Disease, Illness and Condition Library
Depression Sadness may be caused by a setback or a loss, and is often fitting and temporary, but if sadness persists or begins to impair daily life, a mood disorder may be present. Major signs of depression are a persistently low or sad mood, decreased or absent interest in almost all activities, loss of self confidence, and a sense of worthlessness. Usually depression is episodic-that is, bouts of illness are separated by periods of full recovery. Some 18 million Americans experience depression, the world’s number one cause of chronic disability. Mood disorders most often surface between ages 20 and 30, but they can occur at any age. The length of an untreated episode of major depression is usually eight to nine months. This period can be shortened significantly with proper diagnosis and treatment, which leads to a more rapid remission of symptoms in up to 80% of cases. Causes The specific cause of depression is unknown in most cases, but the disorder appears to result from some combination of genetic predisposition and psychological and medical factors. Changes in the Brain: Chemical changes occur in the brain during depression, and researchers believe that these changes are linked to the symptoms of depression. The brain is composed of distinct regions-each with particular functions-made up of networks of nerve cells, or neurons. Messages pass from one neuron to another. One region thought to be involved in depression is the limbic system, which is concerned with emotional behavior. An area within this system called the hypothalamus regulates the pituitary gland and may be involved in the hormonal imbalances sometimes associated with depression. Because individual neurons are separated from others by small gaps (synaptic clefts) at each end, chemicals called neurotransmitters are needed to bridge the synaptic cleft and pass messages from one neuron to the next. Of particular concern in depression are the neurotransmitters norepinephrine, serotonin, and dopamine. Imbalances in the amounts of these substances in the brain appear to contribute to depression or bipolar disorder. Genetic Factors: Genetic factors are clearly important in the development of depression. Research shows that when on identical twin has a mood disorder, there is about a 50% chance that the other will develop the illness at some time. Genetics also plays a role in treatment. Some evidence shows that patients have a better chance of responding to the same antidepressant medication that a depressed first degree relative (a parent, sibling, or child) has responded to. Other Causes In up to 15% of cases, mood disorders are caused by medication, illegal drugs, or neurological or medical abnormalities. For example, depression can result from the chronic use of beta blockers, reserpine derivatives (for high blood pressure), steroid mediations such as prednisone (Deltasone), benzodiazepines (for anxiety), or anti cancer drugs. Withdrawal from central nervous system stimulants, like amphetamines or cocaine, can also precipitate depression. Patients with dementing brain disorders, such as Alzheimer’s disease and Huntington’s disease, are susceptible to depression. Depression can also be a consequence of stroke, affecting about 25% of people who have had a stroke in the left frontal area of the brain. In addition, an underactive thyroid can lead to depression. Overproduction of the steroid hormone cortisol by the adrenal gland (Cushing Syndrome) can cause either depression or mania in some patients. Deficiencies in folic acid, vitamin B6, or vitamin B12 may also cause depression. In study of 700 women published in 2000, those who had a vitamin B12 deficiency were two times more likely to be severely depressed than women who did not have a vitamin B12 deficiency. Symptoms Although severe depression is readily recognized, it can be difficult to differentiate the milder (and more common) forms of depression from the emotional changes that are part of everyday life. The dominant form of depression is major depression, which clinicians distinguish from other forms of the disorder, such as dysthymia grief, and atypical depression. Unlike most medial disorder, depression is not associated with any characteristic laboratory changes or tissue abnormalities that can be used to confirm a diagnosis. The American Psychiatric Association has established diagnostic classification systems to allow consistent diagnosis of major depression. The criteria are contained in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Major Depression: According to DSM-IV, a person is suffering from a major depressive episode if he or she exhibits either the first or second of the following nine symptoms: * Depressed mood with overwhelming feelings of sadness and grief * Loss of interest and pleasure in activities formerly enjoyed * Insomnia, early morning waking, or oversleeping nearly every day * Decreased energy; fatigue * Noticeable changes in appetite and weight (significant loss or gain) * Inability to concentrate; indecisiveness * Physical symptoms of restlessness or being slowed down * Feelings of guilt, worthlessness, and helplessness * Recurrent thoughts of death and suicide; suicide attempts The diagnosis is more certain when these criteria are supplemented by either a positive family history, a prior episode of depression or mania, or the presence of a precipitating factor such