Saturday, 17 November 2012


Feeling sad, or what we may call "depressed", happens to all of us. The sensation usually passes after a while. However, a person with a depressive disorder - clinical depression - finds that his state interferes with his daily life. His normal functioning is undermined to such an extent that both he and those who care about him are affected by it. 

According to MediLexicon's Medical Dictionary depression is "a mental state or chronic mental disorder characterized by feelings of sadness, loneliness, despair, low self-esteem, and self-reproach; accompanying signs include psychomotor retardation (or less frequently agitation), withdrawal from social contact, and vegetative states such as loss of appetite and insomnia."

What are the different forms of depression?

There are several forms of depression (depressive disorders). Major depressive disorder and dysthymic disorder are the most common.
  • Major depressive disorder (major depression) 

    Major depressive disorder is also known as major depression. The patient suffers from a combination of symptoms that undermine his ability to sleep, study, work, eat, and enjoy activities he used to find pleasurable. Experts say that major depressive disorder can be very disabling, preventing the patient from functioning normally. Some people experience only one episode, while others have recurrences.

  • Dysthymic disorder (dysthymia) 

    Dysthymic disorder is also known as dysthymia, or mild chronic depression. The patient will suffer symptoms for a long time, perhaps as long as a couple of years, and often longer. However, the symptoms are not as severe as in major depression, and the patient is not disabled by it. However, he may find it hard to function normally and feel well. Some people experience only one episode during their lifetime, while others may have recurrences.

    A person with dysthymia might also experience major depression, once, twice, or more often during his lifetime. Dysthymia can sometimes come with other symptoms. When they do, it is possible that other forms of depression are diagnosed.

  • Psychotic depression

    When severe depressive illness includes hallucinations, delusions, and/or withdrawing from reality, the patient may be diagnosed with psychotic depression.

  • Postpartum depression (postnatal depression) 

    Postpartum depression is also known as postnatal depression or PND. This is not to be confused with 'baby blues' which a mother may feel for a very short period after giving birth. If a mother develops a major depressive episode within a few weeks of giving birth it is most likely she has developed PND. Experts believe that about 10% to 15% of all women experience PND after giving birth. Sadly, many of them go undiagnosed and suffer for long periods without treatment and support.
  • Bipolar disorder (manic-depressive illness) 

    Bipolar disorder is also known as manic-depressive illness. It used to be known as manic depression. It is not as common as major depression or dysthymia. A patient with bipolar disorder experiences moments of extreme highs and extreme lows. These extremes are known as manias.

What are the signs and symptoms of depression?

Depression is not uniform. Signs and symptoms may be experienced by some sufferers and not by others. How severe the symptoms are, and how long they last depends on the individual person and his illness. Below is a list of the most common symptoms:
  • A constant feeling of sadness, anxiety, and emptiness
  • A general feeling of pessimism sets in (the glass is always half empty)
  • The person feels hopeless
  • Individuals can feel restless
  • The sufferer may experience irritability
  • Patients may lose interest in activities or hobbies they once enjoyed
  • He/she may lose interest in sex
  • Levels of energy feel lower, fatigue sets in
  • Many people with a depressive illness find it hard to concentrate, remember details, and make decisions
  • Sleep patterns are disturbed - the person may sleep too little or too much
  • Eating habits may change - he/she may either eat too much or have no appetite
  • Suicidal thoughts may occur - some may act on those thoughts
  • The sufferer may complain more of aches and pains, headaches, cramps, or digestive problems. These problems do not get better with treatment.
More information on the symptoms of depression is available in our article What Are The Symptoms Of Depression?.

Some illnesses accompany, precede, or cause depression

Anxiety disorders, such as PTSD (post-traumatic stress disorder), OCD (obsessive-compulsive disorder), social phobia, generalized anxiety disorder and panic disorder often accompany depression. 

People who are dependent on alcohol or narcotics have a significantly higher chance of also having depression. 

Depression is much more common for people who suffer from HIV/AIDS, heart disease, stroke cancerdiabetesParkinson's disease, and many other illnesses. According to studies, if a person has depression as well as another serious illness he is more likely to have severe symptoms, and will find it harder to adapt to his medical condition. Studies have also shown that if these people have their depression treated the symptoms of their co-occurring illness improve.

Depression and discrimination

79% of people who have been diagnosed with depression say they have experienced discrimination because of their mental disorder.

Most previous investigations have linked depression as a consequence of discrimination. This study, carried out by researchers from King's College London's Institute of Psychiatry, England, and reported in The Lancet in October 2012, found that it can occur the other way round; people may be discriminated because they have depression.

