.