Depression

Depression
Depression

Overview

Depression (major depressive disorder) is a common and serious medical illness that negatively affects how one feels, thinks, and acts. Depression causes feelings of sadness and/or a loss of interest in activities once enjoyed. It can lead to a variety of emotional and physical problems and can decrease a person’s ability to function at work and home.

Cause

Depression often runs in families. This may be due to your genes, behaviors you learn at home, or your environment. Depression may be triggered by stressful or unhappy life events. Often, it is a combination of these things.

Many factors can bring on depression, including:

• Alcohol or drug use

• Medical conditions, such as cancer or long-term (chronic) pain

• Stressful life events, such as job loss, divorce, or death of a spouse or other family member

• Social isolation (a common cause of depression in older adults)

Symptoms

Depression symptoms can vary from mild to severe and can include:

● Feeling sad or having a depressed mood

● Loss of interest or pleasure in activities once enjoyed

● Changes in appetite — weight loss or gain unrelated to dieting

● Trouble sleeping or sleeping too much

● Loss of energy or increased fatigue

● Increase in purposeless physical activity (e.g., hand-wringing or pacing) or slowed movements and speech (actions observable by others)

● Feeling worthless or guilty

● Difficulty thinking, concentrating, or making decisions

● Thoughts of death or suicide

Symptoms must last at least two weeks for a diagnosis of depression. Some forms of depression are slightly different, or they may develop under unique circumstances, such as:

● Persistent depressive disorder (also called dysthymia) is a depressed mood that lasts for at least two years. A person diagnosed with persistent depressive disorder may have episodes of major depression along with periods of less severe symptoms, but symptoms must last for two years to be considered a persistent depressive disorder.

● Postpartum depression is much more serious than the “baby blues” (relatively mild depressive and anxiety symptoms that typically clear within two weeks after delivery) that many women experience after giving birth. Women with postpartum depression experience full-blown major depression during pregnancy or after delivery (postpartum depression). The feelings of extreme sadness, anxiety, and exhaustion that accompany postpartum depression may make it difficult for these new mothers to complete daily care activities for themselves and/or for their babies.

● Psychotic depression occurs when a person has severe depression plus some form of psychosis, such as having disturbing false fixed beliefs (delusions) or hearing or seeing upsetting things that others cannot hear or see (hallucinations). The psychotic symptoms typically have a depressive “theme,” such as delusions of guilt, poverty, or illness.

● The seasonal affective disorder is characterized by the onset of depression during the winter months when there is less natural sunlight. This depression generally lifts during spring and summer. Winter depression, typically accompanied by social withdrawal, increased sleep, and weight gain, predictably returns every year in seasonal affective disorder.

Bipolar disorder is different from depression, However, It is included in this list because someone with bipolar disorder experiences episodes of extremely low moods that meet the criteria for major depression (called “bipolar depression”). But a person with bipolar disorder also experiences extreme high – euphoric or irritable – moods called “mania” or a less severe form called “hypomania.”

Treatment

Living with depression can be difficult, but treatment can help improve the quality of life.

Medication alone and psychotherapy (cognitive-behavioral therapy, interpersonal therapy) alone can relieve depressive symptoms. A combination of medication and psychotherapy has been associated with significantly higher rates of improvement in more severe, chronic, and complex presentations of depression.

● Pharmacological Treatment

● Electroconvulsive Therapy (ECT)

● Psychotherapy

● Cognitive-Behavioral Therapy (CBT)

● Interpersonal Therapy (IPT)

Pharmacological Treatment

Antidepressant medications work well to treat depression. Sometimes different antidepressant medications would have to be tried before finding the one that works best for the individual. Medications that have helped a close family member of the individual are likely to help the individual seeking treatment as well. Antidepressants usually take some time (2 to 4 weeks) before they impact the symptoms. Appetite, sleep, and concentration typically improves before mood begins to lift. It is important for individuals receiving treatment to give the medication time before deciding that the medication is not working. Antidepressants can have side effects, but many side effects may lessen over time. Talking to a health care provider about the side effects and not discontinuing the antidepressant by oneself is important. Stopping the medication early when one starts feeling better is also not a good idea. Stopping the medication suddenly can cause unpleasant withdrawal symptoms and can be unsafe. It would be best to follow the prescribed course of time and then to stop the medication slowly and safely with the help of a healthcare provider.

