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Depression What is Depression? Most people feel sad or "down" at some time during their lives. These feelings are a normal reaction to a stressful or traumatic life event, but typically these feelings are short-lived. Depression becomes a problem when the symptoms last longer than two weeks and impair normal functioning. Clinical depression is not just feeling blue, it is not something that is "just in your head," and it is not a weakness. It is a medical disorder (just like heart disease or diabetes) that affects one’s thoughts, feelings, health and behavior. Just as with most medical disorders, with proper management, it can be effectively treated. Depression is a type of a mood disorder. There are three types of depression: major (or clinical) depression, dysthmia, and bipolar disorder (also called "manic-depressive illness"). Clinical depression is a fairly common disorder that has been around for as long as man has been recording history. Many famous people have suffered from depression: Abraham Lincoln, Theodore Roosevelt and Georgia O’Keefe, to name a few. What Causes Depression? There are many factors that may predispose one to depression. It is likely that depression is caused by a combination of factors. It may be precipitated by a major life event (such as loss of a loved one), or it may develop without any apparent cause. Approximately 10-15% of the cases of depression are caused by a chronic medical illness such as heart disease, stroke, diabetes, cancer or hypothyroidism. Usually, once the medical illness is treated, the depression is relieved. Factors that may predispose one to depression are: Family history or genetics Medication Environmental triggers (extreme stress or trauma) Alcohol and/or substance abuse Biological factors – abnormalities in neurotransmitters (chemical messengers in the brain); abnormalities in hormones or changes in brain structure Certain personality traits that may increase vulnerability Who Gets Depression? Depression is a common illness that can affect anyone regardless of gender, age, race, ethnicity, or social class. Over 17 million Americans are affected by depression. For reasons that are not entirely clear, depression affects twice as many women as men. It typically appears during the mid- to late-twenties; however, it can occur at any age. Signs and Symptoms There is a wide range of psychological and physical symptoms that are associated with depression. The severity of symptoms varies: some people may have mild symptoms and can function normally, while others have severe symptoms and are unable to perform normal activities. People with depression often experience the symptoms every day for a prolonged period of time. A person is to be diagnosed with depression if the symptoms have been present for at least two weeks. Without treatment, the symptoms will persist and may become harder to treat. The classic symptoms of depression are: Feeling sad, blue or down in the dumps Loss of interest or pleasure in things that one normally enjoys Other symptoms may include: Sleep disturbances (trouble falling or staying asleep, or oversleeping) Low energy levels Eating disturbances (loss of appetite and weight loss or weight gain) Difficulty concentrating or remembering Feelings of guilt, worthlessness or helplessness Thoughts of death or suicide Excessive crying Headaches General aches and pains Gastrointestinal problems (diarrhea, abdominal pain) Sexual problems The Diagnosis of Depression A health care provider should diagnose depression. The health care provider will perform a complete physical exam and obtain a blood sample for laboratory analysis. During the exam, the health care provider will also inquire about symptoms, general health and a family history of general medical and mental illnesses. During the course of the diagnosis, the health care provider will also look for other general medical conditions that may cause the depression. How Serious is Depression? Complications of Depression When depression is treated properly, there are no serious long-term consequences; however, untreated depression causes great suffering and has major financial implications. Depression can have a negative effect on one’s physical health. It may adversely affect the immune system, blood clotting, blood pressure, blood vessels and the heart. There may be a link between depression and the occurrence of a heart attack or a stroke. Depression can also cause one’s family and friends great pain. Depression can have a negative impact on marriage and on the children of depressed parents. Depression may also interfere with a person’s ability to perform his or her job effectively. Suicide is a significant risk associated with depression. A health care provider should see any person with suicidal thoughts immediately. Finally, depression is a costly disorder. It is estimated to cost the United State $43 billion yearly due to decreased productivity at work and medical costs associated with treatment. Long-Term Outlook With proper management, depression can be treated successfully. Some people will experience only one depressive episode; however, approximately 50-60% of people will experience a subsequent episode. Most people will recover completely and will not experience any additional symptoms of depression. What are the Complementary and Alternative Treatments for Depression? Acupuncture Biofeedback Guided Imagery Massage Meditation Yoga What are the Conventional Treatments for Depression? With treatment, approximately 80% of people will experience improvement in symptoms. Despite this success rate, approximately two thirds of people with depression do not seek professional help. This is unfortunate, as depression becomes harder to treat the longer the symptoms persist. The two major forms of therapy are psychotherapy and/or medication. Typically, it takes four to eight weeks for treatment to become effective. There are several types of psychotherapy and no one type has been proven to be more effective than another. The health care provider will determine which type of psychotherapy is most appropriate for each individual. Medication is usually given for at least six months after the symptoms of depression have resolved. The health care provider will determine the best time to discontinue medication. Some people, for example those with numerous recurrences of depressive episodes, may require long-term treatment with an anti-depressant. Medications affect the levels of neurotransmitters in the brain, and they may restore the chemical balance. Types of medication are: Serotonin-reuptake inhibitors (SSRI): often the first type of medication that the health care provider will try. Examples are: fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), and fluvoxamine (Luvox). Tricyclic antidepressants: amitriptyline (Elavil), desipramine (Norpramin), doxepin (Sinequan), imipramine (Tofranil), amoxapine (Asendin), nortriptyline (Pamelor), protriptyline (Vivactil), and trimipramine (Surmontil). Monoamine-oxidase inhibitors (MAOI): phenelzine (Nardil), isocarboxazid (Marplan), and tranylcypromine (Parnate). Other medications: bupropion (Wellbutrin), venlafaxine (Effexor), Nefazodone (Serzone), maprotiline (Ludiomil), and mirtazapine (Remeron). If psychotherapy and medications fail, electroconvulsive therapy (ECT) or "shock therapy" is highly effective, particularly for severe depression. The goals of treatment are to: Relieve symptoms Restore or maintain physical health Create or maintain a strong social support network Restore or maintain the ability to perform usual activities Avoid complications such as heart attack, stroke or suicidal thoughts Provide thorough education regarding depression and its management Self Care How Can Depression Be Managed? There are several things that one can try to manage the symptoms of depression: Maintain good communication with the health care provider. Follow the therapeutic plan as recommended by the health care provider (whether it be medication and/or psychotherapy), as this increases the chances for a full recovery. Avoid becoming isolated; a social support network is important. Avoid alcohol and recreational drugs. Maintain a healthy lifestyle through diet, exercise and adequate sleep.

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