Lead researcher Professor Graham Thornicroft said:

"Previous work in this area has tended to focus on public attitudes towards stigma based on questions about hypothetical situations, but ours is the first study to investigate the actual experiences of discrimination in a large, global sample of people with depression. Our findings show that discrimination related to depression is widespread, and almost certainly acts as a barrier to an active social life and having a fair chance to get and keep a job for people with depression."

What causes depression?

We are still not sure what causes depression. Experts say depression is caused by a combination of factors, such as the person's genes, his biochemical environment, his personal experience and psychological factors. 

MRI (magnetic resonance imaging) has shown that the brain of a person with depression looks different, compared to the brain of a person who has never had depression. The areas of the brain that deal with thinking, sleep, mood, appetite and behavior do not appear to function normally. There are also indications that neurotransmitters appear to be out of balance. Neurotransmitters are chemicals that our brain cells use to communicate. However, imaging technology has not revealed why the depression happened. 

We know that if there is depression in the family a person's chances of developing depression are higher. This suggests there is a genetic link. According to geneticists, depression risk is influenced by multiple genes acting together with environmental and others factors. 

An awful experience can trigger a depressive illness. For example, the loss of a family member, a difficult relationship, physical sexual abuse.

What is the treatment for depression?

Depression is highly treatable - even in its most severe forms. The sooner a person is treated the more effective that treatment will be. Studies have also shown that prompt treatment reduces significantly the likelihood of recurrence. 

As some medications and medical conditions can cause the same symptoms as depression, you need to get your doctor to rule out these possibilities before conducting a physical examination. You will also have an interview and lab tests. When your doctor, usually a GP (general practitioner) at this point, has ruled out a medical condition or pharmacological cause, he will either carry out a psychological evaluation or refer you to a mental health specialist. 

The mental health specialist should carry out a comprehensive diagnostic evaluation. You will be asked whether there is any family history of depression, what your symptoms are and how long they have existed, how severe your symptoms are. You will also be asked whether you consume alcohol or drugs, and whether you have had any suicidal thoughts. 

If you are diagnosed with some form of depressive illness, you will be offered treatment. Depression can be treated with a number of methods; the most common are drugs and/or psychotherapy. 

There is evidence supporting the idea that exercise can help patients with depression, particularly if they have or are at high risk of developing other conditions such as obesity, cardiovascular disease or diabetes, which can often be the case.

Medication for depression

The aim of an antidepressant is to stabilize and normalize the neurotransmitters in our brain (naturally occurring brain chemicals), such as serotonin, dopamine, and norepeniphrine. According to various studies, these neurotransmitters play a vital role in regulating mood. We know they regulate mood, but we are not exactly sure how they do it. 

SSRIs (selective serotonin reuptake inhibitors) are the newest antidepressants; they are also the most popular. Prozac  (fluoxetine), Celexa  (citalopram), and Zoloft  (sertraline) are all SSRIs. 

SNRIs (norepinephrine reuptake inhibitors) are similar to SSRIs. Effexor  (venlafaxine) and Cymbalta (duloxetine) are SNRIs. 

SSRIs and SNRIs are more popular today than older types of antidepressants, mainly because they have fewer side-effects. MAOIs (monoamine oxidase inhibitors) and tricyclics are examples of older antidepressants. Nevertheless, modern antidepressants do affect some people with undesirable side-effects. For people who experience high levels of unpleasant side effects with SSRIs or SNRIs, tricyclics or MAOIs may be a better option. 

If you are taking MAOIs you have to be careful with your diet and other medications. MAOIs have potentially serious interactions with some foods and drugs. Cheeses, wines and pickles have high levels of tyramine, which interact with MAOIs - so they must be avoided. Some decongestants also have tyramine in them. When a MAOI interacts with tyramine the patient may experience a significant rise in blood pressure, which in turn increases the risk of stroke. If a doctor prescribes an MAOI make sure you receive a comprehensive list of foods, medicines and substances you should avoid. 

In the majority of cases, the patient will not notice any really significant benefit from an antidepressant until he has been taking it for a few weeks. It is important to continue taking them for this reason. Make sure you take them according to your doctor's instructions. Even if you feel better, do not stop the medication unless your doctor tells you to. Not only do antidepressants help to make you feel better, they also significantly reduce your chances of having a recurrence or relapse. 

Under a doctor's supervision, if you do come off the medicine it will usually be gradually. In most cases, your body needs time to adjust to the change. Even though antidepressant are said not to be addictive, if you stop taking them abruptly you may experience very unpleasant withdrawal symptoms. Many people who suffer from chronic and recurrent depression continue taking medications for an indefinite period. 