as a recent stroke or the use of medications known to cause mood disorders. Other symptoms of depression include disorganized thinking and delusions. In addition to these disturbances in mood and cognition (thinking), patients with major depression may have abnormalities in body functions such as constipation or decreased sexual drive. Episodes of major depression range from mild to severe. In mild episodes, symptoms barely meet the requirements for a diagnosis and the associated functional impairment is minor. Severe episodes are characterized by several incapacitating symptoms, including a marked decline in mood and interference with social and job related functions. Severely challenged individuals have difficulty with almost every activity- going to work, socializing, and even getting up in the morning. They may be unable to feed and dress themselves or to keep up personal hygiene. Suicide: Suicide is the 11th leading cause of death in the United States and is a major complication of depression. About 1 in 16 people diagnosed with depression die by suicide, and approximately 70% of people who die by suicide are depressed. In the United States the risk of suicide is highest in older white males, in those who live alone, have made prior suicide attempts, refuse psychiatric evaluation, or abuse alcohol or drugs. Although women attempt suicide three to four times more often than men, men are three to four times more likely to be successful. Up to 75 percent of people who die of suicide have visited their medial doctor in the prior month. This suggests that these people “knew” something was wrong, but that neither they nor their doctor recognized depression as the problem. Although it is impossible to predict accurately who will attempt suicide, there are warning signs that a severely depressed person may make an attempt. All too often, friends and family of people who commit suicide are unaware of the gravity of these signs until it is too late. The most important step in preventing suicide is recognizing the risk factors and warning signs and facilitating appropriate treatment of the underlying psychiatric illness. Signs include: * Social isolation that may be self imposed * Drastic mood swings or overall personality changes * Neglecting home, finances, or pets * Exaggerated complaints of aches or pains * Recent psychological trauma, such as a divorce, death or a loved one, or job loss (which may trigger suicidal thinking in an already depressed person) * Giving away cherished belongings to loved ones; putting one’s affairs in order * Sudden calm or cheerfulness after a period of depression * Frequent use of alcohol or other drugs * Buying a gun * Verbal threats of suicide or statements that suggest a desire to die * Family history of suicide or previous suicide attempts * Not all people who commit suicide have these risk factors, however, and most people who do have them are not suicidal. Treatment Treatment of depression has three goals. In order of importance, they are to relieve the symptoms of depression; to return patients to their previous ability to function socially and in the workplace; and to reduce the likelihood of a recurrence. Treatment goals are accomplished over three stages: acute, continuation, and maintenance. Acute treatment focuses on immediate relief from symptoms and restoration of function. Once symptoms respond to acute treatment, continuation treatment is begun to prevent a relapse. If a patient has no symptoms for four to nine months after an episode, he or she is considered recovered. At this point maintenance treatment is initiated to prevent a new episode; it can last from one year to a lifetime, depending on the individual. Depression recurs in about half of cases within two years of stopping treatment, so timing must be carefully considered when stopping mediations. The longer a person remains on treatment, the smaller the likelihood of recurrence. The four treatment options for dealing with depression are antidepressant mediations; psychotherapy; other treatments, such as electroconvulsive therapy or light therapy; and any combination of these. Exercise and a healthy diet also play a role in improving mood and self image. It is important to start treatment as soon as possible, since the disorder becomes more difficult to treat the longer it lasts. Because response to any particular treatment varies from on patient to another, a person who does not improve with the first treatment may respond to a different one. Medications are probably the most common form of therapy, and any given antidepressant has up to a 70% chance of working in a particular individual. Psychotherapy alone helps a significant number of mildly to moderately depressed persons. It has fewer side effects than medication and may be more acceptable than medication to some people. Combination therapy (both medication and psychotherapy) is more effective than either one alone for mild to moderate depression. This option may be beneficial if either treatment alone produces only partial results; if the depression is chronic; or if an evaluation suggests several discrete aspects of a disorder that are each best treated by different means, such as medication for depressive symptoms and psychotherapy for job related problems. The more severe cases of depression are best treated with medication. Up to 90% of extremely depressed people improve with electroconvulsive