Depression: When the Blues Don't Go Away
Everyone occasionally feels blue or sad, but
these feelings usually pass within a couple of
days. When a person has depression, it
interferes with his or her daily life and
routine, such as going to work or school, taking
care of children, and relationships with family
and friends. Depression causes pain for the
person who has it and for those who care about
him or her.
Depression can be very different in different
people or in the same person over time. It is a
common but serious illness. Treatment can help
those with even the most severe depression get
better.
What are the symptoms of
depression?
- Ongoing sad, anxious or empty feelings
- Feelings of hopelessness
- Feelings of guilt, worthlessness, or
helplessness
- Feeling irritable or restless
- Loss of interest in activities or
hobbies that were once enjoyable, including
sex
- Feeling tired all the time
- Difficulty concentrating, remembering
details, or difficulty making decisions
- Not able to go to sleep or stay asleep
(insomnia); may wake in the middle of the
night, or sleep all the time
- Overeating or loss of appetite
- Thoughts of suicide or making suicide
attempts
- Ongoing aches and pains, headaches,
cramps or digestive problems that do not go
away.
Not everyone diagnosed with depression will
have all of these symptoms. The signs and
symptoms may be different in men, women, younger
children and older adults.
Can a person have depression
and another illness at the same time?
Often, people have other illnesses along with
depression. Sometimes other illnesses come
first, but other times the depression comes
first. Each person and situation is different,
but it is important not to ignore these
illnesses and to get treatment for them and the
depression. Some illnesses or disorders that may
occur along with depression are:
- Anxiety disorders, including
post-traumatic stress disorder (PTSD),
obsessive-compulsive disorder (OCD), panic
disorder, social phobia, and generalized
anxiety disorder (GAD);
- Alcohol and other substance abuse or
dependence;
- Heart disease, stroke, cancer, HIV/AIDS,
diabetes, and Parkinson's disease.
Studies have found that treating depression
can help in treating these other illnesses.
When does depression start?
Young children and teens can get depression
but it can occur at other ages also. Depression
is more common in women than in men, but men do
get depression too. Loss of a loved one, stress
and hormonal changes, or traumatic events may
trigger depression at any age.
Is there help?
There is help for someone who has depression.
Even in severe cases, depression is highly
treatable. The first step is to visit a doctor.
Your family doctor or a health clinic is a good
place to start. A doctor can make sure that the
symptoms of depression are not being caused by
another medical condition. A doctor may refer
you to a mental health professional.
The most common treatments of depression are
psychotherapy and medication.
Psychotherapy
Several types of psychotherapy-or "talk
therapy"-can help people with depression. There
are two main types of psychotherapy commonly
used to treat depression: cognitive-behavioral
therapy (CBT) and interpersonal therapy (IPT).
CBT teaches people to change negative styles of
thinking and behaving that may contribute to
their depression. IPT helps people understand
and work through troubled personal relationships
that may cause their depression or make it
worse.
For mild to moderate depression,
psychotherapy may be the best treatment option.
However, for major depression or for certain
people, psychotherapy may not be enough. For
teens, a combination of medication and
psychotherapy may work the best to treat major
depression and help keep the depression from
happening again. Also, a study about treating
depression in older adults found that those who
got better with medication and IPT were less
likely to have depression again if they
continued their combination treatment for at
least two years.
Medications
Medications help balance chemicals in the
brain called neurotransmitters. Although
scientists are not sure exactly how these
chemicals work, they do know they affect a
person's mood. Types of antidepressant
medications that help keep the neurotransmitters
at the correct levels are:
- SSRIs (selective serotonin reuptake
inhibitors)
- SNRIs (serotonin and norepinephrine
reuptake inhibitors)
- MAOIs (monoamine oxidase inhibitors)
- Tricyclics.
These different types of medications affect
different chemicals in the brain.
Medications affect everyone differently.
Sometimes several different types have to be
tried before finding the one that works. If you
start taking medication, tell your doctor about
any side effects right away. Depending on which
type of medication, possible side effects
include:
- Headache
- Nausea
- Insomnia and nervousness
- Agitation or feeling jittery
- Sexual problems
- Dry mouth
- Constipation
- Bladder problems
- Blurred vision, or
- Drowsiness during the day.
Other therapies
St. John's wort
The extract from St. John's wort (Hypericum perforatum), a bushy,
wild-growing plant with yellow flowers, has been
used for centuries in many folk and herbal
remedies. The National Institutes of Health
conducted a clinical trial to determine the
effectiveness of the herb in treating adults who
have major depression. Involving 340 patients
diagnosed with major depression, the trial found
that St. John's wort was no more effective than
a "sugar pill" (placebo) in treating major
depression. Another study is looking at whether
St. John's wort is effective for treating mild
or minor depression.
Other research has shown that St. John's wort
may interfere with other medications, including
those used to control HIV infection. On February
10, 2000, the FDA issued a Public Health
Advisory letter stating that the herb may
interfere with certain medications used to treat
heart disease, depression, seizures, certain
cancers, and organ transplant rejection. The
herb also may interfere with the effectiveness
of oral contraceptives. Because of these
potential interactions, patients should always
consult with their doctors before taking any
herbal supplement.
