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October Blog

OCTOBER BLOG

DEPRESSION

Depression is a mood disorder causing a persistent feeling of sadness and loss of interest. Depression affects how you feel, think and behave and can lead to a variety of emotional and physical problems. You can experience trouble doing normal day-to-day activities and sometimes you may feel as if life isn't worth living! Depression isn't a weakness and you can't simply "snap out" of it and it may require long-term treatment. Depression is one of the most common mental disorders in the U.S and research suggests that depression is caused by a combination of genetic, biological, environmental and psychological factors.

Many suffering from depression feel better with medication, psychotherapy or both. Depression is a disorder that can take a terrible toll on you and your family. Depression is worse when not treated, resulting in emotional, behavioral and health problems.

According to the National Institute of Mental Health., NIMH, major depression affects about 6.7% of the U.S. population over age 18. Between 20% and 25% of adults may suffer an episode of major depression at some point during their lifetime.

Factors that seem to increase the risk of developing or triggering depression include:

Low self-esteem, being too dependent, self-critical or pessimistic
Traumatic or stressful events, such as physical or sexual abuse, the death or loss of a loved one, a difficult relationship or financial problems
Blood relatives with a history of depression, bipolar disorder, alcoholism or suicide
Being lesbian, gay, bisexual or transgender or the development of genital organs that aren't clearly male or female (intersex) in an unsupportive situation
History of mental health disorders - anxiety, eating or post-traumatic stress disorder, PTSD
Abuse of alcohol or recreational drugs
Serious or chronic illness - cancer, stroke, chronic pain or heart disease
Certain medications - some high blood pressure medications or sleeping pills

Depression symptoms in children and teens

Common signs and symptoms of depression in children and teenagers are similar to those of adults, but there can be some differences.

In young children, symptoms may include sadness, irritability, clinginess, worry, aches and pains, refusing to go to school or being underweight.
In teens, symptoms may include sadness, irritability, feeling negative, worthless, anger, poor performance and/or attendance at school, feeling misunderstood or extremely sensitive, using recreational drugs or alcohol, eating or sleeping too much, self-harm, loss of interest in normal activities and avoidance of social interaction.

Depression symptoms in older adults

In older adults, depression often goes undiagnosed and untreated and they may feel reluctant to seek help. Symptoms of depression may be different or less obvious in older adults, such as:

Memory difficulties or personality changes
Physical aches or pain
Fatigue, loss of appetite, sleep problems or lost interest in sex that is not caused by a medical condition or medication
Anti-social - wanting to stay at home or not wanting to experience new things
Suicidal thinking or feelings, especially older men

For many people with depression, symptoms usually are severe enough to cause noticeable problems in day-to-day activities, such as work, school, social activities or relationships. Some may feel miserable or unhappy without understanding why! Depression may occur only once during your life, but some experience multiple episodes. During these episodes, symptoms occur most of the day or every day and may include:

Feelings of sadness, tearfulness, emptiness, hopelessness, worthlessness, guilt or a fixation on past failures or self-blame,
Angry outbursts, irritability or frustration, even over small matters
Loss of interest or pleasure in most or all normal activities, such as sex, hobbies or sports
Sleep disturbances, such as insomnia or sleeping too much
Fatigue and lack of energy, making small tasks difficult to accomplish
Reduced appetite with loss of weight or increased cravings for food and weight gain
Anxiety, agitation or restlessness
Trouble thinking, concentrating, making decisions and remembering things
Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide

What causes depression?

