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Depression

Everything You Want to Know About Depression

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What is depression?

Depression is classified as a mood disorder. It may be
described as feelings of sadness, loss, or anger that
interfere with a person’s everyday activities.

It’s also fairly common. The Centers for Disease Control and
Prevention (CDC)
estimates that 8.1 percent of American
adults ages 20 and over had depression in any given 2-week
period from 2013 to 2016.

People experience depression in different ways. It may
interfere with your daily work, resulting in lost time and
lower productivity. It can also influence relationships and
some chronic health conditions.

Conditions that can get worse due to depression include:

It’s important to realize that feeling down at times is a
normal part of life. Sad and upsetting events happen to
everyone. But, if you’re feeling down or hopeless on a
regular basis, you could be dealing with depression.

Depression is considered a serious medical condition that can
get worse without proper treatment. Those who seek treatment
often see improvements in symptoms in just a few weeks.

Depression can be more than a constant state of sadness or
feeling “blue.”

Major depression can cause a variety of symptoms. Some affect
your mood, and others affect your body. Symptoms may also be
ongoing, or come and go.

The symptoms of depression can be experienced differently
among men, women, and children differently.

Men may experience symptoms related to their:

  • mood, such as anger, aggressiveness,
    irritability, anxiousness, restlessness
  • emotional well-being, such as feeling
    empty, sad, hopeless
  • behavior, such as loss of interest, no
    longer finding pleasure in favorite activities, feeling
    tired easily, thoughts of suicide, drinking excessively,
    using drugs, engaging in high-risk activities
  • sexual interest, such as reduced sexual
    desire, lack of sexual performance
  • cognitive abilities, such as inability to
    concentrate, difficulty completing tasks, delayed responses
    during conversations
  • sleep patterns, such as insomnia, restless
    sleep, excessive sleepiness, not sleeping through the night
  • physical well-being, such as fatigue,
    pains, headache, digestive problems

Women may experience symptoms related to their:

  • mood, such as irritability
  • emotional well-being, such as feeling sad
    or empty, anxious or hopeless
  • behavior, such as loss of interest in
    activities, withdrawing from social engagements, thoughts
    of suicide
  • cognitive abilities, such as thinking or
    talking more slowly
  • sleep patterns, such as difficulty
    sleeping through the night, waking early, sleeping too much
  • physical well-being, such as decreased
    energy, greater fatigue, changes in appetite, weight
    changes, aches, pain, headaches, increased cramps

Children may experience symptoms related to their:

  • mood, such as irritability, anger, mood
    swings, crying
  • emotional well-being, such as feelings of
    incompetence (e.g. “I can’t do anything right”) or despair,
    crying, intense sadness
  • behavior, such as getting into trouble at
    school or refusing to go to school, avoiding friends or
    siblings, thoughts of death or suicide
  • cognitive abilities, such as difficulty
    concentrating, decline in school performance, changes in
    grades
  • sleep patterns, such as difficulty
    sleeping or sleeping too much
  • physical well-being, such as loss of
    energy, digestive problems, changes in appetite, weight
    loss or gain

The symptoms can extend beyond your mind.

There are several possible causes of depression. They can
range from biological to circumstantial.

Common causes include:

  • Family history. You’re at a higher risk
    for developing depression if you have a family history of depression
    or another mood disorder.
  • Early childhood trauma. Some events affect
    the way your body reacts to fear and stressful situations.
  • Brain structure. There’s a greater risk
    for depression if the frontal lobe of your brain is
    less active. However, scientists don’t know if this happens
    before or after the onset of depressive symptoms.
  • Medical conditions. Certain conditions may
    put you at higher risk, such as chronic illness, insomnia,
    chronic pain, or attention-deficit hyperactivity
    disorder (ADHD)
    .
  • Drug use. A history of drug or alcohol
    misuse can affect your risk.

About 21 percent of people who have a
substance use problem also
experience depression. In addition to these causes, other
risk factors for depression include:

  • low self-esteem or being self-critical
  • personal history of mental illness
  • certain medications
  • stressful events, such as loss of a loved one, economic
    problems, or a divorce

Many factors can influence feelings of depression, as well as
who develops the condition and who doesn’t.

The causes of depression are often
tied to other elements of your health.

However, in many cases, healthcare providers are unable to
determine what’s causing depression.

There isn’t a single test to diagnose depression. But your
healthcare provider can make a diagnosis based on your
symptoms and a psychological evaluation.