Electroconvulsive therapy
For cases in which medication and/or psychotherapy does not help treat
depression, electroconvulsive therapy (ECT) may
be useful. ECT, once known as "shock therapy,"
formerly had a bad reputation. But in recent
years, it has greatly improved and can provide
relief for people with severe depression who
have not been able to feel better with other
treatments.
ECT may cause short-term side effects,
including confusion, disorientation and memory
loss. But these side effects typically clear
soon after treatment. Research has indicated
that after one year of ECT treatments, patients
show no adverse cognitive effects.
FDA
warning on antidepressants
Despite the fact that SSRIs and other
antidepressants are generally safe and reliable,
some studies have shown that they may have
unintentional effects on some people, especially
young people. In 2004, the U.S. Food and Drug
Administration (FDA) reviewed data from studies
of antidepressants that involved nearly 4,400
children and teenagers being treated for
depression. The review showed that 4% of those
who took antidepressants thought about or
attempted suicide (although no suicides
occurred), compared to 2% of those who took
sugar pills (placebo).
This information prompted the FDA, in 2005,
to adopt a "black box" warning label on all
antidepressant medications to alert the public
about the potential increased risk of suicidal
thinking or attempts in children and teenagers
taking antidepressants. In 2007, the FDA
proposed that makers of all antidepressant
medications extend the black box warning on
their labels to include young patients up
through age 24 who are taking these medications
for depression treatment. A "black box" warning
is the most serious type of warning on
prescription drug labeling.
The warning also emphasizes that children,
teenagers and young adults taking
antidepressants should be closely monitored,
especially during the initial weeks of
treatment, for any worsening depression,
suicidal thinking or behavior. These include any
unusual changes in behavior such as
sleeplessness, agitation, or withdrawal from
normal social situations.
Results of a review of pediatric trials
between 1988 and 2006 suggested that the
benefits of antidepressant medications likely
outweigh their risks to children and adolescents
with major depression and anxiety disorders. The
study was funded in part by the National
Institute of Mental Health.
How can I find treatment and who pays?
Most insurance plans cover treatment for
depression. Check with your own insurance
company to find out what type of treatment is
covered. If you don't have insurance, local city
or county governments may offer treatment at a
clinic or health center, where the cost is based
on income. Medicaid plans also may pay for
depression treatment.
If you are unsure where to go for help, ask
your family doctor. Others who can help are:
- Psychiatrists, psychologists, licensed
social workers, or licensed mental health
counselors
- Health maintenance organizations
- Community mental health centers
- Hospital psychiatry departments and
outpatient clinics
- Mental health programs at universities
or medical schools
- State hospital outpatient clinics
- Family services, social agencies or
clergy
- Peer support groups
- Private clinics and facilities
- Employee assistance programs
- Local medical and/or psychiatric
societies.
You can also check the phone book under
"mental health," "health," "social services,"
"hotlines," or "physicians" for phone numbers
and addresses. An emergency room doctor also can
provide temporary help and can tell you where
and how to get further help.
Why do
people get depression?
There is no single cause of depression.
Depression happens because of a combination of
things including:
Genes - some types of
depression tend to run in families. Genes are
the "blueprints" for who we are, and we inherit
them from our parents. Scientists are looking
for the specific genes that may be involved in
depression.
Brain chemistry and structure
- when chemicals in the brain are not at the
right levels, depression can occur. These
chemicals, called neurotransmitters, help cells
in the brain communicate with each other. By
looking at pictures of the brain, scientists can
also see that the structure of the brain in
people who have depression looks different than
in people who do not have depression. Scientists
are working to figure out why these differences
occur.
Environmental and psychological
factors - trauma, loss of a loved one,
a difficult relationship, and other stressors
can trigger depression. Scientists are working
to figure out why depression occurs in some
people but not in others with the same or
similar experiences. They are also studying why
some people recover quickly from depression and
others do not.
What if I or someone I know is
in crisis?
If you are thinking about harming yourself,
or know someone who is, tell someone who can
help immediately.
- Call your doctor.
- Call 911 or go to a hospital emergency
room to get immediate help or ask a friend
or family member to help you do these
things.
- Call the toll-free, 24-hour hotline of
the National Suicide Prevention Lifeline at
1-800-273-TALK (1-800-273-8255); TTY:
1-800-799-4TTY (4889) to talk to a trained
counselor.
- Make sure you or the suicidal person is
not left alone.
Personal story
It was really hard to get out of bed in the
morning. I just wanted to hide under the covers
and not talk to anyone. I didn't feel much like
eating and I lost a lot of weight. Nothing
seemed fun anymore. I was tired all the time,
and I wasn't sleeping well at night. But I knew
I had to keep going because I've got kids and a
job. It just felt so impossible, like nothing
was going to change or get better.
I started missing days from work, and a
friend noticed that something wasn't right. She
talked to me about the time she had been really
depressed and had gotten help from her doctor. I
called my doctor and talked about how I was
feeling. She had me come in for a checkup and
gave me the name of a specialist, who is an
expert in treating depression.
Now I'm seeing the specialist on a regular
basis for "talk" therapy, which helps me learn
ways to deal with this illness in my everyday
life, and I'm taking medicine for depression.
Everything didn't get better overnight, but I
find myself more able to enjoy life and my
children.
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