Depression often begins in the teens, 20s or 30s, but it can happen at any age, affecting women more than men. This may occur because women are more likely to seek treatment. Women are biologically vulnerable to depression because of increased stress at home, work, balancing family life with career and caring for an aging parent. Raising a child alone will also increase the risk. Depression in men is significantly underreported. Men who suffer from clinical depression are less likely to seek help or even talk about their experience. It's not exactly known what causes depression. A variety of factors may be involved, such as:

Biological - People with depression appear to have physical changes in their brains. The significance of these changes is still uncertain but may help pinpoint causes.
Brain chemistry - Neurotransmitters are naturally occurring brain chemicals that may play a role. Research indicates that changes in the function and the effect of neurotransmitters and how they interact with neurocircuits, maintaining mood stability, may play a role in depression and its treatment.
Hormones - Changes in the body's balance of hormones may be involved in causing or triggering depression. Hormone changes can result with pregnancy during the weeks or months after delivery, postpartum, as well as thyroid problems, menopause or several other conditions.
Inherited traits - Depression is more common with blood relatives who also have the condition. Researchers are looking for genes that may be involved in causing depression.

Types of depression

Symptoms can vary from person to person. To distinguish the type of depression, practitioners may add one or more specifiers or specific features, such as:

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Anxious distress — depression with unusual restlessness or worry about possible events or loss of control
Mixed features — simultaneous depression and mania, which includes elevated self-esteem, talking too much and increased energy
Melancholic features — severe depression with lack of response to things that used to bring pleasure and associated with early morning awakening, worsened mood in the morning, major changes in appetite or feelings of guilt, agitation or sluggishness
Atypical features — the ability to temporarily be cheered by happy events, increased appetite, excessive need for sleep, sensitivity to rejection and a heavy feeling in the arms or legs
Psychotic features — depression accompanied by delusions or hallucinations
Catatonia — depression that includes motor activity that involves either uncontrollable and purposeless movement or fixed and inflexible posture
Peripartum onset — depression that occurs during pregnancy or in the weeks or months after delivery (postpartum)
Seasonal pattern — depression related to changes in seasons and reduced exposure to sunlight

Other disorders that cause depression symptoms

Other disorders include depression as one of its symptom. It's imperative to get an accurate diagnosis for the appropriate treatment.

Bipolar I and II disorders - These disorders include mood swings that range from highs (mania) to lows (depression). It can be difficult to distinguish between bipolar disorder and depression.
Cyclothymic (sy-kloe-THIE-mik) disorder - involves highs and lows that are milder than those experienced with bipolar disorder.
Disruptive mood dysregulation disorder - More prevalent in children, includes chronic and severe irritability and anger with frequent extreme temper outbursts. This disorder typically develops into depressive disorder or anxiety disorder during the teen years or adulthood.

Persistent depressive disorder - Sometimes called dysthymia (dis-THIE-me-uh), this is a less severe but more chronic form of depression. Usually not disabling, but can prevent normal functioning in daily routines. A person diagnosed may have episodes of major depression with periods of less severe symptoms. The disorder is a depressed mood that lasts for at least two years.

Premenstrual dysphoric disorder - Involves symptoms associated with hormone changes beginning a week before and improve within a few days after the onset of your period. The symptoms usually subside after completion of your period.

Diagnosis

A diagnosis from your medical professional may be based on the following criteria:

Physical exam – which includes asking about you and your family’s health history. In some cases, depression is linked to an underlying physical health problem.
Lab tests - a blood test, genetic test or testing the thyroid to assure its functioning properly.
Psychiatric evaluation

Treatment

Medications and psychotherapy are effective for most with depression. However, many with depression also benefit from a consultation with a psychiatrist, psychologist or other mental health professionals.

Alternative treatment options include brain stimulation therapies such as:

Electroconvulsive therapy (ECT) - ECT is usually used for people who don't get better with medications, can't take antidepressants for health reasons or are at high risk of suicide.
Transcranial magnetic stimulation (TMS) - TMS may be an option for those who haven't responded to antidepressants.

Medications

Many types of antidepressants are available. Be sure to discuss possible major side effects with your doctor or pharmacist.