In most cases, they’ll ask a series of questions about your:

  • moods
  • appetite
  • sleep pattern
  • activity level
  • thoughts

Because depression can be linked to other health problems,
your healthcare provider may also conduct a physical
examination and order blood work. Sometimes thyroid problems or a vitamin D deficiency can
trigger symptoms of depression.

Don’t ignore symptoms of depression. If your mood doesn’t
improve or gets worse, seek medical help. Depression is a
serious mental health illness with the potential for
complications.

If left untreated, complications can include:

Depression can be broken into categories depending on the
severity of symptoms. Some people experience mild and
temporary episodes, while others experience severe and
ongoing depressive episodes.

There are two main types: major depressive
disorder and persistent depressive disorder.

Major depressive disorder

Major depressive disorder is
the more severe form of depression. It’s characterized by
persistent feelings of sadness, hopelessness, and
worthlessness that don’t go away on their own.

In order to be diagnosed with clinical depression, you must
experience 5 or more of the following symptoms over a 2-week
period:

  • feeling depressed most of the day
  • loss of interest in most regular activities
  • significant weight loss or gain
  • sleeping a lot or not being able to sleep
  • slowed thinking or movement
  • fatigue or low energy most
    days
  • feelings of worthlessness or guilt
  • loss of concentration or indecisiveness
  • recurring thoughts of death or suicide

There are different subtypes of major depressive disorder,
which the American Psychiatric Association refers to as
“specifiers.”

These include:

Persistent depressive disorder

Persistent depressive disorder
(PDD)
used to be called dysthymia. It’s a milder, but
chronic, form of depression.

In order for the diagnosis to be made, symptoms must last for
at least 2 years. PDD can affect your life more than major
depression because it lasts for a longer period.

It’s common for people with PDD to:

  • lose interest in normal daily activities
  • feel hopeless
  • lack productivity
  • have low self-esteem

Depression can be treated successfully, but it’s important to
stick to your treatment plan.

Living with depression can be difficult, but treatment can
help improve your quality of life. Talk to your healthcare
provider about possible options.

You may successfully manage symptoms with one form of
treatment, or you may find that a combination of treatments
works best.

It’s common to combine medical treatments and lifestyle
therapies, including the following:

Medications

Your healthcare provider may prescribe:

Each type of medication that’s used
to treat depression has benefits and potential risks.

Psychotherapy

Speaking with a therapist can help you learn
skills to cope with negative feelings. You may also benefit
from family or group therapy sessions.

Light therapy

Exposure to doses of white
light
can help regulate your mood and improve symptoms of
depression. Light therapy is commonly used in seasonal affective disorder,
which is now called major depressive disorder with seasonal
pattern.

Alternative therapies

Ask your healthcare provider about acupuncture or meditation. Some herbal supplements are also
used to treat depression, like St. John’s wort, SAMe, and
fish oil.

Talk with your healthcare provider before taking a supplement
or combining a supplement with prescription medication
because some supplements can react with certain medications.
Some supplements may also worsen depression or reduce the
effectiveness of medication.

Exercise

Aim for 30 minutes of physical activity 3 to 5 days a week.
Exercise can increase your
body’s production of endorphins, which are hormones
that improve your mood.

Avoid alcohol and drugs

Drinking or misusing drugs may
make you feel better for a little bit. But in the long run,
these substances can make depression and anxiety symptoms worse.

Learn how to say no

Feeling overwhelmed can worsen anxiety and depression
symptoms. Setting boundaries in
your professional and personal life can help you feel better.

Take care of yourself

You can also improve symptoms of depression by taking care of
yourself. This includes getting plenty of sleep, eating a healthy diet, avoiding
negative people, and participating in enjoyable activities.

Sometimes depression doesn’t respond to medication. Your
healthcare provider may recommend other treatment options if
your symptoms don’t improve.

These include electroconvulsive therapy
(ECT)
, or repetitive transcranial
magnetic stimulation (rTMS)
to treat depression and
improve your mood.

Traditional depression treatment uses a combination of
prescription medication and counseling. But there are also
alternative or complementary
treatments
you can try.

It’s important to remember that many of these natural
treatments have few studies showing their effects on
depression, good or bad.

Likewise, the U.S. Food and Drug Administration (FDA) doesn’t
approve many of the dietary supplements on the market in the
United States, so you want to make sure you’re buying
products from a trustworthy brand.

Talk to your healthcare provider before adding supplements to
your treatment plan.

Supplements

Several types of supplements are thought to have some
positive effect on depression symptoms.