therapy when it is used as first line treatment. It is usually used only when several other therapies have failed, however, in which case the response rate drops to 50 to 60%. Psychotherapy: An advantage of psychotherapy is that it produces few physiologic side effects - an especially important consideration for older adults who are often taking more than one type of mediation. Psychotherapy may also help patients learn to cope with, or avoid factors contributing to, a recurrence of depression, and offers the possibility of effective treatment for patients who have not responded to drugs. On the downside, it may take longer to achieve any benefit using psychotherapy - six to eight weeks or longer, as compared with four to six weeks for mediation. Also, psychotherapy alone is not effective in patients with severe depression. Based on the severity of the illness and factors specific to each patient, therapists select a combination of diverse approaches from a range of psychotherapeutic techniques, such as interpersonal therapy, behavioral therapy, or cognitive therapy. Essential to all psychotherapy is the establishment of a trusting relationship with therapist that enables the patient to share confidences, life experiences, and problems. As a result, patients unable to communicate owing to severe physical debilitation or delusions caused by depression may not benefit from psychotherapy until mediations or other treatments improve the depression. If psychotherapy alone produces no response by 6 weeks or only a partial response by 12 weeks, mediation should be strongly considered. Medications: There are several advantages to treating depression with mediations: They are effective against mild, moderate, and severe forms of major depression; patients usually respond more quickly to them than to psychotherapy; they are easy to administer; and they require little time from the patient. In addition, patients should be assured that antidepressants are not addictive and, when properly administered, are rarely dangerous. That said, drug treatment can cause unwanted side effects; it requires strict adherence to a medication schedule and repeated medical visits to monitor response; and as many as 10 to 30% of patients fail to complete treatment. Older people and those with chronic illnesses are more susceptible to the adverse effects of antidepressants. Although researchers believe that these drugs work by affecting levels of neurotransmitters (chemical messengers that communicate between nerve cells) in the brain, physicians cannot determine which medication will be most effective in any particular individual. Therefore, drug selection remains largely a process of educated guesses. Family history can also determine which drug is most likely to be effective, as well as which is most likely to cause side effects. In most cases, older patients are started on lower doses than younger patients in order to reduce the risk of side effects. Typically about 60 to 70% of patients have some response to the first antidepressant they try. By themselves, antidepressant drugs usually produce a considerable improvement by four to six weeks, although it may take up to eight weeks to see the full benefit. When a drug proves ineffective, another one is often selected from a different class of medications, since drugs in the same class tend to work similarly. In 20 to 50% of patients, adding the drug lithium can help augment the action of an antidepressant. However, this combination increases the risk of side effects and adverse drug interactions. (For this reason, lithium should be prescribed only by a physician knowledgeable in its use.) If a drug from one class is producing good results but unacceptable side effects, changing to a different drug from the same class may help. If maintenance treatment is no longer required, drugs are discontinued slowly to avoid withdrawal symptoms. Relapses are most common during the first two months after stopping an antidepressant. Therefore, individuals should remain in contact with their physician during this period. (Should a relapse occur, the same drug that was used successfully the first time often proves effective again.) Antidepressants must be used with caution by depressed people who are suicidal; important precautions include frequent follow up visits and prescription for a relatively small number of pills at a time. Suicide attempts or suicidal thoughts are frequent symptoms of depression, and the risk of suicide may increase as depression begins to respond to treatment, because patients might regain just enough energy and motivation to follow through on a suicidal urge. Selective serotonin reuptake inhibitors (SSRIs): These drugs, which include citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft), inhibit the uptake of serotonin and thereby raise its concentration in the synaptic cleft. All of the SSRIs are equally effective and have similar rates and types of side effects, although it is possible that an individual might respond better or have fewer side effects with one medication. Side effects are not always a reason to change medications. For example, paroxetine can produce a sedative effect in some people, this may be beneficial to people with combined anxiety and depression. Because SSRIs have milder side effects than most other antidepressants, they are now preferred by most physicians as the first line drug treatment for