Depression

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Revision as of 05:36, 25 October 2009

Introduction

Symptoms

Causes and Risk Factors

Unlike some medical conditions, depression cannot be traced to a single cause. Research indicates that some genes can increase a person's risk for clinical depression, running in families for generations. It is believed that interaction among multiple genes can lead to depression, but researchers are unable to pinpoint a specific "depression" gene. [1] More particularly, the nerve cells in the brain responsible for moods and emotions connect with one another via chemical messengers called neurotransmitters. The body's production and decomposition of these neurotransmitters, as well as various hormones, is believed to result in depression in some individuals. Early traumatic or abusive experiences in childhood alter the development of emotions and moods, affecting the brain's natural chemistry and response to stress. [2] Hormonal changes in the body also seem to be a key factor, as women are twice as likely as men to experience depression. Certain health conditions or diseases can increase a person's risk; for example, there is a 65% increase risk for depression after having a heart attack. [3] People with a naturally pessimistic outlook and poor self-esteem are also vulnerable to serious depression, and may already suffer from a milder form known as dysthymia. Stressful social changes and events are known to trigger depression, such as a relational breakup or financial troubles, and even joyous occasions like getting married or graduating from school. Preexisting psychological issues like schizophrenia, anxiety and eating disorders, frequently accompany depression. [4] Intense feelings of grief associated with the death of a loved one, losing one's job, retirement, or divorce can also lead to depression (depending upon the individual). Almost 30% of people that struggle with substance abuse also deal with clinical or major depression. [5] Poor diet resulting in vitamin deficiencies, as well as the use of some prescribed medications, can result in depression. Other risk factors include: a chronic medical condition, personality disorder, continual emotional or mental stress, obesity, and isolation from society. [6]

In comparing the brains of people with depression and those without it, researchers have discovered that the hippocampus, a small portion of the brain responsible for storing memories, is notable smaller in people with depression. With a smaller hippocampus, depressed people have fewer chemical receptors, particularly those of serotonin and norepinephrine; these two neurotransmitters have a calming effect on the brain and aid in smooth communication between the brain's nerve cells and the body. Other studies indicate that cortisol, a stress hormone, is overproduced in the brains of depression patients, leading some researchers to postulate that it has a toxic effect on the hippocampus. Still other scientists speculate that people born with a smaller hippocampus are more likely to suffer from depression. In any case, depression is more than just a simple persistent mood; it is a diagnosable medical condition that requires treatment and proper medication. [7]

Treatment

Antidepressants-- Antidepressants are medications that balance out the natural neurotransmitter levels in the brain, specifically serotonin, norepinephrine, and dopamine. These medications take three to four weeks to become effective, and a patient should take them as long as instructed by their doctor, even if symptoms improve, in order to avoid a relapse. When a patient stops taking antidepressants, they must be gradually weaned off or withdrawal effects and a potential relapse could ensue. Sometimes doctors also prescribe a stimulant or anxiety medication in conjunction with antidepressants. Side effects vary depending upon the specific medication, but common side effects include headaches, nausea, sexual and bladder problems, and daytime drowsiness. Combining antidepressants with some medications can lead to serious and life-threatening medical conditions. [8] The main kinds of antidepressants are:

• Selective serotonin reuptake inhibitors (SSRIs)-- The most common type of depression medication and has only mild side effects; [9] boosts the serotonin levels in the brain by preventing "serotonin reuptake," a process in which the nerves that release the serotonin also absorb it again, keeping it from being used by other nerves. [10]
• Serotonin and norepinephrine reuptake inhibitors (SNRIs)-- Prevents serotonin and norepinephrine reuptake. [11]
• Aminoketones-- A weaker type of antidepressant; how it works is not completely known.
• Tetracyclic antidepressants-- Acts upon serotonin and norepinephrine levels; mild side effects.
• Tricyclic antidepressants (TCAs)-- A class of some of the original antidepressant drugs; can have severe reactions in some people, but is useful if newer antidepressants are ineffective.
• Monoamine oxidase inhibitors (MAOIs)-- One of the earliest antidepressants; inhibits the function of an enzyme called monoamine oxidase that breaks down the neurotransmitter hormones; rarely prescribed due to severe reactions with certain foods and other medicines. [12]