If you find one drug does not work after a few weeks tell your doctor and see if he can get you onto another one. Research has shown that treatment is much more successful if a patient switches from a drug that does not seem to be working to another one.

Ketamine provides rapid relief of depressive symptoms

Patients with chronic depression who take a small amount of ketamine may experience considerable improvements within a few hours, researchers from Yale University reported in the journal Science, October 2012 issue.

Ketamine, a pediatric anesthetic, appears to repair synaptic connections between brain cells that have been badly affected by stress or depression.

Ketamine has the potential to offer significant advantages over most antidepressant which can take several weeks, and even months to start working. According to the researchers, one third of all patients complain that antidepressants do not help them at all.

Ketamine, which works on a completely different kind of neurotransmitter system, provides much faster results.

Senior author, Ronald Duman, said "The rapid therapeutic response of ketamine in treatment-resistant patients is the biggest breakthrough in depression research in a half century."

What are the side effects of antidepressants?

Most people who experience side effects will find they are mild and short-lived. It is rare for a patient to have long-term effects, but there are cases. Any unusual reaction you experience should be reported to your doctor straight away. 

 common side effects :
  • Headache, in the beginning. After a while it will go away.
  • Nausea. This also goes away after a while.
  • Insomnia. This may go away after a few weeks. In some cases a reduction of dosage may be necessary.
  • Feeling jittery (agitation).
  • Men may experience erectile dysfunction, delayed ejaculation.
  • Both men and women may have lower libido and find it harder to achieve orgasm.
 side effects:
  • Dry mouth.
  • Constipation.
  • Emptying bladder may be harder, the urine stream may be weaker. A man with an enlarged prostate may be more affected. If it is hard to urinate tell your doctor.
  • Men may experience erectile dysfunction, delayed ejaculation.
  • Both men and women may have lower libido and find it harder to achieve orgasm.
  • Vision may be blurred at first. This usually gets better.
  • Daytime drowsiness at first. This usually goes away after a while. If you do become drowsy do not drive or operate heavy machinery.
In the USA in 2005 the FDA made drug makers adopt a 'black box' warning label on all antidepressant warning about the possibility of suicidal thoughts or attempts at suicide by children and adolescents who take an antidepressant. A review of trials involving over four thousand children revealed that 4% of children and adolescents who took antidepressants thought about or attempted suicide, compared to 2% of those on a placebo (a dummy drug). However, nobody did commit suicide. The warning also said that those taking antidepressants should be watched closely by their doctors during the first weeks of treatment. The warning asks health care professionals to look out for warning signs, such as worsening depression, suicidal thinking or behavior, or any changes in behavior which are out of the ordinary, such as sleeplessness, agitation, or withdrawal from normal social situations. The warning also states that family members and caregivers should also be told that close monitoring is needed, and to report any changes to the doctor. 

The majority of health authorities and experts throughout the world believe that the benefits of taking antidepressants for treating major depression and anxiety disorder among children and adolescents outweigh the risks.

Psychotherapy for treating depression

Psychotherapy has been shown to help people with many forms of depression. Psychotherapy is carried out by a trained psychotherapist. It helps the patient with problems of living. The aim of psychotherapy is to "increase the individual's sense of well being and reduce their subjective sense of discomfort." (Wikipedia). Psychotherapy is also known as 'talk therapy'. 

The psychotherapist aims to improve the mental health of the patient (client) by employing a range of techniques based on experiential relationship building, dialogue, communications and behavior change. 

Depending on the needs of the patient, the treatment may last from ten to 20 weeks, or for much longer. There are two main types of psychotherapy:
  • Cognitive-behavioral therapy (CBT) - helps the patient alter his negative way of thinking and behaving. These negative styles may be contributing to the depression.

  • Interpersonal therapy (IPT) - helps the patient through uneasy personal relationships that could be exacerbating the depression.
The majority of experts say that for a patient with mild to moderate depression psychotherapy may be all that is needed. However, for those with major depression, a combination of medication and psychotherapy is usually more effective. According to various studies, adolescents respond better to a combination of medication and psychotherapy.

Electroconvulsive therapy (ECT) 

There are some patients who do not improve with medication, psychotherapy, or a combination of both. ECT, a term which replaced 'shock therapy' is sometimes useful for treatment-resistant depression. ECT has improved greatly over the years and does provide significant benefits for some patients. Side effects, such as memory loss, confusion and disorientation generally go away not long after treatment is administered. 

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