St. John’s wort

Studies are mixed, but this natural treatment is used
in Europe as an antidepressant medication. In the United
States, it hasn’t received the same approval.

S-adenosyl-L-methionine (SAMe)

This compound has shown in limited studies to possibly ease
symptoms of depression. The effects were best seen in people
taking selective serotonin reuptake
inhibitors (SSRIs)
, a type of traditional antidepressant.

5-hydroxytryptophan (5-HTP)

5-HTP may raise serotonin levels in the brain,
which could ease symptoms. Your body makes this chemical when
you consume tryptophan, a protein building block.

Omega-3 fatty acids

These essential fats are important to neurological
development and brain health. Adding omega-3 supplements to your
diet may help reduce depression symptoms.

Essential oils

Essential oils are a popular natural remedy for many
conditions, but research into their effects on depression is
limited.

People with depression may find symptom relief with the
following essential oils:

  • Wild ginger: Inhaling this strong scent
    may activate serotonin receptors in your brain. This may
    slow the release of stress-inducing hormones.
  • Bergamot: This citrusy essential oil has
    been shown to reduce anxiety in patients awaiting surgery.
    The same benefit may help individuals who experience
    anxiety as a result of depression, but there’s no research
    to support that claim.

Other oils, such as chamomile or rose
oil
, may have a calming effect when they’re inhaled.
Those oils may be beneficial during short-term use.

Vitamins

Vitamins are important to many bodily functions. Research
suggests two vitamins are especially useful for easing
symptoms of depression:

  • Vitamin B: B-12 and B-6 are vital to brain
    health. When your vitamin B levels are low,
    your risk for developing depression may be higher.
  • Vitamin D: Sometimes called the sunshine vitamin because
    exposure to the sun supplies it to your body, Vitamin D is
    important for brain, heart, and bone health. People who are
    depressed are more likely to have low levels of this
    vitamin.

Many herbs, supplements, and vitamins claim to help ease
symptoms of depression, but most haven’t shown themselves to
be effective in clinical research.

Depression isn’t generally considered to be preventable. It’s
hard to recognize what causes it, which means preventing it
is more difficult.

But once you’ve experienced a depressive episode, you may be
better prepared to prevent a future episode by learning which
lifestyle changes and treatments are helpful.

Techniques that may help include:

  • regular exercise
  • getting plenty of sleep
  • maintaining treatments
  • reducing stress
  • building strong relationships with others

Other techniques and ideas may also help you prevent
depression.

Bipolar depression occurs in certain types of bipolar disorder, when the
person experiences a depressive episode.

People with bipolar disorder may experience significant mood
swings. Episodes in bipolar 2, for instance,
typically range from manic episodes of high
energy to depressive episodes of low energy.

This depends on the type of bipolar disorder you have. A
diagnosis of bipolar 1 only has to have the presence of manic
episodes, not depression.

Symptoms of depression in people with bipolar disorder may
include:

  • loss of interest or enjoyment from normal activities
  • feeling sad, worried, anxious, or empty
  • not having energy or struggling to complete tasks
  • difficulty with recall or memory
  • sleeping too much or insomnia
  • weight gain or weight loss as a result of increased or
    decreased appetite
  • contemplating death or suicide

If bipolar disorder is treated, many will experience fewer
and less severe symptoms of depression, if they experience
depressive episodes.

Depression and anxiety can occur in a person
at the same time. In fact, research has shown that over
70 percent of people with
depressive disorders also have symptoms of anxiety.

Though they’re thought to be caused by different things,
depression and anxiety can produce several similar symptoms,
which can include:

  • irritability
  • difficulty with memory or concentration
  • sleep problems

The two conditions also share some common treatments.

Both anxiety and depression can be treated with:

If you think you’re experiencing symptoms of either of these
conditions, or both of them, make an appointment to talk with
your healthcare provider. You can work with them to identify coexisting symptoms of
anxiety and depression
and how they can be treated.

Obsessive-compulsive disorder
(OCD)
is a type of anxiety disorder. It causes unwanted
and repeated thoughts, urges, and fears (obsessions).

These fears cause you to act out repeated behaviors or
rituals (compulsions) that you hope will ease the stress
caused by the obsessions.

People diagnosed with OCD frequently find themselves in a
loop of obsessions and compulsions. If you have these
behaviors, you may feel isolated because of them. This can
lead to withdrawal from friends and social situations, which
can increase your risk for depression.

It’s not uncommon for someone with OCD to also have
depression. Having one anxiety disorder can increase your
odds for having another. Up to 80 percent of people with OCD
also have major depression.

