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Health Information
Depression
En Español (Spanish Version)
Definition
Depression is a
mental illness characterized by feelings of
profound sadness and lack of interest in
enjoyable activities. Depression is not the
same as a blue mood. It is a persistent low
mood that interferes with the ability to
function and appreciate things in life. It
may cause a wide range of symptoms, both
physical and emotional. It can last for
weeks, months, or years. People with
depression rarely recover without treatment.
Causes
The precise
cause of depression is not known. It is
sometimes difficult to determine if
something causes depression, or if it
instead is a result of being depressed (ie,
does substance abuse result from attempts at
self-medicating for depression, or does
chronic substance abuse result in
depression). Examples of possible causes may
be mental, physical, or environmental in
nature and include:
- Stressful
life events (usually in combination with
one or more of the following causes)
- Chronic
stress
- Low
self-esteem
-
Herpes
-
HPV
- Imbalances
in brain chemicals and hormones
- Lack of
control over circumstances (helplessness
and hopelessness)
- Negative
thought patterns and beliefs
- Chronic
pain
- Heart
disease and heart surgery
- Genetic
predisposition
- Altered
brain structure and function, including
after a stroke
- Parkinson’s
disease
- Postpartum
depression occurs after childbirth
- Seasonal
affective disorder is a type of
depression or a worsening of symptoms
thought to be due to the decreased
exposure to sunlight that occurs during
winter months, especially in northern
climates with longer winters.
-
Hypothyroidism
- Anemia
- Cancer
- Substance
abuse
Risk Factors
A risk factor is
something that increases your chance of
getting a disease or condition.
Risk factors
include:
- Sex: female
- Age:
elderly
- Chronic
physical or mental illness, including
thyroid disease, headaches, chronic
pain, and stroke
- Previous
episode of depression
- Major life
changes or stressful life events (eg,
bereavement, trauma)
- Postpartum
depression
- Winter
season for seasonal affective disorder
- Little or
no social support
- Low
self-esteem
- Lack of
personal control over circumstances
- Family
history of depression (parent or
sibling)
- Feelings of
helplessness
- Certain
medications, including medications used
to treat asthma, high blood pressure,
arthritis, high cholesterol, and heart
problems
- Smoking
- Anxiety
- Insomnia
- Personality
disorders
-
Hypothyroidism
Symptoms
Symptoms of
depression are highly variable from person
to person. Some people have only a few
symptoms, while others have many. Symptoms
also vary over time.
Symptoms can
change over time and may include:
- Persistent
feelings of sadness, anxiety, or
emptiness
-
Hopelessness
- Feeling
guilty, worthless, or helpless
- Loss of
interest in hobbies and activities
- Loss of
interest in sex
- Feeling
tired
- Trouble
concentrating, remembering, or making
decisions
- Trouble
sleeping, waking up too early, or
oversleeping
- Eating more
or less than usual
- Weight gain
or weight loss
- Thoughts of
death or suicide with or without suicide
attempts
-
Restlessness or irritability
- Physical
symptoms that defy standard diagnosis
and do not respond well to medical
treatments
Diagnosis
There is no
blood test or diagnostic test for
depression. The doctor will ask about your
symptoms and medical history, giving special
attention to:
- Alcohol and
drug use
- Thoughts of
death or suicide
- Family
members who have or have had depression
- Sleep
patterns
- Previous
episodes of depression
The doctor may
also perform a mental status examination or
neuropsychiatric evaluation to obtain
detailed information about your speech,
thoughts, memory, and mood. Questionnaires
called depression inventories may be
administered. A physical examination and
other diagnostic tests can help rule out
other causes for your symptoms.
Treatment
Treatment
usually includes medication, psychotherapy,
or a combination of the two. Medicine helps
relieve symptoms. Psychotherapy helps you
learn more effective ways to deal with
problems or to identify and resolve the
conflicts contributing to your depression.
There may be a
need for hospitalization in some cases of
severe depression. Depression with psychotic
features usually requires hospitalization
and use of antipsychotic drugs, such as
olanzapine.
Antidepressant Medications
Up to 70% of
depressed patients find relief from
their symptoms with antidepressants.
