Depressive Illnesses

Reactive | Major | Bipolar | Cyclothymia | SAD | Postpartum | Dysthymia

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:

• persistent sadness or emptiness
• feelings of despair, worthlessness, hopelessness or guilt
• inability to enjoy everyday activities, even ones that used to cause pleasure
• chronic insomnia, tiredness, or oversleeping
• thoughts of death or suicide
• problems concentrating or remembering things

Types of depression

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. (Read about "Genetics") Depression also affects women more than men. In addition, there are different types of depression:

• Reactive depression - Sometimes depression is triggered by a specific event - the loss of a loved one, for example, or a job. Major events that affect others, such as the destruction of the World Trade Center in New York, can be a trigger, even to those not directly affected. (Read about "Coping with Tragedy") In such circumstances, it's obviously normal to experience grief or sadness for a period of time. However, if the depression persists for an extended period of time or if it seems to worsen as time goes on, professional mental healthcare may be in order. (Read about "Mental Health")
• Major depression - Also called unipolar depression, major depression is a serious medical illness. According to the National Alliance for the Mentally Ill (NAMI), it affects close to ten million American adults in a given year. Major depression is persistent and can seriously disrupt a person's thoughts, behavior and mood. NAMI says it can also cause physical health problems and is a leading cause of disability in the U.S. and many other developed countries. According to NAMI, major depression can stem from an imbalance in brain chemicals called neurotransmitters, including norepinephrine, serotonin, and dopamine. The Food and Drug Administration (FDA) says that signs and symptoms of major depression include: depressed mood, loss of interest in usual activities, significant change in weight or appetite, insomnia or excessive sleeping (hypersomnia), restlessness/pacing (psychomotor agitation), slowed thoughts and movements (psychomotor slowing), increased fatigue, feelings of guilt or worthlessness, slowed thinking or impaired concentration, and suicide attempts or thoughts of suicide. (Read about "Suicide Prevention") All people with major depression do not experience the same symptoms.
• Bipolar disorder - In bipolar disorder (formerly called manic-depression), depression alternates with periods of hyperactivity and inappropriate "highs." This type of depression can start in adolescence, although it can also develop at a much later age. Bipolar disorder can also be hereditary. The American Psychiatric Association (APA) says eighty to ninety percent of people with bipolar disorder have a relative with either bipolar disorder or depression. APA says bipolar disorder is very treatable; however, patients may resist treatment for a number of reasons. Some may be in denial of the problem. Others may want to get rid of the depressive aspects of their illness, but resist treatment when they are in a manic phase, because they don't want to give up the feelings associated with the manic phase, such as feeling invincible, reckless or "on top of the world." APA, however, says it's essential to treat all phases of bipolar disorder for the most successful outcome. Mood-stabilizing drugs, such as lithium, can be used to stabilize the manic phase, according to APA, but there are side effects to medications. Psychotherapy is also essential for patients and their families, to help them cope with the illness and the damaging effects it may have had on relationships.
• Cyclothymia - Cyclothymia is also called cyclothymic disorder. It is a mild form of bipolar disorder with up and down mood swings, though these swings are not as intense as they are in other types of bipolar disorder.
• Postpartum depression - After the birth of her baby, a woman's mood changes can range from transient "baby blues" immediately following childbirth to an episode of major depression to severe, incapacitating, psychotic depression. The American Academy of Family Physicians (AAFP) says symptoms of what is commonly called the "baby blues" usually start three to four days after delivery, and include mood swings, crying spells and problems concentrating. The symptoms usually go away within ten days of delivery. If the symptoms last or become increasingly severe, however, it's called postpartum depression and medical help is needed. The National Institute of Mental Health (NIMH) says studies suggest that women who experience major depression after childbirth very often have had prior depressive episodes even though they may not have been diagnosed and treated. According to NAMI, studies have shown that as many as 80 percent of women experience a brief period of depressive symptoms during or after pregnancy. In addition, ten to fifteen percent suffer from postpartum clinical depression within three months after birth. One woman in a thousand will have a postpartum psychosis that might lead her to harm herself and/or her baby, according to NAMI.
• Seniors and depression - Another stage of life that can bring on depression occurs as we get older. Seniors may find themselves experiencing the symptoms of depression, as they face changes in their lives and surroundings. (Read about "Depression and Seniors")
• Dysthymia - NAMI says dysthymia is a chronic, but less severe form of depression. NIMH says dysthymia is diagnosed when a depressed mood persists for at least two years in adults (one year in children or adolescents) and is accompanied by at least two other depressive symptoms. Many people with dysthymic disorder also experience major depressive episodes, according to NIMH.
• Seasonal affective disorder (SAD) - Depression can also be seasonal in nature, occurring during the winter months when there is less exposure to light. In addition to the common symptoms of depression, there may also be oversleeping, carbohydrate craving and weight gain, according to NAMI. Seasonal affective disorder can respond to light therapy or medication. In light therapy or phototherapy, you sit in front of a special light box designed to mimic outdoor light. Although less common, some people experience SAD during the summer months.
• Depression and other health problems - The AMA says a number of medical conditions, such as multiple sclerosis, stroke, hypothyroidism, heart disease and cancer can produce symptoms of depression. (Read about "Multiple Sclerosis" "Stroke" "Thyroid" "Coronary Heart Disease" "Cancer: What It Is") Depression can also co-exist with other mental health issues including anxiety disorders and post-traumatic stress. (Read about "Anxiety" "Post-Traumatic Stress")
• Depression and medications - Certain medications can also trigger depression or other mood changes. That's why it's so important to talk with your healthcare provider about medications and potential side effects. If you suspect certain medications may be causing changes in mood, however, do not arbitrarily stop taking the medications on your own. Always consult with a qualified healthcare professional. (Read about "Drug Interaction Precautions")

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.

Treatment options

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:

• selective serotonin reuptake inhibitors or SSRI's
• serotonin-norepinephrine reuptake inhibitors or SNRIs
• norepinephrine-dopamine reuptake inhibitors or NDRIs
• combined reuptake inhibitors and receptor blockers
• tricyclics and tetracyclic antidepressants
• monoamine oxidase inhibitors or MAOIs
• stimulants
• mood-stabilizing medications
• atypical antipsychotics
• thyroid hormones

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.

Related Information:

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