Depression

Depression is a mental illness characterized by feelings of profound sadness and disinterest in enjoyable activities. It may cause a wide range of symptoms, both physical and emotional. Depression is not the same as a blue mood. It can last for weeks, months, or years. People with depression rarely recover without treatment.

Causes

The precise cause of Depression is not known. Causes may be mental, physical, or environmental, including:
  • Stressful life events
  • Chronic stress
  • Low self-esteem
  • Imbalances in brain chemicals and hormones
  • Lack of control over circumstances (helplessness and hopelessness)
  • Negative thought patterns and beliefs

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.
  • Chronic physical or mental illness
  • Major life changes or stressful life events
  • Post-partum depression
  • Little or no social support
  • Low self-esteem
  • Lack of personal control over circumstances
  • Family history of depression (parent or sibling)
  • Feelings of helplessness

Symptoms

Symptoms of Depression are highly variable from person to person. Some people have only a few symptoms, while others have many. Symptoms also vary over time. Symptoms can change over time and may include:
  • Persistent feelings of sadness, anxiety or emptiness
  • Hopelessness
  • Feeling guilty, worthless or helpless
  • Loss of interest in hobbies and activities
  • Loss of interest in sex
  • Feeling tired
  • Trouble concentrating, remembering, making decisions
  • Trouble sleeping, waking up too early, or oversleeping
  • Eating more or less than usual
  • Weight gain or weight loss
  • Thoughts of death or suicide with or without suicide attempts
  • Restlessness or irritability
  • Physical symptoms that defy standard diagnosis and do not respond well to medical treatments

Diagnosis

There is no blood test or diagnostic test for Depression. The doctor will ask about your symptoms and medical history, giving special attention to:
  • Alcohol and drug use
  • Thoughts of death or suicide
  • Family members who have or had Depression
  • Sleep patterns
The doctor may also perform a mental status examination or neuropsychiatric evaluation to obtain detailed information about your speech, thoughts, memory and mood. A physical examination and other diagnostic tests can help rule out other causes your symptoms

Treatment

Treatment usually includes medication, psychotherapy, or a combination of the two. Medicine helps relieve symptoms. Psychotherapy helps you learn more effective ways to deal with problems or to identify and resolve the conflicts contributing to your Depression.
Antidepressant Medications
Up to 70% of depressed patients find relief from their symptoms with antidepressants. These medications, which can take 2 to 6 weeks to reach their maximum effectiveness include:
Selective serotonin reuptake inhibitors (SSRIs)
  • Fluoxetine (Prozac)
  • Sertraline (Zoloft)
  • Paroxetine (Paxil)
  • Citalopram (Celexa)
  • Fluvoxamine (Luvox)

Tricyclic antidepressants

  • Imipramine (Tofranil, Janimine)
  • Doxepin (Adapin, Sinequan)
  • Clomipramine (Anafranil)
Monoamine oxidase inhibitors (MAOIs)
  • Phenelzine (Nardil)
  • Tranylcypromine (Parnate)
Other antidepressants
  • Venlafaxine (Effexor)
  • Nefazodone (Serzone)
  • Mirtazapine (Remeron)
  • Buproprion (Wellbutrin)
Psychotherapy
Short-term (10-20 week) therapy can help some depressed people. Psychotherapy is designed to help you:
  • Cope with difficulties in relationships
  • Change negative thinking and behavior patterns
  • Resolve difficult feelings
Herbal Therapy St. John's wort is an herb that is available without prescription. It is widely used in Europe for the treatment of mild to moderate Depression. There is conflicting evidence as to its effectiveness, however.
Electroconvulsive Therapy (ECT) ECT may be used in people with severe or life-threatening Depression. It is also used for people who cannot take or do not respond to antidepressants. It is considered a safe and effective procedure.
Exercise
Regular exercise has been shown to relieve some of the symptoms of Depression. In the absence of physical restrictions, exercise should play an integral role in the overall management of Depression.

Prevention

Strategies to reduce your chance of becoming depressed include:
  • Being aware of your personal risk
  • Having psychiatric evaluation and psychotherapy if needed
  • Developing social supports
  • Learning stress management techniques
  • Exercising regularly
  • Getting adequate sleep, rest and recreation