Depression

+ Signs and Symptoms

Symptoms of depression do not necessarily come on suddenly; often, they can creep up slowly, evident in a gradual withdrawal from normal life activities. Depression can also develop in relation to a distinct event, such as a death or other loss, family problems, divorce, etc.

The hallmarks of major depression are feelings of sadness and hopelessness, although they are not always present. Each individual may experience it differently in terms of the severity, frequency and duration of symptoms. The following are the most common symptoms of depression. The American Psychiatric Association suggests that professional help is advisable for those who have four or more of the following symptoms continually for more than two weeks:

• Prolonged sadness or unexplained crying spells
• Feelings of hopelessness, pessimism or indifference
• Feelings of guilt, worthlessness, or helplessness
• Disturbed thinking – beliefs not based in reality
• Irritability, anger, agitation, restlessness
• Loss of interest and pleasure in activities formerly enjoyed
• Social withdrawal
• Fatigue and decreased energy; feeling slowed down
• Difficulty concentrating, thinking or remembering details
• Inability to make decisions
• Sleep problems: inability to sleep, fitful sleep, early-morning wakefulness, or sleeping too much
• Physical symptoms, such as headaches, digestive problems or chronic pain that do not improve with treatment
• Noticeable change of appetite, with either significant weight loss without dieting, or weight gain
• Recurring thoughts of death or suicide, or suicide attempts – Individuals with this symptom should receive treatment immediately! Get help now

+ There are several forms of depressive disorders

Major Depressive Disorder is characterized by symptoms that interfere with a person’s ability to work, sleep, study, eat and enjoy life, which can range from mild to severe. Most often, individuals with major depression will have several episodes of depression over their lifetime, but some people may have only a single episode.

Persistent Depressive Disorder is characterized by a depressed mood that lasts for at least two years. Individuals diagnosed with persistent depressive disorder may have episodes of major depression as well as periods with less severe symptoms.

Disruptive Mood Dysregulation Disorder (DMDD) is a childhood condition of extreme irritability, anger, and frequent, intense temper outbursts. DMDD symptoms go beyond a being a “moody” child—children with DMDD experience severe impairment that requires clinical attention. DMDD is a fairly new diagnosis, appearing for the first time in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published in 2013.DMDD symptoms typically begin before the age of 10, but the diagnosis is not given to children under 6 or adolescents over 18. A child with DMDD experiences:

• Irritable or angry mood most of the day, nearly every day
• Severe temper outbursts (verbal or behavioral) at an average of three or more times per week that are out of keeping with the situation and the child’s developmental level
• Trouble functioning due to irritability in more than one place (e.g., home, school, with peers)

To be diagnosed with DMDD, a child must have these symptoms steadily for 12 or more months.

Premenstrual Dysphoric Disorder (PMDD) is a health problem that is similar to premenstrual syndrome (PMS) but is more serious. PMDD causes severe irritability, depression, or anxiety in the week or two before your period starts. Symptoms usually go away two to three days after your period starts. You may need medicine or other treatment to help with your symptoms.

Depression may have psychotic features such as disturbing false beliefs (delusions) or hearing or seeing upsetting things that others cannot hear or see (hallucinations). Depression may occur in a seasonal pattern, which is characterized by the onset of depression during the winter months when there is less natural sunlight. This form of depression generally lifts during spring and summer. In addition, depression may occur with peripartum onset: that is, during or after pregnancy. This occurrence of depression is experienced by an estimated 10-15 percent of women after giving birth. It is much more serious than common “baby blues” when many women feel overwhelmed with the responsibility of caring for a newborn.

+ Depression in Older Adults

Although it is closely associated with dependency and disability in older adults, depression is not a normal part of growing old, and causes great suffering for the individual and family alike. Older adults with depression may have less obvious symptoms, or may be less likely to admit to feelings of sadness or grief. Certain medications and medical conditions may also cause or contribute to depression.

+ Depression in Children and Young People

Young children with depression may pretend to be sick, refuse to go to school, cling to a parent or worry that a parent will die. Older children or teens may be irritable or get into trouble at school. Diagnosis can be more difficult in young people because of normal developmental mood swings.

+ How Common Are Depressive Disorders?

