Qureshi University, Advanced courses, via cutting edge technology, News, Breaking News | Latest News And Media | Current News
admin@qureshiuniversity.com |
Depression
Q: What Is Depression?
Q: What Causes It?
Q: Who Gets Depressed?
Q: How Is It Diagnosed?
Q: How Is It Treated?
Q: Can Psychotherapy Help?
Q: Can Medication Help?
Q: Is entering psychotherapy a good way to quickly get over depression?
Q: Can aerobic exercise Physical activity that requires extra effort help relieve depression?
What Is Depression? Depression is a disorder that involves feelings of sadness lasting for two weeks or longer, often accompanied by a loss of interest in life, hopelessness, and decreased energy. Such distressing feelings can affect one's ability to perform the usual tasks and activities of daily living. This is considered to be clinical depression. It is very different from a temporary case of "the blues " triggered by an unhappy event or stressful situation. Depression affects the mind, but this doesn't mean "it's all in your head." Depression is a medical illness linked to changes in the biochemistry The chemistry of living organisms and life processes. of the brain. Depression is not a weakness of character. Being depressed does not mean that a person is inadequate. It means the person has a medical illness that is just as real as diabetes or ulcers. Like other medical disorders, clinical depression should not be ignored or dismissed. A clinically depressed person cannot simply "snap out of it" any more than a person with an ulcer could simply will it away. * But depression is highly treatable in the vast majority of cases. Up to 90% of depressed people respond positively to one treatment or another. Sometimes psychotherapy or counseling is all that is needed, but there is also a wide array of effective antidepressant medications and other alternatives. Sometimes, the first treatment will work well. At other times, a second or even a third treatment trial is required to find the best (most effective, most easily tolerated) treatment for the individual patient. Clinical depression is an umbrella term used to describe the most common forms of depression, which include: * Major depression, also known as melancholia or unipolar depression, can last up to a year if not treated. A person experiencing an episode of major depression will experience some physical problems, such as headaches, other aches and pains, or digestive upset, for example, in addition to emotional difficulties. * Bipolar disorder Also known as manic depression, this disorder involves mood swings that soar to mania, or unusual elation, and then plummet to depression. , once called manic depressive illness, causes mood swings that soar to unusual elation, and then plummet to depression. A person with severe bipolar disorder may also see or hear things that are not there or experience paranoia (an incorrect feeling that they are in danger from others). * Dysthymia A chronic (ongoing), low-grade depression that often begins in childhood or adolescence and may last for many years in adulthood if not treated. is a chronic (ongoing), low-grade depression. It often begins in childhood or adolescence and may last for many years in adulthood if not treated. It is a less severe form of clinical depression, but at times it can be almost as disabling as major depression. * Seasonal affective disorder (SAD) is a form of depression thought to be triggered by a decrease in exposure to sunlight. In the Northern Hemisphere, the condition usually occurs in late fall and winter, when daylight hours are short, and it is more common in geographical areas that have four clearly defined seasons. Nice To Know: Perhaps nowhere is the connection between mind, body, wellness, and illness more striking than in depression. It is clear that human emotions, including sadness, elation, and anxiousness, are governed by chemical reactions in the brain. That is only the beginning. Scientists have recently begun to unravel the complex interplay between factors that contribute to depression. Illness, heredity, psychological traits, and social environment all play a role. Facts about depression * Depression affects nearly 19 million Americans. * It is the most common mental illness, yet fewer than half of depressed people seek help. * Depression affects one in five people at some point in their life. * It is the leading cause of suicide. * It afflicts twice as many women as men. * Depression affects people in all age groups. * Depression has affected countless accomplished people throughout history, including Abraham Lincoln, Ernest Hemingway, Peter Tchaikovsky, Charles Dickens, Virginia Woolf, Mary Shelley, and Mike Wallace. * The number of people who experience depression has increased with every generation since World War II. Nice To Know Facts about the form of depression known as bipolar disorder: * Bipolar disorder occurs in about one in 10 people with clinical depression. * It usually begins before the age of 30. * It strikes men and women equally. * It is twice as likely as major depression to run in families. * Bipolar disorder triggers more frequent and severe episodes of illness than does major depression. * The most disabling part of bipolar disorder are the often prolonged depressive episodes. What Are The Symptoms Of Depression? Symptoms of depression can vary widely - and they don't always involve the sadness or weepiness that people commonly associate with it. Many people will experience intellectual or psychological changes that affect their thinking, sleep, or energy level. In addition, different types of depression may produce additional symptoms: * Major depression * Bipolar disorder * Dysthymia * Seasonal affective disorder (SAD) Major Depression Experts generally agree that a person has clinical depression when he or she experiences some or all of these symptoms nearly every day for at least two weeks: * Depressed mood * Persistent feelings of hopelessness, guilt or worthlessness * Fatigue or lack of energy * Slowed behavior (the feeling of "dragging oneself around ") * Reduction or loss of pleasure in life * Decreased motivation * Negative or pessimistic thinking * Loss of interest in friends, activities, hobbies or work * Change in eating habits; weight gain or loss * Sleep problems, including waking up early * Frequent crying * Difficulty concentrating, remembering, or making decisions * Irritability * Being anxious or worried a lot * Thoughts of death or suicide * Suicidal Thinking or suicide attempts Understandably, depression can affect all aspects of a person's life (and the lives of family and close friends, too) because it puts a damper on one's overall ability to function. Clinically depressed people often becomes unable to enjoy anything, even things they once enjoyed (a condition called "anhedonic"). * Most people are substantially disabled during a bout of major depression. * Others may continue to function in the sense of holding down a job and meeting other obligations - but just being alive becomes a chore. * Depression is believed to contribute to more than 70% of all suicides. In addition to having the general symptoms of depression, a person experiencing an episode of major depression, also known as melancholia, typically