Depression

Everyone gets sad and feels down from time to time, but when the blues linger for more than a few days and interfere with daily life, depression might be the cause. A common but serious illness, depression affects 5-8 percent of adults in the United States, meaning about 25 million Americans will have an episode of major depression this year. Depression occurs 70 percent more frequently in women than in men for reasons that are not fully understood.[1]

Definition of Depression

True clinical depression, also called major depression, unipolar depression and major depressive disorder, is a mood disorder in which feelings of sadness, loss, anger, or frustration interfere with everyday life for weeks or longer.[2] Depression is a life-long condition in which periods of wellness alternate with recurrences of illness.[1]

Types of Depression

There are different forms of depression, including the following:[3]

Major depressive disorder or major depression: A combination of symptoms that interfere with a person’s ability to work, sleep, study, eat, and enjoy once-pleasurable activities. Most who experience depression need treatment to get better.

Dysthymic disorder or dysthymia: Long-term (two years or longer) symptoms that may not be severe enough to disable a person but can prevent normal functioning or feeling well. People with dysthymia may also experience one or more episodes of major depression during their lifetimes.

Minor depression: Having symptoms for two weeks or longer that do not meet full criteria for major depression. Without treatment, people with minor depression are at high risk for developing major depressive disorder.

The following are other forms of depression.

Psychotic depression: Occurs when a person has severe depression plus some form of psychosis, such as having delusions or hallucinations.

Postpartum depression: Occurs when hormonal and physical changes and the new responsibility of caring for a newborn can be overwhelming.

Seasonal affective disorder (SAD): The onset of depression during the winter months, when there is less natural sunlight. The depression generally lifts during spring and summer.

Bipolar disorder or manic-depressive illness: Characterized by cycling mood changes—from extreme highs to extreme lows.

Childhood depression: Children under stress, who experience loss, or who have attentional, learning, conduct or anxiety disorders are at a higher risk for depression. About 5 percent of children and adolescents in the general population suffer from depression at any given point in time.[4]

Signs & Symptoms of Depression

Depression affects people in different ways. Age, gender and cultural background all play a role. Depression can change or distort the way a person perceives himself and those around him. People who have depression usually see everything with a more negative attitude. Depression can appear as anger and discouragement, rather than feelings of sadness.[5]

Symptoms of depression can include:[5]

  • Agitation, restlessness, and irritability
  • Becoming withdrawn or isolated
  • Difficulty concentrating
  • Dramatic change in appetite, often with weight gain or loss
  • Fatigue and lack of energy
  • Feelings of hopelessness and helplessness
  • Feelings of worthlessness, self-hate, and guilt
  • Loss of interest or pleasure in activities that were once enjoyed
  • Thoughts of death or suicide
  • Trouble sleeping or too much sleeping

Symptoms in children and adolescents

Children and teens might show different signs of depression than those seen in adults. Younger children might experience sadness, irritability, hopelessness and worry while adolescents and teens might display anxiety, anger and avoidance of social interaction. In childhood, depression often occurs along with behavior problems and mental health conditions, such as anxiety or attention-deficit/hyperactivity disorder (ADHD).[5]

Causes of Depression

It isn’t known exactly what causes depression, but the condition is most likely caused by a combination of genetic, biological, environmental, and psychological factors.[6]

Genetics: Some types of depression tend to run in families. Some genetics research indicates that risk for depression results from the influence of several genes acting together with environmental or other factors.

Biological factors: While difficult to prove, longstanding theories about depression suggest that important neurotransmitters—chemicals that brain cells use to communicate—are out of balance in depression.

Brain-imaging technologies, such as magnetic resonance imaging (MRI), have shown that the parts of the brain involved in mood, thinking, sleep, appetite, and behavior of people who have depression look different than those of people without depression.

Environmental: Trauma, loss of a loved one, a difficult relationship, or any stressful situation may trigger a depressive episode while other depressive episodes may occur without an obvious trigger.

Effects of Depression

Complications of depression include:[2]

Treatments for Depression

There are three well-established types of treatment for depression: medications, psychotherapy and electroconvulsive therapy (ECT). In addition, alternative therapies or holistic approaches, such as acupuncture, meditation, and nutrition have helped people manage depression. The National Alliance on Mental Health indicates the following as forms of treatment.[7]

Medications

In some cases, people may have to try various doses and different antidepressants before finding the one or the combination that is most effective. Below is a list of common medications used to treat depression.

Selective serotonin reuptake inhibitors (SSRIs): As the most common agents prescribed for depression worldwide, these agents include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa) and escitalopram (Lexapro). They block the reuptake of serotonin from the synapse to the nerve, which increases the level of serotonin.

