Depression
Depressive disorders have been with mankind since the beginning of recorded history. In the Bible, King David, as well as Job, suffered from this affliction. Hippocrates referred to depression as melancholia, which literally means black bile. Black bile, along with blood, phlegm, and yellow bile were the four humors (fluids) that described the basic medical physiology theory of that time. Depression, also referred to as clinical depression, has been portrayed in literature and the arts for hundreds of years, but what do we mean today when we refer to a depressive disorder? In the 19th century, depression was seen as an inherited weakness of temperament. In the first half of the 20th century, Freud linked the development of depression to guilt and conflict. John Cheever, the author and a modern sufferer of depressive disorder, wrote of conflict and experiences with his parents as influencing his development of depression.
In the 1950s and '60s, depression was divided into two types, endogenous and neurotic. Endogenous means that the depression comes from within the body, perhaps of genetic origin, or comes out of nowhere. Neurotic or reactive depression has a clear environmental precipitating factor, such as the death of a spouse, or other significant loss, such as the loss of a job. In the 1970s and '80s, the focus of attention shifted from the cause of depression to its effects on the afflicted people. That is to say, whatever the cause in a particular case, what are the symptoms and impaired functions that experts can agree make up a depressive disorder? Although there is some argument even today (as in all branches of medicines), most experts agree on the following:
- 1. A depressive disorder is a syndrome (group of symptoms) that reflects a sad and/or irritable mood exceeding normal sadness or grief. More specifically, the sadness of depression is characterized by a greater intensity and duration and by more severe symptoms and functional disabilities than is normal.
- 2. Depressive signs and symptoms are characterized not only by negative thoughts, moods, and behaviors but also by specific changes in bodily functions (for example, crying spells, body aches, low energy or libido, as well as problems with eating, weight, or sleeping). The functional changes of clinical depression are often called neurovegetative signs. This means that the nervous system changes in the brain cause many physical symptoms that result in diminished participation and a decreased or increased activity level.
- 3. Certain people with depressive disorder, especially bipolar depression (manic depression), seem to have an inherited vulnerability to this condition.
- 4. Depressive disorders are a huge public-health problem, due to its affecting millions of people. About 10% of adults, up to 8% of teens and 2% of preteen children experience some kind of depressive disorder.
- The statistics on the costs due to depression in the United States include huge amounts of direct costs, which are for treatment, and indirect costs, such as lost productivity and absenteeism from work or school.
- Adolescents who suffer from depression are at risk for developing and maintaining obesity.
- In a major medical study, depression caused significant problems in the functioning of those affected more often than did arthritis, hypertension, chronic lung disease, and diabetes, and in some ways as often as coronary artery disease.
- Depression can increase the risks for developing coronary artery disease, HIV, asthma, and many other medical illnesses. Furthermore, it can increase the morbidity (illness/negative health effects) and mortality (death) from these and many other medical conditions.
- Depression can coexist with virtually every other mental health illness, aggravating the status of those who suffer the combination of both depression and the other mental illness.
- Depression in the elderly tends to be chronic, has a low rate of recovery, and is often undertreated. This is of particular concern given that elderly men, particularly elderly white men have the highest suicide rate.
5. Depression is usually first identified in a primary-care setting, not in a mental health practitioner's office. Moreover, it often assumes various disguises, which causes depression to be frequently underdiagnosed.
6. In spite of clear research evidence and clinical guidelines regarding therapy, depression is often undertreated. Hopefully, this situation can change for the better.
7. For full recovery from a mood disorder, regardless of whether there is a precipitating factor or it seems to come out of the blue, treatment with medication and/or electroconvulsive therapy (ECT) (see discussion below) and psychotherapy are necessary.
Contents |
[edit] Causes, incidence, and risk factors
The exact cause of depression is not known. Many researchers believe it is caused by chemical imbalances in the brain, which may be hereditary or caused by events in a person's life.
Some types of depression seem to run in families, but depression can also occur in people who have no family history of the illness. Stressful life changes or events can trigger depression in some people. Usually, a combination of factors is involved.
Men and women of all ages, races, and economic levels can have depression. Depression can also occur in children and teenagers.
A number of factors can play a role in depression:
- Alcohol or drug abuse
- Life events or situations, such as:
- Breaking up with a boyfriend or girlfriend, failing a class, illness or death in the family, or parents divorcing (for adolescents)
- Childhood events, such as abuse or neglect
- Divorce, death of a friend or relative, or loss of a job (for adults)
- Social isolation (common in the elderly)
- Medical conditions such as hypothyroidism (underactive thyroid), medications (such as sedatives and high blood pressure medications), cancer, major illness, or prolonged pain
- Sleeping problems
[edit] Symptoms
Depression can change or distort the way adolescents see themselves and their lives, as well as other people around them. People who have depression usually see everything with a more negative attitude, unable to imagine that any problem or situation can be solved in a positive way.