has: * Severe sleep disturbances (insomnia) * Marked loss of appetite/weight * Incapacity to be motivated or to experience pleasure * Severe guilt/self-criticism In children and adolescents, other signs of depression are often present in addition to the above symptoms. They include: * Falling grades * Irritability * Conduct problems * Social withdrawal * Complaints of physical problems such as headaches and stomachaches * Low energy * Poor concentration * Changes in eating or sleeping patterns Need To Know: Experts estimate that 2% of children and between 4% and 8% of teenagers suffer from depression. Most likely to be depressed are girls after the onset of puberty. In the elderly, depression may be accompanied by a focus on physical ailments, such as stomach upset or aches and pains. Nice To Know: Q: My 70-year-old grandfather lives alone, has been active in his retirement community, and generally gets along fine. But lately he seems sad and has been behaving strangely, forgetting things, and not getting dressed. What could be wrong? A: In the elderly, depression is often accompanied by other symptoms, such as confusion, forgetfulness, and inattention to personal hygiene and appearance. These problems are sometimes mistaken for dementia, but they may be masking depression. Be sure that your grandfather receives medical attention immediately and that he is properly diagnosed and treated accordingly. In addition, general medical problems can cause depression, such as thyroid disease, endocrine disease, diseases of the central nervous system, and some cancers. Bipolar Disorder A person with bipolar disorder Also known as manic depression, this disorder involves mood swings that soar to mania, or unusual elation, and then plummet to depression. , or manic depressive illness, has severe mood swings that soar to mania, or with extreme elation, and then plummet to depression. During the depressive phase, the symptoms are the same as those of clinical depression, though the risk of suicide is higher. During the manic phase, the person may exhibit some or all of these symptoms: * Increased energy * Racing, disconnected thoughts * Increased talking and physical activity * Decreased need for sleep * Extreme feelings of excitement, joy, agitation or irritation that may be inappropriate to a given situation * Impulsive behavior and poor judgment; classic manic behavior includes excessive spending or rash business decisions * Increase in impulsive sexual activity * Odd or improper social behavior * Grandiosity, an elevated belief in one's own importance A person with bipolar disorder may also: * Hallucinate, seeing or hearing things that are not there * Experience paranoia, feeling they are in danger * Harbor false, unshakeable beliefs about such things as wealth, power, or "super" abilities A person with severe mania may need to be hospitalized until his or her mood and behavior are stabilized. Mania can last up to three months if not treated. Some people exhibit hypomania, which involves milder episodes of mania. Bipolar disorder may follow different patterns. * The person may experience normal moods in between the two extremes. * The person may plummet rapidly into depression within a few days of mania (this is called rapid cycling). Dysthymia A Chronic form of depression, dysthymia A chronic (ongoing), low-grade depression that often begins in childhood or adolescence and may last for many years in adulthood if not treated. often begins in childhood or adolescence and typically lasts for many years into adulthood if not treated. People with dysthymia: * Feel emotionally numb; they exist in a state of perpetual, low-level melancholy, going through the motions of everyday life with very little enthusiasm or interest * Tend to be negative thinkers, usually seeing the proverbial glass as half-empty instead of half-full * Are unable to savor or enjoy anything (anhedonic), even things they once enjoyed * Often subsequently develop episodes of major depression Because dysthymia is so chronic (ongoing), existing in this way becomes so familiar that the sufferer, family, and friends may believe it is simply the person's nature or personality. Many sufferers do not seek treatment because they do not realize they are clinically depressed. Recovery from dysthymia is often incomplete, and there is a high risk that the person may sink into major depressive episodes throughout life. When this happens, he or she is suffering from double depression. Seasonal Affective Disorder (SAD) Seasonal affective disorder is a form of depression thought to be triggered by a decrease in exposure to sunlight. Besides depressed mood and general symptoms of depression , symptoms may include: * Cravings for sweet and starchy foods * Weight gain * A need for more sleep This type of depression may be less severe than major depression. The condition usually disappears in the spring. What Causes Depression? The precise cause of depression is not known, but evidence points to several factors, including: * Heredity * Biochemical makeup * Psychological makeup * Stressful life events * Fluctuating hormone levels * Other factors such as general medical conditions and certain medications Heredity Depression does "run in families. " People with a close relative who has had major depression or bipolar disorder Also known as manic depression, this disorder involves mood swings that soar to mania, or unusual elation, and then plummet to depression. are twice as likely to develop depression themselves. About one-third to one-half of depressions are thought to be largely due to genetic factors. Those most likely to have a genetic form of depression have recurrent episodes, as do one or more close relatives. Biochemical Makeup Every human being has a unique biochemical makeup. Whether or not a person will experience depression (or other neurological disorders) depends largely on the function and chemical makeup of select neural systems in the brain. A person's biochemistry The chemistry of living organisms and life processes. is an intricate balancing act. Think of a choreographed ballet with a troupe of dancers performing at once. If one or more of the dancers are out of step, the whole production is thrown off balance. So it is with an individual's biochemistry. The brain is the "master " control center that governs our lives in every conceivable way. Just as messages from the brain (in the form of electrical impulses) control our movements, other messages control our emotions. * Neurons, or nerve cells, are the most basic units in the brain. Neurons are separated by gaps called synapses. * Chemical substances called neurotransmitters Chemical messengers that carry messages or signals between the various nerves in the brain; the neurotransmitters serotonin, dopamine, and norepinephrine are believed to be the chemical messengers responsible for moods and emotions. carry messages or signals across these gaps to various nerve cells. * If there is a deficiency or an imbalance in certain neurotransmitters, a variety of disorders can result. * The neurotransmitters serotonin, dopamine, and norepinephrine are just a few of the chemical messengers believed to be responsible for moods and emotions. A disturbance in these chemical