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Although we may use the word "depression" in conversation as a synonym for having a "case of the blues," real depression is, in fact, very serious. According to the National Institute of Mental Health (NIMH), research indicates that many kinds of depression are caused by an imbalance of certain chemicals in the brain. (Read about "The Brain")
The American Medical Association (AMA) says depression is one of the "most common, most dangerous and most treatable" of diseases. Symptoms of depressive disorders (also called affective disorders) vary from person to person, but can include:
NIMH says over 15 million Americans suffer from depressive illnesses. Symptoms of depression can begin at any age. Depression can strike anyone, although some people may be more genetically at risk of depressive disorders. Depression also affects women more than men. In addition, there are different types of depression:
Research is ongoing into possible causes of depression and other mental illnesses. Studies examine the genetic and environmental risks for depression - both alone and when it occurs with other problems such as anxiety disorders. (Read about "Anxiety") Several parts of the brain are under investigation. Using brain imaging technologies and neurochemical techniques, scientists are finding that a network of interacting structures is responsible for our emotions. NIMH says brain imaging research is revealing that in depression, neural circuits responsible for moods, thinking, sleep, appetite, and behavior fail to function properly, and that the regulation of critical neurotransmitters is impaired. Research is also looking into the role of the amygdala, an almond-shaped structure deep within the brain. The amygdala is believed to serve as a communications hub between the parts of the brain that process incoming sensory signals and the parts that interpret them.
NIMH also says that the hypothalamic-pituitary-adrenal (HPA) axis, the hormonal system that regulates the body's response to stress (Read about "Stress"), is overactive in many people with depression. Research findings suggest that persistent overactivation of this system may lay the groundwork for depression. Other research focuses on the hippocampus, another brain structure that is responsible for processing stimuli. The hippocampus plays a key role in the brain by helping to encode information into memories. Scientists hope that greater understanding of the brain, and how it works, can lead to better understanding of depression and many other mental illnesses.
When depression alone is the problem, treatment options depend on the severity of the depression. NIMH says that in milder cases of depression, lifestyle changes, such as getting more exercise, can be helpful. If symptoms persist, however, behavioral therapy may be needed.
There are many forms of psychotherapy, some short-term, others conducted on more of an ongoing basis. Psychotherapists help patients gain insight into and resolve their problems through verbal exchanges as well as help patients learn how to gain more satisfaction from their activities and unlearn behavioral patterns that contribute to or result from their depression.
NIMH says two of the short-term psychotherapies that research has shown helpful for some forms of depression are interpersonal and cognitive-behavioral therapies. Interpersonal therapists focus on the patient's disturbed personal relationships that both cause the depression and make it worse. Cognitive-behavioral therapists help patients change the negative styles of thinking and behaving that is often associated with depression. There are also psychodynamic therapies, which focus on resolving the patient's conflicted feelings.
Depression however, may also require medications. This is most true for severe depressive illnesses, particularly those that are recurrent. NIMH says medications can be used along with, or preceding, psychotherapy for the best outcome. According to the National Alliance for the Mentally Ill (NAMI), different classes of medications that can be used include:
NIMH says that if medication is used, it's most effective when combined with therapy, so that the medication can help provide symptom relief and psychotherapy can help the patient learn more effective ways to deal with life's problems. It is also essential that anyone taking medications be aware of potential side effects. Some medications may interact with other medicine, or even with foods. Some medications can cause side effects that include dry mouth (Read about "Oral Health"), weight gain and drowsiness. Other types of medications can lead to insomnia, restlessness, headache or more serious concerns. Sexual side effects are another concern. (Read about "Erectile Dysfunction") In addition, certain antipsychotic drugs may increase the risk of diabetes and high blood pressure. (Read about "Diabetes" "Hypertension: High Blood Pressure") Any side effects should be reported at once. Medications should also be monitored carefully by the patient's healthcare provider. (Read about "Medicine Safety")
The American College of Obstetricians and Gynecologists (ACOG) has concerns about selective serotonin reuptake inhibitors (SSRI's) and other related antidepressants for pregnant women.(Read about "Healthy Pregnancy") The group advises that women and their doctors should carefully consider all the ramifications of being on the drugs or not while pregnant. The concern is the higher risk of birth defects (Read about "Birth Defects") in babies whose mothers take medications. This concern needs to be balanced against the risks of untreated mental health issues, which can also affect a developing fetus.
In some cases of depression that do not respond to antidepressants or counseling, electroconvulsive therapy (ECT) may be an option. ECT uses an electrical shock to cause a seizure in the brain. This seizure can cause the release of brain chemicals that can improve mood. The procedure is done under anesthesia. (Read about "Anesthesia") AAFP says there can be side effects from the anesthesia, the actual treatment or both, including memory loss, confusion, nausea, headache and heart rhythm changes. (Read about "Arrhythmia") Patients need to weigh potential benefits against these risks.
Vagus nerve stimulation has also been approved for cases of chronic or severe depression that has not responded to other treatments. In vagus nerve stimulation, an electrical signal is sent along the vagus nerve to your brain. These signals may alter mood and improve depression. The signal is sent from a surgically implanted device. As with other treatments, you need to weigh the potential benefits against the risks.
NAMI says that once diagnosed, 80 percent of clinically depressed individuals can be effectively treated. The thing to remember is that in many cases of depression, it's not possible to just "snap out of it." That's why it's important to take depression seriously and seek appropriate treatment if you're concerned about depression in yourself or in someone you care for.
All Concept Communications material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.
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