What is depression and who does it
affect?
Depression affects more than 9% of the
population (20 million people) of adults each year. Depression is generally
broken into 3 levels of severity: mild, moderate and severe.
Research indicates that depressive illnesses are disorders of the brain. Brain-imaging technologies, such as magnetic resonance imaging (MRI), have shown that the brains of people who have depression look different than those of people without depression. The parts of the brain responsible for regulating mood, thinking, sleep, appetite and behavior appear to function abnormally. In addition, important neurotransmitters–chemicals that brain cells use to communicate–appear to be out of balance. But these images do not reveal why the depression has occurred.
Some types of depression tend to run in families, suggesting a genetic link. However, depression can occur in people without family histories of depression as well. Genetics research indicates that risk for depression results from the influence of multiple genes acting together with environmental or other factors.
In addition, trauma, loss of a loved one, a difficult relationship, or any stressful situation may trigger a depressive episode. Subsequent depressive episodes may occur with or without an obvious trigger.
Depression is more common among women than among men. Biological, life cycle, hormonal and psychosocial factors unique to women may be linked to women's higher depression rate. We know that hormones directly affect brain chemistry that controls emotions and mood. For example, women are particularly vulnerable to depression after giving birth, when hormonal and physical changes, along with the new responsibility of caring for a newborn, can be overwhelming. Many new mothers experience a brief episode of the "baby blues," but some will develop postpartum depression, a much more serious condition that requires active treatment and emotional support for the new mother. Women who experience postpartum depression often have had prior depressive episodes.
Depression
in Women:
Some women may also be susceptible to a severe form of premenstrual syndrome (PMS), sometimes called premenstrual dysphoric disorder (PMDD), a condition resulting from the hormonal changes that typically occur around ovulation and before menstruation begins; decline in estrogen in particular. During the transition into menopause, some women experience an increased risk for depression. Scientists are exploring how the cyclical rise and fall of estrogen and other hormones may affect the brain chemistry that is associated with depressive illness.
Finally, many women face the additional stresses of work and home responsibilities, caring for children and aging parents, abuse, poverty, and relationship strains. It remains unclear why some women faced with enormous challenges develop depression, while others with similar challenges do not.
Depression
in Men:
Men often experience depression differently than women and may have different ways of coping with the symptoms. Men are more likely to acknowledge having fatigue, irritability, loss of interest in once–pleasurable activities, and sleep disturbances. Women on the other hand are more likely to admit to feelings of sadness, worthlessness and/or excessive guilt.
Men are more likely than women to turn to alcohol or drugs when they are depressed, or become frustrated, discouraged, irritable, angry and sometimes abusive. Men more so than women tend to throw themselves into their work to avoid talking about their depression with family or friends; they also are more likely to engage in reckless, risky behavior. Even though more women attempt suicide, many more men die by suicide in the United States.
Depression
in the Elderly:
Depression is not a normal part of aging, and studies show that most seniors feel satisfied with their lives, despite increased physical ailments. However, when older adults do have depression, it may be overlooked because seniors may show different, less obvious symptoms, and may be less inclined to experience or acknowledge feelings of sadness or grief.
Some older adults may experience what some call vascular depression, also called arteriosclerotic depression or subcortical ischemic depression. Vascular depression may result when blood vessels become less flexible and harden over time, becoming constricted. Such hardening of vessels prevents normal blood flow to the body's organs, including the brain. Those with vascular depression may have, or be at risk for, a co–existing cardiovascular illness or stroke.
Although many people assume that the highest rates of suicide are among the young, older white males age 85 and older actually have the highest suicide rate. Many have a depressive illness that their primary care professionals may not detect, despite the fact that these suicide victims often visit their primary care provider within one month of their deaths.
The majority of older adults with depression improve when they receive treatment with an antidepressant, psychotherapy, or a combination of both. Research has shown that psychotherapy and medication in combination treatment is most effective in reducing the rate of depressive recurrences in older adults. Psychotherapy alone also can be effective in prolonging periods free of depression, especially for older adults with minor depression, and it is particularly useful for those who are unable or unwilling to take antidepressant medication.
Symptoms of depression as commonly manifest in the Elderly:
Depression
in Children:
Research has shown that childhood depression often persists, recurs and continues into adulthood, especially if it goes untreated. The presence of childhood depression also tends to be a predictor of more severe illnesses in adulthood.
