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Depression
 

Most people have felt sad or depressed at times. Feeling depressed can be a normal reaction to loss, life's struggles, or an injured self-esteem.

But when feelings of intense sadness -- including feeling helpless, hopeless, and worthless -- last for days to weeks and keep you from functioning normally, your depression may be something more than sadness. It may very well be clinical depression -- a treatable medical condition.

What is depression?
According to the DSM-IV, a manual used to diagnose mental disorders, depression occurs when you have at least five of the following nine symptoms at the same time:

a depressed mood during most of the day, particularly in the morning
fatigue or loss of energy almost every day
feelings of worthlessness or guilt almost every day
impaired concentration, indecisiveness
insomnia or hypersomnia (excessive sleeping) almost every day
markedly diminished interest or pleasure in almost all activities nearly every day
recurring thoughts of death or suicide (not just fearing death)
a sense of restlessness -- known as psychomotor agitation -- or being slowed down -- retardation
significant weight loss or gain (a change of more than 5% of body weight in a month)
How long do these signs have to be present before they are diagnosed as depression?
With major or clinical depression, one of the key signs is either depressed mood or loss of interest. For a diagnosis of depression, these signs should be present most of the day either daily or nearly daily for at least two weeks. In addition, the depressive symptoms need to cause clinically significant distress or impairment. They cannot be due to the direct effects of a substance, for example, a drug or medication. Nor can they be the result of a medical condition such as hypothyroidism. Finally, if the symptoms occur within two months of the loss of a loved one, they will not be diagnosed as depression.



What are some common feelings associated with depression?
According to the National Institute of Mental Health, people with depressive illnesses do not all experience the same symptoms. How severe they are, how frequent, and how long they last will vary. It depends on the individual and his or her particular illness. Here are common symptoms people with depression experience:

difficulty concentrating, remembering details, and making decisions
fatigue and decreased energy
feelings of guilt, worthlessness, and/or helplessness
feelings of hopelessness and/or pessimism
insomnia, early morning wakefulness, or excessive sleeping
irritability, restlessness
loss of interest in activities or hobbies once pleasurable, including sex
no pleasure left in life any more
overeating or appetite loss
persistent aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment
persistent sad, anxious, or "empty" feelings
thoughts of suicide, suicide attempts
While these are common symptoms of depression, they may also occur in patterns. For example, a person may experience depression with mania or hypomania -- a condition sometimes called manic depression. Or the symptoms may be seasonal as in the case of seasonal affective disorder.

There are several types of manic depression. People with bipolar II disorder have at least one episode of major depression and at least one hypomanic -- mild elation or high -- episode. People with bipolar I disorder have a history of at least one manic -- extreme elation or high -- episode, with or without past major depressive episodes. A patient with unipolar depression has major depression only but does not have hypomania or mania.

Childhood depression is different from the normal "blues" and everyday emotions that occur as a child develops. If your child is sad, this does not necessarily mean he or she has significant depression. It's when the sadness becomes persistent -- day after day -- that depression may be an issue. Or, if your child has disruptive behavior that interferes with normal social activities, interests, schoolwork, or family life, it may indicate that he or she has a depressive illness. Keep in mind that while depression is a serious illness, it is also a treatable one.

For more information, see WebMD's Childhood Depression.

What about depression in teens?
It is common for teens to occasionally feel unhappy. However, when the unhappiness lasts for more than two weeks and the teen experiences other symptoms of depression, then he or she may be suffering from adolescent depression. Because as many as one in every 33 children and one in eight adolescents suffer with depression, talk to your doctor and find out if your teen may be depressed. There is effective treatment available to help teens move beyond depression as they grow older.

For more information, see WebMD's Teen Depression.



Is depression difficult to diagnose?
It is estimated that, by the year 2020, major depression will be second only to ischemic heart disease in terms of the leading causes of illness in the world. But patients with depression sometimes fail to realize (or accept) that there is a physical cause to their depressed moods. As a result, they may search endlessly for external causes.