This dual diagnosis is a concern with children, too. Their
compulsive behaviors, which may be first developing at a
young age, can make them feel unusual. That can lead to
withdrawing from friends and can increase the chance of child
developing depression.

Some individuals who have been diagnosed with major
depression may also have symptoms of another mental disorder
called psychosis. When the two
conditions occur together, it’s known as depressive psychosis.

Depressive psychosis causes people to see, hear, believe, or
smell things that aren’t real. People with the condition may
also experience feelings of sadness, hopelessness, and
irritability.

The combination of the two conditions is particularly
dangerous. That’s because someone with depressive psychosis
may experience delusions that cause them to have thoughts of
suicide or to take unusual risks.

It’s unclear what causes these two conditions or why they can
occur together, but treatment can successfully ease symptoms.
Treatments include medications and electroconvulsive therapy
(ECT)
.

Understanding the risk factors and possible causes can help
you be aware of early symptoms.

Pregnancy is often an exciting time for people. However, it
can still be common for a pregnant woman to experience
depression.

Symptoms of depression during
pregnancy
include:

  • changes in appetite or eating habits
  • feeling hopeless
  • anxiety
  • losing interest in activities and things you previously
    enjoyed
  • persistent sadness
  • troubles concentrating or remembering
  • sleep problems, including insomnia or sleeping too much
  • thoughts of death or suicide

Treatment for depression during pregnancy may focus entirely
on talk therapy and other natural treatments.

While some women do take antidepressants during their
pregnancy, it’s not clear which ones are the safest. Your
healthcare provider may encourage you to try an alternative
option until after the birth of your baby.

The risks for depression can continue after the baby arrives.
Postpartum depression, which is
also called major depressive disorder with peripartum onset,
is a serious concern for new mothers.

Recognizing the symptoms may help
you spot a problem and seek help before it becomes
overwhelming.

Research has established a link between alcohol use and
depression. People who have depression are more likely to
misuse alcohol.

Out of the 20.2 million U.S. adults who experienced a
substance use disorder, about 40 percent had a cooccurring
mental illness.

According to a 2012 study, 63.8 percent of people who are
alcohol dependent have depression.

Drinking alcohol frequently can make symptoms of depression
worse, and people who have depression are more likely to
misuse alcohol or become dependent on it.

Depression can be temporary, or it can be a long-term
challenge. Treatment doesn’t always make your depression go
away completely.

However, treatment often makes symptoms more manageable.
Managing symptoms of depression involves finding the right
combination of medications and therapies.

If one treatment doesn’t work, talk with your healthcare
provider. They can help you create a different treatment plan
that may work better in helping you manage your condition.

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Antidepressants

Antidepressants

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An antidepressant is the name given to a medicine that can help
relieve the symptoms of depression, such as low mood, anxiety, and worthlessness.

Antidepressants are classified into different types depending
on their structure and the way that they work. There are at
least seven types of antidepressant:

  • Monoamine oxidase inhibitors (MAOIs)
  • Norepinephrine and dopamine reuptake inhibitors (NDRIs)
  • Selective serotonin reuptake inhibitors (SSRIs)
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs)
  • Serotonin antagonist and reuptake inhibitors (SARIs)
  • Tricyclic antidepressants (TCAs) and tetracyclic
    antidepressants (TeCAs)
  • And the miscellaneous antidepressants.

MAOIs and TCAs were among the first antidepressants developed.
They have largely been superseded by newer antidepressants
(such as the SSRIs) that have fewer side effects, although
these older antidepressants may still suit certain people or be
effective when other antidepressants have been ineffective.

Antidepressants are thought to work by increasing levels of
certain neurotransmitters, such as dopamine, serotonin, and/or
norepinephrine, in the brain.

What are antidepressants used for?

Antidepressants help to relieve the symptoms of depression such
as low mood, irritability, feelings of worthlessness,
restlessness, anxiety, and difficulty in sleeping.

In addition to depression, certain antidepressants may also be
used to treat a range of other conditions, for example:

It is important to note that not all antidepressants are used
to treat the conditions mentioned above.

Antidepressants generally provide some relief of symptoms
within one to two weeks; however, it may take six to eight
weeks of treatment before the full effects are seen.

What are the differences between antidepressants?

There are distinct differences between the different classes of
antidepressants available because they all work in a different
way. In addition, within each class, there are differences
between individual antidepressants with regards to how long
they remain in the body, how they are metabolized, and how much
they interact with other medications.

