The amount of people affected by clinical depression is astounding; the outcome of this devastating illness can end in several ways. At the early age of twelve began my never-ending battle with clinical depression; this has been the biggest set-back of my life, and it has impacted everyone around me.
Clinical depression is a psychological disorder distinguished by the symptoms of insomnia, a loss of appetite, the inability to concentrate, feelings of hitting “rock bottom,” sadness, guilt, helplessness, suicide, self-harm and hopelessness. Depression affects one in four adults, and one in eight teenagers. When a person is depressed, his or her thoughts and feelings are of darkness, self-hatred, and hurt. He or she stops sleeping or sleep more than normal, and usually have a rapid weight gain or loss. He or she becomes isolated away from friends and family, staying away from the public and things that they enjoyed previously in his or her life.
When untreated, depression can lead to self-harm or self-mutilation, “cutting,” which is an emotional outlet through physical pain; suicide, which is the leading cause of deaths to adolescents between the ages of ten and nineteen.
Before I became depressed I was a very happy, active, out-going and loving child. Once I developed depression I had destroyed all relationships; my family, my friends. I had this uncontrollable anger and hurt. My school work became affected, and I was pulled out to be home schooled. I became a “cutter,” prone to suicidal thoughts, and even attempted in my eighth grade year. I was unable to do anything aside from sleep; I had no desire to do anything that I once loved. And worst of all, I was unable to pull myself out of it without the help of therapy and medication.
Depression impacted my life in so many ways. I have very low self-esteem, and many people have not forgotten the “angry Jennifer.” Although there have been several negative impacts, there have been many positive ones, as well. My battle with depression has helped me find a career. I wish to become a psychiatrist, and help other people who are going through what I’ve been through, aiding them in over coming this obstacle. I feel that my depression has made me who I am today, and all in all, a better person. I’m stronger and I know that I can over come anything that is thrown my way.
I said all of that to say this: depression is a medical illness. Many people believe that there is no such thing as a “mental illness” but I know differently; I have experienced differently. If you feel symptoms of what could be depression, go to your doctor immediately, as well as tell someone you are close to—your best friend, your mother, your father, your significant other. Your loved ones can and will help you get through it.
Everything below is cited from the website www.emedicinehealth.com/depression. There are facts, causes, symptoms, treatments, medications, and more.
Some depression facts and statistics:
· Clinical depression affects about 19 million Americans annually.
· It is estimated to contribute to half of all suicides.
· About 5%-10% of women and 2%-5% of men will experience at least one major depressive episode during their adult life.
· Depression affects people of all races, incomes, and ages, but it is three to five times more common in the elderly than in young people.
Some causes of depression:
The causes of depression are complex. Genetic, biological, and environmental factors can contribute to its development. In some people, depression can be traced to a single cause, while in others, a number of causes are at play. For many, the causes are never known.
- Currently, it appears that there are biochemical causes for depression, occurring as a result of abnormalities in the levels of certain chemicals in the brain.
- These chemicals are called neurotransmitters.
- The abnormalities are thought to be biological and are not caused by anything you did.
- While we still don't know exactly how levels of these neurotransmitters affect mood, we do know that the levels can be affected by a number of factors.
- Heredity: Certain types of depression seem to run in certain families. Research is ongoing as to exactly which genes are involved in depression. Just because someone is your family has depression, however, doesn't mean you will. Sometimes, family members who were known to abuse alcohol or other drugs were unwittingly trying to improve their mood (often called "self-medication" by professionals). Likewise, you can become depressed even if no one else in your family is known to have depression.
- Personality: People with certain personality traits are more likely to become depressed. These include negative thinking, pessimism, excess worry, low self-esteem, overdependence on others, and ineffective responses to stress.
- Situations: Difficult life events, loss, change, or persistent stress can cause levels of neurotransmitters to become unbalanced, leading to depression. Even happy events, such as childbirth, can be stressful and cause postpartum depression.
- Medical conditions: Depression is more likely to occur with certain medical conditions. These "co-occurring" conditions include heart disease, stroke, diabetes, cancer, hormonal disorders (especially perimenopause or hypothyroidism, known as "low thyroid"), Parkinson disease, and Alzheimer disease. Clinical depression should not be considered a normal or natural reaction to illness.
- Medications: Some medications used for long periods, such as prednisone, certain blood pressure medicines, sleeping pills, and even birth control pills in some cases, can cause depression.
- Substance abuse: While it has long been believed that depression caused people to misuse alcohol and drugs in an attempt to make themselves feel better (self-medication), it is now thought that the reverse can also be the case; substance abuse can actually cause depression.
- Diet: Deficiencies in certain vitamins, such as folic acid and B-12, may cause depression.