In the U.S., about 14.8 million adults suffer from major depression, according to the National Institute of Mental Health. The suicide risk in people with this type of depression is the highest rate for any psychiatric state. For people between the ages of 10 and 24, suicide is the third leading cause of death. Unfortunately, most people with clinical depression never seek treatment. Left undiagnosed and untreated, depression can worsen, lasting for years and causing untold suffering, and possibly suicide.



What are the warning signs of suicide?
Depression carries a high risk of suicide. Anybody who expresses suicidal thoughts or intentions should be taken very, very seriously. Do not hesitate to call your local suicide hotline immediately. Call 1-800-SUICIDE (1-800-784-2433) or 1-800-273-TALK (1-800-273-8255) -- or the deaf hotline at 1-800-4889. Or contact a mental health professional immediately.

Warning signs of suicide include:

thoughts or talk of death or suicide
thoughts or talk of self-harm or harm to others
aggressive behavior or impulsiveness
Previous suicide attempts increase the risk for future suicide attempts and completed suicide. All mention of suicide or violence must be taken seriously. If you intend or have a plan to commit suicide, go to the emergency room for immediate treatment.

There are a number of different types of depression including:

major depression
chronic depression (dysthymia)
bipolar depression
seasonal depression (SAD or seasonal affective disorder)
psychotic depression
postpartum depression
substance-induced mood disorder (SIMD)


Are there other types of depression?
Other types of depression that can occur include:

double depression -- a condition that happens when a person with chronic depression (dysthymia) experiences an episode of major depression
secondary depression -- a depression that develops after the development of a medical condition such as hypothyroidism, stroke, Parkinson's disease, or AIDS, or after a psychiatric problem such as schizophrenia, panic disorder, or bulimia
chronic treatment-resistant depression -- a condition that lasts over a year and is extremely difficult to treat with antidepressants and other psychopharmacologic drugs and psychotherapies
masked depression -- a depression that is hidden behind physical complaints for which no organic cause can be found.
For chronic treatment-resistant depression, electroconvulsive therapy (ECT) is usually the treatment of choice.

Can depression occur with other mental illnesses?
Depression commonly occurs with other illnesses such as anxiety, obsessive compulsive disorder, panic disorder, phobias, and eating disorders. If you or a loved one has symptoms of depression and/or these other mental illnesses, talk to your doctor. Treatment is available to lift the depression so you or a loved one can regain your meaningful life.

For more information, see WebMD's Depression and Other Mental Illnesses.

Can depression have physical symptoms?
Because certain brain chemicals or neurotransmitters, specifically serotonin and norepinephrine, influence both mood and pain, it's not uncommon for depressed individuals to have physical symptoms. These symptoms may include joint pain, back pain, gastrointestinal problems, sleep disturbances, and appetite changes. The symptoms may also be accompanied by slowed speech and physical retardation. Many patients go from doctor to doctor seeking treatment for their physical symptoms when, in fact, they are clinically depressed.

Where can I get help for depression?
If you or someone you know is experiencing symptoms of depression, seek your health care provider's advice for treatment or referral to a mental health professional

Depression is an extremely complex disease. It occurs for a variety of reasons. Some people experience depression during a serious medical illness. Others may have depression with life changes such as a move or the death of a loved one. Still others have a family history of depression. Those who do may experience depression and feel overwhelmed with sadness and loneliness for no known reason.


You Don't Have to Live With Depression
Understand the symptoms of depression, from sadness to hopelessness to headache. 



What Are the Main Causes of Depression?
There are a number of factors that may increase the chance of depression, including the following:

Abuse. Past physical, sexual, or emotional abuse can cause depression later in life.
Certain medications. For example, some drugs used to treat high blood pressure, such as beta-blockers or reserpine, can increase your risk of depression.
Conflict. Depression may result from personal conflicts or disputes with family members or friends.
Death or a loss. Sadness or grief from the death or loss of a loved one, though natural, can also increase the risk of depression.
Genetics. A family history of depression may increase the risk. It's thought that depression is passed genetically from one generation to the next. The exact way this happens, though, is not known.
Major events. Even good events such as starting a new job, graduating, or getting married can lead to depression. So can moving, losing a job or income, getting divorced, or retiring.
Other personal problems. Problems such as social isolation due to other mental illnesses or being cast out of a family or social group can lead to depression.
Serious illnesses. Sometimes depression co-exists with a major illness or is a reaction to the illness.
Substance abuse. Nearly 30% of people with substance abuse problems also have major or clinical depression.
How Is Biology Related to Depression?
Researchers have noted differences in the brains of people who are depressed as compared to people who are not. For instance, the hippocampus, a small part of the brain that is vital to the storage of memories, appears to be smaller in people with a history of depression than in those who've never been depressed. A smaller hippocampus has fewer serotonin receptors. Serotonin is a calming brain chemical known as a neurotransmitter that allows communication between nerves in the brain and the body. It's also thought that the neurotransmitter norepinephrine may be involved in depression.

