Health, Love and Entertainment: Depression Complete Info

by Amy Scholten, MPH

Definition

Depression is a mental illness characterized by feelings of profound sadness and lack of interest in enjoyable activities. Depression is not the same as a blue mood. It is a persistent low mood that interferes with the ability to function and appreciate things in life. It may cause a wide range of symptoms, both physical and emotional. It can last for weeks, months, or years. People with depression rarely recover without treatment.

Causes

The precise cause of depression is not known. It is sometimes difficult to determine if something causes depression, or if it instead is a result of being depressed (ie, does substance abuse result from attempts at self-medicating for depression, or does chronic substance abuse result in depression). Examples of possible causes may be mental, physical, or environmental in nature and include:

Stressful life events (usually in combination with one or more of the following causes)
Chronic stress
Low self-esteem
Imbalances in brain chemicals and hormones
Lack of control over circumstances (helplessness and hopelessness)
Negative thought patterns and beliefs
Chronic pain
Heart disease and heart surgery
Genetic predisposition
Altered brain structure and function, including after a stroke
Parkinson’s disease
Postpartum depression occurs after childbirth
Seasonal affective disorder is a type of depression or a worsening of symptoms thought to be due to the decreased exposure to sunlight that occurs during winter months, especially in northern climates with longer winters.
Hypothyroidism
Anemia
Cancer
Substance abuse

Scan of Brain Function

Chemical, hormonal, and physical changes in the brain may cause depression.

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

Risk factors include:

Sex: female
Age: elderly
Chronic physical or mental illness, including thyroid disease, headaches, chronic pain, and stroke
Previous episode of depression
Major life changes or stressful life events (eg, bereavement, trauma)
Postpartum depression
Winter season for seasonal affective disorder
Little or no social support
Low self-esteem
Lack of personal control over circumstances
Family history of depression (parent or sibling)
Feelings of helplessness
Certain medications, including medications used to treat asthma, high blood pressure, arthritis, high cholesterol, and heart problems
Smoking
Anxiety
Insomnia
Personality disorders
Hypothyroidism

Symptoms

Symptoms of depression are highly variable from person to person. Some people have only a few symptoms, while others have many. Symptoms also vary over time.

Symptoms can change over time and may include:

Persistent feelings of sadness, anxiety, or emptiness
Hopelessness
Feeling guilty, worthless, or helpless
Loss of interest in hobbies and activities
Loss of interest in sex
Feeling tired
Trouble concentrating, remembering, or making decisions
Trouble sleeping, waking up too early, or oversleeping
Eating more or less than usual
Weight gain or weight loss
Thoughts of death or suicide with or without suicide attempts
Restlessness or irritability
Physical symptoms that defy standard diagnosis and do not respond well to medical treatments

Diagnosis

There is no blood test or diagnostic test for depression. The doctor will ask about your symptoms and medical history, giving special attention to:

Alcohol and drug use
Thoughts of death or suicide
Family members who have or have had depression
Sleep patterns
Previous episodes of depression

The doctor may also perform a mental status examination or neuropsychiatric evaluation to obtain detailed information about your speech, thoughts, memory, and mood. Questionnaires called depression inventories may be administered. A physical examination and other diagnostic tests can help rule out other causes for your symptoms.

Treatment

Treatment usually includes medication, psychotherapy, or a combination of the two. Medicine helps relieve symptoms. Psychotherapy helps you learn more effective ways to deal with problems or to identify and resolve the conflicts contributing to your depression.

There may be a need for hospitalization in some cases of severe depression. Depression with psychotic features usually requires hospitalization and use of antipsychotic drugs, such as olanzapine.

Antidepressant Medications

Up to 70% of depressed patients find relief from their symptoms with antidepressants. These medications, which can take 2 to 6 weeks to reach their maximum effectiveness, include:

Selective Serotonin Reuptake Inhibitors (SSRIs)

Fluoxetine (eg, Prozac)
Sertraline (eg, Zoloft)
Paroxetine (eg, Paxil)
Citalopram (eg, Celexa)
Fluvoxamine (eg, Luvox)
Escitalopram (eg, Lexapro)