- Certain people are more likely to develop clinical depression. The following are risk factors for depression in adults:
- Female sex
- Advanced age
- Lower socioeconomic status
- Recent stressful life experience
- Chronic (long-term) medical condition
- Underlying emotional or personality disorder
- Substance abuse (such as alcohol, sleeping medications, medications for panic or anxiety, or cocaine)
- Family history of depression, especially in a close relative (such as parent, brother or sister, or child)
- Lack of social support
- Many of these risk factors also apply to children. Other risk factors for depression in children include the following:
- Continual mental or emotional stress, at home or at school
- A recent loss
- Attention, learning, or conduct disorder
- Obesity
- Risk factors for depression in elderly people include those listed for adults. Especially important are the following:
- Co-occurring illnesses: These become much more important risk factors in the elderly because of the higher incidence of these illnesses in older people. Diseases with which depression is more likely to occur include heart disease, stroke, diabetes, cancer, thyroid disease, Parkinson disease, and Alzheimer disease--all diseases that are much more common in elderly people than in other age groups.
- Medication effects: Like co-occurring illnesses, medication use is much more common in the elderly. Depression is a side effect of some medications in the elderly.
- Not taking medication for medical conditions: Some medical conditions, if untreated, may cause depression. An example is hypothyroidism (low thyroid).
- Living alone, social isolation
- Being recently widowed
Symptoms and signs of depression:
Clinical depression is not something you feel for a day or two before feeling better. In true depression, symptoms last weeks or months, sometimes years if you don't seek treatment. If you are depressed, you are often unable to perform daily activities. You may not care enough to get out of bed or get dressed, much less work, do errands, or socialize.
- Adults: You may be said to be suffering from a major depressive episode if you have a depressed mood for at least two weeks and have at least five of the following symptoms:
- Feeling sad or blue
- Crying spells
- Loss of interest or pleasure in usual activities
- Significant increase or decrease in appetite
- Significant weight loss or weight gain
- Inability to sleep or excessive sleeping
- Agitation or irritability
- Fatigue or loss of energy
- Feelings of worthlessness or excessive guilt
- Thoughts of death or suicide
- Children: Children with depression also experience these classic symptoms, but may exhibit other symptoms as well, including the following:
- Poor school performance
- Persistent boredom
- Frequent complaints of physical problems such as headaches and stomachaches
- Some of the classic adult symptoms of depression may also be more obvious in children, such as change in eating or sleeping patterns. (Has the child lost or gained weight in recent weeks or months? Does he or she seem more tired than usual?)
- Teenagers may show depression by taking more risks and/or showing less concern for their own safety.
- Parents of children with depression report noticing the following behavior changes. If you notice any of these, discuss this with your health-care provider.
- The child cries more often or more easily.
- The child spends more time alone, away from friends and family.
- The child actually becomes more "clingy" and may become more dependent on certain relationships. This is less common than social withdrawal, though.
- The child expresses thoughts about hurting him or herself, or exhibits harmful behavior. The child seems to be overly pessimistic or exhibits excessive guilt or worthlessness.
- Elderly: While any of the classic symptoms of depression may occur in elderly people, other symptoms also may be noted.
- Diminished ability to think or concentrate
- Unexplained physical complaints (for example, abdominal pain, changes in bowel habits, or muscle aches)
- Memory impairment (in about 10% with severe depression)
When Should I Seek Medical Help?
If you feel that you are depressed, you may wish to talk about your feelings with a family member or a close friend. Communication is one of the keys to early diagnosis and treatment. People close to you may have felt you were depressed. With their encouragement, you should call your health-care provider.
If you feel someone else is depressed, talk to the person.
- You may notice a person showing the signs of depression mentioned under Symptoms. If you see worthlessness, excessive guilt, hopelessness, or any suicidal thoughts, contact a health-care provider immediately.
- With mild or moderately severe symptoms of short duration (weeks), it may be reasonable to contact a health-care provider for an appointment.
- It is often helpful to accompany a family member or friend to the medical office and offer support as needed.
- If the person has severe symptoms, cannot care for himself or herself, or is threatening to harm himself or herself, seek immediate treatment in a hospital emergency department.
After you are diagnosed with depression, your health-care provider will usually want you to be in frequent contact. You (or your family) may need to contact your primary-care provider, psychiatrist, or psychologist if any of these events occur:
- You are experiencing any unexpected or serious medication side effects.
- You start any new medication.
- You develop additional symptoms of depression.
- You feel that you are having setbacks and your present therapy is ineffective.
- You continue to suffer from bouts of anxiety and depression.
- You have trouble coping with your feelings and are starting to feel as if you are losing control.
With severe depression, hospitalization may be necessary. You may choose to come to the hospital for evaluation, or your family or friends may need to bring you to the hospital for evaluation in these circumstances:
- You have thoughts of hurting yourself.
- You have thoughts of hurting someone else.
- You are no longer able to care for yourself.
- You refuse to follow through with important treatment recommendations, such as taking your medication.
Medical Treatment:
Therapy frequently includes antidepressant medication and supportive care such as psychotherapy. Other less widely used therapies, such as electroconvulsive therapy, are used in severe cases.
Therapy may be provided by your health-care provider or by a specially trained mental-health professional.
- Psychiatrists are medical doctors who have completed specialized training in mental disorders.
