Depression (Short Version)

Depression (major depressive disorder or clinical depression) is a common but serious mood disorder. It causes severe symptoms that affect how you feel, think, and handle daily activities, such as sleeping, eating, or working.

If you have been experiencing some of the following signs and symptoms most of the day, nearly every day, for at least two weeks, you may be suffering from depression:

·       Persistent sad, anxious, or "empty" mood

·       Feelings of hopelessness, or pessimism

·       Irritability

·       Feelings of guilt, worthlessness, or helplessness

·       Loss of interest or pleasure in hobbies and activities

·       Decreased energy or fatigue

·       Moving or talking more slowly

·       Feeling restless or having trouble sitting still

·       Difficulty concentrating, remembering, or making decisions

·       Difficulty sleeping, early-morning awakening, or oversleeping

·       Appetite and/or weight changes

·       Thoughts or acts of self-harm

·       Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment

Depression, even the most severe cases, can be treated. The earlier that treatment can begin, the more effective it is. Depression is usually treated with medication, psychotherapy, or a combination of the two.

Depression (Long Version)

Introduction

Depression (major depressive disorder or clinical depression) is a common but serious mood disorder. It causes severe symptoms that affect how you feel, think, and handle daily activities, such as sleeping, eating, or working. To be diagnosed with depression, the symptoms must be present for at least two weeks.

Depression is one of the most common mental disorders in the world. Current research suggests that depression is caused by a combination of genetic, biological, environmental, and psychological factors.

Depression can happen at any age, but often begins in adulthood. Depression is now recognized as occurring in children and adolescents, although it sometimes presents with more prominent irritability than low mood.

Depression, especially in midlife or older adults, can co-occur with other serious medical illnesses, such as diabetes, cancer, heart disease, and Parkinson's disease. These conditions are often worse when depression is present. A doctor experienced in treating these complicated illnesses can help work out the best treatment strategy.

The following are some of the risk factors for developing depression:

·       Personal or family history of depression

·       Major life changes, trauma, or stress

·       Certain physical illnesses and medications

Signs and Symptoms

If you have been experiencing some of the following signs and symptoms most of the day, nearly every day, for at least two weeks, you may be suffering from depression:

·       Persistent sad, anxious, or "empty" mood

·       Feelings of hopelessness, or pessimism

·       Irritability

·       Feelings of guilt, worthlessness, or helplessness

·       Loss of interest or pleasure in hobbies and activities

·       Decreased energy or fatigue

·       Moving or talking more slowly

·       Feeling restless or having trouble sitting still

·       Difficulty concentrating, remembering, or making decisions

·       Difficulty sleeping, early-morning awakening, or oversleeping

·       Appetite and/or weight changes

·       Thoughts of death or suicide, or suicide attempts

·       Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment

Not everyone who is depressed experiences every symptom. Some people experience only a few symptoms while others may experience many.

Treatment and Therapies

Depression, even the most severe cases, can be treated. The earlier that treatment can begin, the more effective it is. Depression is usually treated with medication, psychotherapy or a combination of the two. If these treatments do not reduce symptoms, electroconvulsive therapy (ECT) and other brain stimulation therapies may be options to explore.

A.   Medications

Antidepressants are medicines that treat depression. They may help improve the way your brain uses certain chemicals that control mood or stress. You may need to try several different antidepressant medicines before finding the one that improves your symptoms and has manageable side effects. A medication that has helped you or a close family member in the past will often be considered.

Antidepressants take time – usually 2 to 4 weeks – to work, and often, symptoms such as sleep, appetite, and concentration problems improve before mood lifts, so it is important to give medication a chance before reaching a conclusion about its effectiveness. If you begin taking antidepressants, do not stop taking them without the help of a doctor. Sometimes people taking antidepressants feel better and then stop taking the medication on their own, and the depression returns. When you and your doctor have decided it is time to stop the medication, usually after a course of 6 to 12 months, the doctor will help you slowly and safely decrease your dose. Stopping them abruptly can cause withdrawal symptoms.

B.   Psychotherapies

Several types of psychotherapy (also called "talk therapy" or, in a less specific form, counseling) can help people with depression. Examples of evidence-based approaches specific to the treatment of depression include cognitive-behavioral therapy (CBT), interpersonal therapy (IPT), and problem-solving therapy.

C.   Brain Stimulation Therapies

If medications do not reduce the symptoms of depression, electroconvulsive therapy (ECT) may be an option to explore. Based on the latest research:

·       ECT can provide relief for people with severe depression who have not been able to feel better with other treatments.

·       Electroconvulsive therapy can be an effective treatment for depression. In some severe cases where a rapid response is necessary or medications cannot be used safely, ECT can even be a first-line intervention.

·       Once strictly an inpatient procedure, today ECT is often performed on an outpatient basis. The treatment consists of a series of sessions, typically three times a week, for two to four weeks.

·       ECT may cause some side effects, including confusion, disorientation, and memory loss. Usually these side effects are short-term, but sometimes memory problems can linger, especially for the months around the time of the treatment course. Advances in ECT devices and methods have made modern ECT safe and effective for the vast majority of patients. Talk to your doctor and make sure you understand the potential benefits and risks of the treatment before giving your informed consent to undergoing ECT.

·       ECT is not painful, and you cannot feel the electrical impulses. Before ECT begins, a patient is put under brief anesthesia and given a muscle relaxant. Within one hour after the treatment session, which takes only a few minutes, the patient is awake and alert.