systems has a profound negative effect on mood and emotions. Psychological Makeup It is said that a person's basic personality traits are often defined in early childhood. One defining factor is the social environment to which we are exposed. What happens to us in childhood can have a deep-rooted effect on our attitudes and behaviors in adulthood. For instance: * Long-standing neglect or physical or mental abuse in childhood will affect one's view of the world later on, and appear to be risk factors for developing depression and other disorders. * Conditions of social deprivation, such as overcrowding and the lack of a confiding relationship with a trustworthy person, can affect the quality of one's relationships throughout life. Stressful Life Events A person's reactions to external factors can affect the normal level and activity of the chemical messengers in the brain, thus affecting mood and emotions. A stressful life event can plunge a person into clinical depression, especially if a person is at risk for depression due to other factors. Stressful life events include: * Prolonged medical illness * Illness or death of a loved one * Divorce * Ending a close relationship * Loss of a job * Moving to a new home * Financial or legal problems Fluctuating Hormone Levels In women, fluctuating hormone levels can contribute to depression. Conditions linked to hormones in women are: * Premenstrual syndrome. Approximately 3% to 8% of women in their reproductive years are affected with premenstrual syndrome (PMS) during the week or so before their menstrual period. PMS is characterized by depressed mood, mood swings, irritability, and tension or anxiety. It lessens with the onset of the menstrual period each month. * Depression after pregnancy. This temporary form of depression is strongly linked to hormonal fluctuations following pregnancy, but social factors may play a role in some cases. For instance, a professional woman who is suddenly faced with being home every day, essentially alone with a baby, may feel isolated and depressed. * Depression in menopause. Menopausal depression was once attributed to middle-aged women feeling sad over the loss of their childbearing capabilities (the loss of their "youth" or "femininity"), and the loss of their grown children (the "empty nest"). There is no evidence that this is true. In fact, evidence suggests that for some women, menopause and the "empty nest" may signify a new freedom in their lives to pursue long-delayed interests and devote more time to their own needs. For further information on premenstrual syndrome, see Premenstrual Syndorme. For further information about depression after pregnancy, see Depression After Pregnancy. However, hormonal fluctuations in menopause are real, and some women suffer mood swings, fatigue, and depression. Hormone replacement therapy (HRT) can lift mood and fatigue among women who are medically able and who choose to take HRT. However, the risks of HRT must also be considered. Other Factors Other factors that can lead to depression include: * Alcohol or drug abuse * Use of certain medications, such as steroids and some blood pressure medications * Underlying general medical conditions that can cause depressive symptoms, such as hypothyroidism (underactive thyroid gland), chronic fatigue syndrome, and others. * "Burnout," a depletion of mental and physical energy usually stemming from prolonged overwork and/or an overload of demands and obligations placed upon an individual For further information about hypothyroidism see, Hypothyroidism. Nice To Know: Psychological theories about the root causes of depression include: * Guilt. One theory suggests that depression, like bereavement, is a response to loss. This may include loss of a person, job, or role. In bereavement, intense feelings towards a loved one are often mixed. The adult in us will tell us not to speak ill of the deceased, but the child inside us feels sadness but also anger at having been abandoned. Freudian theory maintains that because this second reaction is socially unacceptable, we unknowingly hide it from ourselves and direct the anger inwards as guilt. This suppressed guilt is thought by some to lead to depression. * Pessimism. Another theory suggests that some people have a habitually pessimistic view of themselves, the world, and the future. Such people tend to form false conclusions about their experiences. For example, a man greets a woman friend across a busy street. When she does not respond, he concludes that she no longer wishes to know him because he is not likeable. He fails to consider other reasons behind the incident - maybe she didn't even notice him with the crowded sidewalk and the noisy traffic. Repeated experiences of this sort, when interpreted in this negative way, can foster or maintain depression. Who Gets Depressed? Depression afflicts approximately 19 million Americans, from children to the elderly, in all walks of life. It reportedly afflicts twice as many women as men (although some observers speculate that this could be because fewer men admit they need treatment). Among those prone to depression are people: * With close relatives who have had depression, especially recurrent depressive episodes or who have bipolar disorder Also known as manic depression, this disorder involves mood swings that soar to mania, or unusual elation, and then plummet to depression. * Who have had depression before * With low self-esteem or self-loathing * With chronic medical disorders, including thyroid disease, diabetes, and high blood pressure * Who take certain medications, including oral contraceptives, steroids, and some medications for high blood pressure * With a loved one who is seriously ill * Who are alcoholic or drug-abusing * Who are withdrawing from alcohol or drug addiction * Who are going through stressful or traumatic life events When depression first occurs in those over age 60, it: * May be a predictor of Alzheimer's disease * May be caused by an undiagnosed general medical disorder before the symptoms of the disorder become evident * May be a side effect of many drugs that are commonly prescribed for the elderly How Can I Tell If I Need Treatment For Depression? We all feel blue sometimes, and it is normal to be sad in reaction to an event that is unhappy, stressful, or traumatic. Grief will follow the illness or death of a loved one, the loss of a close relationship, or termination from a job. Financial or legal problems can cause anxiety and depressed mood. These normal reactions to such situations are termed reactive mood disturbance or adjustment disorder . The difference between someone experiencing a reactive mood disturbance and someone who is clinically depressed is: * Someone with a reactive mood disturbance will soon be able to place things in perspective and move on with other areas of life. * A person who is clinically depressed is unable to get past the grief or disappointment - and sometimes the grief is for non-specific or vaguely defined reasons. Clinical depression can be compared to a veil that clouds and dulls one's entire view of the world. A depressed person may not recognize when a clinical problem is present. It is easy to explain away the symptoms by blaming them on stress or adverse