Depression

Major Depressive Disorder is the leading cause of disability in the U.S. for individuals aged 15-44. It affects approximately 14.8 million American adults, or about 6.7 percent of the U.S. population age 18 and older in a given year.

Major depression is diagnosed when five or more symptoms of depression, such as feeling sad, hopeless, worthless, or pessimistic, are present for at least two weeks. In addition, people with major depression often have behavioral changes, such as new eating and sleeping patterns. Major depression is also known as unipolar depression or major depressive disorder and increases a person's risk of suicide.

What causes Depression and who is at risk?

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 may be 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.

Each year, more than 18 million Americans -- men and women of all ages, races, and economic levels -- have depression. It occurs more often in women and the median age of onset is 32. Women are especially vulnerable to depression after giving birth because of the hormonal and physical changes that occur (post-partum depression). While new mothers commonly experience temporary "baby blues," depression that lasts longer than 2-3 weeks is not normal and requires treatment.

Major depression can occur in children and teenagers (cf. adolescent depression) and in the elderly (cf. depression - elderly); all of these patients can benefit from treatment.

Symptoms of Depression

  • Trouble sleeping or excessive sleeping
  • A dramatic change in appetite, often with weight gain or loss
  • Fatigue and lack of energy
  • Feelings of worthlessness, self-hate, and inappropriate guilt
  • Extreme difficulty concentrating
  • Agitation, restlessness, and irritability
  • Inactivity and withdrawal from usual activities, a loss of interest or pleasure in activities that were once enjoyed (such as sex)
  • Feelings of hopelessness and helplessness
  • Thoughts of death or suicide

Depression can also appear as anger and discouragement rather than feelings of hopelessness and helplessness. If depression is very severe, it may be accompanied by psychotic symptoms, such as hallucinations and delusions. These are usually consistent with the depressed mood and may focus on themes of guilt, personal inadequacy, or disease.

Diagnosis

Major depression is diagnosed if a person reports having five or more depressive symptoms for at least two weeks. Beck's Depression Scale Inventory or other screening tests for depression can be helpful in diagnosing depression.

Underlying medical disorders that can cause symptoms of depression, such as chronic fatigue syndrome, diabetes or Parkinson's disease, should also be ruled out before making the diagnosis of depression.

Call your doctor if:

Call 911, a suicide hotline, or get safely to a nearby emergency room if:

  • you have thoughts of suicide, a suicidal plan, or thoughts of harming yourself or others.
  • You hear voices that are not there.
  • You have frequent crying spells with little or no provocation.
  • You have had feelings of depression that disrupt work, school, or family life for longer than two weeks.
  • You think that one of your current medications may be making you feel depressed. DO NOT change or stop any medications without consulting your doctor.
  • You believe that you should cut back on drinking, a family member or friend has asked you to cut back, you feel guilty about the amount of alcohol you drink, or you drink alcohol first thing in the morning.

Treatment Options

Depression can be treated in a variety of ways, particularly with medication and counseling. Some studies have shown that antidepressant drug therapy combined with psychotherapy appears to have better results than either therapy alone and most people seem to benefit from a combination of the two.

Medications include tricyclic antidepressants, monoamine oxidase inhibitors, selective serotonin re-uptake inhibitors (SSRIs), and some newer antidepressant drugs. While antidepressant medications can be very effective, some may not be appropriate for everyone. For example, in September 2004 the FDA began considering a warning that some antidepressants may increase the risk of suicidal tendencies in children.

Lithium and thyroid supplements may be needed to enhance the effectiveness of antidepressants. For persons with psychotic symptoms, such as delusions or hallucinations, antipsychotic medications may also be needed.

Tricyclic Antidepressants

Generic Name Brand Name(s)
amitriptyline Elavil, Endep
amoxapine Asendin
clomipramine Anafranil
desipramine Norpramin
doxepin Adapin, Sinequan
imipramine Tofranil
nortriptyline Aventyl HCl, Pamelor
protriptyline Vivactil
trimipramine Surmontil

Monoamine Oxidase Inhibitors

Generic Name Brand Name(s)
isocarboxazid Marplan
phenelzine Nardil
selegiline transdermal Emsam
tranylcypromine Parnate

Tetracyclic Antidepressants

Generic Name Brand Name(s)
maprotiline Ludiomil
mirtazapine Remeron, Remeron SolTab

Selective Serotonin Reuptake Inhibitors (SSRIs)

Generic Name Brand Name(s)
citalopram Celexa
escitalopram Lexapro
fluoxetine Prozac, Prozac Weekly, Sarafem
fluvoxamine Luvox
paroxetine Paxil, Paxil CR, Pexeva
sertraline Zoloft

Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs)

Generic Name Brand Name(s)
venlafaxine Effexor, Effexor XR
duloxetine Cymbalta

Other Antidepressants

Generic Name Brand Name(s)
bupropion Wellbutrin, Wellbutrin SR, Wellbutrin XL
lithium Eskalith, Eskalith-CR, Lithobid
nefazodone Serzone (discontinued)
trazodone Desyrel

Electroconvulsive therapy (ECT) is a treatment that causes a seizure by means of an electrical current. ECT may improve the mood of severely depressed or suicidal people who don't respond to other treatments.

Research is now being conducted on transcranial magnetic stimulation (TMS), which alters brain functioning in a way similar to ECT, but with fewer side effects. Use of light therapy for depressive symptoms in the winter months and interventions to restore a normal sleep cycle may also be effective in relieving depression.

As treatment takes effect, negative thinking diminishes. It takes time to feel better, but there are usually day-to-day improvements. It is important to maintain a healthy lifestyle. Eat well-balanced meals, avoid alcohol and drugs (which make depression worse and may interfere with medications), get regular exercise and sleep, and seek supportive interpersonal relationships.

Many consumers try herbal products for depression. St. John's wort has a long history of use in Germany and has gained popularity as an herbal antidepressant in the United States. Most of the German studies indicated that St. John's wort was comparable to some antidepressants. However, a large study conducted by the National Center for Complementary and Alternative Medicine found that St. John's wort was NOT effective for treating major depression.

Because herbal products can have side effects, always tell your doctor if you are using them.

Some episodes of depression can be avoided by:

  • Learning how to relax and manage stress
  • Avoiding alcohol, drugs, and caffeine
  • Exercising regularly
  • Maintaining good sleep habits

Counseling may help you through times of grief, stress, or low mood. Family therapy may be particularly important for teens who feel blue. For the elderly or others who feel socially isolated or lonely, volunteering or getting involved in group activities may also help. Medications and psychiatric counseling may prevent recurrences. However, some episodes of depression are not preventable.

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