Depression is a disorder that affects your thoughts, moods, feelings, behavior and physical health. People used to think it was “all in your head” and that if you really tried, you could “pull yourself out of it.” Doctors now know that depression is not a weakness, and you can’t treat it on your own. It’s a medical disorder with a biological or chemical basis.
Sometimes, a stressful life event triggers depression. Other times depression seems to occur spontaneously with no identifiable specific cause. Whatever the cause, depression is much more than grieving or a bout of the blues.
Depression may occur only once in a person’s life. Often, however, it occurs as repeated episodes over a lifetime, with periods free of depression in between. Or it may be a chronic condition, requiring ongoing treatment over a lifetime. The disorder affects more than 18 million Americans of all ages and races.
Medications are available that are generally safe and effective, even for the most severe depression. With proper treatment, most people with serious depression improve, often within weeks, and can return to normal daily activities.
Two hallmarks of depression symptoms key to establishing a diagnosis are:
In addition, for a doctor or other health professional to diagnose depression, most of the following signs and symptoms also must be present most of the day, nearly every day for at least two weeks:
Depression can also cause a wide variety of physical complaints, such as generalized itching, blurred vision, excessive sweating, dry mouth, gastrointestinal problems (indigestion, constipation and diarrhea), headache and backache.
Children, teens and older adults may react differently to depression. In these groups, symptoms may take different forms or may be masked by other conditions.
There’s no single cause for depression. The illness often runs in families. Experts believe a genetic vulnerability combined with environmental factors, such as stress or physical illness, may trigger an imbalance in brain chemicals called neurotransmitters, resulting in depression. Imbalances in three neurotransmitters serotonin, norepinephrine and dopamine seem to be linked to depression.
Scientists don’t fully understand how imbalances in neurotransmitters cause signs and symptoms of depression. It’s not certain whether changes in neurotransmitters are a cause or a result of depression.
Factors that contribute to depression include:
To diagnose depression, your doctor may perform a physical examination, including tests to rule out conditions that can cause symptoms that mimic depression.
If your doctor sees signs of severe depression or suspects the possibility of suicide, he or she may refer you to a medical doctor who specializes in mental illness (psychiatrist) or even recommend immediate hospitalization.
Your doctor or psychiatrist diagnoses depression based on the hallmark signs and symptoms of the disease, plus the presence of other signs and symptoms that typically accompany depression.
The development of newer antidepressant medications and mood-stabilizing drugs has improved the treatment of depression. Medications can relieve symptoms of depression and have become the first line of treatment for most types of the disorder.
Treatment may also include psychotherapy, which may help you cope with ongoing problems that may trigger or contribute to depression. A combination of medications and a brief course of psychotherapy usually is effective if you have mild to moderate depression. If you’re severely depressed, initial treatment usually is with medications or electroconvulsive therapy. Once you improve, psychotherapy can be more effective.
Doctors usually treat depression in two stages. Acute treatment with medications helps relieve symptoms until you feel well. Once your symptoms ease, maintenance treatment typically continues for six to 12 months to prevent a relapse. It’s important to keep taking your medication even though you feel fine and are back to your usual activities. Episodes of depression recur in the majority of people who have one episode, but continuing treatment for at least six months greatly reduces your risk of a rapid relapse. If you’ve had two or more previous episodes of depression, your doctor may suggest long-term treatment with antidepressants.
According to the American Diabetes Association, certain antipsychotic drugs may increase the risk of diabetes, obesity and high blood pressure. A study published in the February 2004 issue of Diabetes Care recommends that doctors screen and monitor people who take Risperdal, Seroquel and Zyprexa.
Most antidepressants have a similar level of effectiveness. However, a medication that works for someone else might not work for you. Doctors choose antidepressants based on your family history and the match between your symptoms and the medication’s side effects. For example, if you have insomnia, a sedating antidepressant may help you. But if you’re lethargic, then a more energizing antidepressant may be more helpful.
Most antidepressants are slow to work. You may see a response in two weeks, but many people don’t see a full benefit for six to eight weeks. If your response to medication hasn’t resulted in satisfactory progress after six to eight weeks, your doctor may suggest either adding another antidepressant or replacing the first medication with another drug from a different chemical family.
One person’s body may break down drugs faster or slower than another person’s body. Scientists are developing techniques to measure this. If you’ve taken several medications and your condition hasn’t improved or you’ve experienced side effects, tell your doctor. He or she may order blood tests for you to determine how rapidly your body breaks down your current medications.
In addition to medications, depression treatment may include:
There are several types of psychotherapy. Each type involves a short-term, goal-oriented approach aimed at helping you deal with a specific issue. Prolonged psychotherapy is seldom necessary to treat depression. If an underlying factor contributing to your depression is an inability to get along with others or difficulty finding your place in life, then prolonged psychotherapy could help you.
The success of therapy depends on finding a doctor, psychiatrist or psychologist you’re comfortable with. Both medications and psychotherapy can take four to eight weeks to have an effect. Specialized and supervised group therapy, such as bereavement groups, stress management classes, marital counseling and family therapy, also may help.
Despite the images that many people conjure up, electroconvulsive therapy is generally safe and effective. In fact, it’s the gold standard for treatment of severe depression.
In this therapy, you receive a light general anesthesia and a muscle relaxant. An electrical current is passed through your brain for one to three seconds. The stimulus causes a controlled seizure, which typically lasts for 20 to 90 seconds. You wake up in five to 10 minutes and should rest for about half an hour. Most people require six to 10 treatments.
Experts aren’t sure how this therapy relieves symptoms of depression. The seizure may affect levels of neurotransmitters in your brain. The most common side effect is confusion that lasts a few minutes to several hours. A few people have some memory loss for several weeks. This therapy is usually used for people who don’t respond to medications and for those at high risk of suicide. It may be the only treatment available for severely depressed older adults who can’t take medications because of heart disease.
This therapy may help if you have seasonal affective disorder. This disorder involves periods of depression that recur at the same time each year, usually when days are shorter in the fall and winter. Scientists believe fewer hours of sunlight may increase levels of melatonin, a brain hormone thought to induce sleep and depress mood. Treatment in the morning with a specialized type of bright light, which suppresses production of melatonin, may help if you have this disorder.
Herbal and dietary supplements sold in stores have become increasingly popular. People take them to help prevent or treat a number of health conditions. Some of these alternative therapies are being studied to determine their effectiveness in helping depression. Within the next few years, researchers may know more about these products, how effective they are and if they can cause other health problems or interfere with medications.
In the meantime, talk with your doctor before taking any herbal or dietary supplement. The downfall of herbal and dietary products is that they aren’t regulated. The Food and Drug Administration doesn’t test them for safety, purity or effectiveness. You can’t always be sure of what you’re getting and if it’s safe.
Some popular supplements marketed or taken for treatment of depression include:
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