events. And even when stress or events are the trigger, understanding the cause is not always enough to lift the depression. Simply taking a vacation will not "cure" clinical depression, because the root of the problem will still be present upon one's return. It is sensible to ask a close friend or relative to give an honest opinion about how they think the individual is doing. Professional help may be needed if: * There is agreement that the person is not functioning well * Many of the symptoms of major depression have been present for at least two weeks * Suicidal thinking is prominent How Is Depression Diagnosed? Since many general medical illnesses can cause the same symptoms, a thorough medical evaluation is essential, especially if the first depression occurs after the age of 40. The first step is to seek treatment from a qualified professional whom you trust. You may choose to consult: * Your family physician or internist * A psychiatrist, a medical doctor who specializes in diagnosing and treating mental illness; psychiatrists are able to prescribe prescription medications and to diagnose general medical conditions * A psychologist, who is a therapist with a PhD in psychology and/or a related discipline, or a therapist with a master's degree * A licensed clinical social worker (LCSW), who is a counselor with a master's degree in counseling * A marital, family, and child counselor (MFCC) * A psychiatric social worker or psychiatric nurse or nurse practitioner * A certified alcohol- and substance-abuse counselor, when depression is linked to alcoholism or drug addiction Psychologists, counselors and social workers cannot write prescriptions, but they often work in association with a psychiatrist or general medical practitioner when medications are recommended. It is important to seek treatment from a professional whom you trust. If the professional has a manner that seems indifferent, or intimidating to you in any way, seek a different professional. The clinician will take a careful history, asking about: * How the symptoms developed, how long they have been present, how severe they are, and if they have ever been treated before * Past and current medical conditions * Alcohol and drug use * Family medical history * Family psychiatric history, especially as pertains to blood relatives who have or who have had depression * Whether suicide has ever been considered or attempted How Is Depression Treated? Depending on the type and severity of depression, treatment may involve: * Psychotherapy (counseling), which is the treatment of mental and emotional disorders by psychologic techniques and counseling * Antidepressant medications which can restore proper chemical balance in the brain * Other treatments such as light therapy and electroconvulsive therapy Treatment is successful in 80% to 90% of clinically depressed people. * In mild to moderate depression, psychotherapy may be all that is needed. * Regular exercise is also beneficial for helping to uplift mood in milder forms of depression. * If symptoms don't improve in a couple of months, and certainly in more severe cases of depression, medication may be needed. * If there is a risk of suicide, medication or hospitalization may be necessary right away. * For some people, the best and most lasting results are obtained with a combination of psychotherapy and antidepressant medication. To be considered recovered, one must be in remission - that is, depressive symptoms must not be present - for four to six months. The person should have returned to his or her usual ways of thinking, feeling, and behaving. How Can Psychotherapy Help? Psychotherapy is the treatment of mental and emotional disorders by psychologic techniques and counseling. Psychotherapists can include: * Psychiatrists * Licensed psychologists * Psychiatric nurses or nurse practitioners * Psychiatric social workers * Individuals trained in counseling Various methods of psychotherapy can help depression, including: * Cognitive therapy * Interpersonal therapy * Situational counseling * Group therapy Cognitive Therapy The word "cognitive " pertains to the mental processes of comprehension, judgment, memory, and reasoning. Cognitive therapy (also known as cognitive behavioral therapy) is based on the premise that people become or remain depressed because they are drawing distorted, negative conclusions about situations and people with whom they interact. Cognitive therapy helps a person become aware of how distorted thinking is self-defeating and can lead to depression. The person learns to recognize thought patterns and change attitudes and behavior accordingly. Common types of distorted thinking among depressed people include: * Over generalizing ("all men are ignorant") * All-or-nothing thinking (perceiving something as happening "always" or "never") * Seeing only the negatives (the glass half-empty instead of half-full) * Jumping to conclusions (without knowing all the facts or giving the other person a chance to explain) * Overanalyzing (brooding, thinking too much about something) * Blaming oneself for things beyond one's control ("If I'd been a better child, my parents wouldn't have gotten divorced.") The first step in cognitive therapy is to identify how and when one leaps to the wrong conclusions and to catch oneself in the act. The person is often encouraged to keep a diary of how he or she is thinking and feeling throughout the day, and of what is going on in his/her life. A chart divided into columns can be helpful. Under each column, the person typically lists: * The situation * Negative thoughts (about the situation) * Feelings (resulting from the negative thoughts) * Rational thoughts (upon considering all sides of the situation) * Feelings now (that one has realized it isn't that bad, that there are alternatives) The second step is to discuss with the therapist alternative ways of drawing conclusions. An example is the situation of the man who feels shunned when his greeting is not returned: Situation I called hello to Marla across the street but she ignored me. Negative thoughts She doesn't want to associate with me anymore; I'm not likeable. Feelings Hurt, lonely, depressed. Rational thoughts There was so much noisy traffic between us, she might not even have seen me, much less heard me. New Feelings Neutral. No cause to be hurt or depressed. I can get on with my day. The person must take a very proactive role in cognitive therapy and be willing to work at it. A person who does so may feel empowered with the knowledge that in many everyday situations, we can choose how we react and how we feel. This empowerment can help dispel feelings of depression. Interpersonal Therapy Interpersonal therapy examines one's relationships and interactions with others. This form of therapy helps a person recognize how the quality of his or her relationships can play a part in depression. Among the goals are to: * Honestly identify one's needs in a relationship * Examine healthy and unhealthy behaviors that one practices to get those needs met * Improve communication and behavior in relationships * Learn new ways to cope with stress and other problems Situational Counseling Situational counseling involves seeing a professional who specializes in the area that is