DEPRESSION TREATMENT

Depression is an extremely complex disease. No one knows exactly what causes it, but it can occur for a variety of reasons. Some people experience depression during a serious illness. Others may have depression with life changes such as a move or the death of a loved one. Still others have a family history of depression. Those who do may experience depression and feel overwhelmed with sadness and loneliness for no known reason.

Symptoms

There are a lot of signs of depression, but you may not have them all. How intense they are, and how long they last, are different from person to person.

Some of the ways you might feel are:

Sad, empty, or anxious. It will continue over time without getting better or going away.

Helpless, worthless, or guilty. You may feel bad about yourself or your life, or think a lot about losses or failures.

Hopeless. You may be pessimistic or believe that nothing good will ever happen. You may even think about suicide.

Irritable. You may get restless or more cranky than usual.

Less interest in activities. Hobbies or games you usually enjoy may not appeal to you. You may have little or no desire to eat or have sex.

Less energetic. You may feel extremely tired or think more slowly. Daily routines and tasks may seem too hard to manage.

Trouble concentrating. It could be tough to focus. Simple things like reading a newspaper or watching TV may be hard. You may have trouble remembering details. It might seem overwhelming to make a decision, whether it’s big or small.

Changes in the way you sleep. You may wake up too early or have trouble falling asleep. The opposite can also happen. You may sleep much longer than usual.

Changes in appetite. You may overeat or not feel hungry. Depression often leads to weight gain or weight loss.

Aches and pains. You may have headaches, cramps, an upset stomach, or digestive problems.

Causes of Depression

There are a number of factors that may increase the chance of depression, including the following:

• Abuse. Past physical, sexual, or emotional abuse can increase the vulnerability to clinical depression later in life.

• Certain treatments. Some, such as isotretinoin (used to treat acne), the antiviral interferon-alpha, and corticosteroids, can increase your risk of depression.

• Conflict. Depression in someone who has the biological vulnerability to develop depression may result from personal conflicts or disputes with family members or friends.

• Death or a loss. Sadness or grief from the death or loss of a loved one, though natural, may increase the risk of depression.

• Genetics. A family history of depression may increase the risk. It’s thought that depression is a complex trait, meaning that there are probably many different genes that each exert small effects, rather than a single gene that contributes to disease risk. The genetics of depression, like most psychiatric disorders, are not as simple or straightforward as in purely genetic diseases such as Huntington’s chorea or cystic fibrosis.

• Major events. Even good events such as starting a new job, graduating, or getting married can lead to depression. So can moving, losing a job or income, getting divorced, or retiring. However, the syndrome of clinical depression is never just a “normal” response to stressful life events.

• Other personal problems. Problems such as social isolation due to other mental illnesses or being cast out of a family or social group can contribute to the risk of developing clinical depression.

• Serious illnesses. Sometimes depression co-exists with a major illness or may be triggered by another condition.

• Substance abuse. Nearly 30% of people with substance abuse problems also have major or clinical depression.

Types of Depression

Major Depression

You may hear your physician call this “major depressive disorder.” You might have this type if you feel depressed most of the time for most days of the week.

Some other symptoms you might have are:

• Loss of interest or pleasure in your activities

• Weight loss or gain

• Trouble getting to sleep or feeling sleepy during the day

• Feelings restless and agitated, or else very sluggish and slowed down physically or mentally

• Being tired and without energy

• Feeling worthless or guilty

• Trouble concentrating or making decisions

• Thoughts of suicide

Your therapist might diagnose you with major depression if you have five or more of these symptoms on most days for 2 weeks or longer. At least one of the symptoms must be a depressed mood or loss of interest in activities.

Talk therapy can help. You’ll meet with a mental health specialist who will help you find ways to manage your depression. Treatments called antidepressants can also be useful.

When therapy and treatments aren’t working, two other options your therapist may suggest are:

• Electroconvulsive therapy (ECT)

• Repetitive transcranial magnetic stimulation (rTMS)

ECT uses electrical pulses and rTMS uses a special kind of magnet to stimulate certain areas of brain activity. This helps the parts of your brain that control your mood work better.

Persistent Depressive Disorder

If you have depression that lasts for 2 years or longer, it’s called persistent depressive disorder. This term is used to describe two conditions previously known as dysthymia (low-grade persistent depression) and chronic major depression.

You may have symptoms such as:

• Change in your appetite (not eating enough or overeating)

• Sleep too much or too little

• Lack of energy, or fatigue

• Low self-esteem

• Trouble concentrating or making decisions

• Feel hopeless

You may be treated with psychotherapy, over the counter treatments, or a combination of the two.

Bipolar Disorder

Someone with bipolar disorder, which is also sometimes called “manic depression,” has mood episodes that range from extremes of high energy with an “up” mood to low “depressive” periods.

When you’re in the low phase, you’ll have the symptoms of major depression.

Treatment can help bring your mood swings under control. Whether you’re in a high or a low period, your therapist may suggest a mood stabilizer, such as lithium.

Traditional antidepressants are not always recommended as first-line treatments for bipolar depression because there’s no proof from studies that these treatments are more helpful than a placebo (a sugar tablet) in treating depression in people with bipolar disorder. Also, for a small percentage of people with bipolar disorder, some traditional antidepressants may increase the risk of causing a “high” phase of illness, or speeding up the frequency of having more episodes over time.

Psychotherapy can also help support you and your family.

Seasonal Affective Disorder (SAD)

Seasonal affective disorder is a period of major depression that most often happens during the winter months, when the days grow short and you get less and less sunlight. It typically goes away in the spring and summer.

If you have SAD, antidepressants can help. So can light therapy. You’ll need to sit in front of a special bright light box for about 15-30 minutes each day.

Psychotic Depression

People with psychotic depression have the symptoms of major depression along with “psychotic” symptoms, such as:

• Hallucinations (seeing or hearing things that aren’t there)

• Delusions (false beliefs)

• Paranoia (wrongly believing that others are trying to harm you)

A combination of antidepressant and antipsychotic’s can treat psychotic depression. ECT may also be an option.

Peripartum (Postpartum) Depression

Women who have major depression in the weeks and months after childbirth may have peripartum depression. Antidepressant treatment can help similarly to treating major depression that is unrelated to childbirth.

Premenstrual Dysphoric Disorder (PMDD)

Women with PMDD have depression and other symptoms at the start of their period.

Besides feeling depressed, you may also have:

• Mood swings

• Irritability

• Anxiety

• Trouble concentrating

• Fatigue

• Change in appetite or sleep habits

• Feelings of being overwhelmed

Antidepressants or sometimes oral contraceptives can treat PMDD.

Situational Depression

This isn’t a technical term in psychiatry. But you can have a depressed mood when you’re having trouble managing a stressful event in your life, such as a death in your family, a divorce, or losing your job. Your therapist may call this “stress response syndrome.”

Psychotherapy can often help you get through a period of depression that’s related to a stressful situation.

Atypical Depression

This type is different than the persistent sadness of typical depression. It is considered to be a “specifier” that describes a pattern of depressive symptoms. If you have atypical depression, a positive event can temporarily improve your mood.

Other symptoms of atypical depression include:

• Increased appetite

• Sleeping more than usual

• Feeling of heaviness in your arms and legs

• Oversensitive to criticism

Antidepressants can help. Your therapist may suggest a type called an SSRI (selective serotonin reuptake inhibitor) as the first-line treatment.

She may also sometimes recommend an older type of antidepressant called an MAOI (monoamine oxidase inhibitor), which is a class of antidepressants that has been well-studied in treating atypical depression.