depression. Studies have demonstrated that SSRIs are as effective as tricyclics; about 50% of patients taking an SSRI achieve a complete resolution of all their depressive symptoms. Advantages of SSRIs over the tricyclics include a lower risk of fatal overdoses and serious heart rhythm disturbances in people with cardiac disease. Side effects of SSRIs include insomnia, drowsiness, nausea, anxiety, and weight loss. Another troublesome side effect is sexual dysfunction-for example, diminished sexual desire, changes in the sensations of arousal, and orgasmic disturbances-which may occur in about 37% of both men and women taking these drugs. Any of these side effects usually develop within the first week of starting an SSRI, though they may arise more slowly as blood levels of the mediation build up. Ways to combat sexual dysfunction include choosing a medication with a low rate of sexual side effects (such as bupropion), waiting to see if sexual side effects decrease, changing the time you take the mediation (possibly to nighttime), reducing the dosage, taking drug holidays (for example, not taking the mediation on the weekend), or adding another mediation, such as sildenafil (Viagra). (Do not change any aspect of your mediation regimen without first consulting your doctor.) Recently, it was recognized that SSRIs may produce neurological side effects- symptoms like those of Parkinson disease, such as impaired muscle tone, tremors, and spasms, or feelings of restlessness that can become so severe that patients are unable to sit still; however, these side effects are rare. Tricyclics: Named for their chemical structure-a chain of three rings-these drugs raise brain concentrations of the neurotransmitters norepinephrine and serotonin by blocking their reabsorption by the nerve cells (neurons) that release them. A puzzling feature of tricyclics is that their effect on neurotransmitters is rapid, but it takes weeks before depression improves. Tricyclics are used mainly treat moderate to severe depression. About 60% of tricyclic users experience significant improvement within four to six weeks. Each of the tricyclics is believed to be equally effective, but side effects may vary. Six to eight seeks of treatment may be needed before deciding whether a tricyclic is working. Failure to improve may be due to ineffectiveness of the mediation or lack of compliance by the patient. About one third of patients stop taking tricyclics because of side effects, and about two thirds of older patients miss 25 to 50% of their doses. Poor compliance leads to irregular blood levels of the drug and an unfavorable response. The most prominent side effects of tricyclics are drowsiness, orthostatic hypotension (dizziness on standing due to a drop in blood pressure), a fine tremor or the hands, nausea and vomiting, blurred vision, dry mouth, rapid heart rate, difficulty urinating, and constipation. Dopamine reuptake inhibitors: Bupropion (Wellbutrin) decreases the reuptake of dopamine, a neurotransmitter and a precursor of other neurotransmitters. This drug causes less drowsiness and other side effects than the tricyclics, but on rare occasions, it can cause seizures, particularly at higher doses. Monoamine oxidase (MAO) inhibitors: Like tricyclics, MAO inhibitors increase brain levels of norepinephrine, serotonin, and dopamine, in this case by blocking the action of the enzyme MAO, which normally inactivates these three neurotransmitters. MAO inhibitors are effective in many depressed patients, especially those whose depression is accompanied by marked anxiety, panic attacks, heightened appetite, or excessive sleeping. The results of one small study suggest that the MAO inhibitor selegiline (Eldepryl), a drug commonly used to treat Parkinson disease, may help older adults whose depression has not respond to other drugs or to electroconvulsive therapy. MAO inhibitors can cause some of the same side effects as the tricyclics. These drugs should not be used by patients with active alcoholism, congestive heart failure, or severe impairment of liver or kidney function, or by those who are taking multiple mediations for high blood pressure. In addition, MAO inhibitors have the unique potential for causing a sudden, extreme elevation in blood pressure (a hypertensive crisis) when people using them take certain drugs or consume foods or beverages containing tyramine. Tyramine is found in nasal decongestants, cold or allergy medicines, very ripe bananas, beer, and aged or smoked meats, among other things. (Patients taking an MAO inhibitor must get a complete list of restricted foods and drugs from their doctor.) Serotonin and norepinephrine reuptake inhibitors: Trazodone (Desyrel) and venlafaxine (Effexor) are serotonin and norepinephrine reuptake inhibitors. Like the tricyclics, these drugs work by training brain concentrations of the neurotransmitters serotonin and norepinephrine. They are often the most effective drugs for older patients. Possible side effects include nausea, dry mouth, dizziness, and drowsiness. Venlafaxine may increase blood pressure in some people, so monitoring blood pressure is important for anyone taking this drug. Alternative treatments: Despite the availability of a full arsenal of medications proven to be effective for treating depression, some people are turning to alternative treatments for this condition. Most of these alternative treatments, including St. John’s wort