Selective serotonin reuptake inhibitors (SSRIs)
Serotonin-norepinephrine reuptake inhibitors (SNRIs)
Atypical antidepressants
Tricyclic antidepressants - can be very effective, but cause severe side effects. Tricyclics generally aren't prescribed unless an SSRI was prescribed first, without improvement.
Monoamine oxidase inhibitors (MAOIs) - MAOIs requires a strict diet because of dangerous, occasionally deadly interactions with foods ― such as certain cheeses, pickles and wines. MAOIs may be prescribed when other drugs haven't worked, but they can also have serious side effects and cannot be combined with SSRIs.
Other medications - may be added to the treatment regimen to enhance antidepressant effects. Your doctor may recommend combining antidepressants or adding mood stabilizers or antipsychotics.

There are also risks with abruptly stopping medications. Don't stop taking an antidepressant without talking to your doctor first. Antidepressants aren't considered addictive, but physical dependence, different from addiction, can occur.

Stopping treatment abruptly or missing doses can cause withdrawal-like symptoms or may cause a sudden worsening of depression. Work with your doctor to gradually and safely decrease your dose.

Antidepressants and pregnancy

If you're pregnant or breast-feeding, antidepressants may pose an increased health risk to your unborn or nursing child. Talk with your doctor if you become pregnant or you're planning to become pregnant.

Antidepressants and increased suicide risk

Most antidepressants are generally safe, but the Food and Drug Administration (FDA) requires all antidepressants to carry a “black box warning,” the strictest warning for prescriptions. In some cases, children, teenagers and young adults under age 25 may have an increased suicidal thoughts or behavior when taking antidepressants, especially in the initial introduction of medications or changes in the dosage or medication. Antidepressants are more likely to reduce suicide risk by improving mood.

Supplements, nutrients and herbs used for the treatment of depression

St. John's Wort - may be helpful for mild or moderate depression. St. John's Wort can interfere with certain medications, such as heart drugs, blood-thinning drugs, birth control pills, chemotherapy, HIV/AIDS medications and drugs to prevent organ rejection after a transplant. Taking St. John's wort while taking antidepressants can cause serious side effects.
SAMe, S-adenosylmethionine - is a synthetic form of a chemical that occurs naturally in the body and acts as an antidepressant. SAMe may trigger mania in people with bipolar disorder.
Omega-3 fatty acids - found in cold-water fish, flaxseed, flax oil, walnuts and some other foods is used for the treatment of depression. Omega 3 aids in the transmission of nerve impulses needed for normal brain function. In high doses, Omega-3 may interact with other medications.
L-tyrosine – alleviates stress by boosting production of adrenaline and increases dopamine levels which influences moods
Vitamin B complex – is necessary for the normal functioning of the brain and nervous system. Plus:

Vitamin B-6 – for normal brain function
Vitamin B-12 – for the production of the neurotransmitter acetylcholine
Vitamin B-5 – the most potent anti-stress vitamin
Folic acid – usually a deficiency found

Zinc - usually a deficiency found
Choline and Inositol or Lecithin – important in brain function and neurotransmission
Gamma-amino-butyric, GAMA – has a tranquilizing effect
Nicotinamide adenine dinucleotide, NADH – enhances the production of dopamine, serotonin and noradrenaline, key neurotransmitters
Kava Kava – helps induce calm and relieve depression

When to get emergency help

If you are having thoughts of hurting yourself or suicide, call 911 or your local emergency number immediately. Here are other options that are available:

Call your doctor or mental health professional.
Call a suicide hotline number

In the U.S., call the National Suicide Prevention Lifeline at 1-800-273-TALK

(1-800-273-8255).

To reach the Veterans Crisis Line, press 1.

Reach out to someone you trust – a close friend or loved one.
Contact a minister, spiritual leader or someone else in your faith community.
If you have a loved one who is in danger of suicide or has made a suicide attempt, make sure someone stays with that person.

Call 911 or your local emergency number immediately. Or, if you think you can do so safely, take the person to the nearest hospital emergency room.

Prevention

There's no sure way to prevent depression. However, these strategies may help.

Take steps to control stress, to increase your resilience and boost your self-esteem.
Reach out to family and friends, especially in times of crisis, to help you weather rough spells.
Get treatment at the earliest sign of a problem to help prevent depression from worsening.
Consider getting long-term maintenance treatment to help prevent a relapse of symptoms.