A child with depression may pretend to be sick, refuse to go to school, cling to a parent, or worry that a parent may die. Older children may sulk, get into trouble at school, be negative and irritable, and feel misunderstood. Because these signs may be viewed as normal mood swings typical of children as they move through developmental stages, it may be difficult to accurately diagnose a young person with depression.
Before puberty, boys and girls are equally likely to develop depressive disorders. By age 15, however, girls are twice as likely as boys to have experienced a major depressive episode.
Depression in adolescence comes at a time of great personal change–when boys and girls are forming an identity distinct from their parents, grappling with gender issues and emerging sexuality, and making decisions for the first time in their lives. Depression in adolescence frequently co–occurs with other disorders such as anxiety, disruptive behavior, eating disorders or substance abuse. It can also lead to increased risk for suicide.
An NIMH–funded clinical trial of 439 adolescents with major depression found that a combination of medication and psychotherapy was the most effective treatment option. Other NIMH–funded researchers are developing and testing ways to prevent suicide in children and adolescents, including early diagnosis and treatment, and a better understanding of suicidal thinking.
MAJOR TYPES OF DEPRESSION:
Major depressive disorder (MDD): also called major depression, and clinical depression, is characterized by a combination of symptoms that interfere with a person's ability to work, sleep, study, eat, and enjoy once–pleasurable activities. Major depression is disabling and prevents a person from functioning normally. An episode of major depression may occur only once in a person's lifetime, but more often, it recurs throughout a person's life.
Dysthymic disorder, also called dysthymia, is characterized by long–term (two years or longer) but less severe symptoms that may not disable a person but can prevent one from functioning normally or feeling well. People with dysthymia may also experience one or more episodes of major depression during their lifetimes.
Postpartum depression, which is diagnosed if a new mother develops a major depressive episode within one month after delivery. It is estimated that 10 to 15 percent of women experience postpartum depression after giving
birth.
Seasonal affective disorder (SAD), which is characterized by the onset of a depressive illness during the winter months, when there is less natural sunlight. The depression generally lifts during spring and summer. SAD may be effectively treated with light therapy, but nearly half of those with SAD do not respond to light therapy alone. Antidepressant medication and psychotherapy can reduce SAD symptoms, either alone or in combination with light
therapy.
Persistent sad, anxious or "empty" feelings
Feelings of hopelessness and/or pessimism
Feelings of guilt, worthlessness and/or helplessness
Irritability, restlessness
Loss of interest in activities or hobbies once pleasurable, including sex
Fatigue and decreased energy
Difficulty concentrating, remembering details and making decisions
Insomnia, early–morning wakefulness, or excessive sleeping
Overeating, or appetite loss
Thoughts of suicide, suicide attempts
Persistent aches or pains, headaches, cramps or digestive problems that do not ease even with treatment
Treatment: What can I do that will help me?
Depression, even the most severe cases, is a highly treatable disorder. As with many illnesses, the earlier that treatment can begin, the more effective it is and the greater the likelihood that recurrence can be prevented.
The first step to getting appropriate treatment is to visit a mental health care
provider. Certain medications, and some medical conditions such as viruses or a thyroid disorder, can cause the same symptoms as depression. A
mental health care provider can rule out these possibilities by conducting a physical examination, interview and lab tests.
Once we eliminate a medical condition as a cause, we next to a history including
when they started, how long they have lasted, their severity, and whether they have occurred before and if so, how they were treated.
Once diagnosed, a person with depression can be treated with a number of methods.
There are a number of options available for
treatment of depression. They include: psychotherapy (talk
therapy), which generally provides the greatest benefit. Antidepressant
medications have been shown to be effective in treating depression, and in some
cases are needed only for a short time, in other cases will be needed for the
rest of the individual’s life. A third treatment option is complementary
alternative medicine therapy (CAM-T). CAM therapies include relaxation,
meditation, hypnosis, herbal, aromatherapy, reiki, autogenic relaxation, and so
forth. The CAM therapies are generally less effective than psychotherapy, and
traditional medication therapy, but when combined with psychotherapy and
medication we get synergy (1+1+1=100; or more than the sum of the parts).
In truth each case of depression
is as unique as the fingerprint. For this reason there is no real “cookbook”
treatment that can be posted. The best plan of care is tailored to the
individual by a trained psychotherapist. Again generally speaking when we
combine medication therapy with psychotherapy we get real synergy (more than the
sum of the parts).