and Sadenosylmethionine (SAM-e), are considered dietary supplements in the United States and therefore have not been tested or approved by the Food and Drug Administration (FDA). No one is sure how well they work or exactly how they may interact with certain prescription medications. In addition, one concern with alternative treatments is that individuals tend to medicate themselves instead of being evaluated and monitored by a health professional. As a result, they may not recognize worsening symptoms. St. John’s wort, which is extracted from a yellow flowered plant called Hypericum perforatum, is the best known of the supplements professed to be natural antidepressants. The American College of Physicians and the American Society of Internal Medicine recently included it in their guidelines as a treatment option for mild depression, but two large studies published in the Journal of the American Medical Association in 2000 and 2001 found that St. John’s wort was no more effective than a placebo for treating major depression. Thus, the authors recommend that people with major depression not take St. John’s wort until well designed studies support its use. Another supplement high promoted for the treatment of depression is S-adenosylmethionine, better known as SAM-e. But results of published studies that claim to show the benefits of SAM-e are not at all convincing. Electroconvulsive Therapy: Electroconvulsive therapy (ECT) is a relatively painless procedure that is effective in treating major depression. People with depression typically first receive psychotherapy, antidepressant medication, or a combination of the two. These treatments, though often effective, take time to work. This delay can be dangerous for patients whose depression is accompanied by delusions or intense suicidal thoughts. ECT can work much more quickly than antidepressants and is useful when patients are at immediate risk for self injury or suicide. ECT can help other patients as well. It may be prescribed when antidepressant medications have not worked. It can be useful for older patients who are unable to tolerate antidepressants and for pregnant women in whom mediation might damage the fetus. ECT is performed under general anesthesia (along with a muscle relaxant) in an inpatient or outpatient setting. Because patients are under anesthesia and have taken muscle relaxants, they neither convulse nor fell the current. Patients awaken about five to ten minutes after the end of the treatment, and most are oriented and alert within a half hour. Typically, ECT is given 2 to 3 times a week for a total of 6 to 12 sessions. These sessions improve depression in 50 to 70% of patients, a response rate similar to that of antidepressant drugs. Yet the benefits of ECT are short lived. Within a year, 50 to 60% or patients relapse. Patients may have to continue receiving ECT periodically or take antidepressant medication to prevent relapse. The immediate side effects of the procedure can be headaches, nausea, muscle aches and soreness, disorientation, and confusion lasting about an hour. Patients may also develop memory problems, including difficulty recalling newly acquired information, though this problem should end in the weeks following a course of treatment. Patients can also lose memories that were formed up to six months before the procedure. Usually, learning and memory return to normal within a few months of the last treatment. Patients may never recover memories of events immediately surrounding an ECT session. No one is sure how ECT helps certain mental disorders. It may flood the brain with neurotransmitters such as serotonin and dopamine, which are known to be involved in depression. ECT may also help regulate hormones that play a role in these disorders. Depression in Older Adults Although increasing age alone does not put a person at greater risk for depression, the incidence of depression is higher in older adults. A survey of Californians’, age 50 to 95, found that factors such as chronic illness, physical disabilities, and social isolation-which often coincide with increasing age-were more predictive of depression than age. As a result, depression in older adults is a serious problem. The National Institute of Mental Health’s Epidemiologic Catchment Area Study estimated that at least 1 million of the nation’s 31 million people age 65 and older suffer from major depression, and an additional 5 million have depressive symptoms that are severe enough to require treatment. Unfortunately, the disease is often misdiagnosed and left untreated in the elderly. According to Diagnosis and Treatment of Depression in Late Life, a consensus report from the National Institute of Health (NIH): “What makes depression in the elderly so insidious is that neither the victim nor the health care provider may recognize its symptoms in the context of the multiple physical problems of many elderly people.” Many older persons who live alone have inadequate support mechanisms and are confused by the multitude of systems available to provide medical care, social services, and financial assistance for their medical needs. Older adults also tend to be embarrassed and reluctant to seek professional help for emotional problems, partly because the stigma of psychiatric illness is especially strong among people in this age group. In addition, friends and family often fail to recognize signs of distress. Older depressed