Psychotherapy-- Although depression is primarily caused by chemical factors in the brain, the psychological connection is unmistakable. Psychotherapy consists of the depressed patient speaking with a professional counselor who then aids the person in recognizing and responding to the factors triggering their depression. Three main types of psychotherapy are: cognitive behavioral therapy, interpersonal therapy, and pschodynamic therapy. Cognitive behavioral therapy focuses on isolating and correcting inaccurate perceptions the patient has; gradually they learn to identify true and false assumptions they have about themselves and their environment. Interpersonal therapy works on the depressed person's relationships with their family and friends. This therapy is recommended for those suffering depression from social and relational difficulties, grief, or a life-changing event, as it improves self esteem and communication skills. Psychodynamic therapy assumes that a person's depression is a result of unsettled and mostly unconscious problems (most from childhood); talking about these experiences works to bring closure and better coping techniques regarding the involved emotions. Both interpersonal and psychodynamic therapies are administered for about three to four months. [13] Even though individual therapy is common, group therapy also has many benefits; it increases the social interaction of people struggling with depression and allows them to draw encouragement from one another. Therapy in general focuses on strengthening and building relationships (attempting to prevent future depression), introducing positive responses to life's difficulties, and establishing healthy boundaries to reduce stress. [14]

Electroconvulsive Therapy-- If a patient doesn't respond to other forms of depression treatment, electroconvulsive therapy (ECT) is frequently administered; ECT is also resorted to when a depressed patient is suicidal or needs immediate treatment, has schizophrenia, major depression, bipolar disorder, etc. In ECT the patient takes a muscle relaxant and put under general anesthesia. Electrodes are placed on the patient's head and, using a carefully controlled electric current, stimulate a brief brain seizure. [15] The shock lasts a mere second or two, but in those seconds the brain releases numerous chemicals, including neurotransmitters; the plentiful supply improves the brain's communication and weakens the depression. Side effects include short-term memory loss, muscle aches, headache, and confusion. [16] ECT is usually administered several times a week, often supplemented by an antidepressant to prevent relapse; eventually, the treatments are reduced to once a week, and then monthly for up to a year. Research shows no sign of negative cognitive effects on patients after a year of electroconvulsive therapy. [17]

Alternatives-- Besides therapy and medicine, depression can be simply treated by alterations in lifestyle. For example, daily exercise, a balanced diet, and plenty of sleep, all positively contribute towards a person's mental and physical well-being. Reducing stress and keeping socially active are also healthy lifestyle decisions that can lessen the impacts or occurrences of depression. Current research is investigating the effectiveness of relaxation techniques (like yoga, meditation, etc.) and acupuncture in treating forms of depression. [18] A popular natural remedy is St. John's Wort, a medicinal plant widely used in Europe to treat depression. Although this plant extract has been used for centuries, studies show conflicting results as to its effectiveness in treating depression; most conclude that it's useful in treating minor depression, but does little for major depression. Part of its popularity lies in its few side effects and various forms, from liquid extracts to tea and pills. [19]

Reactions

Men--In the U.S. alone, around six million men suffer from a form of depression every year. When men become depressed, they are more likely to admit a lack of interest in their hobbies or work, poor sleep, irritability, and fatigue, than express feelings of guilt or melancholy. Rather than seek medical attention when depression symptoms occur, many men resort to drugs or alcohol; they feel frustrated, angry, and sometimes become violent and abusive. Others immerse themselves in their work, trying to deny the depression to themselves as well as friends and family. Some men even become reckless, not caring how they drive or taking unnecessary risks. The connection between suicide and depression is also clearly seen. Men are four times as likely as women to take their own lives; this statistic could reflect how men often resist seeking proper treatment or receive incorrect diagnosis. [20]

Women--Women are twice as likely as men to experience depression, and this disparity crosses all racial, economical, and ethnic boundaries worldwide; around one in eight women suffer from a depressive episode in their lifetime. Unlike men, women react to depression by excessive sleeping and eating (particularly carbohydrates), as well as weight gain. Guilty emotions and depression-related feelings are also more pronounced in women and they have a higher rate of thyroid problems. Researchers have developed many theories as to why women are especially vulnerable to depression. Premenstrual, pregnancy, and infertility problems contribute to major hormonal changes within the body, increasing a woman's risk for depression. Postpartum depression, or "baby blues", is a frequent condition in which a new mother temporarily experiences a form of depression, but this typically dissipates within a few weeks and only continues if the mother has severe and lasting depression. Perimenopause and menopause also change the hormone levels in a woman's body and can induce depression, especially in those with a previous history of depression. Socially, the strain of playing various roles (worker, mother, wife) can put women at risk; single mothers are especially vulnerable. Discrimination in the workplace, low socioeconomic status, and society's continual emphasis on youth and beauty are other potential factors that can lead to depression in women. Men distract themselves when they're depressed, but women tend to hold onto their depression, discussing it with friends and trying to find the causes, which maintains or even worsens the depression. Women also develop depression under low levels of stress because females have a hormone called progesterone that prevents the body from ceasing the production of stress hormones (men don't have progesterone.) Difficulties with self-esteem and relationships have significant impacts on the feminine mind, and both of these can trigger depression. [21] Seniors-- Teenagers and Children--

Forms and Related Disorders

References