What Is Depression?
Depression has a variety of symptoms, but the most common is
a deep feeling of sadness. People with depression may feel tired,
listless, hopeless, helpless, and generally overwhelmed by life.
Simple pleasures are no longer enjoyed, and their world can appear
dark and uncontrollable. Emotional and physical withdrawal are
common responses of depressed people.
Depression can strike at any time, but most often appears for the
first time during the prime of life, from ages 24 to 44. One in
four women and one in 10 men will confront depression at some point
in their lives.
Symptoms of Depression
Depression is diagnosed if a person experiences (1) persistent
feelings of sadness or anxiety or (2) loss of interest or pleasure
in usual activities in addition to five or more of the following
symptoms for at least 2 consecutive weeks.
- Changes in appetite that result in weight losses or gains not
related to dieting
- Insomnia or oversleeping
- Loss of energy or increased fatigue
- Restlessness or irritability
- Feelings of worthlessness or inappropriate guilt
- Difficulty thinking, concentrating, or making decisions
- Thoughts of death or suicide or attempts at suicide
Depression is diagnosed only if the above symptoms are not due
to other conditions (e.g., neurological or hormonal problems) or
illnesses (e.g., cancer, heart attack) and are not the unexpected
side effects of medications or substance abuse.
What Causes Depression?
Several factors play a role in the onset of depression.
Biochemistry. Deficiencies in two
chemicals in the brain, serotonin and norepinephrine, are thought
to be responsible for certain symptoms of depression, including
anxiety, irritability, and fatigue.
Genetics. Depression can run in families.
For example, if one identical twin has depression, the other twin
has a 70% chance of also having the illness sometime in life.
Personality. People with low self-esteem,
who are easily overwhelmed by stress, or who are generally pessimistic
appear to be vulnerable to depression.
Environmental factors. Continuous
exposure to violence, neglect, abuse, or poverty may make people
who are already susceptible to depression all the more vulnerable
to the illness.
However, it should be noted that depression can still occur under
ideal living circumstances.
How Is Depression Treated?
Unfortunately, depression cannot be controlled for any length
of time simply through exercise, through changes in diet, or by
taking a vacation. But it is among the most treatable of mental
disorders. Between 80% and 90% of people with depression respond
well to treatment, and almost all patients gain some relief from
their symptoms.
Before a specific treatment is recommended, a psychiatrist will
conduct a thorough diagnostic evaluation, consisting of an interview
and a physical examination. Its purpose is to reveal specific symptoms,
medical and family history, cultural setting, and environmental
causes of stress to arrive at a proper diagnosis and to determine
the best treatment.
Medication
Antidepressants may be prescribed to correct imbalances in the
levels of chemicals in the brain. These medications are not sedatives,
"uppers," or tranquilizers; they are not habit-forming;
and they generally have no stimulating effect on people not experiencing
depression.
There are several types of antidepressant medications used to treat
depressive disorders. These include newer medications-chiefly the
selective serotonin reuptake inhibitors (SSRIs)-the tricyclics,
and the monoamine oxidase inhibitors (MAOIs). The SSRIs-and other
newer medications that affect neurotransmitters such as dopamine
or norepinephrine-generally have fewer side effects than tricyclics.
Sometimes the doctor will try a variety of antidepressants before
finding the most effective medication or combination of medications.
Sometimes the dosage must be increased to be effective. Although
some improvements may be seen in the first few weeks, antidepressant
medications must be taken regularly for 3 to 4 weeks (in some cases,
as many as 8 weeks) before the full therapeutic effect occurs.
Patients often are tempted to stop medication too soon. They may
feel better and think they no longer need the medication. Or they
may think the medication isn't helping at all. It is important to
keep taking medication until it has a chance to work, though side
effects (see section on Side Effects, page 13) may appear before
antidepressant activity does. Once the individual is feeling better,
it is important to continue the medication for 4 to 9 months to
prevent a recurrence of the depression. Some medications must be
stopped gradually to give the body time to adjust, and many can
produce withdrawal symptoms if discontinued abruptly. For individuals
with bipolar disorder and those with chronic or recurrent major
depression, medication may have to be maintained indefinitely.
Antidepressant drugs are not habit-forming. However, as is the
case with any type of medication prescribed for more than a few
days, antidepressants have to be carefully monitored to see if the
correct dosage is being given. The doctor will check the dosage
and its effectiveness regularly.
For the small number of people for whom MAO inhibitors are the
best treatment, it is necessary to avoid certain foods that contain
high levels of tyramine, such as many cheeses, wines, and pickles,
as well as medications such as decongestants. The interaction of
tyramine with MAOIs can bring on a hypertensive crisis, a sharp
increase in blood pressure that can lead to a stroke. The doctor
should furnish a complete list of prohibited foods that the patient
should carry at all times. Other forms of antidepressants require
no food restrictions.
Medications of any kind
- prescribed, over-the counter, or borrowed
- should never be mixed without consulting the doctor. Other health
professionals who may prescribe a drug-such as a dentist or other
medical specialist-should be told of the medications the patient
is taking. Some drugs, although safe when taken alone can, if
taken with others, cause severe and dangerous side effects. Some
drugs, like alcohol or street drugs, may reduce the effectiveness
of antidepressants and should be avoided. This includes wine,
beer, and hard liquor. Some people who have not had a problem
with alcohol use may be permitted by their doctor to use a modest
amount of alcohol while taking one of the newer antidepressants.
Side Effects
Antidepressants may cause mild and, usually, temporary side
effects (sometimes referred to as adverse effects) in some people.
