Depression
Depressive Illness
A depressive illness is a “whole-body” illness, involving your body,
mood, thoughts, and behavior. It affects the way you eat and sleep,
the way you feel about yourself, and the way you think about things.
A depressive illness is not a passing blue mood. It is not a sign of
personal weakness or a condition that can be willed or wished away.
People with depressive illness cannot merely “pull themselves together”
and get better. Without treatment, symptoms can last for weeks, months,
or years. Appropriate treatment, however, can help over 80 percent of
those who suffer from depression.
Symptoms of depression
- Persistent sad, anxious, or “empty” mood
- Feelings of hopelessness, pessimism
- Feelings of guilt, worthlessness, helplessness
- Loss of interest or pleasure in hobbies and activities that you
once enjoyed, including sex - Insomnia, early-morning awakening, or oversleeping
- Appetite and/or weight loss or overeating and weight gain
- Decreased energy, fatigue, being “slowed down”
- Thoughts of death or suicide, suicide attempts
- Restlessness, irritability
- Difficulty concentrating, remembering, making decisions
- Persistent physical symptoms that do not response to treatment,
such as headaches, digestive disorders, and chronic pain
A less severe type of depression, dysthymia, involves long-term,
chronic symptoms that do not disable, but keep you from functioning
at “full-steam” or from feeling good.
Causes of Depression
There is a risk for developing depression when there is a family history,
indicating that a biological vulnerability can be inherited. However, not
everybody with a genetic vulnerability develops the illness. Apperently
additional factors, possibly a stressful environment and other psychosocial
factors, are involved in the onset of depression.
Though depression seems to occur, generation after generation, in some
families, it can also occur in people who have no family history of
depression. Whether the disease is inherited or not, it is evident that
individuals with depressive illness often have too little or too much
of certain neurochemicals.
Psychological makeup also play a role in vulnerability to depression.
People who have low self-esteem, who consistently view themselves
and the world with pessimism, or who are readily overwhelmed by
stress are prone to depression.
A serious loss, chronic illness, difficult relationship, financial problem,
or any unwelcome change in life patterns can also trigger a depressive
episode. Very often, a combination of genetic, psychological, and
enviromental factors is involved in the onset of a depressive illness.
Treatment
A variety of antidepressant medications and psychotherapies can be
used to treat depressive illness. Some people do weel with psychotherapy,
some with antidepressants. Some do best with combined treatment :
Medication to gain relatively quick symptom relief and psychotherapy
to learn more effective ways to deal with life’s problems. Depending on
your diagnosis and severity of symptoms, you may be described
medication and/or treated with one of the several forms of psychotherapy
that have proven effective for depression. It is important to note that
most people can be suscessfully treated for depression on and outpatient
basis.
On rare occasions, electroconvulsive therapy (ECT) is useful, particularly
for individuals whose depression is severe or life-threatening or who
cannot take antidepressant medication. ECT often is effective in cases
where antidepressant medications do not provide sufficient relief of
symptoms.
Antidepressant Medications
Three groups of antidepressant medications have been used to treat
depressive illness: tricyclics, monoamine oxidase inhibitors (MAOIs),
and lithium. Lithium is the treatment of choice for manic-depressive
illness and some form of recurrring major depression. Sometimes your
doctor will try a variety of antidepressants before finding the medication
or combination of medications most effective for you. Sometimes the
dosage must be increased to be effective.
There are now newer antidepressants available that are neither tricyclics
nor MAOIs, and generally lack the side effects associated with these two
traditional classes of drugs. One type, SSRIs (serotonin-specific reuptake
inhibitors), selectively blocks the reuptake of one of the major
neurotransmitters, serotonin. Another type is believed to act on the
neurotransmitter, dopamine.
Patients often are tempted to stop medication too soon. It is important
to keep taking medicine until your doctor says to stop, even if you feel
better beforehand. Some medications must be stopped gradually to give
your body time to adjust. In cases of manic-depressive illness and
chronic major depression, medication may have to become part of
everyday life to avoid disabling symptoms.
Antidepressant drugs are not habit-forming, so you need not be
concerned about that. However, as is the case with any type of medication
prescribed for more than a few days, antidepressants have to be carefully
monitored to see if you are getting the correct dosage. Your doctor will
want to check the dosage and its effectiveness regularly.
If you are taking MAO inhibitors, you will have to avoid certain food,
such as cheeses, wines, and pickles. Be sure you get a complete list of
food you should not eat from your doctor and always carry it with you.
Other forms of antidepressants required no food restrictions.
Never mix medications of any kind- Prescribed, over-the-counter, or
borrowed-without consulting your doctor. Besure to tell your dentist or
any other medical specialist who prescribes a drug that you are taking
antidepressants. Some of the most benign drugs when taken alone can
cause severe and dangerous side effects if taken with others. Some drug,
like alcohol, reduce the effectiveness of antidepressants and should be
avoided. This includes wine, beer, and hard liquor.
Antianxiety drugs or sedatives are not antidepressants. They are
sometimes prescribed along with antidepressants; however, they
should not be taken alone for depressive illness. Sleeping pills and
stimulants, such as amphetamines, are also inappropriate.