Scientists do not know why the hippocampus is smaller in those with depression. Some researchers have found that the stress hormone cortisol is produced in excess in depressed people. These investigators believe that cortisol has a toxic or poisonous effect on the hippocampus. Some experts theorize that depressed people are simply born with a smaller hippocampus and are therefore inclined to suffer from depression.

One thing is certain -- depression is a complex illness with many contributing factors. The latest scans and studies of brain chemistry that show the effects of antidepressants help broaden our understanding of the biochemical processes involved in depression. As scientists gain a better understanding of the cause(s) of depression, health professionals will be able to make better "tailored" diagnoses and, in turn, prescribe more effective treatment plans.

How Is Genetics Linked to the Risk of Depression?
We know that depression seems to run in families. This suggests that there's a genetic link to depression. Children, siblings, and parents of people with severe depression are much more likely to suffer from depression than are members of the general population. Multiple genes interacting with one another in special ways probably contribute to the various types of depression that run in families. Yet despite all the evidence of a family link to depression, scientists still have not been able to identify a "depression" gene.

Can Certain Drugs Cause Depression
In certain people, drugs may lead to depression. For example, medications such as barbiturates, benzodiazepines, and beta-blockers have been associated with depression, especially in older people. Likewise, medications such as corticosteroids, opioids (codeine, morphine), and anticholinergics taken to relieve stomach cramping have been found to cause mania, which is a highly elated state associated with bipolar disorder.

For in depth information, see WebMD's Medicines That Cause Depression.

What’s the Link Between Depression and Chronic Illness?
In some people, a chronic illness causes depression. A chronic illness is an illness that lasts for a very long time and usually cannot be cured completely. However, chronic illnesses can often be controlled through diet, exercise, lifestyle habits, and certain medications. Some examples of chronic illnesses that may cause depression are diabetes, heart disease, arthritis, kidney disease, HIV/AIDS, lupus, and multiple sclerosis (MS). Hypothyroidism may also lead to depressed feelings.

Researchers believe that treating the depression may also help the co-existing illness improve.



Is Depression Linked to Chronic Pain?
When pain lingers for weeks to months, it's referred to as being "chronic." Not only does chronic pain hurt, it also disturbs your sleep, your ability to exercise and be active, your relationships, and your productivity at work. Can you see how chronic pain may also leave you feeling sad, isolated, and depressed?

There is help for chronic pain and depression. A multifaceted program of medicine, psychotherapy, support groups, and more can help you manage your pain, ease your depression, and get your life back on track.

For in depth information, see Depression and Chronic Pain.

Does Depression Often Occur With Grief?
Grief is a common response to loss. Losses that may lead to grief include the death or separation of a loved one, loss of a job, death or loss of a beloved pet, or any number of other changes in life, such as divorce, becoming an "empty nester," or retirement. Anyone can experience grief and loss, but not everyone will experience depression. Each person is unique in how he or she copes with these feelings.

Depression Treatment Options
Once you have a depression diagnosis, your doctor will discuss the different depression treatment options with you. The kind of depression treatment that's best for you depends on the type of depression you have. For example, some patients with clinical depression are prescribed antidepressants. Others are prescribed antidepressants and psychotherapy. Still others may undergo electroconvulsive therapy (ECT), also called electroshock therapy. This treatment may be used with patients who do not respond to standard depression treatment options

Whatever depression treatment your doctor prescribes, it's important to understand that there are no "instant" solutions. You may have to try several antidepressants to find the most effective drug for you. In addition, you'll have to take the antidepressant for several weeks to see if it benefits you at all. Being patient is important. Trust your doctor to know your personal history. With that, he or she can find the best depression treatment options that help improve your mood.