patients are more likely to tell their primary care physician about physical complaints than about subjective feelings of depressed mood. For example, they may report loss of appetite, insomnia, lack of energy, or loss of interest and enjoyment in daily activities. Unfortunately, both doctor and patient often consider these symptoms a “normal part of aging” that accompanies the physical, social, and economic problems faced by many older adults. Depression is sometimes left undiagnosed because of life circumstances that are common in later years. The elderly are typically subjected to numerous stressful life situations: loss of spouse, family members, or friends by death or geographic relocation; retirement, which may be accompanied by a loss of status and self identity; diminished financial resources; fears of death or loss of independence and self sufficiency; social isolation; and medical problems. Any of these factors may trigger symptoms of depression that are attributed to life stresses and not recognized as a true depressive illness. In addition, the higher prevalence of concurrent medical conditions and a greater use of medications in older people further complicate the diagnosis. While the depression may be a primary disorder, it may also result from some underlying organic cause such as cancer, stroke, or a reaction to a prescription drug. The possibility of dementia adds further difficulties: Symptoms of major depression can mimic symptoms (for example, disorientation, distractibility, or memory loss) of a dementing disease such as Alzheimer’s disease. Thus, doctors need to perform a careful mental status evaluation, as well as a medical history and physical exam, to find the primary cause of the psychological symptoms. Treatment: Older people are more susceptible to adverse side effects than younger ones, so drug therapy must be approached carefully. Older people may require smaller dosages as well as closer monitoring for toxic reactions and to see whether the drugs are being taken as prescribed. Moreover, the elderly use prescription drugs approximately three times more often than the general population and are therefore at greater risk for adverse interactions between these drugs and antidepressants. Treatment can also be difficult in reluctant patients and in those lacking a social support system to help them with practical considerations such as costs and transportation for visits to a doctor. Despite all of these obstacles, treatment for depression in older patients is generally effective; even partial success can lead to improved quality of life and productivity. Some studies even suggest that treatment with mediations is more effective in older patients than in younger ones. Grief versus Depression The loss of a loved one can cause intense mental anguish. Occasionally, this anguish triggers a major depressive episode, but few people in mourning experience true clinical depression. If acute symptoms of grief-such as sadness accompanied by sleeping difficulties or weight loss-do not show signs of subsiding within two months of the loss, the person may have unresolved grief and may develop major depression. According to the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, symptoms indicative of major depression, but not of normal grief, include: * Excessive guilt (unrelated to things done or not done at the time of the death) * Excessive thoughts of death * Excessive feelings of worthlessness * A slowing of one’s actions or movements (psychomotor retardation) * Impaired ability to perform functions of daily life * Hallucinations (other than brief episodes of hearing or seeing the deceased person) Major depression can also be distinguished from grief by the timing of the symptoms. Unlike grief, during which a person can have good and bad days, depression is experienced persistently throughout (or at specific times) every day. Other indications that a person may have major depression are the presence of suicidal thoughts or physical complaints that cannot be explained; trouble sleeping or early morning awakenings that last over six weeks; or loss of more than 15 pounds. People with unresolved grief may also experience apathy or panic attacks, or they may feel as if they are developing the symptoms suffered by the deceased person. Treatment: If you feel that a loss has left you with unresolved grief and depression, you should seek help. A bereavement support group might be useful for some people. Other people may prefer individual counseling sessions to address both the issues surrounding the loss and the related depression. In some cases, antidepressant medication may be needed to help a person return to daily functioning while working through the grief and depression. Exercising regularly can also be helpful in dealing with depression and stress. Dysthymia Dysthymia is a chronic form of depression that is milder than major depression. It is characterized by the presence of depressed mood for most of the day, for more days than not, over a period of at least two years. It may be intermittent, with periods of feeling normal, but the duration of the relief lasts for no more than two months. Because the onset of symptoms is insidious, the disorder often goes unnoticed. On average, symptoms, which can wax and wane, last 16 years before a diagnosis is made. Dysthymia is twice as common in women as in men, but older patients are as likely to