Depression

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Depressive disorders are psychiatric illnesses that affect mood, body, behavior and mind. Without treatment, symptoms can last for weeks, months or years.

These are the most prevalent types of depressive disorders:

1. Major depression - a combination of symptoms that interfere with the ability to work, sleep, eat and enjoy once pleasurable activities. Disabling episodes may occur one or more times in a lifetime.

2. Dysthymia - long-term, chronic symptoms that are not disabling but that keep people from functioning at their best or from feeling good. People with dysthymia may also experience major depressive episodes.

3. Bipolar disorder (formerly called manic-depression) - cycles of depression and elation or mania. Mood changes can be dramatic and rapid, but more often are gradual. It is often a chronic, recurring condition.

During any one-year period, approximately 18 million adults in the United States suffer from a depressive illness. Women are twice as likely as men to suffer from depression.

Some types of depression run in families. Bipolar disorder and major depression seem to do so sometimes.

Psychological makeup plays a role. People who have low self-esteem, are pessimistic or are easily overwhelmed by stress are prone to depression.

Major life traumas - serious losses, difficult relationships or any unwelcome changes in life patterns - can also trigger depression.

Depression frequently accompanies medical conditions (stroke, heart disease, cancer), other psychiatric disorders (anxiety disorders, eating disorders) and substance abuse.

People who are depressed may be at a higher risk of suicide, especially if their depression is not treated.

Symptoms of bipolar disorder and depression - and the severity of symptoms - vary with the individual.

Symptoms of depression include:
• persistent sad, anxious or empty mood
• feelings of hopelessness and pessimism
• loss of interest or pleasure in activities once enjoyed, including sex
• sleep disturbance
• appetite disturbance
• decreased energy, fatigue
• thoughts of death or suicide
• suicide attempts
• restlessness, irritability
• difficulty concentrating, remembering and making decisions
• persistent physical symptoms unresponsive to treatment

People with bipolar disorder have episodes of mania in addition to depression.

Symptoms of mania include:
• inappropriate elation
• severe insomnia
• grandiose ideas
• increased talking
• disconnected and racing thoughts
• increased sexual desire
• markedly increased energy
• poor judgment
• inappropriate social behavior

Antidepressant medications, psychotherapies, or both can help approximately 80 percent of those with depression, preventing or reducing the severity of episodes. However, nearly two-thirds of people with depression do not seek treatment.

1. Medications - A variety of antidepressant medications are used to treat major depression and dysthymia. Tricyclic antidepressants were discovered in the 1950s and 1960s and have been the standard of treatment for many years. These medications are safe and effective and have helped many people. Over the past decade, however, new medications called selective serotonin reuptake inhibitors (SSRIs) have come into use; among them is Prozac. These newer drugs are also safe and effective but tend to have fewer side effects than the older medications.

Antianxiety drugs or sedatives are sometimes prescribed with antidepressants to treat major depression and dysthymia.

Bipolar disorder or manic depression is usually treated with mood-stabilizing drugs. Sometimes mood-stabilizing drugs are cautiously combined with antidepressant medications.

2. Psychotherapy - Many forms of psychotherapy are effective in treating depression, including short-term therapies. Talking therapies help individuals resolve their problems through dialogue with the therapist. Behavioral therapies help people learn how to obtain more satisfaction and rewards through their own actions and help them unlearn the behavioral patterns that contribute to their depression.

3. Electroconvulsive therapy (ECT) - ECT can be useful for individuals whose depression is severe or life-threatening or who cannot take antidepressant medication.

The National Institutes of Health recently launched the first U.S. clinical trial of St. John's wort (Hypericum perforatum) to assess its effectiveness in treating depression; it is widely used in Europe for this purpose. In the United States, St. John's wort is available at many pharmacies and supermarkets as an herbal nutritional supplement. However, people who think that they might be depressed should be evaluated by a mental health provider before beginning self-treatment with this supplement.

Although depressive disorders essentially cannot be prevented, efforts to address low self-esteem and pessimism may help. Early identification and treatment can prevent a more severe manifestation of the disorder.