Depression Highlights

Have you or has someone you know ever felt so depressed that you
lost all interest or pleasure in any activity, together with feelings of
worthlessness or hopelessness? When these feelings are
accompanied by changes in appetite and sleep, problems
concentrating and physical complaints, the chance is high that
you have a depression. In this case an appropriate diagnosis
and early treatment by a physician is very important.

The support and involvement of family and friends family and
friends can play a crucial role in helping someone who is
suffering a depression, by motivating the patient to visit a
doctor and to take the medication punctually.


Diagnosis of depression

A doctor will make a diagnosis of major depression if a person
shows at least five symptoms of depression and normal daily
functioning is affected consistently over a period of o minimum
two weeks.

Some people will be diagnosed with a less severe form of
depression, called dysthymia (or dysthemic disorder).
Dysthemia is diagnosed when the person has suffered from
a depressed mood for at least two years, and also shows two
of the symptoms of depression. Many people with dysthymia
also have major depressive episodes. If this is the case,
the person will be diagnosed with double depression.

While major depression and dysthymia are the primary forms of
depression, a variety of other types of depression are recognised.
These include: SAD or seasonal affective disorder if people
experience depression during the winter season and bipolar
disorder or manic depression.

Physical illnesses and depression often go together.
In some cases, physical symptoms such as: headaches,
stomach pain or nausea, constant back or neck aches,
breathing problems for which doctors cannot find a physical
cause, may be signs of underlying depression. The reverse
may also be true.

Depression can hide other health problems. These can remain
unnoticed and untreated in people with depression. Unexplained
trouble sleeping, trembling hands, dizzy spells, digestive upsets,
and migraine headaches are all common signals that something
may be wrong. If you experience any of these problems when
diagnosed with depression, make sure to mention them to
your doctor.

Suicidal thoughts or tendencies in people with depression must
be taken seriously and may be avoided with the right diagnosis
or treatment. If you suffer from depression and have such
thoughts or feelings discuss them with a healthcare professional
or someone you can trust without delay. Should a beloved one
with depression ever express such thoughts, make sure you
discuss these thought with a healthcare professional and
encourage your relative or friend to seek medical help and advice.

Treatment of depression

Depression can be treated successfully. However, people tend
to react differently to the available treatments. For example,
one medication may be effective and well tolerated in one
person but not another. As well as medication, support
groups can help some people deal with major life changes
that require new coping skills or social support and
psychological treatments are also useful to treat depression.

Choosing the right treatment is an individual process that will
depend not only on the severity and the type of depression,
but also on the person's circumstances and his or her
preferences and the doctor's recommendation.

Psychotherapy

Psychotherapy can be worthwhile for some people with
depression. This treatment helps people identify the factors
that contribute to their depression. Psychotherapy also
provides support to help people deal effectively with the
psychological, behavioural, interpersonal and environmental
causes of their depression. Certain types of psychotherapy,
such as cognitive-behavioural therapy (CBT) and interpersonal
therapy (IPT), seem to be particularly useful.

Skilled therapists can help depressed people identify the
problems that contribute to the depression, and help them
understand which of those problems they may be able to
resolve or alleviate. They can point out a number of options
for the future and set realistic goals to improve mental and
emotional wellbeing. Therapists also help individuals identify
how they may have successfully dealt with similar feelings
in the past.

Psychotherapy is also intended to help people identify
negative or distorted thinking patterns that contribute to
feelings of hopelessness and helplessness. For example,
depressed individuals may tend to over-generalise and think
in terms of always or never. They may also take events
personally. A therapist can guide a person in developing
a more positive outlook on life and in improving the
interactions with other people that contribute to their
depression.

Therapists also guide people in regaining a sense of control
and pleasure in life. Psychotherapy can help people
appreciate choices and incorporate enjoyable,
fulfilling activities back into their lives.

There is evidence that psychotherapy may reduce the
chance of future episodes of depression or reduce their
severity. People can also learn skills to arm them better
against later episodes of depression whilst being treated
with psychotherapy.

Antidepressant drugs

Some people with depression require medical treatment
and need medication. The doctor will prescribe
antidepressants or antidepressant drugs. When
prescribing such medication, the doctor should clearly
explain what dose to take and talk about possible side
effectsand the way antidepressants could interact with
other medication.

Antidepressants can improve mood, sleep, appetite,
and concentration. However, it can take from 6 to 12 weeks
before real signs of improvement are experienced for some
medications. This may dishearten people as they cannot
see the promised improvements immediately. It is
important to keep on taking your medication or discuss
the medication with your doctor.