Major depressive disorder is one of the most common mental disorders in the United States. According to the National Institute of Mental Health, approximately 6.7 percent of U.S. adults experience major depressive disorder each year. Women are nearly twice as likely as men to experience depression during their lifetimes. Depression affects more than 6.5 million of the 35 million Americans aged 65 years or older. In addition, 3.3 percent of teenagers (13 to 18 years old) have experienced a seriously debilitating depressive disorder. Fortunately, it is a highly treatable disorder.

+ Diagnosis

The first step to getting appropriate treatment is to visit a physician or mental health specialist. A doctor should conduct a thorough diagnostic evaluation to rule out other medical causes for the symptoms of depression, such as a thyroid disorder, vitamin B12 deficiency, virus or certain medications. The evaluation should include a physical exam, an interview and lab tests. If the doctor finds no medical condition causing the depression, he or she may refer you to a mental health professional for an evaluation.

+ Treatment

The good news is that even the most severe cases of depression can be treated effectively, and nearly all find some relief from symptoms. The sooner treatment can begin, the better the results. Depending on the results of evaluations, depressive disorders are commonly treated with medication, psychotherapy or a combination of the two. The specific depression treatment prescribed will depend on the individual’s age, general state of health and medical history, as well as the extent of the depression, among other factors.

Medication

Antidepressants may be prescribed to correct imbalances in the levels of chemicals in the brain called neurotransmitters, especially serotonin and norepinephrine. Other antidepressant medications act on the neurotransmitter dopamine. Patients may experience some improvement within the first week or two of treatment. However it can take two to three months to realize the full benefits. If there has been little to no improvement after several weeks, their doctor will alter the dose of the medication, or will add or substitute another medication. Typically, psychiatrists will advise patients to take medication for depression for six months or longer after symptoms have improved. If there have been two or three episodes of major depression, they may recommend long-term maintenance treatment to reduce the risk of future episodes. Psychiatrists sometimes use other types of medications to increase the effectiveness of antidepressant medications or to target specific symptoms, such as medications for sleep and anxiety, antipsychotic medications, lithium, and thyroid medications.

Psychotherapy

For mild to moderate depression, psychotherapy, “or talk therapy,” may be the best option. However, for moderate to severe depression, or for certain people, psychotherapy is often coupled with antidepressant medications. Therapy may be provided by a psychiatrist, a psychologist, a social worker, a counselor or a psychiatric nurse. Providing educational and emotional support, psychotherapy focuses on helping people with depression cope with their symptoms and feelings, change behaviors that may contribute to depression, and find effective solutions to psychosocial problems. Cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT) are effective in treating depression. CBT helps people with depression restructure negative thought patterns. IPT helps people understand and work through troubled relationships that may cause their depression or make it worse.

Electroconvulsive therapy (ECT)

Electroconvulsive therapy is a medical treatment that involves a brief electrical stimulation of the brain while the patient is under anesthesia. One of psychiatry’s oldest and most effective treatments, ECT is indicated for treating severe major depression in patients:

• Whose severe major depression does not respond to medication and psychotherapy
• Who cannot tolerate medication, such as women who are pregnant
• Who cannot participate effectively in therapy
• Who have certain life-threatening or serious psychiatric conditions requiring urgent intervention

Formerly known as “shock therapy,” ECT has been greatly improved and is used to treat about 100,000 patients with depression each year. Usually, patients will require several treatments over the course of 2-3 weeks.

Transcranial Magnetic Stimulation (TMS)

Transcranial magnetic stimulation (TMS) is a helpful, noninvasive procedure for treating primarily milder cases of depression. Approved by the Food and Drug Administration in 2008, it is another option for patients who have not found relief from medication, or who cannot – or choose not to – take medications. A special electromagnetic coil is placed against the scalp by the forehead, and it sends short bursts of magnetic energy to stimulate nerve cells in the shallow part of the brain involved with mood regulation. TMS treatments can be performed in a physician’s office without anesthesia. To be effective, patients typically must undergo daily treatments lasting 30 to 60 minutes for four to six weeks.

+ Co-occurring Conditions

Other psychiatric illnesses may come on before or after the onset of a depressive disorder, but depression and other illnesses interact differently in different people. In any case, co-occurring illnesses need to be diagnosed and treated. Some of the most common psychiatric disorders that can co-occur with depression are anxiety disorders, such as post-traumatic stress disorder (PTSD); obsessive-compulsive disorder (OCD); panic disorder; social phobia; generalized anxiety disorder (GAD); and alcohol and drug use disorders.