be men as women. Some medial conditions, including neurological disorders (such as multiple sclerosis and stroke), hypothyroidism, fibromyalgia, and chronic fatigue syndrome, are associated with dysthymia. Severe psychological stress, such as death of a spouse or caring for a chronically ill loved one, can also trigger dysthymia. In particular older patients who have been free from psychiatric disorders often develop dysthymia after such life stresses. Symptoms: In addition to depressed mood, symptoms include two or more of the following: * Poor appetite or overeating * Insomnia or hypersomnia * Low energy or fatigue * Low self esteem * Poor concentration * Difficulty making decisions * Feeling of hopelessness About one out of every ten people with dysthymia also have recurrent episodes of major depression, a condition known as double depression. Symptoms that accompany dysthymia during major depressive episodes include; * Feelings of worthlessness; low self esteem * Noticeable changes in appetite and weight (significant loss or gain) * Noticeable changes in sleep patterns (such as insomnia, early morning awakening, or oversleeping) * Decreased energy; fatigue * Inability to concentrate or think; indecisiveness * Persistent feelings of hopelessness Treatment: many of the treatments used for major depression can also treat dysthymia effectively, particularly the selective serotonin reuptake inhibitors, or SSRIs. If drugs provide relief, they should be continued for at least two years, and lifetime use may be warranted. Psychotherapy may also be beneficial. In addition, steps should be taken to provide support during periods of ongoing stress, such as illness. Nutrition Helpful for Depression (from Smart Medicine for Healthier Living) Many depressed people, including those who are just “on edge,” neglect themselves and eat poorly. Take a good multivitamin and mineral formula daily to make sure your body has all the basic nutrients it requires. * Calcium and magnesium are crucial to the central nervous system. They work best when taken together. Take a calcium and magnesium combination formula that supplies 500 milligrams of calcium and 250 to 500 milligrams of magnesium twice daily. * Chromium helps keep blood sugar levels in balance. Take 200 micrograms twice a day for one month, and then reduce to 200 micrograms daily. * DL-phenylalanine (DLPA) can be very helpful for short period of time, if taken correctly. Take 500 to 1,000 milligrams twice a day, between meals, with water or juice only. Do not take it with protein foods. Take it for up to three weeks. * Levels of folic acid are often significantly lower than normal in people who are depressed. Take 800 micrograms of folic acid twice a day for one month. Thereafter, take 800 micrograms once daily. If you take any of the B vitamins individually, you should also take a B complex supplement at a different time of day. * Inositol is a B vitamin required for the activity of several important neurotransmitters, including serotonin. Levels of inositol are often low in depressed people. In one study, subjects given 1 gram of inositol per day had therapeutic results similar to common antidepressant drugs, but with no unwanted side effects. The same results were confirmed in additional studies. Further, Chinese medicine teaches that stagnation of the liver contributes to numerous problems, including depression. Inositol promotes the export of fat from the liver, thus helping relieve stagnation of this important organ. Take 500 milligrams of inositol three times daily for one week. If you fail to see improvement after that time, discontinue use; otherwise, continue taking 500 milligrams three times daily as needed. This dosage of inositol should be used under the supervision of a physician. * Melatonin may be useful for some cases of seasonal affective disorder. Some experts believe the body’s melatonin mechanism is involved in this form of depression. Melatonin can also be helpful if you are having problems with insomnia. Take 3 milligrams each evening, between on half hour and two hours before retiring for the night. * Vitamin B12 can help to increase energy, improve brain function, and improve mood. In study of 700 women published in 2000, those who had a vitamin B12 deficiency were two times more likely to be severely depressed than women who did not have a vitamin B12 deficiency.
Smart Medicine for Healthier Living Merck Manual of Medical Information Natural and Herbal Supplements Related to Depression
depression related conditions - Continue Melancholy Lift - A safe, non-addictive, FDA-registered natural remedy containing 100% homeopathic ingredients especially selected to temporarily relive feelings of melancholy, sadness, grief and weepiness. - Continue
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| Alcoholism and Depression Alcoholism makes recovery from depression more difficult. A recent study compared 176 men and women who fit the criteria for both alcoholism and major depression with 412 people who had major depression alone. Subjects who were never alcoholics or who no longer drank were twice as likely to recover form an episode of major depression than the active alcoholics. However, active alcoholism did not increase the chance of having recurrent episodes of major depression. This suggests that depression is triggered by other factors. |
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