Antidepressants are an effective modality of treatment. They may present risks to some individuals, especially children, teens, and young adults. Antidepressants are not usually prescribed in children and are not the first line of treatment in adolescents. Antidepressants may cause some people to have negative reactions when they first start taking the medication. Some may become agitated at first before it begins to work. Others may have suicidal thoughts or make suicide attempts. It is important for individuals taking antidepressants to be monitored closely, especially when they first start taking them. It should be kept in mind that for most people the risks of untreated depression far outweigh those of antidepressant medications when they are used under a doctor’s careful supervision.

Electroconvulsive Therapy (ECT)

Electroconvulsive therapy (ECT) is useful for patients who are not responding well to medications or are suicidal. ECT is an effective treatment for patients who do not respond to drug therapy, are psychotic, or are suicidal or dangerous to themselves. The onset of action may be more rapid than that of drug treatments, with benefits often seen within 1 week of commencing treatment. The indications for the use of ECT include the following:

● Failure of drug therapies

● History of good response to ECT

● Patient preference

● High risk of suicide

● High risk of medical morbidity and mortality

Although advances in ECT treatment have improved the safety and tolerability of this modality there are some risks such as those associated with postictal confusion, and, more rarely, short-term memory difficulties.

Psychotherapy

Cognitive Behavior Therapy and Interpersonal Therapy are evidence-based psychotherapies that are effective in the treatment of depression.

Cognitive-Behavioral Therapy (CBT)

CBT is based on the premise that patients with depression have thought that is characterized by dysfunctional negative views of oneself, one’s life experiences (and the world in general), and one’s future – the cognitive triad. Thus, a clinically depressed person is likely to believe themselves as being incapable and helpless, to view others as being judgmental and critical, and the future as being bleak and unrewarding. CBT is a structured and didactic form of therapy that focuses on helping individuals identify and modify maladaptive thinking and behavior patterns. There is research evidence supporting the effectiveness of CBT with individuals of all ages. It is also considered to be efficacious for the prevention of relapse.

Interpersonal Therapy (IPT)

Interpersonal therapy (IPT) is a time-limited treatment for major depressive disorder. It aims at reducing or eliminating depressive symptoms by improving the quality of the patient’s current interpersonal relations and social functioning.

Other

Considerations

Depression can occur in people of all ages:

• Adults

• Teenagers

Older adults

What are the different types of depression?

Two of the most common forms of depression are:

• Major depression—having symptoms of depression most of the day, nearly every day for at least 2 weeks that interfere with your ability to work, sleep, study, eat, and enjoy life. An episode can occur only once in a person’s lifetime, but more often, a person has several episodes.

• Persistent depressive disorder (dysthymia)—having symptoms of depression that last for at least 2 years. A person diagnosed with this form of depression may have episodes of major depression along with periods of less severe symptoms.

Some forms of depression are slightly different, or they may develop under unique circumstances, such as:

• Perinatal Depression: Women with perinatal depression experience full-blown major depression during pregnancy or after delivery (postpartum depression).

Seasonal Affective Disorder (SAD): SAD is a type of depression that comes and goes with the seasons, typically starting in the late fall and early winter and going away during the spring and summer.

• Psychotic Depression: This type of depression occurs when a person has severe depression plus some form of psychosis, such as having disturbing false fixed beliefs (delusions) or hearing or seeing upsetting things that others cannot hear or see (hallucinations).

Other examples of depressive disorders include disruptive mood dysregulation disorder (diagnosed in children and adolescents) and premenstrual dysphoric disorder. Depression can also be one phase of bipolar disorder (formerly called manic-depression). But a person with bipolar disorder also experiences extreme high—euphoric or irritable —moods called “mania” or a less severe form called “hypomania.”

Source

https://www.psychiatry.org/patients-families/depression/what-is-depression                            https://adaa.org/understanding-anxiety/depression-treatment-management  https://www.nimh.nih.gov/health/publications/depression/index.shtml