Depression

What is Depression?
Depression is a disorder of mood in which there are severe and long lasting feelings of sadness, hopelessness, or related symptoms that can interfere with the ability of a person to function in life.

What are the causes and risk factors of Depression?
Depression has many causes. Psychological factors that increase the risk of depression include:

• Trouble expressing anger in a healthy way
• Low self-esteem
• Strong dependency needs
• Poor people skills
• A pessimistic view of oneself and the world

Genetic inheritance is a strong risk factor for many people, as is a high level of stress. In recent years, it has become clear that depression also involves a very specific chemical imbalance in the areas of the brain that are responsible for mood and emotion.

What happens to people who have Depression?
Depression is a one-time illness for about half the people who suffer from it. For the other half there is a lifelong risk of repeated episodes of depression. These people are said to have Recurrent Major Depression. In most people with recurrent depression, the symptoms disappear completely between episodes, but for about one- third of people with depression, there are lingering symptoms between episodes.

What are the symptoms of depression?
The symptoms of depression may include:

• Sadness
• Feeling hopeless or helpless
• Poor appetite with weight loss
• Increased appetite with weight gain
• Trouble sleep or sleeping too much
• Agitation
• Self-reproach
• Excessive guilt
• Inability to concentrate
• Indecisiveness
• Frequent thoughts of death or suicide
• Irritability
• Hallucinations
• Anxiety
• Worry about one's physical health
• Phobias
• Drug or alcohol abuse
• Problems at school or work
• Increased emotionality
• Memory loss
• Apathy
• Distractibility
• Delusions
• Tearfulness
• Brooding
• Panic attacks
• Aggressiveness
• Social withdrawal
• Poor grooming
• Memory loss
• General slowing down
• Loss of interest or pleasure in things that used to be fun
• Loss of energy
• Tiredness
• Feelings of worthlessness

These symptoms must be severe enough to cause significant distress or loss of functioning.

What happens if the symptoms return after I get them under control?
Since depression is an illness that may return, plan what to do if signs of relapse appear. List which specific symptoms are danger signs. Make a plan to call your therapist immediately when those symptoms occur, and at the same time increase the amount of daily structure and decrease stress and responsibility for awhile.

What can I do to deal with my Depression?

Some of the things a person can do to make the fullest possible recovery are:

• Maintain a consistent daily schedule.
• Take medicines as prescribed.
• Return to your responsibilities slowly and gradually.
• Set realistic goals.
• Ask for help when you need it.
• Meet regularly with your therapist (consult your doctor if you do not have one).
• Get enough sleep. Go to sleep and get up at about the same times every day.
• Eat a healthy diet.
• Exercise regularly.
• Before taking a new prescription or over-the-counter medication, check with the person who prescribes your psychiatric medication.
• Discuss the social use of alcohol with your doctor.
• Avoid street drugs.
• Build and keep friendships and a network of support.
• Take a course in stress management or assertiveness.
• Work hard in therapy.

What is the treatment of Depression?
Treatment usually involves lifestyle changes, psychotherapy, and perhaps medicines. Antidepressant medicines are frequently prescribed, and sometimes other kinds of medicines are needed, too medicines sometimes used: lithium, antipsychotics (when psychotic symptoms are present), mood stabilizers, or stimulants. Psychotherapies that have been proven effective in treating depression include interpersonal, cognitive-behavioral and others. ECT (shock treatments) is an effective treatment for major depression when medicines have not worked, or when medicines cannot be used because of health problems.
**Your doctor will decide which treatment is right for you.

Medication Choices:
While all antidepressants have roughly equivalent efficacy for alleviation of depressive symptoms, the newer category called “SSRIs” offer advantages over the older antidepressants in terms of safety and tolerability. SSRI side effects may include sexual dysfunction and a slightly increased risk of gastrointestinal bleeding, especially in patients taking anti-inflammatory medication.
Drugs that commonly are used to treat depression include:
Doxepin, bupropion (Wellbutrin), fluoxetine (Prozac), paroxetine, sertraline, citalopram (Celexa), escitalopram (Lexapro), and venlafaxine (Effexor).

References:
1. Hasin, DS, Goodwin, RD, Stinson, FS, Grant, BF. Epidemiology of major depressive disorder: results from the National Epidemiologic Survey on Alcoholism and Related Conditions. Arch Gen Psychiatry 2005; 62:1097.
2. Freeman, EW, Sammel, MD, Lin, H, Nelson, DB. Associations of hormones and menopausal status with depressed mood in women with no history of depression. Arch Gen Psychiatry 2006; 63:375.
3. Nierenberg, AA, Farabaugh, AH, Alpert, JE, et al. Timing of onset of antidepressant response with fluoxetine treatment. Am J Psychiatry 2000; 157:1423.
4. Ekselius, L, von Knorring, L. Effect on sexual function of long-term treatment with selective serotonin reuptake inhibitors in depressed patients treated in primary care. J Clin Psychopharmacol 2001; 21:154.
5. Trivedi, MH, Rush, AJ, Wisniewski, SR, et al. Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: implications for clinical practice. Am J Psychiatry 2006; 163:28.
6. Medwatch 2005 safety summary. Available at: www.fda.gov/medwatch/safety/2005/safety05.htm#Paxil2 (Accessed October 3, 2005).

Copyright 2007, MD Kiosk