***Please note: In March, 2004, the Food and Drug Administration (FDA) issued a Public Health Advisory that cautions physicians, patients, families, and caregivers of patients with depression to closely monitor both adults and children receiving certain antidepressant medications. The FDA is concerned about the possibility of worsening depression and/or the emergence of suicidal thoughts, especially among children and adolescents at the beginning of treatment, or when there’s an increase or decrease in the dose. The medications of concern—mostly SSRIs (Selective Serotonin Re-uptake Inhibitors)—are: Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine), Luvox (fluvoxamine), Celexa (citalopram), Lexapro (escitalopram), Wellbutrin (bupropion), Effexor (venlafaxine), Serzone (nefazodone), and Remeron (mirtazapine). Of these, only Prozac (fluoxetine) is approved for use in children and adolescents for the treatment of major depressive disorder. Prozac (fluoxetine), Zoloft (sertraline), and Luvox (fluvoxamine) are approved for use in children and adolescents for the treatment of obsessive compulsive disorder. For more information, please visit http://www.fda.gov/cder/drug/antidepressants.

Tricyclic Antidepressants

Imipramine (eg, Tofranil)
Doxepin (eg, Adapin, Sinequan)
Clomipramine (eg, Anafranil)
Nortriptyline (eg, Pamelor)
Amitriptyline (eg, Elavil)

Monoamine Oxidase Inhibitors (MAOIs)

Phenelzine (eg, Nardil)
Tranylcypromine (eg, Parnate)

Other Antidepressants

Venlafaxine (eg, Effexor)
Nefazodone (eg, Serzone)
Mirtazapine (eg, Remeron)
Bupropion (eg, Wellbutrin)
Duloxetine (eg, Cymbalta)

Psychotherapy

Short-term (10 to 20 weeks) therapy can help some depressed people. Psychotherapy is designed to help you:

Cope with difficulties in relationships
Change negative thinking and behavior patterns
Resolve difficult feelings

Electroconvulsive Therapy (ECT)

Electroconvulsive therapy is the use of an electric stimulus to produce a generalized seizure. ECT may be used in people with severe or life-threatening depression. It is also used for people who cannot take or do not respond to antidepressants. It is considered a safe and effective procedure.

Exercise

Regular exercise has been shown to relieve some of the symptoms of depression. In the absence of physical restrictions, exercise should play an integral role in the overall management of depression.

Phototherapy

Phototherapy involves sitting under special fluorescent lights for a prescribed amount of time per day, usually about 30 minutes every morning.

Dietary Supplement and Herbal Therapy

St. John's wort is an herb that is available without prescription. It is widely used in Europe for the treatment of mild to moderate depression. There is conflicting evidence as to its effectiveness, however.

There is also recent evidence that DHEA (a dietary supplement) and an ingredient in fish oil (EPA, eicosapentanoic acid) may help some people with depression, but some experts dispute these findings. Always discuss the use of dietary and herbal supplements with your doctor.

Dietary Manipulations

Research suggests that diets high in tryptophan, certain B vitamins, and fish oil may be helpful in relieving or preventing depression. Always discuss the use of such supplements with your doctor.

Vagal Nerve Stimulation (VNS)

Vagal nerve stimulation was approved by the FDA in 2005 as therapy for depression that is resistant to multiple trials of antidepressants. VNS involves the surgical implantation of a pacemaker-like device that stimulates the vagus nerve, located in the neck, with electrical impulses.

Vagus Nerve

Stimulation of the vagus nerve (yellow) at the neck is a depression therapy option.

Prevention

Strategies to reduce your chance of becoming depressed include:

Being aware of your personal risk
Having a psychiatric evaluation and psychotherapy if needed
Developing social supports
Learning stress management techniques
Exercising regularly
Do not abuse or overuse alcohol or drugs
Getting adequate sleep, rest, and recreation

RESOURCES:

Depression and Bipolar Support Alliance
http://www.ndmda.org

International Foundation for Research and Education on Depression
http://www.ifred.org

The National Mental Health Association
http://www.nmha.org

CANADIAN RESOURCES:

Canadian Psychiatric Association
http://www.cpa-apc.org

Mental Health Canada
http://www.mentalhealthcanada.com/

References:

Drugs for psychiatric disorders. T reatment Guidelines from the Medical Letter. 2003;1:11.

Groves DA, Brown VJ. Vagal nerve stimulation: a review of its applications and potential mechanisms that mediate its clinical effects. Neurosci Biobehav Rev. 2005;29:493-500.

National Institute of Mental Health website. Available at: http://www.nimh.nih.gov/.

The National Mental Health Association website. Available at: http://www.nmha.org/.

Health, Love and Entertainment

Depression Complete Info