Depression is our most common mental disorder. It afflicts an estimated
50 million Americans, 35 million of whom receive some form of
treatment. All of us can be affected, regardless of age and social or
economic status. Although it is generally assumed that the disorder is
more prevalent among women than men, it may well be that men are
equally affected, but that women are more likely to seek help.
Common Characteristics of Depression
Now and then, everyone feels down; differentiating normal
sadness from clinical depression is sometimes difficult. In response to
life circumstances--for example, the loss of a loved one or job, or an
illness--all of us become sad, and some of us become depressed--a
condition commonly referred to as reactive depression. Others,
particularly people with a family history of depression, seem to have
an inherited tendency for depression and may become depressed in the
absence of obvious external distress or upset.
Diagnosis of Depression
The American Psychiatric Association has defined depression, in
part, as "loss of interest or pleasure in all or almost all usual
activities and pastimes." As a clinical condition, depression is
usually identified by the extent to which its symptoms interfere with
normal functioning. In contrast, the feelings of melancholy that are a
natural consequence of stressful or sorrowful life events are more
transitory. Grief is dealt with more or less philosophically, the sense
of self remains intact and the daily round of involvements is resumed.
Stressful circumstances that can result in depression may occur
at any age from infancy through old age. Hereditary depression also may
occur at any age, and it tends to recur. Very often, it alternates with
periods of extreme euphoria--a condition often referred to as
manic-depression.
In diagnosing depression, at least four of the following
symptoms must be present most of the time for a minimum of two weeks
(except in children under 6 years of age, in which case at least three
of the first four must be noted): (1) altered eating habits, manifested
by marked increase or decrease in appetite and significant change in
weight; (2) insomnia or excessive sleepiness; (3) hyperactivity or
slowed movement; (4) loss of interest or pleasure in usual activities
or decrease in sexual drive; (5) loss of energy or fatigue; (6)
feelings of worthlessness, guilt or self-reproach; (7) reduced ability
to concentrate or think, and (8) recurrent thoughts of death or suicide
or attempted suicide.
Some symptoms of depression, such as feelings of guilt or inadequacy,
may be apparent only to the person experiencing them. But these
feelings in turn bring about changes in attitudes and behavior that are
noticeable to friends, family, colleagues: a withdrawal from the usual
relationships; an inability to find pleasure in the normal joys of
living; overreacting to the minor irritations of daily life; emotional
instability and inexplicable mood swings; impaired concentration;
crying spells, anxiety attacks and an increasing inability to get out
of bed in the morning to face the day's responsibilities.
Physical symptoms also may appear--insomnia, headaches,
gastrointestinal disturbances and, in some cases, a change in appetite
or sexual function.
A child of any age may be sending out signals for help in
dealing with a depression when he or she complains of headaches and
cramps with no physical cause; refuses to see friends; has raging
tantrums for no reason; neglects schoolwork, and is self-destructive.
A transitory post-partum depression--also known as
"after-the-baby blues"--is a common and normal condition that may
affect both parents. However, if the new mother's feelings of
helplessness or entrapment and resentment persist to the point where
she keeps losing sleep or is afraid to handle the baby because she
thinks she might harm it, professional help is needed.
Depression may also manifest itself as a reaction--probably
biochemical--to such infectious diseases as hepatitis, mononucleosis
and tuberculosis. A number of drugs, particularly central nervous
system depressants, or "downers," especially alcohol and barbiturates
among others, also may be responsible for feelings of depression.
Treatment of Depression
Some people with a genetic tendency to recurrent sieges of mild
depression are able to deal with the problem without medication. They
find relief in working at meaningful and productive tasks, in spending
time with friends who enhance their self-esteem or in regularly
scheduling strenuous exercise, which may be alternated with periods of
relaxation or medication.
In many patients, antidepressant drugs along with or followed by
counseling may be required. Most studies have shown that psychotherapy
and medication are complementary and additive in value. The medication
seems to affect the specific symptoms and the psychotherapy affects the
problems of living. The most commonly prescribed types of drugs are:
Tricyclic antidepressants. These drugs work through the central
nervous system to relieve the symptoms. Most take several days or even
up to four to six weeks to have their full effect. Some tricyclic
antidepressants are combined with anti-anxiety agents if anxiety is
present.
Monoamine oxidase (MAO) inhibitors. These drugs block the action
of an enzyme that aids in the breakdown of certain chemicals in the
brain. They are faster acting than the tricyclic antidepressants,
usually working within several days. People taking MAO inhibitors must
be careful not to eat foods containing tyramine--for example, certain
types of ripe cheese or red wine--because the combination may lead to
dangerously elevated blood pressure. They should obtain a diet sheet
from their physician with details of foods to be avoided.
Lithium salts. These are naturally occurring crystalline salts,
used to treat manic depression, a disorder marked by extreme mood
swings from exhilaration to deep depression. They may be given in
combination with an anti-depressive drug during the acute phase, and
then be taken alone to prevent the mood swings. The lithium dosage
should be carefully monitored by a doctor, since even a slight overdose
may have toxic effects.
Other non-drug treatments are also available, and may be
recommended, depending upon the severity and duration of the
depression.
Summing Up
Depression can be a serious illness that interferes with one's ability
to function and cope with life's adversities. Fortunately, a number of
effective treatments for depression have been developed, and most
people now recognize that telling a depressed person to "buck up" is
not likely to do any good. Most cases of depression improve within a
few months of treatment. Even when symptoms continue beyond that time,
they are likely to be sufficiently alleviated so that the patient can
resume most normal activities; at the same time, he can learn how to
avoid unnecessarily stressful situations and achieve an increasing
level of equanimity through an individually prescribed combination of
self-awareness, suitable medication and--where indicated--a program of
counseling, psychotherapy or other treatments.
treatment. All of us can be affected, regardless of age and social or
economic status. Although it is generally assumed that the disorder is
more prevalent among women than men, it may well be that men are
equally affected, but that women are more likely to seek help.
