Depression

Do you ever wake up feeling extremely sad? You look out the window and it's cloudy outside. Surely, it's the weather that's caused the change in your mood. Last week, you were unhappy because your boss has been giving you grief about your lateness. The week before that you were in a funk after your date failed to return any of your calls. Now, that you think about it you can't recall the last time you were in a good mood. Does this constant sadness seem familiar to you? For as long as you can remember your mood has been on the downside. When family and friends ask you what's wrong you have all kinds of excuses as to why you're feeling "blue." Well, maybe its time to take a closer look at the underlying reason why you can't seem to shake your sadness.

According to the New England Journal of Medicine, depression affects 12% of men and 20% of women in the United States. The diagnosis of depression is reserved for those who can not seem to shake their daily woes. Depression leads to emotions that can be disruptive to daily activities such as sleeping, eating and concentrating. Eventually, this medical problem can result in a complete inability to find happiness or pleasure in life. Without proper medical attention depression may lead to suicidal thoughts.

So, what causes someone to be depressed? For the most part, researchers have not been able to pinpoint the cause for depression. The contributing factors are a bit complex. However, research involving genetic studies and drug therapies has shown the involvement of three key brain chemicals - serotonin, dopamine and norepinephrine. These chemicals work together to maintain normal brain functions such as movement, memory and emotion. Too little of any and these neurochemicals may led to a state of depression.

Ever wonder why some people are affected more profoundly by sadness than others who may experience similar disappointments in life? It's because depression is not the same in everyone and the risk factors are varied. For instance, a woman with a family history of depression who has had a major depressive episode is at greater risk than someone who doesn't have these factors.

In order to seek help knowing the signs of clinical depression as opposed to just being sad or bereaved is critical. The hallmark of clinical depression is a severe and persistent sadness that interferes with one's daily activities and relationships. Depression may manifest in people differently. Symptoms are usually sadness, especially in the morning, feeling of worthlessness, guilt, indecisiveness, and agitation all within a two-week period.

Interestingly enough, some individuals may no longer feel depressed. Excited they may even create a list of great things to accomplish and become flooded with ideas. They're feeling better than they have in weeks and even decide to stop by the HR office at work to request vacation time. After all, it's about time they took that trip to the Caribbean.

On the drive home the gridlock doesn't bother them. Without thinking twice they book a fantastic trip and everything is fine until they realize how much work they must do before they leave for vacation. Besides that most of their bathing suits don't even fit anymore. They become annoyed at themselves for eating junk food for the past three weeks and canceling their gym membership. They have spiraled down from a momentary high. What's happened?

This bout of mania may be experienced by a small percentage of depressed people. These manic episodes refer to individuals who are pleasure seeking, hyperactive and extremely euphoric. Incidents of mania should not be confused with manic depression which is a separate psychiatric condition also known as bipolar disorder. The disorder is called manic depression because one's mood usually swings from high (manic) to low (depressed) emotional states. The disorder affects six million people without prejudice across gender, race, social or ethnic lines.

Depressed people can seek medical attention and receive various forms of treatment. Antidepressants are usually prescribed to target the neurochemicals - serotonin, dopamine and norepinephrine. Drugs known as selective serotonin reuptake inhibitors (Zoloft, Paxil) work to increase the level of serotonin in the brain. This class is also referred to as SSRIs. Another drug class known as selective serotonin and norepinephrine reuptake inhibitors (SNRIs) increases both neurochemicals. Some examples of SNRIs are Desryel and Effexor. Wellbutrin is an antidepressant that increases levels of dopamine.

Tricyclic antidepressants (Norpramin) are usually prescribed to treat a broader range of depression from mild to severe cases. MAOIs such as Nardil are prescribed only when other drug options are not effective. These drugs are not to be mixed with certain foods like wine and cheese because they result in extremely hypertensive states.

It's important to implement psychotherapy as part of the treatment plan. Antidepressants do not work immediately. It may take eight to 12 weeks for symptomatic improvements. Psychotherapy provides an outlet for depressed patients to begin working on certain issues all while under the supervision of a professional.

For manic episodes lithium is used. As a last resort for patients who are not responsive to any antidepressants treatments and are experiencing suicidal thoughts electroconvulsive therapy (ECT) is considered. The mechanism is unclear however post-ECT depressed patients no longer have symptoms.

Depression can progress into a debilitating condition that prevents people from living a normal life. The most important choice that can be made is to get help which is a step toward regaining a better and healthier life.

Sources: http://www.ndmda.org/, http://patients.uptodate.com/topic.asp?file=mentl_h/2952&title=Depression, R.H. Belmaker, M.D., and Galila Agam, Ph.D., "Major Depressive Disorder." New England Journal of Medicine. 358.1 (2008) 55-68