Typically these are annoying, but not serious. However, any unusual
reactions or side effects or those that interfere with functioning
should be reported to the doctor immediately. The most common
side effects of tricyclic antidepressants, and ways to deal with
them, are:
- Dry mouth it is helpful to
drink sips of water; chew sugarless gum; clean teeth daily.
- Constipation bran cereals,
prunes, fruit, and vegetables should be in the diet.
- Bladder problems emptying the
bladder may be trouble-some, and the urine stream may not be
as strong as usual; the doctor should be notified if there is
marked difficulty or pain.
- Sexual problems sexual functioning
may change; if worrisome, it should be discussed with the doctor.
- Blurred vision this will pass
soon and will not usually necessitate new glasses.
- Dizziness rising from the bed
or chair slowly is helpful.
Drowsiness as a daytime problem this usually passes soon.
A person feeling drowsy or sedated should not drive or operate
heavy equipment. The more sedating antidepressants are generally
taken at bedtime to help sleep and minimize daytime drowsiness.
The newer antidepressants have different types of side effects:
- Headache this will usually
go away.
- Nausea this is also temporary,
but even when it occurs, it is transient after each dose.
- Nervousness and insomnia (trouble falling
asleep or waking often during the night) these
may occur during the first few weeks; dosage reductions or time
will usually resolve them.
- Agitation (feeling jittery)
if this happens for the first time after the drug is taken and
is more than transient, the doctor should be notified.
- Sexual problems the doctor should
be consulted if the problem is persistent or worrisome.
Psychotherapy
Psychotherapy, or "talk therapy," may be used either
alone for treatment of mild depression or in combination with
antidepressant medications for moderate to severe depression.
Psychotherapy can involve only the individual patient or include
others. Family or couples therapy helps to address specific issues
that can arise within these close relationships. Group therapy involves
people with similar illnesses. Depending on the severity of the
depression, treatment can take a few weeks or substantially longer.
However, in many cases, significant improvement can be made in 10-15
sessions.
Depression is never normal and always produces needless suffering.
With proper diagnosis and treatment, depression can be overcome
in the vast majority of people. If you are experiencing symptoms
of depression, see your physician or psychiatrist, describe your
concerns, and request a thorough evaluation. You will feel better.
How to Help Yourself
Depressive disorders make one feel exhausted, worthless, helpless,
and hopeless. Such negative thoughts and feelings make some people
feel like giving up. It is important to realize that these negative
views are part of the depression and typically do not accurately
reflect the actual circumstances. Negative thinking fades as treatment
begins to take effect. In the meantime:
- Set realistic goals in light of the depression and assume a
reasonable amount of responsibility.
- Break large tasks into small ones, set some priorities, and
do what you can as you can.
- Try to be with other people and to confide in someone; it is
usually better than being alone and secretive.
- Participate in activities that may make you feel better.
- Mild exercise, going to a movie, a ballgame, or participating
in religious, social, or other activities may help.
- Expect your mood to improve gradually, not immediately. Feeling
better takes time.
- It is advisable to postpone important decisions until the depression
has lifted. Before deciding to make a significant transition-change
jobs, get married or divorced-discuss it with others who know
you well and have a more objective view of your situation.
- People rarely "snap out of" a depression. But they
can feel a little better day-by-day.
- Remember, positive thinking will replace the negative thinking
that is part of the depression and will disappear as your depression
responds to treatment.
- Let your family and friends help you.
Depression in Women
Women experience depression about twice as often as men. Many
hormonal factors may contribute to the increased rate of depression
in women-particularly such factors as menstrual cycle changes,
pregnancy, miscarriage, postpartum period, pre-menopause, and
menopause. Many women also face additional stresses such as responsibilities
both at work and home, single parenthood, and caring for children
and for aging parents.
A recent NIMH study showed that in the case of severe premenstrual
syndrome (PMS), women with a preexisting vulnerability to PMS experienced
relief from mood and physical symptoms when their sex hormones were
suppressed. Shortly after the hormones were re-introduced, they
again developed symptoms of PMS. Women without a history of PMS
reported no effects of the hormonal manipulation.
Many women are also particularly vulnerable after the birth of
a baby. The hormonal and physical changes, as well as the added
responsibility of a new life, can be factors that lead to postpartum
depression in some women. While transient "blues" are
common in new mothers, a full-blown depressive episode is not a
normal occurrence and requires active intervention. Treatment by
a sympathetic physician and the family's emotional support for the
new mother are prime considerations in aiding her to recover her
physical and mental well-being and her ability to care for and enjoy
the infant.
Other Sources of Information
National Depression Screening Day
For FREE depression screening in your community
800-573-4433.
Depression Awareness Recognition & Treatment
(D/ART)
5600 Fishers Lane, Room 14C03
Parklawn Building
Rockville, MD 20857
301-443-4140
www.nimh.nih.gov/DART/index.htm
NAMI (National Alliance for the Mentally Ill)
Colonial Place Three
2107 Wilson Blvd. - Suite 300
(703) 524-7600
(703) 524-9094 (fax)
NAMI HelpLine: 1-800-950-NAMI (6264)
www.nami.org
National Depressive and Manic-Depressive Association
730 N. Franklin, #501
Chicago, IL 60610
312-642-0049
www.ndmda.org
National Foundation for Depressive Disorders
P.O. Box 2257
New York, NY 10016
800-248-4344
National Institute of Mental Health Information
Resources and Inquiries Branch
5600 Fishers Lane, Room 7C02
Rockville, MD 20857
301-443-4513
www.nimh.nih.gov
National Mental Health Association
1021 Prince Street
Alexandria, VA 22314
703-684-7722
www.nmha.org
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