Depression

Depression definition

A depressive disorder is a syndrome (group of symptoms) that reflects a sad mood exceeding normal sadness or grief. More specifically, the sadness of depression is characterized by a greater intensity and duration and by more severe symptoms and functional disabilities than is normal. Depression symptoms are characterized not only by negative thoughts, moods, and behaviors, but also by specific changes in bodily functions (e.g., eating, sleeping, and sexual activity). The functional changes are often called neurovegetative signs. Certain people with depressive disorder, especially bipolar depression (manic depression), seem to have an inherited vulnerability to this condition. Depressive disorders are a huge public health problem.

Signs and Symptoms

• Sleep disturbances—at least 90% of people with depression have either insomnia (sleeplessness) or hypersomnia (excessive sleeping)
• Significant change in appetite (often resulting in either weight loss or weight gain)
• Persistently sad, anxious, or "empty" mood.
• Feelings of hopelessness, pessimism.
• Feelings of guilt, worthlessness, helplessness.
• Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex.
• Insomnia, early-morning awakening, or oversleeping.
• Decreased appetite and/or weight loss, or overeating and weight gain.
• Fatigue, decreased energy, being "slowed down."
• Thoughts of death or suicide, suicide attempts.
• Restlessness, irritability.
• Difficulty concentrating, remembering, making decisions.
• Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain.
  

Causes

There's no single known cause for depression. The illness often runs in families. Experts believe a genetic vulnerability combined with environmental factors, such as stress or physical illness, may trigger an imbalance in brain chemicals called neurotransmitters, resulting in depression. Imbalances in three neurotransmitters — serotonin, norepinephrine and dopamine — seem to be linked to depression.

Scientists don't fully understand how imbalances in neurotransmitters cause signs and symptoms of depression. It's not certain whether changes in neurotransmitters are a cause or a result of depression.

Factors that contribute to depression include:

• Heredity—a recently identified gene called SERT that regulates the brain chemical serotonin, has been linked to depression
• Chronic stress (such as from loss, abuse, or deprivation in early childhood)
• Amount of exposure to light
• Sleep disturbances
• Social isolation
• Nutritional deficiencies (especially folate [vitamin B9] and omega-3 fatty acids)
• Serious medical conditions, such as heart attack or cancer
• Certain medications, including those for high blood pressure, high cholesterol, or irregular heartbeat

Risk Factors

Depression affects all ages and all races. Twice as many women experience depression as men. While men are less likely to become depressed than women are, depression does affect men as well. Gender differences in depression may be due in part to biological causes, such as hormones and different levels of neurotransmitters.

Other factors that may put you at an increased risk of depression include a family history of the disorder, pregnancy or stressful life events, such as the loss of a loved one or a job.

The following factors may increase an individual's risk for an initial or recurrent episode of depression:

• Prior episodes of depression
• Family history of depression
• Suicide attempt—a former attempt of suicide during a major depressive episode increases the likelihood of another episode of depression
• Female gender—the incidence of depression appears to be greater in women than in men, however, some researchers speculate that women may simply report their symptoms more frequently than men and that men may be more apt to mask their depressive symptoms with alcohol. Therefore, it is still unclear whether women truly have a greater risk for depression.
• Young adulthood or middle age—the highest occurrence of depression is between the ages of 25 and 44; the elderly are also at particular risk due to death of loved ones, physical illness, and loss of independence
• Stressful life events (such as the death of a loved one), particularly if the event occurs at a young age
• Postpartum period
• Chronic medical or psychological conditions including autoimmune diseases (such as lupus), cancer, heart disease, chronic headaches, chronic pain, anxiety, obsessive-compulsive disorder, and borderline personality disorder; medical conditions that cause shifts in hormones, such as thyroid disorders or menopause, may also contribute to depression.
• History of abuse (such as mental, physical, or sexual)
• Lack of social support system (such as a network of close friends or family)
• Current or past alcohol or drug abuse—25% of people with addictions have depression

Diagnosis

It is hard for people who have not experienced clinical depression, either personally or by regular exposure to people suffering it, to understand its emotional impact and severity, interpreting it instead as being similar to "having the blues" or "feeling down." As the list of symptoms above indicates, clinical depression is a serious, potentially lethal systemic disorder characterized by interlocking physical, affective, and cognitive symptoms that have consequences for function and survival well beyond sad or painful feelings.Working together with a primary care physician is extremely important, however, because he or she is often the person who makes a referral to a psychiatrist who, in turn, makes a definite diagnosis of depression. Proper diagnosis of depression is the first step toward proper treatment.

Treatment Approach

The development of newer antidepressant medications and mood-stabilizing drugs has improved the treatment of depression. Medications can relieve symptoms of depression and have become the first line of treatment for most types of the disorder.

Treatment may also include psychotherapy, which may help you cope with ongoing problems that may trigger or contribute to depression. A combination of medications and a brief course of psychotherapy usually is effective if you have mild to moderate depression. If you're severely depressed, initial treatment usually is with medications or electroconvulsive therapy. Once you improve, psychotherapy can be more effective.

Doctors usually treat depression in two stages. Acute treatment with medications helps relieve symptoms until you feel well. Once your symptoms ease, maintenance treatment typically continues for four to nine months to prevent a relapse. It's important to keep taking your medication even though you feel fine and are back to your usual activities. Episodes of depression recur in the majority of people who have one episode, but continuing treatment greatly reduces your risk of a rapid relapse. If you've had two or more previous episodes of depression, your doctor may suggest long-term treatment with antidepressants.

Medications:

• Selective serotonin reuptake inhibitors (SSRIs).
• Tricyclic and tetracyclic antidepressants.
• Monoamine oxidase inhibitors (MAOIs).
• Stimulants.
• Lithium and mood-stabilizing medications.
• Other treatments
  In addition to medications, depression treatment may include:
• Psychotherapy.
• Electroconvulsive therapy.
• Light therapy

Pregnancy

Postpartum depression is experienced by 8% to 20% of women following delivery.
The safety of SSRIs and tricyclic antidepressant medications during pregnancy remains uncertain. The physician will provide guidance regarding use or avoidance of antidepressants during pregnancy.