These medications, which can take 2 to 6
weeks to reach their maximum
effectiveness, include:
Selective Serotonin Reuptake
Inhibitors (SSRIs)
-
Fluoxetine (eg, Prozac)
-
Sertraline (eg, Zoloft)
-
Paroxetine (eg, Paxil)
-
Citalopram (eg, Celexa)
-
Fluvoxamine (eg, Luvox)
-
Escitalopram (eg, Lexapro)
***Please
note: In March, 2004, the Food and
Drug Administration (FDA) issued a
Public Health Advisory that cautions
physicians, patients, families, and
caregivers of patients with depression
to closely monitor both adults and
children receiving certain
antidepressant medications. The FDA is
concerned about the possibility of
worsening depression and/or the
emergence of suicidal thoughts,
especially among children and
adolescents at the beginning of
treatment, or when there’s an increase
or decrease in the dose. The medications
of concern—mostly SSRIs (Selective
Serotonin Re-uptake Inhibitors)—are:
Prozac (fluoxetine), Zoloft
(sertraline), Paxil (paroxetine), Luvox
(fluvoxamine), Celexa (citalopram),
Lexapro (escitalopram), Wellbutrin
(bupropion), Effexor (venlafaxine),
Serzone (nefazodone), and Remeron
(mirtazapine). Of these, only Prozac
(fluoxetine) is approved for use in
children and adolescents for the
treatment of major depressive disorder.
Prozac (fluoxetine), Zoloft
(sertraline), and Luvox (fluvoxamine)
are approved for use in children and
adolescents for the treatment of
obsessive compulsive disorder. For more
information, please visit
www.fda.gov/cder/drug/antidepressants.
Tricyclic Antidepressants
-
Imipramine (eg, Tofranil)
-
Doxepin (eg, Adapin, Sinequan)
-
Clomipramine (eg, Anafranil)
-
Nortriptyline (eg, Pamelor)
-
Amitriptyline (eg, Elavil)
Monoamine Oxidase Inhibitors (MAOIs)
-
Phenelzine (eg, Nardil)
-
Tranylcypromine (eg, Parnate)
Other Antidepressants
-
Venlafaxine (eg, Effexor)
-
Nefazodone (eg, Serzone)
-
Mirtazapine (eg, Remeron)
-
Bupropion (eg, Wellbutrin)
-
Duloxetine (eg, Cymbalta)
Psychotherapy
Short-term
(10 to 20 weeks) therapy can help some
depressed people. Psychotherapy is
designed to help you:
- Cope
with difficulties in relationships
- Change
negative thinking and behavior
patterns
- Resolve
difficult feelings
Electroconvulsive Therapy (ECT)
Electroconvulsive therapy is the use of
an electric stimulus to produce a
generalized seizure. ECT may be used in
people with severe or life-threatening
depression. It is also used for people
who cannot take or do not respond to
antidepressants. It is considered a safe
and effective procedure.
Exercise
Regular
exercise has been shown to relieve some
of the symptoms of depression. In the
absence of physical restrictions,
exercise should play an integral role in
the overall management of depression.
Phototherapy
Phototherapy
involves sitting under special
fluorescent lights for a prescribed
amount of time per day, usually about 30
minutes every morning.
Dietary Supplement and Herbal Therapy
St. John's
wort is an herb that is available
without prescription. It is widely used
in Europe for the treatment of mild to
moderate depression. There is
conflicting evidence as to its
effectiveness, however.
There is
also recent evidence that DHEA (a
dietary supplement) and an ingredient in
fish oil (EPA, eicosapentanoic acid) may
help some people with depression, but
some experts dispute these findings.
Always discuss the use of dietary and
herbal supplements with your doctor.
Dietary Manipulations
Research
suggests that diets high in tryptophan,
certain B vitamins, and fish oil may be
helpful in relieving or preventing
depression. Always discuss the use of
such supplements with your doctor.
Vagal Nerve Stimulation (VNS)
Vagal nerve
stimulation was approved by the FDA in
2005 as therapy for depression that is
resistant to multiple trials of
antidepressants. VNS involves the
surgical implantation of a
pacemaker-like device that stimulates
the vagus nerve, located in the neck,
with electrical impulses.
Prevention
Strategies to
reduce your chance of becoming depressed
include:
- Being aware
of your personal risk
- Having a
psychiatric evaluation and psychotherapy
if needed
- Developing
social supports
- Learning
stress management techniques
- Exercising
regularly
- Do not
abuse or overuse alcohol or drugs
- Getting
adequate sleep, rest, and recreation
RESOURCES:
Depression and Bipolar Support Alliance
www.ndmda.org
National Institute of Mental Health
www.nimh.nih.gov
International Foundation for Research and
Education on Depression
www.ifred.org
The National Mental Health Association
www.nmha.org
CANADIAN RESOURCES:
Canadian Psychiatric Association
www.cpa-apc.org
Mental Health Canada
www.mentalhealthcanada.com
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