Depression is "a mental state or chronic mental disorder characterized by feelings of sadness, loneliness, despair, low self-esteem, and self-reproach; accompanying signs include psychomotor retardation (or less frequently agitation), withdrawal from social contact, and vegetative states such as loss of appetite and insomnia."
What are the different forms of depression?
There are several forms of depression (depressive disorders). Major depressive disorder and dysthymic disorder are the most common.
Major depressive disorder (major depression)
Major depressive disorder is also known as major depression. The patient suffers from a combination of symptoms that undermine his ability to sleep, study, work, eat, and enjoy activities he used to find pleasurable. Experts say that major depressive disorder can be very disabling, preventing the patient from functioning normally. Some people experience only one episode, while others have recurrences.
Dysthymic disorder (dysthymia)
Dysthymic disorder is also known as dysthymia, or mild chronic depression. The patient will suffer symptoms for a long time, perhaps as long as a couple of years, and often longer. However, the symptoms are not as severe as in major depression, and the patient is not disabled by it. However, he may find it hard to function normally and feel well. Some people experience only one episode during their lifetime, while others may have recurrences.
A person with dysthymia might also experience major depression, once, twice, or more often during his lifetime. Dysthymia can sometimes come with other symptoms. When they do, it is possible that other forms of depression are diagnosed.
Psychotic depression
When severe depressive illness includes hallucinations, delusions, and/or withdrawing from reality, the patient may be diagnosed with psychotic depression.
Postpartum depression (postnatal depression)
Postpartum depression is also known as postnatal depression or PND. This is not to be confused with 'baby blues' which a mother may feel for a very short period after giving birth. If a mother develops a major depressive episode within a few weeks of giving birth it is most likely she has developed PND. Experts believe that about 10% to 15% of all women experience PND after giving birth. Sadly, many of them go undiagnosed and suffer for long periods without treatment and support.
Bipolar disorder (manic-depressive illness)
Bipolar disorder is also known as manic-depressive illness. It used to be known as manic depression. It is not as common as major depression or dysthymia. A patient with bipolar disorder experiences moments of extreme highs and extreme lows. These extremes are known as manias.
What are the signs and symptoms of depression?
Depression is not uniform. Signs and symptoms may be experienced by some sufferers and not by others. How severe the symptoms are, and how long they last depends on the individual person and his illness. Below is a list of the most common symptoms:
A constant feeling of sadness, anxiety, and emptiness
A general feeling of pessimism sets in (the glass is always half empty)
The person feels hopeless
Individuals can feel restless
The sufferer may experience irritability
Patients may lose interest in activities or hobbies they once enjoyed
He/she may lose interest in sex
Levels of energy feel lower, fatigue sets in
Many people with a depressive illness find it hard to concentrate, remember details, and make decisions
Sleep patterns are disturbed - the person may sleep too little or too much
Eating habits may change - he/she may either eat too much or have no appetite
Suicidal thoughts may occur - some may act on those thoughts
The sufferer may complain more of aches and pains, headaches, cramps, or digestive problems. These problems do not get better with treatment.
What causes depression?
We are still not sure what causes depression. Experts say depression is caused by a combination of factors, such as the person's genes, his biochemical environment, his personal experience and psychological factors.
MRI (magnetic resonance imaging) has shown that the brain of a person with depression looks different, compared to the brain of a person who has never had depression. The areas of the brain that deal with thinking, sleep, mood, appetite and behavior do not appear to function normally. There are also indications that neurotransmitters appear to be out of balance. Neurotransmitters are chemicals that our brain cells use to communicate. However, imaging technology has not revealed why the depression happened.
We know that if there is depression in the family a person's chances of developing depression are higher. This suggests there is a genetic link. According to geneticists, depression risk is influenced by multiple genes acting together with environmental and others factors.
An awful experience can trigger a depressive illness. For example, the loss of a family member, a difficult relationship, physical sexual abuse.
What is the treatment for depression?
Depression is highly treatable - even in its most severe forms. The sooner a person is treated the more effective that treatment will be. Studies have also shown that prompt treatment reduces significantly the likelihood of recurrence.
As some medications and medical conditions can cause the same symptoms as depression, you need to get your doctor to rule out these possibilities before conducting a physical examination. You will also have an interview and lab tests. When your doctor, usually a GP (general practitioner) at this point, has ruled out a medical condition or pharmacological cause, he will either carry out a psychological evaluation or refer you to a mental health specialist.
The mental health specialist should carry out a comprehensive diagnostic evaluation. You will be asked whether there is any family history of depression, what your symptoms are and how long they have existed, how severe your symptoms are. You will also be asked whether you consume alcohol or drugs, and whether you have had any suicidal thoughts.
If you are diagnosed with some form of depressive illness, you will be offered treatment. Depression can be treated with a number of methods; the most common are drugs and/or psychotherapy.
Medication for depression
The aim of an antidepressant is to stabilize and normalize the neurotransmitters in our brain (naturally occurring brain chemicals), such as serotonin, dopamine, and norepeniphrine. According to various studies, these neurotransmitters play a vital role in regulating mood. We know they regulate mood, but we are not exactly sure how they do it.
SSRIs (selective serotonin reuptake inhibitors) are the newest antidepressants; they are also the most popular. Prozac (fluoxetine), Celexa (citalopram), and Zoloft (sertraline) are all SSRIs.
SNRIs (norepinephrine reuptake inhibitors) are similar to SSRIs. Effexor (venlafaxine) and Cymbalta (duloxetine) are SNRIs.
SSRIs and SNRIs are more popular today than older types of antidepressants, mainly because they have fewer side-effects. MAOIs (monoamine oxidase inhibitors) and tricyclics are examples of older antidepressants. Nevertheless, modern antidepressants do affect some people with undesirable side-effects. For people who experience high levels of unpleasant side effects with SSRIs or SNRIs, tricyclics or MAOIs may be a better option.
If you are taking MAOIs you have to be careful with your diet and other medications. MAOIs have potentially serious interactions with some foods and drugs. Cheeses, wines and pickles have high levels of tyramine, which interact with MAOIs - so they must be avoided. Some decongestants also have tyramine in them. When a MAOI interacts with tyramine the patient may experience a significant rise in blood pressure, which in turn increases the risk of stroke. If a doctor prescribes an MAOI make sure you receive a comprehensive list of foods, medicines and substances you should avoid.
In the majority of cases, the patient will not notice any really significant benefit from an antidepressant until he has been taking it for a few weeks. It is important to continue taking them for this reason. Make sure you take them according to your doctor's instructions. Even if you feel better, do not stop the medication unless your doctor tells you to. Not only do antidepressants help to make you feel better, they also significantly reduce your chances of having a recurrence or relapse.
Under a doctor's supervision, if you do come off the medicine it will usually be gradually. In most cases, your body needs time to adjust to the change. Even though antidepressant are said not to be addictive, if you stop taking them abruptly you may experience very unpleasant withdrawal symptoms. Many people who suffer from chronic and recurrent depression continue taking medications for an indefinite period.
If you find one drug does not work after a few weeks tell your doctor and see if he can get you onto another one. Research has shown that treatment is much more successful if a patient switches from a drug that does not seem to be working to another one.
St. John's Wort for treating depression
St. John's Wort is a plant that grows in the wild. It is bushy and has yellow flowers. It is also known by its scientific Latin name Hypericum perforatum. It has been used for hundreds of years in Europe for the treatment of mild to moderate depression, and has become popular in other parts of the world. Some studies have shown that St. John's wort might be as effective as antidepressants in treating major depression