linked to the depression. For example: * If the depression is associated with a death, it can be helpful to seek a counselor who specializes in bereavement. * If the depression is associated with alcohol or drug abuse, it can be helpful to seek a counselor who specializes in addiction. * If the person is suffering from a chronic illness or has a loved one with a chronic illness, there are counselors and support groups for many such situations (cancer and AIDS support groups, for instance). A local hospital or clinic may be able to provide a referral. Group Therapy A psychologist or trained counselor guides a small group of people in discussions of problems and how they are handled. Group counseling can be effective because: * It shows the person that he or she is not alone * It helps the person realize that many people share similar problems * Learning from one's peers can be a powerful step on the road to recovery Need To Know: How long to continue psychotherapy is a highly personal decision. At the beginning, a person may see the therapist once a week or more often if necessary. Most people taper off to once a week or biweekly thereafter. If therapy does not relieve the depression after 10 or 12 weeks, another option (such as medication) should be added. Nice To Know: Q: Is entering psychoanalysis a good way to quickly get over depression? A: Not necessarily. When we think of Sigmund Freud (the "grandfather" of psychoanalysis), we think of traditional psychoanalysis, or analytic psychotherapy. We picture the patient lying on a couch while talking, sometimes not even facing the therapist. The therapist often says little. This style of therapy rests on the principle that what develops reflects the pattern of earlier relationships, and that because the therapist is relatively passive, various emotions may freely emerge and may then be identified as the source of current problems. This type of therapy is not aimed primarily at relieving symptoms of depression, but rather at helping people learn more about themselves and how their past has contributed to the present. Any benefits from this type of analysis can take years. If one is depressed and in need of help now, it is advisable to seek treatment with a therapist who specializes in one of the newer approaches. How Can Medication Help? Not everyone with depression needs medication. Your doctor will conduct a thorough assessment to determine, based on your level of depression, whether medication is needed and which type would work best . Different types of antidepressants are available, and they are designed to restore proper chemical balance in the brain. Most individuals benefit most from a combination of medication and psychotherapy. Today's antidepressants are not addictive and are highly successful. In one study, up to 90% of people with major depression improved after taking the right antidepressant drug in the right amount. One of the most important things to realize when taking antidepressant medications is that it is not like taking a painkiller for a headache. If you take a painkiller, the pain goes away shortly. Antidepressants, however, must build up gradually in the bloodstream to reach an optimal, stabilized level. It can take three to six weeks for any antidepressant to offer relief. In the early stages, sometimes antidepressants can make one feel worse before feeling better, because most of these medications have side effects. If a person is already depressed, it can be difficult to cope with side effects such as drowsiness, dizziness, nausea, dry mouth, constipation, and sexual side effects. While none are dangerous, they can be bothersome and may be intolerable to some people. Need To Know: While the list of possible side effects from antidepressants can be lengthy, the important thing to remember is that they are possible side effects, and an individual will rarely (if ever) experience more than a few. Each person must weigh the inconvenience of side effects with the inconvenience of depression, which, without treatment, can hinder one's entire life. No two individuals will respond the same way to an antidepressant, and so the person and doctor must embark on a course of trial-and-error to find the right dosage. * A dose that is too low may not offer relief. * A dose that is too high may make side effects too pronounced. When the right dose and/or combination is found, side effects can fade and a person's mood and depressive symptoms can lift like a curtain rising on the world. This is the time when the person may benefit most from working with a good psychotherapist (while staying on the medication). Taking an antidepressant alone, without psychotherapy, may quell depressive symptoms biologically - but may not address the psychological part of it. Learning (through psychotherapy or counseling) how one's behavior or thought patterns contribute to depression can be very important in preventing a relapse. Need To Know: A lack of compliance - when an individual fails to take the medication as prescribed - is the biggest reason for failure. So it is crucial, if you are treated with medication, to take the medication every day as prescribed, and to be patient. * After a short time, most side effects usually disappear or lessen to an acceptable level. * If they do not, the doctor can prescribe a different medication or a combination of medications. * It is common for a person to remain on an antidepressant for six to nine months or even longer, to prevent a relapse of depression. Long-term medication, sometimes referred to as maintenance medication, may be needed for chronic depressions such as dysthymia A chronic (ongoing), low-grade depression that often begins in childhood or adolescence and may last for many years in adulthood if not treated. and to prevent relapses in recurrent major depression. While antidepressants are not addictive or habit-forming, unpleasant withdrawal symptoms can occur if they are halted abruptly. Discontinuing a medication should be done in gradually decreasing dosages and in consultation with the prescribing physician. There are several different types of antidepressant medications: * Selective serotonin re-uptake inhibitors (SSRIs) * Tricyclics * Monoamine oxidase inhibitors (MAOIs) * Heterocyclics * Newer drugs * Mood-stabilizing drugs Selective Serotonin Re-Uptake Inhibitors (SSRIs) Selective serotonin re-uptake inhibitors (SSRIs) are usually the first types of medications prescribed for depression. They work by increasing the serotoninlevels in the brain. Serotonin is one of the chemical messengers in the brain responsible for moods and emotions. These medications include: * Citalopram (Cylexa) * Fluoxetine (Prozac) * Paroxetine (Paxil) * Sertraline (Zoloft) Some people believe SSRIs have been to depression what antibiotics once were to bacterial infections - "miracle drugs. " Most individuals respond very well to SSRIs. Because they target serotonin activity selectively, they have fewer side effects than the other more broad-acting medications, tricyclics and MAOIs. * One of the biggest problems with SSRIs is that they may cause sexual dysfunction - loss of interest in sex and/or difficulty achieving orgasm - in up to 20% of people. * Milder side effects that some people experience