Medication:
Antidepressants work to normalize naturally occurring brain chemicals called neurotransmitters, notably serotonin,
norepinephrine, and dopamine. Scientists studying depression have found that these particular chemicals
sometimes called catacholamines are involved in regulating mood, but they are unsure of the exact ways in which they work.
The newest and most popular types of antidepressant medications are called selective serotonin reuptake inhibitors (SSRIs). SSRIs include fluoxetine (Prozac), citalopram (Celexa),
escitalopram (Lexapro) sertraline (Zoloft) and several others. Serotonin and norepinephrine reuptake inhibitors (SNRIs) are similar to SSRIs and include venlafaxine (Effexor) and duloxetine (Cymbalta). SSRIs and SNRIs are more popular than the older classes of antidepressants, such as tricyclics–named for their chemical structure–and monoamine oxidase inhibitors (MAOIs) because they tend to have fewer side effects. However, medications affect everyone differently–no one–size–fits–all approach to medication exists. Therefore, for some people, tricyclics or MAOIs may be the best choice.
People taking MAOIs must adhere to significant food and medicinal restrictions to avoid potentially serious interactions. They must avoid certain foods that contain high levels of the chemical tyramine, which is found in many cheeses, wines and pickles, and some medications including decongestants. MAOIs interact with tyramine in such a way that may cause a sharp increase in blood pressure, which could lead to a stroke. A
provider should give a patient taking an MAOI a complete list of prohibited foods, medicines and substances.
For all classes of antidepressants, patients must take regular doses for at least three to four weeks before they are likely to experience a full therapeutic effect. They should continue taking the medication for the time specified by their
prescriber, even if they are feeling better, in order to prevent a relapse of the depression. Medication should be stopped only under a
licensed professionals supervision. Some medications need to be gradually stopped to give the body time to adjust. Although antidepressants are not habit–forming or addictive, abruptly ending an antidepressant can cause withdrawal symptoms or lead to a relapse. Some individuals, such as those with chronic or recurrent depression, may need to stay on the medication indefinitely.
In addition, if one medication does not work, patients should be open to trying another. NIMH–funded research has shown that patients who did not get well after taking a first medication increased their chances of becoming symptom–free after they switched to a different medication or added another medication to their existing one.
Sometimes stimulants, anti–anxiety medications, or other medications are used in conjunction with an antidepressant, especially if the patient has a co–existing mental or physical disorder. However, neither anti–anxiety medications nor stimulants are effective against depression when taken alone, and both should be taken only under
a practitioners close supervision.
What are the side effects of antidepressants?
Antidepressants may cause transient (mild and often temporary) side effects in some people, but they are usually not long–term. However, any unusual reactions or side effects that interfere with normal functioning should be reported to
the prescriber immediately.
The most common side effects associated with SSRIs and SNRIs include:
Headache–usually temporary and will subside.
Nausea–temporary and usually short–lived.
Insomnia and nervousness (trouble falling asleep or waking often during the night)–may occur during the first few weeks but often subside over time or if the dose is reduced.
Agitation (feeling jittery).
Constipation, or diarrhea
Sexual problems–both men and women can experience sexual problems including reduced sex drive, erectile dysfunction, delayed ejaculation, or inability to have an orgasm.
Tricyclic antidepressants also can cause side effects including:
Dry mouth-it is helpful to drink plenty of water, chew gum, and clean teeth daily.
Constipation-it is helpful to eat more bran cereals, prunes, fruits, and vegetables.
Bladder problems–emptying the bladder may be difficult, and the urine stream may not be as strong as usual. Older men with enlarged prostate conditions may be more affected. The prescriber should be notified if it is painful to urinate.
Sexual problems–sexual functioning may change, and side effects are similar to those from SSRIs.
Blurred vision–often passes soon and usually will not require a new corrective lenses prescription.
Drowsiness during the day–usually passes soon, but driving or operating heavy machinery should be avoided while drowsiness occurs. The more sedating antidepressants are generally taken at bedtime to help sleep and minimize daytime drowsiness.
FDA Warning on antidepressants:
Despite the relative safety and popularity of SSRIs and other antidepressants, some studies have suggested that they may have unintentional effects on some people, especially adolescents and young adults. In 2004, the Food and Drug Administration (FDA) conducted a thorough review of published and unpublished controlled clinical trials of antidepressants that involved nearly 4,400 children and adolescents. The review revealed that 4% of those taking antidepressants thought about or attempted suicide (although no suicides occurred), compared to 2% of those receiving placebos.
