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Depression (Major Depressive Disorder)

• Definition of Depression (Major Depressive Disorder)
• Description of Depression (Major Depressive Disorder)
• Causes and Risk Factors of Depression (Major Depressive Disorder)
• Symptoms of Depression (Major Depressive Disorder)
• Diagnosis of Depression (Major Depressive Disorder)
• Treatment of Depression (Major Depressive Disorder)
• What Questions To Ask Your Doctor About Depression (Major Depressive Disorder)
• Alternative Depression (Major Depressive Disorder)

Definition of Depression (Major Depressive Disorder)

Depression is a medical disorder characterized by feelings of sadness, hopelessness, pessimism, guilt, and a general loss of interest in life, combined with a sense of reduced emotional well-being and low energy. People with depression also tend to have disturbed sleep, reduced appetite and may even feel suicidal.

Description of Depression (Major Depressive Disorder)

Symptoms of depression can occur as a result of a wide range of medical and psychiatric disorders. In a person who has been found to not be medically ill, there are three common psychiatric diagnoses in which depression is present: major depressive disorder, Dysthymic disorder, and bipolar disorder:

• 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 tend to have fewer symptoms than those with major depression, but the symptoms last longer and develop more slowly. 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.

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Causes and Risk Factors of Depression (Major Depressive Disorder)

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.

Depressed mood can be caused my a variety of medical conditions and by certain medications, including certain sedating and heart medications. Once these conditions are treated or the medication stopped or changed, the depressive symptoms will usually go away.

Symptoms of Depression (Major Depressive Disorder)

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 of Depression (Major Depressive Disorder)

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 of Depression (Major Depressive Disorder)

Treatment of depression 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:

  amitriptyline (Elavil)

  imipramine (Trofanil,Janimine)

  nortryptyline (Pamelor)

  despiramine (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 phenelzine (Nardil) and tranylcypromine (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 has been used to improve the benefit of SSRIs and alone is effective in treating bipolar disorder.
• Selective serotonin reuptake inhibitors (SSRIs) include:

  fluoxetine (Prozac)

  fluvoxamine (Luvox)

  paroxetine (Paxil)

  sertraline (Zoloft)

  citalopram (Celexa)

  escitalopram oxalate (Lexapro)

  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. Two other antidepressants that affect two neurotransmitters, serotonin and norepinephrine, are venlafaxine (Effexor) and nefazodone (Serzone). Another of the newer antidepressants, bupropion (Wellbutrin), is chemically unrelated to the other antidepressants. It has more effect on norepinephrine and dopamine than on serotonin.

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, psychiatrist 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 commonly used 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.

What Questions To Ask Your Doctor About Depression (Major Depressive Disorder)

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?

Alternative Depression (Major Depressive Disorder)

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.