Serotonin and norepinephrine reuptake inhibitors (SNRIs): As the second most popular antidepressants worldwide, these agents include venlafazine (Effexor), desvenlafazine (Pristiq) and duloxetine (Cymbalta). They block the reuptake of both serotonin and norepinephrine from the synapse into the nerve, which increases the amount of these chemicals.

Norepinephrine-dopamine reuptake inhibitor (NDRI): Bupropion (Wellbutrin) is a popular antidepressant medication, which blocks the reuptake of dopamine and norepinephrine and increases these neurotransmitters in the brain.

Mirtazapine (Remeron): Targets specific serotonin and norepinephrine receptors in the brain, indirectly increasing the activity or several brain circuts. Mirtazapine is used less often than other, newer antidepressants (SSRIs, SNRIs, buroprion) because it is associated with more weight gain, sedation and sleepiness.

Atypical antipsychotics: Aripirazole (Abilify) and quetiapine (Seroquel) are atypical antipsychotics used to augment the depression when used along with antidepressants.

Psychotherapy

There are several types of psychotherapy that have been shown to be effective for depression, including cognitive behavioral therapy (CBT) and interpersonal therapy (IPT). In general, these two types of therapies usually last only 10-20 weeks.

Cognitive behavioral therapy (CBT): Helps to change the negative thinking and behavior associated with depression while teaching people to recognize negative thoughts or mindsets and replace them with positive thoughts leading to more effective, beneficial behavior.

Interpersonal therapy (IPT): Focuses on improving personal relationships that may contribute to a person’s depression.

Psychoeducation: Teaches a person about his or her illness, how to treat it and how to recognize signs of relapse so that he or she can get necessary treatment before the illness worsens or occurs again.

Family psychoeducation: Helps to reduce distress, confusion and anxieties within the family and can help the person recover.

Self-help and support groups: People share personal experiences, referrals to qualified specialists and community resources and information about what works best when trying to recover.

Electroconvulsive Therapy (ECT)

ECT is a highly effective treatment for severe depression episodes and for severe depression with psychosis. When medication and psychotherapy are not effective in treating severe symptoms-such as acute psychosis or thoughts of suicide-or if a person cannot take antidepressants, ECT may be considered. ECT can be combined with antidepressants for some individuals. Memory problems can follow ECT treatments, so a careful risk-benefit assessment needs to be made for this important and effective intervention.

Other Forms of Treatment

Transcranial Magnetic Stimulation (TMS)

The Food and Drug Administration approved the use of TMS for major depression in 2008. Early research indicates it to be a low-risk intervention that may help a person who has not responded to antidepressants.

Complementary and Alternative Medicine (CAM)

Alternative forms of medicine have become increasingly popular, although the FDA has not approved any. For instance, omega-3 fatty acids, found in fish oil, has been thought to help mental illnesses because of its ability to protect or support the replenishing of neurons and connections in areas of the brain that are affected by these illnesses.

Aerobic Exercise

Aerobic exercise is usually a key component to a treatment plan for mild to moderate depression. Harvard Medical school notes exercise enhances the action of endorphins, and endorphins reduce the perception of pain as well as potentially have the ability to improve mood. In addition, exercise stimulates the neurotransmitter norepinephrine, which may directly improve a person’s mood.

References

  1. National Alliance on Mental Health. What is depression? Retrieved February 5, 2013, from http://www.nami.org/Template.cfm?Section=depression.
  2. US National Library of Medicine. Major depression. Retrieved February 5, 2013, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001941/.
  3. National Institute of Mental Health. What are the different forms of depression? Retrieved February 5, 2013, from http://www.nimh.nih.gov/health/publications/depression/what-are-the-different-forms-of-depression.shtml.
  4. American Academy of Child & Adolescent Psychiatry. The Depressed Child. Retrieved February 5, 2013, from http://aacap.org/cs/root/facts_for_families/the_depressed_child.
  5. Mayo Clinic. Depression (major depression) symptoms. Retrieved February 5, 2013, from http://www.mayoclinic.com/health/depression/DS00175/DSECTION=symptoms.
  6. National Institute of Mental Health. What causes depression? Retrieved February 5, 2013, from http://www.nimh.nih.gov/health/publications/depression/what-causes-depression.shtml.
  7. National Alliance on Mental Health. Depression: Treatments, Services and Support. Retrieved February 5, 2013, from http://www.nami.org/Template.cfm?Section=Depression&Template=/ContentManagement/ContentDisplay.cfm&ContentID=88858.

By C. J. Newton, MA, Counseling.info Editor

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