may include insomnia (common), nausea, diarrhea or loose stools, headache, nervousness, anxiety, mild shaking, and drowsiness (uncommon). Tricyclics Tricyclics, which have been used since the 1950s, had been the standard treatment for depression before SSRIs were introduced. Tricyclics include: * Imipramine (Tofranil, Janimine) * Amitriptyline (Elavil, Endep) * Desipramine (Norpramin) * Nortriptyline (Pamelor, Aventyl) * Protriptyline (Vivactil) * Trimipramine (Surmontil) * Doxepin (Sinequan) * Amoxapine (Asendin) * Clomipramine (Anafranil) Tricyclics are available in generic form, which is less expensive than brand-name drugs. Tricyclics are effective for depression, but their biggest drawbacks are their side effects. Most users experience some side effects, which may include drowsiness, constipation, dry mouth, blurred vision, weight gain, difficulty in urinating, sexual dysfunction, insomnia, disturbances in heart rhythm, anxiety, shaking, and orthostatic hypotension (a sudden drop in blood pressure when standing, which causes dizziness). People with certain heart conditions should not use tricyclics. Monoamine Oxidase Inhibitors (MAOIs) Monoamine oxidase inhibitors (MAOIs) are usually tried when other antidepressants have been ineffective. Some MAOIs are available in a patch form as an alternative to pills. They include: * Tranylcypromine (Parnate) * Phenelzine (Nardil) MAOIs have been around for decades and also are available in generic form. They elevate mood by blocking the actions of a chemical in the brain (monoamine oxidase), which normally breaks down the neurotransmitters Chemical messengers that carry messages or signals between the various nerves in the brain; the neurotransmitters serotonin, dopamine, and norepinephrine are believed to be the chemical messengers responsible for moods and emotions. that stimulate the brain. Possible side effects include constipation, dry mouth, drowsiness or insomnia, nervousness, anxiety, jerking of the muscles, dizziness on standing, weight gain, sexual dysfunction, and problems urinating. Because they can cause birth defects, pregnant women should not take MAOIs. MAOIs also can interact badly with other drugs and with certain foods. Need To Know: If you are taking MAOIs People taking MAOIs must avoid foods that are high in a substance called tyramine, because the interaction can cause severe high blood pressure (hypertension) and headaches. * Foods and liquids to avoid include aged cheeses (ricotta, yogurt, cottage cheese, cream and processed cheeses are safe); fermented or aged foods (corned beef, salami, fermented sausage, pepperoni, summer sausage, pickled herring); spoiled fruit, banana peel (fresh bananas are safe); aged liver (chicken, beef or pork); liverwurst, broad bean pods, meat or yeast extracts, sauerkraut, red wine, sherry, vermouth, cognac, beer and ale. * In rare instances, other foods also may cause high blood pressure when taken with MAOIs. These include chocolate, anchovies, caviar, coffee, colas, figs, mushrooms, beets, rhubarb, curry powder, junket, Worcestershire, soy sauce, licorice, and snails. These latter foods may be eaten in small amounts. People on MAOIs must also avoid: * Decongestants * Cold, allergy and sinus medications (including pseudoephedrine and phenylpropanolamine) * Asthma inhalants (pure steroid inhalants are safe) * Amphetamines * Preparations containing methylphenidate, ephedrine, cyclopentamine, metaraminol, and phenylephrine. Other medications that pose moderate risks include antihistamines, narcotics (codeine is safe), local anesthetics with epinephrine, levodopa, and dopamine. Clearly, anyone taking MAOIs needs to read food and medication labels very carefully. Always consult with your physician before starting new medicaion or taking over-the-counter medication as well as herbal medications such as St. John's Wort. Heterocyclics Like SSRIs, heterocyclic drugs target specific chemical messengers in the brain that regulate mood. They include: * Amoxipine (Asendin) * Maprotiline (Ludiomil) * Trazodone (Desyrel) Common side effects of Asendin include dry mouth, blurred vision, constipation, and drowsiness. Ludiomil may cause these effects, plus drowsiness, dizziness, and nervousness. Desyrel has been associated with all of the above, as well as fatigue, nausea, vomiting, insomnia, and headache. Newer Drugs Some of the newer drugs developed to treat depression include: * Bupropion-SR or XL (Wellbutrin and Zyban, used for smoking cessation) * Venlafaxine-XR (Effexor) * Nefazodone (Serzone) * Mirtazapine (Remeron) These types of medications work selectively on certain neurotransmitters. Their side effects vary; for example: * Side effects of Wellbutrin may include insomnia, nervousness, or dizziness, * People with a history of seizures should not take bupropion . * Effexor may cause sedation or insomnia, sexual dysfunction, or loss of appetite. * Nefazodone may cause sedation. * Mirtazapine may cause sedation or weight gain. Mood-Stabilizing Drugs The most commonly used mood-stabilizing drug is lithium carbonate, available under the brand names Lithonate, Eskalith, Lithobid , and Lithotabs . Lithium carbonate is the most commonly prescribed medication for bipolar disorder Also known as manic depression, this disorder involves mood swings that soar to mania, or unusual elation, and then plummet to depression. , and it may be used in conjunction with another antidepressant. * Too high a dose can cause lithium poisoning. Therefore blood levels must be monitored regularly by the physician. * Side effects that may occur on low doses include stomach upset, frequent urination, hand tremor, mild thirst, and nausea. * Too-high doses may cause diarrhea, drowsiness, lack of coordination, muscular weakness, and vomiting. * Lithium levels can be affected by dehydration, fluctuating salt levels in the body, or diuretic medications used to treat high blood pressure. Other Treatments For Depression In addition to psychotherapy and medication, other treatments for depression include: * Over-the-counter alternatives * Phototherapy for seasonal affective disorder * Electroconvulsive therapy * Vagus nerve stimulation (VNS) therapy Over-The-Counter Alternatives Two over-the-counter preparations may be helpful for mild to moderate depression. * St. John's Wort is an herbal remedy whose mild antidepressant action has been reported by numerous physicians. It is widely prescribed in Europe for mild to moderate depression. A recent definitive U.S. clinical trial did not find it to be efficacious, however. Most people tolerate it well, but reported side effects include sensitivity to sun, gastrointestinal problems, and allergic reactions. The formula should contain at least 0.3% hypericin, the active ingredient in St. John's Wort. * SAM-e (S-adenosylmethionine) is a natural component of living cells involved in many of the body's mechanisms. Over-the-counter formulas are derived from yeast. SAM-e is said to have very few side effects. Its efficacy remains controversial. Need To Know: Both of these remedies have been used successfully for many years in Europe. Neither is considered a drug, so they are not regulated by the U.S. Food and Drug Administration. Take care to choose a standardized formula. Most