What Are Depression Drugs?
Depression drugs include many types of antidepressants and other mood stabilizers. They can help lift your mood and ease the sadness and hopelessness you feel. You'll need to work with your doctor to find the depression medicine that is most effective with the fewest side effects.

For in-depth information, see WebMD's Depression Medicines.

How Do Antidepressants Work?
It's thought that three chemical messengers are involved with depression. The three are norepinephrine, serotonin, and dopamine, which are neurotransmitters. Neurotransmitters transmit electrical signals between brain cells.

Researchers agree that if there is a chemical imbalance in these brain chemicals, then clinical states of depression result. Antidepressant medications work by increasing the availability of neurotransmitters or by changing the sensitivity of the receptors for these chemical messengers. It is believed that modifying these brain chemicals can help improve emotions.

What Are the Types of Antidepressants?
There are several types of antidepressants. These depression medications are also used to treat conditions that have depression as a component of the disease. For example, they might be used to treat bipolar disorder.

These drugs improve symptoms of depression. The major types of antidepressants include:

Selective serotonin reuptake inhibitors (SSRIs). SSRIs are a newer form of antidepressant. These drugs work by altering the amount of a chemical in the brain called serotonin.
Serotonin and norepinephrine reuptake inhibitors (SNRIs). SNRIs are another newer form of antidepressant medicine. They treat depression by increasing availability of the brain chemicals serotonin and norepinephrine.
Tricyclic antidepressants (TCAs). TCAs primarily affect the levels of two chemical messengers in the brain, norepinephrine and serotonin. Although these drugs are effective in treating depression, they can have more side effects than other drugs. So they typically aren't the first drugs used.
Monoamine oxidase inhibitors (MAOIs). MAOIs are most effective in people with depression who do not respond to other treatments. They are also effective for treating other mental illnesses. Substances in certain foods like cheese, beverages like wine, and medications can interact with an MAOI. So people taking this drug must adhere to strict dietary restrictions. For this reason these antidepressants also aren't usually the first drugs used.


Why Are Stimulants Prescribed for Depression?
Doctors sometimes prescribe other medications such as stimulants and anti-anxiety drugs to use in conjunction with an antidepressant. This is especially likely if the patient has a co-existing mental or physical disorder. However, neither anti-anxiety medications nor stimulants are effective against depression when taken alone.

Talk to your doctor about this type of treatment. Ask if it might boost the effect of your antidepressant.

What Is Psychotherapy's Role in Depression Treatment?
The role of psychotherapy in treating depression is to help the person develop appropriate and workable coping strategies. These strategies help deal with everyday stressors and increase medication adherence. There are different types of psychotherapy, including individual, family, and group therapy. Your doctor will help you find the best type of psychotherapy for you.

For in-depth information, see WebMD's Psychotherapy for Depression.

When Is electroconvulsive therapy (ECT) Recommended for Depression?
Electroconvulsive therapy (ECT), also known as electroshock therapy, is typically used to treat severe depression. During ECT, a skilled doctor applies a brief electric current through the scalp to the brain. This current induces a seizure. ECT is very effective at treating depression.

ECT is generally used when severe depression is unresponsive to other forms of therapy. Or it might be used when patients pose a severe threat to themselves or others and it is dangerous to wait until medications take effect.

For in-depth information, see WebMD's Electroconvulsive Therapy (ECT) for Depression.

What Is the Transcranial Magnetic Stimulation (TMS) Device for Treating Depression?
The FDA has cleared the NeuroStar TMS device for treating depressed adults for whom one antidepressant has failed to work.

While ECT uses an electric current to induce seizure, TMS creates a magnetic field to induce a much smaller electric current in a specific part of the brain without causing seizure or loss of consciousness.

TMS is used to treat milder depression and works best in patients who have failed to benefit from one, but not two or more, antidepressant treatments. Also, unlike ECT, TMS does not require sedation and is administered on an outpatient basis.

Patients undergoing TMS must be treated four or five times a week for four weeks.