Even if symptoms start improving or disappear altogether,
people often still have to continue taking the medication for
six months or longer. This will prevent relapse and will keep
the symptoms of depression at bay. Therefore antidepressants
are typically taken for several months. In some cases, however,
patients and their doctors may decide that a longer course of
therapy is necessary. This is especially the case if people
suffer from several episodes of depression. Some people
may have to stay on medication for the rest of their life to
prevent relapse.

There are several types of antidepressants. All antidepressants
work by altering the effects of important brain chemicals, called
neurotransmitters. These are found in nerve cells or neurones.
The neurones use the neurotransmitters to communicate with
each other. The neurotransmitters that play the most significant
part in the treatment of depression are serotonin and noradrenaline.


Tricyclic antidepressants (TCAs)
and monoamine oxidase inhibitors (MAOIs)

The older antidepressant drugs or tricyclic antidepressants
(TCAs) and monoamine oxidase inhibitors (MAOIs)) have
effects on both serotonin and noradrenaline. These older
agents can be difficult to tolerate because of their side
effects or, in the case of the MAOIs, dietary and
medication restrictions.

If another antidepressant, is prescribed, MAOIs should
be stopped some time before starting the new medication,
to make sure the MAOI has cleared from the body.

Older antidepressants tend to have more severe side
effects than the newer agents used to treat depression.

Selective serotonin reuptake inhibitors (SSRIs)

Selective serotonin reuptake inhibitors (SSRIs) are a newer
type of antidepressants. They tend to have fewer and less
severe side effects than the older drugs. This means that
people find it easier to continue taking them.

Other newer antidepressants

Several other newer types of antidepressants are alsoavailable.
In general, fewer side effects are experienced when taking the
newer antidepressant than when taking TCAs and MAOIs.
These newer agents include: Venlafaxine and Nefazodone.

Different types of antidepressant medication can be effective
to reduce the symptoms of depression, but some people will
react better to one type of medication than another. Other
people may experience more side effects with one drug than
with another. Finding the right medication at the right dose
may take some time. However it is important to keep taking
your medication and you should never stop taking your
medication without talking to your doctor first.

The majority of people with depression improve considerably
when they receive appropriate treatment with medication or
psychotherapy. On the whole a combination of the two types
of treatment or combination therapy seems to be the most
effective way of treating depression.

Electroconvulsive therapy (ECT)

Electroconvulsive therapy (ECT) only tends to be used if
no other treatment works or if waiting for a drug to take
effect would be impractical (e.g. when a person is very
likely to attempt suicide). ECT is considered an effective
treatment for people with severe depression, and works
quickly in most people.

ECT is a procedure in which a brief application of electricity
is used to produce a generalised seizure. It is not known
how or why ECT works or what the seizure does to the brain.
During the 1940's and 50's, the treatment was administered
mostly to people with severe mental illnesses. Today, ECT
is generally used in treating patients with severe depression,
acute mania, and certain schizophrenic syndromes.

ECT may be beneficial for the following conditions:

* severe depression with insomnia (trouble sleeping),
weight change, feelings of hopelessness or guilt,
and suicidal or homicidal thoughts.
* severe depression that does not respond to
antidepressants (medicines used to treat depression)
or counselling.
* severe depression in patients who can't take
antidepressants.
* severe mania (too much talking, insomnia, weight loss
and impulsive behaviour) that does not respond
to medication.

ECT is administered or prescribed as a series of treatments,
about three times a week for two to four weeks. Before the
treatment, the patient is given a general anaesthetic and a
muscle relaxant. Electrodes are then attached to the patient's
scalp and an electrical current is applied which causes a brief
convulsion. Minutes later, the patient wakes up, with no
recollection of the treatment or the events leading up to the
treatment. As with other antidepressant treatments,
follow-up treatment with drugs or occasional ECT is
often required to help prevent relapse.
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Depression has to be diagnosed accurately to maximise the
benefits of ECT. The risks and possible adverse side effects
of ECT should be weighted up against those of alternative
treatments.

ECT is still a controversial treatment. Much of this
controversy relates to the effectiveness and side effects of
the treatment. Because of the concern about permanent
memory loss and confusion surrounding ECT, some
experts recommend that the treatment only be used as
a last resort.

While some studies have demonstrated 80% improvement
in severely depressed patients after ECT, other studies
indicate that relapse is common, even for patients who
take medication after ECT.