Depression is one of the most common psychological problems today. Each year over 17 million American adults experience a period of clinical depression.
Depression is a very specific and difficult psychiatric disorder because it can interfere with normal functioning, and frequently causes problems with work, social and family adjustment. Not only that – it also causes pain and suffering not only to the person with the disorder, but also to those who care about them.
Signs and symptoms of depression
There are two characteristic hallmarks of depression:
• Loss of interest in normal daily activities
• Depressive mood
Not every person exhibiting these signs suffers from depression; generally, the signs must be present for at least two weeks.
Other characteristic symptoms of depression are:
• Sleep disturbances
• Impaired thinking or concentration
• Changes in weight
• Fatigue or slowing of body movements
• Low self-esteem
• Less interest in sex
• Appetite and weight loss or overeating and weight gain
• Thoughts of death or suicide; suicide attempts
• Restlessness, irritability
• Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain
“Physical symptoms” of depression
Most patients also complain of some physical symptoms such as:
• gastrointestinal problems
• headache and backache
Possible causes of depression
There's no single known cause for depression. Because the illness often runs in families, psychiatrists believe that a genetic vulnerability combined with environmental factors, such as stress or physical illness, may trigger an imbalance in brain chemicals called neurotransmitters, resulting in depression. That’s why we can't talk about possible cause of depression but rather about factors that contribute to depression. Some of the most common are:
Heredity: Researchers have identified genes that may be involved in depression moods.
Stress: Stressful life events can sometimes trigger depression, although there are no rules.
Medications: Long-term use of certain medications, such as drugs used to control high blood pressure or sleeping pills, may cause symptoms of depression.
Chronic illnesses: If a person has a chronic illness, such as heart disease, stroke, diabetes, cancer or Alzheimer's disease, it is at a higher risk of developing depression.
Personality types: Certain personality types, such as those with low self-esteem, self-critical, or pessimistic are at high risk of developing depression.
After-birth depression: It is common for mothers to feel a mild form of distress that usually occurs a few days to weeks after giving birth. This can eventually escalate into a depression disorder.
Alcohol, nicotine and drug abuse: People with depression commonly use alcohol, nicotine, and mood-altering drugs as a way to ease the symptoms, not knowing that these substances can only contribute to the primary disorder – depression.
Different types of depression
There are several kinds of depressive disorders, including the following.
Major depression: This type of mood disturbance lasts more than two weeks and the most common symptoms are overwhelming feelings of sadness and grief, loss of interest or pleasure in activities, and feelings of worthlessness or guilt.
Dysthymia: Although some think that dysthymia isn’t depression, it is typically described as a less severe but more chronic form of the disorder. Signs and symptoms usually aren't as disabling as those of major depression are.
Adjustment disorders: It is completely normal that someone is feeling tense, sad, overwhelmed, or angry if someone close to them died or received a diagnosis of terminal illness. This is known as an adjustment disorder – a situation when someone’s response to a stressful event or situation causes depression.
Bipolar disorder: Patients suffering from bipolar disorder experience recurrent episodes of depression and mania. Because this condition involves emotions at both extremes (poles), it's called bipolar disorder, or manic-depressive disorder. Most common symptoms of mania include: Abnormal or excessive elation, unusual irritability, decreased need for sleep, grandiose notions, increased talking, racing thoughts, increased sexual desire, markedly increased energy, poor judgment or inappropriate social behavior.
Seasonal affective disorder: Seasonal affective disorder is a pattern of depression related to changes in seasons and a lack of exposure to sunlight. The most common symptoms are headaches, irritability and a low energy level.
Diagnosis of depression
Physical and psychological examination: The first step in setting the appropriate treatment for depression is a physical examination by a physician. If a physical cause for the depression is ruled out, a psychological evaluation should be done by the physician or by referral to a psychiatrist or psychologist. In most cases, this is enough to establish the right diagnosis.
Mental status examination: A diagnostic evaluation should also include a mental status examination to determine if some cognitive patterns or memory have been affected.
Treatment – Medications
Selective serotonin reuptake inhibitors (SSRI): Considered the most effective antidepressive medications, selective serotonin reuptake inhibitors are fluoxetine (Prozac®, Sarafem®), paroxetine (Paxil®), sertraline (Zoloft®), citalopram (Celexa®) and escitalopram (Lexapro®). They work by increasing the availability of the neurotransmitter serotonin in a patient’s brain.
Tricyclic and tetracyclic antidepressants (TTA): These antidepressants also affect neurotransmitters, but by a different mechanism than SSRI. The most commonly used are amitriptyline, desipramine (Norpramin®), nortriptyline (Aventyl®, Pamelor®), protriptyline (Vivactil®), trimipramine (Surmontil®) and a combination of perphenazine and amitriptyline. Tetracyclics include maprotiline and mirtazapine (Remeron®).
Monoamine oxidase inhibitors (MAOI): These drugs prevent the breakdown of neurotransmitters. Most commonly used are phenelzine (Nardil®) and tranylcypromine (Parnate®).
Stimulants: Sometimes psychiatrists prescribe stimulants such as methylphenidate (Ritalin®, Concerta®), dextroamphetamine (Dexedrine®, Dextrostat®) or modafinil (Provigil®).
Lithium and mood-stabilizing medications: Lithium (Eskalith®, Lithobid®), valproic acid (Depakene®), divalproex (Depakote®) and carbamazepine (Tegretol®, Carbatrol®) are often prescribed for treatment of bipolar depression.
Certain other medications called atypical antipsychotics are also being used for treatment of psychotic disorders - olanzapine (Zyprexa®), risperidone (Risperdal®) and quetiapine (Seroquel®)
Depression could be treated with several different types of psychotherapy. Each type involves a short-term approach aiming to help a patient deal with a specific issue. Of course, no goal comes quickly and that’s why prolonged psychotherapy is usually necessary to treat depression. The success of therapy depends on the doctor’s expertise as much as the patient’s ability to be comfortable with the therapist. There are several types of specialized and supervised group therapies, such as bereavement groups, stress management classes, marital counseling and family therapy.
Electroconvulsive therapy: Although people consider this form of therapy rather invasive and unsafe, a proven fact is that electroconvulsive therapy is generally safe and effective. Although the results are positive, it’s still unclear how it works. Experts are assuming that the procedure may affect levels of neurotransmitters in a patient’s brain, relieving the symptoms of depression. The most common side effect is confusion that lasts a few minutes to several hours although some people experience transient memory loss.
Light therapy: Although this form of therapy can't be used with all types of depression, light therapy may help in treatment of seasonal affective disorder. This disorder involves periods of depression that recur at the same time each year, usually when days are shorter in the fall and winter. This is because scientists believe that hours of sunlight may increase levels of melatonin – a brain hormone considered to the be the main regulator of sleep and depression moods.