- Psychologists have graduate (after college) training that includes experience in a mental-health-care facility.
- Psychotherapists may have a degree in medicine (psychiatry), psychology, social work, mental-health counseling, or couples and family therapy, as well as additional more specialized education or training.
Regardless of which is used, psychotherapy, medication, or a combination, most people with depression can safely be treated in a series of office (outpatient) visits. Inpatient care (in the hospital) may be necessary for people with more serious symptoms and is required for those who are contemplating suicide or cannot care for themselves.
The More Common Medications:
The major classes of antidepressant medication are the selective serotonin re-uptake inhibitors (SSRIs), the tricyclic antidepressants (TCAs), the monoamine oxidase inhibitors (MAOIs), and the atypical antidepressants.
SSRI medications affect levels of serotonin in the brain. For many people, these medications are the first choice. Examples of these medications are listed here. The generic name is first, with the brand name in parentheses. These drugs are best known by their brand names.
- Fluoxetine (Prozac)
- Sertraline (Zoloft)
- Paroxetine (Paxil)
- Fluvoxamine (Luvox)
- Citalopram (Celexa)
- Escitalopram (Lexapro)
TCAs are often prescribed in severe cases of depression or when SSRI medications don't work. Like the SSRIs, most of these are better known by their brand names.
- Amitriptyline (Elavil)
- Clomipramine (Anafranil)
- Desipramine (Norpramin)
- Doxepin (Adapin)
- Imipramine (Tofranil)
- Nortriptyline (Pamelor)
- Protriptyline (Vivactil)
- Trimipramine (Surmontil)
The MAOIs are not used as often since the introduction of the SSRIs. Because of interactions, the MAOIs may not be taken with many other types of medicines, and some types of foods that are high in tyramine (like aged cheeses, wines, and cured meats) must be avoided as well.
- Phenelzine (Nardil)
- Tranylcypromine (Parnate)
The atypical antidepressant medications work differently than the commonly used SSRIs. These medications may be prescribed when SSRIs have not worked.
- Bupropion (Wellbutrin)
- Mirtazapine (Remeron)
- Nefazodone (Serzone)
- Trazodone (Desyrel)
- Venlafaxine (Effexor)
One-half to two-thirds of people who take antidepressant medications get better.
- It may take anywhere from one to six weeks to start feeling better. Don't give up taking the medication if you don't feel better right away.
- Your health-care provider will see you again during this period to see if your body is tolerating the medication and if your symptoms are better. If they are not, he or she may adjust your dose or prescribe a different medication.
Even after you feel better, you should continue to take the medication for six to nine months.
- Stopping the medication too soon may cause your symptoms to return, or to get worse.
- Some people need to take the medication for longer periods of time to keep the depression from returning.
Do not stop taking the medication without talking to your health-care provider.
- Stopping abruptly may cause serious withdrawal effects.
- If you and your health-care provider agree it is time to stop the medication, the dose usually will be slowly tapered to prevent these effects.
The side effects of antidepressant medications vary considerably from drug to drug and from person to person.
- Common side effects include dry mouth, sexual dysfunction, nausea, tremor, insomnia, blurred vision, constipation, and dizziness.
- You may need to follow some dietary restrictions if you are taking MAOI medications.
- In very rare cases, some patients have been thought to have become acutely more depressed once on the medication, even attempting or completing suicide or homicide. Children and teenagers are thought to be particularly vulnerable to this rare possibility.
- If an antidepressant medication is prescribed for you, ask your health-care provider what kind of side effects you can expect.
Getting Help [Support Groups and Counseling]:
If you or someone you know is considering suicide, call 800-SUICIDE.
Additional information about depression can be obtained from these organizations:
National Depressive and Manic-Depressive Association
730 N. Franklin Street, Suite 501
Chicago, IL 60610
(800) 826-3632
National Foundation for Depressive Illness
PO Box 2257
New York, NY 10116
(800) 239-1265 or (212) 268-4260
National Institute of Mental Health
(301) 443-4513 (local)
1-866-615-6464 (toll-free)
nimhinfo@nih.gov
National Mental Health Association
1021 Prince Street
Alexandria, VA 22314
(703) 684-7722 (local)
(800) 969-NMHA (6642) (toll-free)
Credit: Authors and Editors
Author: Roxanne Dryden-Edwards, MD
Editor: Melissa Conrad Stöppler, MD, Chief Medical Editor, eMedicineHealth.com
Previous contributing authors and editors
Author: Sarah C Aronson, MD, Associate Professor, Departments of Psychiatry and Medicine, Case School of Medicine/University Hospitals of Cleveland.
Editors: Ronald C Albucher, MD, Assistant Chief, Psychiatry Service, VA Ann Arbor Healthcare System; Clinical Assistant Professor, Department of Psychiatry, University of Michigan School of Medicine; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine; Alan D Schmetzer, MD, Professor and Assistant Chair for Education, Department of Psychiatry, Indiana University School of Medicine.
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