Depression

Mukesh Kamdar, MD

Major Depressive disorder, also referred to as clinical depression, affects approximately 6-7% of the US population, age 18 or older, in any given year. According to the World Health Organization it is also the leading cause of disability in the US for individuals age 15 to 45. It affects nearly twice as many women as men and, on average, appears first in the late teens to the early twenties.

WHAT IS DEPRESSION?

Depression is a serious medical illness that negatively impacts your self worth and how you feel and act. The most common symptom is a deep sense of sadness or a loss of interest for anything pleasurable. There are other symptoms of depression such as:

• Changes in appetite that may result in weight loss or weight gain. Some people tend to gain weight due to compulsive overeating in an effort to self-medicate their depression. Often times there is marked loss of appetite - especially in the elderly.
• Sleep disturbances that can include difficulty falling asleep or early morning awakening with difficulty in going back to sleep. Some people experience excessive sleepiness or a need to stay "under the covers".
• Lack of energy or worsening fatigue.
• Extreme irritability or impatience that is completely out of character for that individual.
• Feelings of low self worth and excessive amount of guilt.
• Difficulty concentrating and thinking or making even minor decisions. There may also be short term memory impairment.
• Negative thoughts, including thoughts about death and dying, attempting self harm, or contemplating suicide.

HOW DO YOU SEPARATE NORMAL SADNESS FROM DEPRESSION?

Loss of a loved one, termination from a job, or the end of a relationship can all be very difficult life events that can result in feelings of sadness and grief. When events like these happen, people often talk about being "depressed". However sadness and depression are not the same. Sadness will lessen with time while a depressive disorder can continue for months and years. It is not unusual for someone who is prone to clinical depression to be vulnerable to a recurrence of a depressive bout following one of the difficult life events listed above.

WHAT ARE THE CAUSES OF DEPRESSION?

First and foremost, depression can affect anyone - even those who are living in a so-called ideal environment with a minimal amount of stress from daily living. There can be several precipitating factors that influence the onset and course of a depressive episode.

• Biochemistry: There are several neurotransmitters in the brain that play a role in mood regulation. The two that have been studied the most are serotonin and norepinephrine. A third – dopamine – has been studied to a lesser extent. Abnormalities in these chemicals, especially their reduced availability, seems to contribute to the emergence of depressive symptoms.
• Genetics: Depression can certainly run in families. Often there is a family history of depression or bipolar disorder (manic depressive illness) that can be passed on to the next generation. It also appears that a family history of alcoholism can make the offspring more susceptible to depressive illness.
• Personality: Individuals with a "depressive personality" who lack a sense of optimism and have longstanding low self-esteem are more likely to develop depression.
• Situational and environmental factors: Those people who have experienced more than their fair share of losses or have been exposed to violence or trauma are more vulnerable to develop depression. Occasionally a medical condition such as a brain tumor or a thyroid or vitamin deficiency can cause depression. It is important in such cases to be evaluated by a psychiatrist or another physician who can rule out any of the above medical conditions and recommend further testing or referral to an appropriate specialist.

TREATMENT OF DEPRESSION

Depression is one of the most treatable psychiatric conditions; most people will eventually respond to appropriate treatment. In general, all mental health professionals agree that mild depression can be successfully treated with "talk therapy" utilizing cognitive behavioral techniques (CBT). However, for moderate to severe depression, a combination of antidepressant therapy and cognitive behavioral therapy has the best chance of a positive outcome. Psychotherapy or "talk therapy" can also help educate about the early signs and symptoms of depression and when and how to seek timely intervention. In addition, “talk therapy can be useful in resolving ongoing interpersonal problems such as marital discord and family conflicts, as well as teaching stress management.

Antidepressants are prescribed to address the chemical imbalance of the serotonin, norepinephrine and dopamine systems. These medications are specific drugs that are not be confused with "uppers" or tranquilizers. They are not addictive. It typically takes 3 to 4 weeks to see an improvement of symptoms and some people actually notice a marked reduction in anxiety and irritability within days. It is important to stay on the medications for at least six to nine months after an improvement in symptoms. Those individuals who have had two or three episodes of major depression will require long term "maintenance therapy" with these medications in order to prevent a recurrence of depression. It is very important to ask questions about the benefits and side effects of the various antidepressants and ask your psychiatrist why he or she chose a particular antidepressant to treat your depression.

Regular exercise, observing healthy nutritional habits and sleeping at least six to eight hours every night will greatly enhance a speedy recovery and decrease the risk for future episodes.