Symptoms include:
- Agitation, restlessness, and irritability
- Dramatic change in appetite, often with weight gain or loss
- Extreme difficulty concentrating
- Fatigue and lack of energy
- Feelings of hopelessness and helplessness
- Feelings of worthlessness, self-hate, and inappropriate guilt
- Inactivity and withdrawal from usual activities, a loss of interest or pleasure in activities that were once enjoyed (such as sex)
- Thoughts of death or suicide
- Trouble sleeping or excessive sleeping
Depression can appear as anger and discouragement, rather than as feelings of hopelessness and helplessness. Use of alcohol or illegal substances may be more likely to occur.
If depression is very severe, there may also be psychotic symptoms, such as hallucinations and delusions. These symptoms may focus on themes of guilt, inadequacy, or disease.
[edit] Signs and tests
Major depression is diagnosed if a person reports having five or more depressive symptoms for at least 2 weeks. Beck's Depression Scale Inventory or other screening tests for depression can be helpful in making the diagnosis.
Before diagnosing depression, the health care provider should rule out medical conditions that can cause symptoms of depression.
[edit] Treatment
Medicines that you take for other problems could cause or worsen depression. You may need to change them. DO NOT change or stop taking any of your medications without consulting your doctor.
People who are so severely depressed that they are unable to function, or who are suicidal and cannot be safely cared for in the community may need to be treated in a psychiatric hospital.
Most people benefit from antidepressant drug therapy, along with psychotherapy. As treatment takes effect, negative thinking diminishes. It takes time to feel better, but there are usually day-to-day improvements.
MEDICATIONS FOR DEPRESSION
Drugs used to treat depression are called antidepressants.
- Selective serotonin re-uptake inhibitors (SSRIs) are the most commonly used antidepressants. Names include: fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), fluvoxamine (Luvox), citalopram (Celexa), and escitalopram (Lexapro).
- Serotonin norepinephrine reuptake inhibitors (SNRIs) are also commonly used. Names include desvenlafaxine (Pristiq), venlafaxine (Effexor), and duloxetine (Cymbalta).
- Other medicines used to treat depression include: tricyclic antidepressants, bupropion (Wellbutrin), and monoamine oxidase inhibitors.
People with psychotic symptoms, such as delusions or hallucinations, may need antipsychotic medications.
Some people with major depression may feel better after taking antidepressants for a few weeks. However, many people need to take medication for 4 - 9 months to get a full response and to prevent depression from coming back.
Some people who do not improve with routine dosages of antidepressants and talk therapy have what is called treatment-resistant depression. They are often prescribed higher (but still safe) doses of their antidepressants, or a combination of medications. Lithium and thyroid hormone supplements also may be added to help the antidepressants work better.
Women being treated for depression who are pregnant or thinking about becoming pregnant should not stop taking antidepressants without first talking to their doctors.
An over-the-counter herb called St. John's wort may help some people with mild depression only. It can change the way other medicines work in your body, including antidepressants and birth control pills. Always talk to your doctor before trying this herb.
Note: Young adults ages 18 - 24 should be watched more closely for suicidal behavior, especially during the first few months after starting medications.
TALK THERAPY
People with depression benefit from some type of talk therapy and counseling. Talk therapy is a good place to talk about feelings and thoughts, and most importantly, learn ways to deal with them.
Types of talk therapy include:
- Cognitive behavioral therapy teaches depressed people ways of fighting negative thoughts. People can learn to be more aware of their symptoms, learn what seems to make depression worse, and learn problem-solving skills.
- Psychotherapy can help someone with depression understand the issues that may be behind their behaviors, thoughts, and feelings.
- Joining a support group of people who are experiencing problems like yours can also help. Ask your therapist or doctor for a recommendation.
OTHER THERAPIES
Electroconvulsive therapy (ECT) may improve the mood of severely depressed or suicidal people who don't respond to other treatments. It may also help with depressed patients who have psychotic symptoms.
Transcranial magnetic stimulation (TMS) uses high frequency magnetic pulses that target affected areas of the brain. It is often thought to be a second-line treatment after ECT.
Use of light therapy for depressive symptoms may help in the winter months to restore a normal sleep cycle. However, by itself it is not an effective treatment for major depression.