Common Characteristics of Depression
Now and then, everyone feels down; differentiating normal
sadness from clinical depression is sometimes difficult. In response to
life circumstances--for example, the loss of a loved one or job, or an
illness--all of us become sad, and some of us become depressed--a
condition commonly referred to as reactive depression. Others,
particularly people with a family history of depression, seem to have
an inherited tendency for depression and may become depressed in the
absence of obvious external distress or upset.
Diagnosis of Depression
The American Psychiatric Association has defined depression, in
part, as "loss of interest or pleasure in all or almost all usual
activities and pastimes." As a clinical condition, depression is
usually identified by the extent to which its symptoms interfere with
normal functioning. In contrast, the feelings of melancholy that are a
natural consequence of stressful or sorrowful life events are more
transitory. Grief is dealt with more or less philosophically, the sense
of self remains intact and the daily round of involvements is resumed.
Stressful circumstances that can result in depression may occur
at any age from infancy through old age. Hereditary depression also may
occur at any age, and it tends to recur. Very often, it alternates with
periods of extreme euphoria--a condition often referred to as
manic-depression.
In diagnosing depression, at least four of the following
symptoms must be present most of the time for a minimum of two weeks
(except in children under 6 years of age, in which case at least three
of the first four must be noted): (1) altered eating habits, manifested
by marked increase or decrease in appetite and significant change in
weight; (2) insomnia or excessive sleepiness; (3) hyperactivity or
slowed movement; (4) loss of interest or pleasure in usual activities
or decrease in sexual drive; (5) loss of energy or fatigue; (6)
feelings of worthlessness, guilt or self-reproach; (7) reduced ability
to concentrate or think, and (8) recurrent thoughts of death or suicide
or attempted suicide.
Some symptoms of depression, such as feelings of guilt or inadequacy,
may be apparent only to the person experiencing them. But these
feelings in turn bring about changes in attitudes and behavior that are
noticeable to friends, family, colleagues: a withdrawal from the usual
relationships; an inability to find pleasure in the normal joys of
living; overreacting to the minor irritations of daily life; emotional
instability and inexplicable mood swings; impaired concentration;
crying spells, anxiety attacks and an increasing inability to get out
of bed in the morning to face the day's responsibilities.
Physical symptoms also may appear--insomnia, headaches,
gastrointestinal disturbances and, in some cases, a change in appetite
or sexual function.
A child of any age may be sending out signals for help in
dealing with a depression when he or she complains of headaches and
cramps with no physical cause; refuses to see friends; has raging
tantrums for no reason; neglects schoolwork, and is self-destructive.
A transitory post-partum depression--also known as
"after-the-baby blues"--is a common and normal condition that may
affect both parents. However, if the new mother's feelings of
helplessness or entrapment and resentment persist to the point where
she keeps losing sleep or is afraid to handle the baby because she
thinks she might harm it, professional help is needed.
Depression may also manifest itself as a reaction--probably
biochemical--to such infectious diseases as hepatitis, mononucleosis
and tuberculosis. A number of drugs, particularly central nervous
system depressants, or "downers," especially alcohol and barbiturates
among others, also may be responsible for feelings of depression.
Treatment of Depression
Some people with a genetic tendency to recurrent sieges of mild
depression are able to deal with the problem without medication. They
find relief in working at meaningful and productive tasks, in spending
time with friends who enhance their self-esteem or in regularly
scheduling strenuous exercise, which may be alternated with periods of
relaxation or medication.
In many patients, antidepressant drugs along with or followed by
counseling may be required. Most studies have shown that psychotherapy
and medication are complementary and additive in value. The medication
seems to affect the specific symptoms and the psychotherapy affects the
problems of living. The most commonly prescribed types of drugs are:
Tricyclic antidepressants. These drugs work through the central
nervous system to relieve the symptoms. Most take several days or even
up to four to six weeks to have their full effect. Some tricyclic
antidepressants are combined with anti-anxiety agents if anxiety is
present.
Monoamine oxidase (MAO) inhibitors. These drugs block the action
of an enzyme that aids in the breakdown of certain chemicals in the
brain. They are faster acting than the tricyclic antidepressants,
usually working within several days. People taking MAO inhibitors must
be careful not to eat foods containing tyramine--for example, certain
types of ripe cheese or red wine--because the combination may lead to
dangerously elevated blood pressure. They should obtain a diet sheet
from their physician with details of foods to be avoided.
Lithium salts. These are naturally occurring crystalline salts,
used to treat manic depression, a disorder marked by extreme mood
swings from exhilaration to deep depression. They may be given in
combination with an anti-depressive drug during the acute phase, and
then be taken alone to prevent the mood swings. The lithium dosage
should be carefully monitored by a doctor, since even a slight overdose
may have toxic effects.
Other non-drug treatments are also available, and may be
recommended, depending upon the severity and duration of the
depression.
Summing Up
Depression can be a serious illness that interferes with one's ability
to function and cope with life's adversities. Fortunately, a number of
effective treatments for depression have been developed, and most
people now recognize that telling a depressed person to "buck up" is
not likely to do any good. Most cases of depression improve within a
few months of treatment. Even when symptoms continue beyond that time,
they are likely to be sufficiently alleviated so that the patient can
resume most normal activities; at the same time, he can learn how to
avoid unnecessarily stressful situations and achieve an increasing
level of equanimity through an individually prescribed combination of
self-awareness, suitable medication and--where indicated--a program of
counseling, psychotherapy or other treatments.
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