importantly, always consult with your physician before trying either of these over-the-counter remedies. They should not be combined with prescription antidepressants. In cases of major depression, they should not be used to replace prescription medication. Nice To Know: Q: Can aerobic exercise Physical activity that requires extra effort of the heart and lungs to meet the body's increased demand for oxygen; examples include running, swimming, cycling, and vigorous dancing. help relieve depression? A: Aerobic exercise, done on a regular basis, can help ease symptoms of mild to moderate depression. It is believed that regular aerobic exercise stimulates the body's production of endorphins, which are natural painkillers that produce a calming effect on the central nervous system. To reap these benefits, one must engage in continuous aerobic activity for a minimum of 20 minutes, three times a week. Examples of aerobic exercise include brisk walking, jogging or running, bicycling, swimming, dancing, rowing, and playing racquet sports. Sometimes the mere act of getting out - whether for a brisk walk or a focused session at the gym - can have a revitalizing effect. However, before embarking on any exercise program, always consult with your physician. There may be medical reasons why certain exercises are advisable, while others are not. Light Therapy For Seasonal Affective Disorder It is said that exposure to natural sunlight is the cure for seasonal affective disorder (SAD). Some people with mild to moderate SAD do very well with phototherapy, also known as light therapy. Here is how it works: * Therapeutic light boxes wired with full-spectrum bulbs are used. Unlike regular household incandescent or fluorescent bulbs, full-spectrum bulbs recreate the full spectrum of colors in sunlight. * While the light simply appears as white to the naked eye, the brain recognizes the full spectrum. A therapeutic light box must provide at least 2,000 to 10,000 lux (a measure of light). * A person with SAD sits within three feet of the box for 30 to 60 minutes every morning. The person can read or watch TV as long as the retina A 10-layered tissue membrane of the eye that transmits visual impulses through the optic nerve to the brain. of the eye is exposed to the light. Electroconvulsive Therapy Electroconvulsive therapy (ECT) is commonly called shock therapy because a low-voltage electric current is used to cause a seizure. It is the seizure, not the shock, that is therapeutic. ECT is most often reserved for: * People whose depression is so severe that they are at risk for suicide * People who do not respond to antidepressant medications * Those who are unable to take medication, such as pregnant women or people with other medical problems The methods of conducting ECT have been refined over the years. Today, the success rate of ECT in people suffering from mood disorders is more than 90%. Need To Know: ECT was introduced in the 1930s, and in those days it was performed in a somewhat primitive manner. Images from Hollywood have perhaps fostered an unnecessary fear of ECT. In the film "One Flew Over the Cuckoo's Nest," for example, a patient is administered ECT by cold, institutional personnel. In reality, however, modern ECT is administered in a safe, humane, and painless manner. ECT is performed on an outpatient basis, and hospitalization is not necessary. * First, the patient is given a muscle relaxant. * Electrodes are fastened with conducting cream to the skin. * The patient is then placed under general anesthesia and is asleep while a current is applied. * The body undergoes mild convulsions for a short period of time. The procedure is carefully monitored by the doctor, anesthesiologist, and nurse. * Usually a series of treatments is required to lift severe depression. Some people receive six treatments every two to five days, while others may need more treatments over several months. ECT causes little stress to the body, and most people tolerate it well. The risks of the procedure are associated with the use of general anesthesia. People may feel groggy from the muscle relaxant, and it may take a few hours to recover from the anesthesia. Some may experience temporary memory loss or confusion. Sometimes partial, mild memory loss may persist. Vagus nerve stimulation (VNS) therapy This intervention is approved for use in Canada and Europe for those treatment-resistant depressions that will require long term therapy. It is under FDA review in the U.S. Treatment entails day surgery in which a stimulator (about the size of a small stopwatch) is implanted in the left side of the chest and wired to the left vagus nerve. VNS has already been used for treatment-refractory epilepsy in Europe and the U.S. The device delivers intermittent (30 seconds on, 5 minutes off) stimulation to the left vagus nerve. This treatment is typically added to ongoing antidepressant medications. VNS seems to gradually reduce depressive symptoms over time in treatment-resistant chronic or recurrent depressions. It may change the neurochemistry involved in depression or regulate brain circuits that control mood, motivation, sleep, appetite, etc. How To Prevent A Relapse While recovering from depression: * Take it one day at a time. * Don't expect too much too soon. * Set realistic, doable daily goals. * Take part in activities that make you feel better. * Do not underestimate the power of laughter. It's hard to feel depressed when you're laughing. * Seek out people who are supportive and helpful. * Stick to your treatment plan; for example, take your medication as prescribed and keep your psychotherapy appointments. Sometimes the early phase of counseling can be difficult as the person recalls sad or frustrating experiences. The person must give the therapeutic process a chance to help one deal with such situations. This is one key to taking charge of one's emotional health. How To Information: People at risk for depression, and those who are depressed, should avoid : * Alcohol and drugs. These may temporarily numb one's emotional pain, but they will depress the nervous system well into the next day. Alcohol and drugs can also interact badly with some antidepressant medications. * Negative situations and judgmental or demanding people who bring one down. Avoid "friends" who are mainly interested in negative gossip and in hearing about one's problems. Such people usually become disinterested in hearing about one's successes. * Isolation. Don't withdraw from others, no matter how tempting. Get out among people, even if it means going for a walk in the park or attending a museum exhibit. * Brooding. If one gets on a negative train of thought, practice distraction techniques to derail the train. One simple technique is to inwardly (or, if possible, vocally) shout "STOP!" to oneself, or to physically bang one's fist on a solid object, such as a table, while shouting "STOP!" Replace the thoughts with positive or more productive ones. Learn the art of meditation, which can clear the mind of useless thoughts and foster inner calm. There are many self-help tapes and books on meditation and other relaxation and distraction techniques, such as creative visualization or guided imagery. Who Is At Risk For Recurring Depression? Any