Depression

Many, people mistakenly equate sadness with depression. From time to time, everyone feels sad often for a good reason such as a setback at work or the death of a loved one. Most people cope with such feelings and over time, shake off the sadness.

In contrast, clinical depression appears without an apparent reason and increasingly interferes with a person's ability to function.

Psychiatrists categorize the different types of depression according to the following characteristics:

Major depressive episode, in which symptoms have no identifiable cause and prevent the person from performing normal daily activities The episode may be isolated or recurrent.

Monk episode, in which abnormal euphoria or irritability dominate.

Mixed episode, in which mood alternates between mania and depression for at least one week. (This is also referred to as manic/depression or bipolar disorder.)

Dysthymic disorder, in which a depressed mood prevails, but some normal activities can be performed.

The cause of these disorders is unknown, although some researchers believe that biochemical changes in the brain may be responsible. Because depression tends lo run in families, there may be a hereditary link loo Sometimes depression develops as a response -- perhaps biochemical -- to an infectious disease such as hepatitis. In addition, alcohol and other drugs can induce depression.

Diagnostic Studies and Procedures

Diagnosis is based on symptoms and a medical history. If a doctor suspects clinical depression, she will probably refer the patient to a psychiatrist or clinical psychologist for testing.

Medical Treatments

Depression responds to medical treatment better than many other mental disorders. Approaches fall into three categories -- medication, psychological therapy, and elect electroconvulsive therapy.

Drug Therapy

Antidepressant medications include tricyclic drugs, monoamine oxidase (MAO) inhibitors, and serotonin uptake inhibitors, all of which alleviate symptoms, and lithium, a drug that is used on a long-term basis to control the euphoric phase of manic-depressive illness. Tricyclics, which include amitriptyline (Elavil, Endep, and others), amoxapine (Asendin), and imipramine (Tofranil and others), work by blocking the reabsorption of brain chemicals called neurotransmitters, thereby increasing their levels in the brain. MAO inhibitors, such as isocarboxazid (Marplan) and phenelzine (Nardil), block an enzyme that breaks down neurotransmitters. Fluoxetine (Prozac), the prototype of the newest class of antidepressants, works by blocking the absorption of serotonin; this is a potent brain chemical that seems to have mood-regulating properties.

As responses to antidepressants vary, trial and error is often necessary to find the best medication or combination.

Tricyclic drugs are useful in alleviating such symptoms as loss of appetite and weight, decreased capacity to feel pleasure, lethargy, suicidal thoughts, hopelessness, and excessive guilt. Some of the newer tricyclics take effect within a few days, while older ones require several weeks. Side effects, such as dry mouth, drowsiness, and constipation, tend to subside with time.

MAO inhibitors are more often prescribed for depression characterized by increased appetite and excessive fatigue and sleepiness. Patients taking them must follow dietary restrictions because tyramine, a substance in cured meat, aged cheese, and red wine, for example, can react with the drug to precipitate a dangerous rise in blood pressure.

The serotonin blocker Prozac works faster than most other antidepressants, and is especially effective in combatting lethargy, drowsiness, and overeating. Among its side effects are nervousness, insomnia, anxiety, and loss of appetite.

Lithium can be highly effective in reducing the frequency and severity of manic-depressive cycles, although some patients do better with other drugs such as carbamazepine (Tegretol).

Psychotherapies. These "talking" treatments focus on helping patients resolve emotional problems by gaining insight into their own psychological makeup. Traditional psychotherapy looks for a childhood source of the problem, while other approaches address current conflicts and interpersonal problems.

Behavioral and cognitive forms of psychotherapy teach patients new ways to view the world. Depressed people tend to expect failure and often make false assumptions about the behavior and motives of others. Cognitive therapists strive to help these patients correct their negative beliefs.

Interpersonal therapy is based on the concept that depression occurs when personal relationships are disturbed, and that these relationships perpetuate symptoms, which worsen the interpersonal problems; the end result is a dysfunctional cycle. By focusing on issues, interpersonal therapists help patients understand their illness and feelings, and find ways to improve relationships.

Electroconvulsive Therapy. Although this method, often referred to as ECT or shock treatment, is not used as often as in the past, it is still highly effective in treating suicidal patients. The patient is given a general anesthetic, eliminating pain and memory of the procedure. Electrodes are placed on one or both sides of the scalp and a mild electric shock is administered to the brain, resulting in a minor seizure. There is temporary loss of memory for events of the past 6 to 12 months.

Alternative Therapies

Major or recurrent depression requires medical treatment. Alternative therapies are useful adjuncts that may be adequate for overcoming the milder forms.

Ayurveda. This ancient method of healing from India promotes emotional and physical well being with a regimen of diet, exercise, and herbal remedies designed to correct individual imbalances.

Creative Therapies. Art, music, dance, and other forms of artistic expression are especially beneficial during recovery from depression, because they help a patient to build self-esteem.

Light Therapy. People who repeatedly suffer depression only during the winter have seasonal affective disorder, or SAD, associated with insufficient exposure to daylight. Typical treatment involves sitting under special lights for several hours a day.

Naturopathy and Nutrition Therapy, Diet plays a major role in brain function, but there is considerable disagreement over nutritional treatment of any mental disorder. Many nutrition therapists advise a sugar-free, low-fat diet that is high in complex carbohydrates and protein. Some also recommend supplements of B-complex vitamins.

Self-Treatment

Exercise can work as well as antidepressant drugs for mild depression or dysthymia. Aerobic exercise is especially effective, because it stimulates a release of endorphins, the body's own pain-relieving and mood-lifting chemicals.

Its best to stick to normal routines, particularly if you are experiencing reactive depression. Daily chores anchor you in reality; they may also prevent deeper depression.

Never overlook the power of laughter. A funny movie or an amusing book can often improve your mood.

Other Causes of Depression

Chronic fatigue syndrome has many of the hallmarks of depression. Among the elderly, symptoms of depression are often confused with dementia. An underactive thyroid can cause symptoms similar to those of depression, as can many serious illnesses; for example, depression is common following a heart attack. Medications, such as those used to lower blood pressure, frequently cause transient depression.