Monoamine oxidase inhibitors (MAOIs)

MAOIs block the effects of monoamine oxidase enzymes, thereby
increasing the concentration of dopamine, norepinephrine, and
serotonin in the brain.

Norepinephrine and dopamine reuptake inhibitors (NDRIs)

NDRIs block the reuptake of norepinephrine and dopamine,
increasing the concentration of these two neurotransmitters in
the nerve synapse.

Selective serotonin reuptake inhibitors (SSRIs)

SSRIs increase levels of serotonin in the brain by preventing
the reuptake of serotonin by nerves.

Serotonin and norepinephrine reuptake inhibitors (SNRIs)

SNRIs block the reuptake of both serotonin and norepinephrine,
increasing the concentration of these two neurotransmitters in
the nerve synapse.

Serotonin antagonist and reuptake inhibitors (SARIs)

SARIs prevent the reuptake of serotonin and affect the binding
of serotonin to certain receptors

Tricyclic antidepressants (TCA) and tetracyclic antidepressants
(TeCAs)

TCAs and TeCAs work by increasing levels of norepinephrine and
serotonin. They may also block the actions of other
neurotransmitters, such as acetylcholine and histamine.

Tricyclics

Tetracyclics

Miscellaneous antidepressants

Increase levels of neurotransmitters by an unknown mechanism of
action that is different from other pre-existing classes of
antidepressant.

Are antidepressants safe?

When taken at the recommended dosage, antidepressants are
considered safe. However, some have been associated with severe
side effects, some potentially fatal, such as:

  • An increase in suicidal thoughts and behaviors,
    particularly in children and young adults under the age of 25
    years. This is most likely to occur when starting therapy
  • An increased risk of seizures in people with a history of seizures
  • Serotonin syndrome – this is caused by excessive levels of
    serotonin in the body and is more likely to occur with higher
    dosages of SSRIs or when SSRIs are administered with other
    medications that also release serotonin. Symptoms include
    agitation,
    confusion, sweating, tremors, and a rapid heart rate
  • The precipitation of a manic episode in people with
    undiagnosed bipolar disorder
  • Duloxetine: A
    severe discontinuation syndrome
  • MAOIs: Very severe drug interactions, very severe food
    interactions, and rarely, rapid but transient increases in
    blood pressure within 30 minutes to two hours of MAOI ingestion
  • Nefazodone:
    Life-threatening liver failure, more common two weeks to six
    months after starting therapy
  • SSRIs and vortioxetine: An increase in the risk of
    bleeding, especially if used with other medications that also
    increase bleeding risk
  • TCAs: An increased risk of arrhythmias, heart attacks,
    stroke, and other cardiovascular effects, particularly in
    people with pre-existing heart disease; and the triggering of
    an angle closure attack in people with angle-closure glaucoma

For a complete list of severe side effects, please refer to the
individual drug monographs.

What are the side effects of antidepressants?

Not everybody experiences significant side effects with
antidepressants, and some antidepressants are more likely to
cause side effects than others. Some of the more commonly
reported side effects include:

Some antidepressants have been associated with a
discontinuation syndrome when they have been stopped suddenly.
For this reason, it is best to withdraw all antidepressants
slowly.

For a complete list of side effects, please refer to the
individual drug monographs.

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Psychological Treatments

Psychological treatments for depression

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Psychological treatments (also known as talking therapies) can
help you change your thinking patterns and improve your coping
skills so you’re better equipped to deal with life’s stresses
and conflicts. As well as supporting your recovery,
psychological therapies can also help you stay well by
identifying and changing unhelpful thoughts and behaviour.

There are several types of effective psychological treatments
for depression, as well as
different delivery options. Some people prefer to work one on
one with a professional, while others
get more out of a group environment. A growing number of online
programs, or e-therapies, are also available. 

Cognitive behaviour therapy (CBT)

CBT is a structured psychological treatment which recognises
that the way we think (cognition) and act (behaviour) affects
the way we feel. CBT is one of the most effective treatments
for depression, and has been found to be useful for a wide
range of ages, including children, adolescents, adults and
older people. 

CBT involves working with a professional (therapist) to
identify thought and behaviour patterns that are either making
you more likely to become depressed, or stopping you from
getting better when you’re experiencing depression.

It works to change your thoughts and behaviour by teaching you
to think rationally about common difficulties, helping you to
shift negative or unhelpful thought patterns and reactions to a
more realistic, positive and problem-solving approach.

CBT is also well-suited to being delivered electronically
(often called e-therapies).

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