Be sure to call your doctor if you have a question about any drug or if
you are having a problem you believe is drug related.
Side effects
Antidepressants may cause mild and usually temporary side effects in
some people. Typically these are annoying, but not serious. However
unusual side effects or those that interfere with functioning should be
reported to your doctor. The most common side effects usually
asssociated with tricyclic antidepressants and ways to deal with them are:
1.Dry mouth
-drink lots of waterl; chew sugarless guml; clean teeth daily.
2.Constipation
-eat bran cereals, prunes, and other friuts and vegetables.
3.Bladder problems
-emptying your bladder may be troublesome and your urine stream
may not be as strong as usual; call your doctor if there is any pain.
4.Sexual problems
-sexual functioning may change; if worrisome, discuss with your doctor.
5.Blurred vision
-this will pass soon; do not get new glasses.
6.Dizziness
-rise from bed or chair slowly.
7.Drowsiness
-this will pass soon; do not drive or operate heavy equipment if
feeling drowsy or sedated.
The newer antidepressants have different types of side effects:
1.Headache
-this will usually go away.
2.Nausea
-even when it occurs, it is usually transient.
3.Nervousness and insomnia
-this may occur during the first few weeks; if persistent,
discuss with your doctor.
4.Agitation
-if this happens for the first time after the drug is taken and
is more than transient, consult your doctor.
Psychotherapies
There are many forms of psychotherapy used to help depressed
individuals, including some short-term (10-20 weeks) therapies.
“Talking” therapies help patients gain insight into and resolve their
problems through verbal “give-and-take”with the therapist.
“Behavior therapist help patients learn how to obtain more satisfation
and rewards through their own actions and how to unlearn the
behavioral patterns that contribute to their depression.
Two of the short-term psychotherapies that research has shown
helpful forsome forms of depression are Interpersonal and
Cognitive/Behavior Therapies. Interpersonal therapists focus on
the patient’s disturbed personal relationships that both cause and
exacerbate the depression. Cognitive/Behavioral therapists
help patients change the negative styles of thinking and behaving
often associated with depression.
Psychodynamic therapies, sometimes used to treat depression,
focus on resolving the patient’s internal psychological conflicts
that are typically thought to be rooted in childhood.
In general, the severe depressive illness, particularly those
that are recurrent, will require medication (or ECT under special
conditions) along with psychotherapy for the best outcome.
Helping Yourself
Depressive illness make you feel exhausted, worthless, helpless,
and hopeless. Such negative thoughts and feelings make some
people feel like giving up.It is important to realize that this negative
views are part of depression and typically do not accurately reflect
your situation. Negative thinking fades as treatment begins to take
effect. In the meantime:
- Do not set yourself difficult goals or take on a great deal of
responsibility. - Break large tasks into small ones, set some priorities, and do
what you can as you can. - Do not expect too much from yourself. This will only increase
feeling of failure. - Try to be with other people; it is usually better than being alone.
- Participate in activities that may make you feel better. You might
try mild exercise, going to movie, a ballgame, or participating in
religious or social activities. Don’t overdo it or get upset if your
mood is not greatly improved right away. Feeling better take time. - Do not make major life decisions, such as changing jobs or getting
married or divorced, without consulting others who know you well
and who have a more objective view of your situation. In any case,
it is advisable to postpone important decisions until your depression
has lifted. - Do not expect to “snap out” of your depression. People rarely do .
Help yourself as much as you can, and do not blame youeself for
not being up to par. - Remember, do not accept your negative thinking. It is part of your
depression and will disappear as your depression responds to treatment.
Family and Friends Can Help
Since depression can make you feel exhausted and helpless, you will
want and probably need help from others. However, people who have
never had a depressive illness may not fully understand its effect.
They won’t mean to hurt you, but they may say and do thinks that do.
It may help to share this page with those you most care about so they
can understand and help you.
Helping the depressed person
The most important thing any one can do for the depressed person is
to help him or her get appropriate diagnosis and treatment. This may
involve encoraging the individual to stay with treatment until symptoms
begin to abate (several weeks), or to seek different treatment if no
improvement occurs.On occasion, it may require making and
appointment and accompanying the depressed personto the doctor.
It may also mean monitoring whether thedepressed person is taking
medication.
The second most important thing is to offer emotional support.
This involves understanding, patience, affection, and encouragement.
Engage the depressed person in conversation and listen carefully.
Always report them to the doctor.
Invite the depressed person for walks, outings, to the movies,
and other activities. Be gently insistent if your invitation is refused.
Encourage participation in some activities that once gave pleasure,
such as hobbies, sports, religious or cultural activities, but do not
push the depressed personto undertake too much too soon.
The depressed person needs diversion and company, but too many
demands can increase feeling of failure.
Do not accuse the depressed person of faking illness or of laziness,
or expect him or her “to snap out of it.” Eventually, with treatment,
most depressed people do get better. Keep that in mind, and keep
reassuring the depressed person that with time and help, he or she
will feel better.