individuals who have experienced clinical depression are at risk of relapses throughout life. At higher risk for recurring depression are: * Individuals who have suffered at least two episodes of depression (they are at higher risk for another bout within five years) * People with dysthymia A chronic (ongoing), low-grade depression that often begins in childhood or adolescence and may last for many years in adulthood if not treated. * People with bipolar disorder Also known as manic depression, this disorder involves mood swings that soar to mania, or unusual elation, and then plummet to depression. How Can Friends And Family Help? * If a loved one is depressed, don't tell the person to just "snap out of it." It's not that simple. * Be supportive and listen to complaints without being judgmental. * Depression is a biological illness. Learn about the facts and the myths. * If someone is so depressed that he or she is not functioning normally, assist that person in getting to a doctor and in keeping appointments. Remind them to take their medication on schedule. * Encourage the depressed person to participate in enjoyable activities, but don't "push" or pressure the person. * Consider family therapy or a family support group if the person's depression is associated with factors affecting the whole family. * Pay attention to remarks about suicide. Encourage the person to report these feelings to his or her therapist or doctor. Are There New Treatments On The Horizon? New treatments for depression that are on the horizon include: * Transcranial magnetic stimulation (TMS). This is a painless, experimental treatment for stimulating the brain without the use of electrodes, anesthesia, or surgical techniques. Basically, in a series of treatments, a clinician passes a powerful electromagnet over the skull, mainly targeting the left side of the forehead. Certain magnetic fields are thought to stimulate neurons, although exactly why is not yet known. TMS does not cause the memory loss associated with ECT, and other than brief headache, there are no reported side effects. This treatment is under investigation and is considered very promising. * Cingulotomy . This is a form of brain surgery performed to alleviate chronic pain. It has shown promising results for easing depression in some people when all other treatments have failed. Neurosurgeons apply heat or cold to interrupt the cingulate gyrus, which is a bundle of nerve fibers in the brain's frontal lobe. Memory and intelligence are not affected. * Vagus nerve stimulation . Surgery is used to implant a small generator, about the size of a pocket watch, into the chest. Wires snake up into the neck to periodically stimulate the vagus nerve, which runs into the base of the brain. Vagus nerve stimulators have been used to reduce epileptic seizures, and they also show potential for severe depression. * Newer drugs. Pharmaceutical companies also are on a continual quest to develop antidepressant medications that work in different ways. For instance, it is believed that agents that inhibit substance P, a brain chemical associated with mood disturbance, may show potential. Frequently Asked Questions Here are some frequently asked questions related to Depression Q: Is entering psychoanalysis a good way to quickly get over depression? A: Not necessarily. When we think of Sigmund Freud (the "grandfather" of psychoanalysis), we think of traditional psychoanalysis, or analytic psychotherapy. We picture the patient lying on a couch while talking, sometimes not even facing the therapist. The therapist often says little. This style of therapy rests on the principle that what develops reflects the pattern of earlier relationships, and that because the therapist is relatively passive, various emotions may freely emerge and may then be identified as the source of current problems. This type of therapy is not aimed primarily at relieving symptoms of depression, but rather at helping people learn more about themselves and how their past has contributed to the present. Any benefits from this type of analysis can take years. If one is depressed and in need of help now, it is advisable to seek treatment with a therapist who specializes in one of the newer approaches. Q: Can aerobic exercise Physical activity that requires extra effort of the heart and lungs to meet the body's increased demand for oxygen; examples include running, swimming, cycling, and vigorous dancing. help relieve depression? A: Aerobic exercise, done on a regular basis, can help ease symptoms of mild to moderate depression. It is believed that regular aerobic exercise stimulates the body's production of endorphins, which are natural painkillers that produce a calming effect on the central nervous system. To reap these benefits, one must engage in continuous aerobic activity for a minimum of 20 minutes, three times a week. Examples of aerobic exercise include brisk walking, jogging or running, bicycling, swimming, dancing, rowing, and playing racquet sports. Sometimes the mere act of getting out - whether for a brisk walk or a focused session at the gym - can have a revitalizing effect. However, before embarking on any exercise program, always consult with your physician. There may be medical reasons why certain exercises are advisable, while others are not. Q: My 70-year-old grandfather lives alone, has been active in his retirement community, and generally gets along fine. But lately he seems sad and has been behaving strangely, forgetting things, and not getting dressed. What could be wrong? A: People over age 65 are four times as likely to suffer from depression as other age groups. In the elderly, depression is often accompanied by other symptoms, such as confusion, forgetfulness, and inattention to personal hygiene and appearance. These problems are sometimes mistaken for dementia, but they may be masking depression. Be sure that your grandfather receives medical attention immediately and that he is properly diagnosed and treated accordingly. In addition, general medical problems can cause depression, such as thyroid disease, endocrine disease, diseases of the central nervous system, and some cancers. Q: Lately, I've been feeling as if I'm losing my mind - I can't seem to think clearly. Could this be depression? A: It could be. Many people with depression will find that their ability to think and reason is affected. Some will find it hard to make decisions. Others may have mood changes. Some may find that their mind wanders when they are watching a movie, or that they have trouble finishing an article when reading the newspaper. From there, depression can progress even further, affecting sleep, appetite, and energy level. Q: What causes clinical depression? A: Clinical depression may be caused by certain medical disorders (like thyroid disease or metabolic disorders), by substance abuse, or by certain prescription medicines, or it may accompany another psychiatric disorder such as panic disorder or obsessive-compulsive disorder. Finally, most commonly, it may occur as part of mood disorders like major depression, dysthymia A chronic (ongoing), low-grade depression that often begins in childhood or adolescence and may last for many years in adulthood if not treated. , or bipolar di