This information prompted the FDA, in 2005, to adopt a "black box" warning label on all antidepressant medications to alert the public about the potential increased risk of suicidal thinking or attempts in children and adolescents taking antidepressants. In 2007, the FDA proposed that makers of all antidepressant medications extend the warning to include young adults up through age 24. A "black box" warning is the most serious type of warning on prescription drug labeling.
The warning emphasizes that children, adolescents and young adults taking antidepressants should be closely monitored, especially during the initial weeks of treatment. Possible side effects to look for are worsening depression, suicidal thinking or behavior, or any unusual changes in behavior such as sleeplessness, agitation, or withdrawal from normal social situations.
Results of a comprehensive review of pediatric trials conducted between 1988 and 2006 suggested that the benefits of antidepressant medications likely outweigh their risks to children and adolescents with major depression and anxiety disorders.28 The study was funded in part by the National Institute of Mental Health.
Psychotherapy:
Several types of psychotherapy–or "talk therapy"–can help people with depression.
Some regimens are short–term (10 to 20 weeks) and other regimens are longer–term, depending on the needs of the individual. Two main types of psychotherapies–cognitive–behavioral therapy
(CBT) and interpersonal therapy (IPT)-have been shown to be effective in treating depression. By teaching new ways of thinking and behaving, CBT helps people change negative styles of thinking and behaving that may contribute to their depression. IPT helps people understand and work through troubled personal relationships that may cause their depression or make it worse.
For mild to moderate depression, psychotherapy may be the best treatment option. However, for major depression or for certain people, psychotherapy may not be enough. Studies have indicated that for adolescents, a combination of medication and psychotherapy may be the most effective approach to treating major depression and reducing the likelihood for
recurrence. Similarly, a study examining depression treatment among older adults found that patients who responded to initial treatment of medication and IPT were less likely to have recurring depression if they continued their combination treatment for at least two
years.
Nourishment
Take in adequate and nourishing meals. You
cannot go wrong eating an Asian model diet. An Asian model diet consists of
mostly vegetables, and fruit with just enough meat to add spice and protein. The
vegetables should preferably be either raw, or steamed with minimum fat. A good
way to remember how much fat is too much for vegetables is “remember if they
are shiny when wet, they contain too much fat”.
Avoid Negative Thinking
Negative thinking (I’ll never get better, or
I don’t deserve the good stuff) is something you cannot afford. The most
powerful part of your mind is the unconscious mind. Like an iceberg, which is
mostly under water with only a small portion sticking above the water; most of
the mind is unconscious with only a small part of the mind making up the
conscious mind.
The conscious mind is like a little child in
that it does not like to be “told” what to do or think, but is very much so
influenced by suggestion.
Negative thoughts like “I’ll never amount
to anything” suggest to the unconscious mind that it should set about making
this come true in your life.
On the other hand if you replace these negative
thoughts with positive thoughts like “in time I see myself growing as a
person, reaching my positive goals”. Then the unconscious mindsets about
looking for ways to make this prophesy come to pass, which leads us to
affirmations.
Power of positive self-affirmations
Affirmations are statements we say aloud. We
say them as if they have already happened. In doing so we actually program the
subconscious mind like a computer to make true that which you have told it to
become true.
Feel free to create your own affirmations or
use these:
“I feel vital, full of energy and vigor”
“I feel confident and content”
"I deserve the good stuff."
"I deserve happiness."
"I feel in control of my mood, it is
uplifting.”
"I find a sense of discovery in my daily
life routines."
"I deserve the love and respect of
others."
Stay away from Negative People
To a large degree we become like those we
associate with. If we hang out with pessimistic negative people we find our own
negative pessimistic thoughts being strengthen.
On the other hand if we spend time with people
who are positive and optimistic we will see our own positive beliefs and
feelings strengthen, growing and take form.
About the Author:
Donald W. Ahrens Jr, PMH-NP, A.R.N.P. is a
psychiatric Nurse Practitioner who provides full spectrum psychiatric service
which is to say: psychotherapy, medication therapy, and Complementary Therapies
(Donald is trained in hypnosis, progressive muscle relaxation, autogenic
relaxation, aroma therapy, biofeedback and more than 20 years of Zen
Meditation). Full Spectrum Psychiatric service brings as many scientifically
researched methods as the patients is interested in perusing to bear in the
treatment of psychiatric disorders serving the people of Wichita and the
surrounding metropolitan area.
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