More detailed description about depression

Everyone sometimes feels sad or tired for various reasons. Daily stressors and pressures in the family and on the job all make us feel less upbeat than usual. However, as a rule, such sadness disappears within hours or days. In certain instances, however, the sadness and glumness remain for several weeks which may constitute a disease state, medically termed depression.

Depression is one of the most common diseases in the world. Research shows that around 5% of the population suffers from depression. The first signs of disease usually appear in the 2nd or 3rd decade of life, sometimes also earlier or later in life. Women run a higher risk; female sufferers make twice the number of male sufferers.

The exact cause of this disease has not yet been discovered. However, there are many factors that contribute to its development. It is a well-established fact that the disease has a strong genetic component. If a close kin suffers from depression, it is more likely that the disease will also affect the other relatives. The appearance of depression can be triggered by a stressful lifestyle, suicide in the family or other stressful events, chronic diseases (such as cancer, AIDS, Parkinson's disease), substance abuse (alcohol or illicit drugs), the post-partum state, etc.

Symptoms and depression types

The symptoms vary and an individual patient may not present all of them. They include a long-lasting feeling of sadness, despair, low self-esteem, helplessness, sleep disturbances (insomnia or excessive sleepiness), concentration difficulties, difficulties maintaining a steady body weight (fast weight gain or weight loss), restlessness, loss of sexual drive and suicidal thoughts.

There are different types of depressive disorders:

• Depression proper,
• Dysthymic disorder (similar to depression, but with milder symptoms),
• Psychotic depression (depression compounded by the symptoms of psychosis such as hallucinations, illusions and loss of the sense of reality),
• Post-partum depression (which can appear even 1 month after giving birth in 10% of women).

Diagnosis

Due to the specific nature of disease, a psychiatrist should make the final diagnosis and institute treatment. In addition to laboratory tests, the patient exam should primarily focus on the psychological evaluation because certain diagnostic criteria must be met in order to establish a diagnosis of depression. The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a manual published by the American Psychiatric Association and is most widely used worldwide. It includes a list of different categories of mental illnesses and criteria for their diagnoses.

Prevention

It is of utmost importance to first recognize the depressive mood. One needs to discuss their feelings with one's loved ones. One needs to admit and permit oneself small weaknesses and accept them as part of the personality package. The daily stressors need to be minimized; to that effect, it is a good idea to make a list of priorities and goals and select the more easily-attainable goals, especially at the beginning of the process of escaping the depressive mood.

A schedule should be made which includes time for entertainment, hobbies, taking strolls, resting as well as sport activities which seem to be the best weapon against depression. Half an hour of pursuing sport activities per day attains the same result as one antidepressant pill. However, since motivation of the depressed person is weak, it is a good idea to become part of an organized sport group. Loved ones can be the source of motivational support in the case that they are able to recognize depression. One needs to take care of oneself in this phase. Contacts with friends need to be re-established and regular visits should be on the agenda. A conversation with a trusted friend alone can have an immensely therapeutic effect. An open discussion is a problem for men who are not used to discussing their problems.

If all that is too much since depression is too deep, one should allow oneself to seek professional help and accept pharmacological therapy if deemed necessary by one's family physician or psychiatrist.

Therapy

Depression can be successful treated. Various psychotherapeutic techniques as well as antidepressants are used. In mild cases psychotherapy suffices while in moderate to severe cases a combination of both is employed. Various psychotherapeutic techniques enable one to recognize one's own mood and a way of responding to mood changes. They allow a depressed person to take responsibility for their own life and personal decisions without seeking reasons for their state outside of themselves. They help the person develop a better and more efficient communication, alter the old behavioural patterns as well as manage stressful situations.

In case of moderate, severe or deep depressive disorders, pharmacotherapy with antidepressants is necessary; it contributes to the minimization and removal of signs of depressive disorders. There are numerous antidepressants available which increase the concentration of neurotransmitters between the nerve cells or inhibit the breakdown of these substances, thereby re-establishing a biological balance in the brain.

Three main groups of medications are used:

• Selective serotonin re-uptake inhibitors (SSRI). These drugs prevent the re-uptake of serotonin, which is usually lacking in depression, into the nerve cells and thus prevent its inactivation;
• Tricyclic antidepressants, an older drug type, act to increase the concentration of various neurotransmitters in the brain;
• Monoamine oxidase inhibitors (MAOI); MAO is an enzyme that breaks down neurotransmitters that are important in depression. Lately, antidepressants have been in use that raise the level of noradrenaline and dopamine in the brain, in addition to increasing serotonin.

Antidepressants normally take their full effect only after 14 days of continuous use. Normally, they are taken for 6 months during which time a close cooperation between the patient and the psychiatrist is required. If depression reappears upon discontinuing the effective pharmacological therapy, a life-long pharmacotherapy with antidepressants usually becomes necessary. Sometimes, mood stabilizers are added to antidepressants. They belong to the group of anticonvulsants; the most commonly used drug is carbamazepine.

Electroconvulsive therapy sometimes becomes the therapy of last resort in severe and drug-unresponsive depression. This therapy is conducted under general anaesthesia. However, electroconvulsive therapy is not always possible; there are numerous reasons for it, one of them being the claim that this therapy leads to brain damage. An alternative that has lately gained popularity is the transcranial magnetic stimulation (TMS) which is the stimulation of the brain cortex with magnetic fields. Extensive research on this methods has not yet been conducted, thus the method remains experimental.

Back to basic description