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What is depression?
Depression can make you feel hopeless and worthless and cause you to lose
interest in everyday activities such as work, hobbies or sex. Depression is
a common illness that costs billions in health care costs and lost productivity
in the United States each year, according to the National Institute of Mental
Depression is one of the world's oldest and most common ailments. It can
have both physical and psychological symptoms. Millions of Americans are estimated
to suffer from depression, a condition so widespread that it has been dubbed
"the common cold of mental illness".
While sadness touches all of our lives at different times, the illness of
depression can have enormous depth and staying power. Even the ancient Greeks
noted how disabling it could be, and that it was more than a passing bout of
sadness or dejection, or feeling down in the dumps. If you have ever suffered
from depression or been close to someone who has, you know that this illness
cannot be lifted at will or wished or joked away. A man in the grip of depression
can't solve his problems by showing a little more backbone. Nor can a woman
who is depressed simply shake off the blues.
Nearly 25 percent of U.S. adults have depression at some point. Many things
can trigger depression, such as serious illness, divorce or the death of a loved
one. Often a cause can't be found. Alone or along with psychotherapy, antidepressants
are widely used for depression. More than 80 percent of those with depression
feel better when they get the right treatment, according to NIMH.
Being depressed has nothing to do with personal weakness. Scientists developing
knowledge of brain chemistry and findings from brain imaging studies reveal
that changes in nerve pathways and brain chemicals called neurotransmitters
can affect your moods and thoughts. These neurological changes may bubble up
as symptoms of depression -- including derailed sleep, suppressed appetite, agitation,
exhaustion, or apathy. In addition, genetic studies show that although no single
gene prompts depression, a combination of genetic variations may heighten vulnerability
to this disease.
Even so, depression is widely misunderstood. Myths and misconceptions have
led many people to believe things about depression that simply are not true.
Depression is not a sign of weakness. It is not a lack of character or courage.
Being depressed is not abnormal. The most common complaint of people who seek
counseling is that of feeling depressed. In fact, it is estimated that over
six million people in the United States need professional help for depression.
Depressed people are not crazy. Many get better on their own or with help from
other people. Only a small percentage of depressed people need institutional
care. Mental depression is not the same as feeling blue. Everyone has times
of feeling blue. People often refer to these feelings by saying they are "depressed."
However, mental depression is more intense, lasts longer, and significantly
interferes with day-to-day activities.
Nerve pathways, chemistry, and genetics aren't the whole story, though. Depression
could be described as a lake fed by many streams. Its tributaries include traumatic
or stressful life events, such as the death of a loved one, and psychological
traits, such as a pessimistic outlook or a tendency toward isolation. An episode
of depression may result from one particularly powerful experience or from a
confluence of several factors. According to the National Institute of Mental
Health, during a given year approximately 1 in 10 adults will suffer from some
form of depression. Each episode usually affects a chain of people. It can fray
bonds between you and your family and friends by spoiling intimacy, sapping
emotional resources, and stealing the joy of shared pleasures.
Thankfully, years of research and breakthroughs have made this serious illness
easier to treat. Early recognition of the signs of depression is more common
than in the past. Newer treatments, such as drugs targeted at specific changes
in brain chemistry, can cut short otherwise crippling episodes. A variety of
drugs and therapies can also be combined to boost the likelihood of a full remission.
Just like a rash or heart disease, depression can take many forms. Definitions
of depression and the therapies designed to ease this disease's grip continue
to evolve. These shifts will continue to percolate through the field as more
research flows in.
Major depression may make you feel as though work, school, relationships,
and other aspects of your life have been derailed or put on hold indefinitely.
You feel constantly sad or burdened, or you lose interest in all activities,
even those you previously enjoyed. This holds true nearly all day, on most days,
and lasts at least two weeks.
Despite such wide variations, depression does have certain common patterns.
For example, women are almost twice as likely as men to suffer from depression.
And while major depression may start at any time in life, the initial episode
occurs, on average, during the mid-20s.
Depression or hopelessness may feel so paralyzing that you find it hard to
seek help. Even worse, you may believe that treatment could never overcome the
juggernaut bearing down. Yet nothing could be further from the truth. The vast
majority of people who receive proper treatment rebound emotionally within two
to six weeks and then take pleasure in life once again. When major depression
goes untreated, though, suffering can last for months.
While your body is designed to deal with many sources of stress, some varieties
may put you at greater risk for depression or anxiety. Research from the National
Institute of Mental Health has found that long-term or severe stresses have
far-reaching effects. For example, investigators studying a fairly small group
of women who had survived physical or sexual abuse in childhood noted that they
were more likely to have overly sensitive and longer-lasting reactions to stressful
experiences. And some animal studies have found that traumas early in life,
such as separation from a mother, can wreak long-lasting biological changes.
What causes depression?
It's often said that depression results from a chemical imbalance, but that
figure of speech doesn't capture how complex the disease is. Depression has
many causes, including genetic vulnerability and other influences such as life
events, illnesses, and medications.
There are few depression causes: the brain, nerve cell communication,
hormones and the hpa axis, early losses and life events and temperament, grief,
mood changes due medications, mood changes due medical problems, seasonal mood
changes and some other less common.
Popular lore has it that emotions reside in the heart. Science, though, tracks
the seat of your emotions to the brain. While researchers believe that brain
chemicals and neural pathways have a major impact on depression, their understanding
of the neurological underpinnings of mood is incomplete. The outer edges of
the puzzle appear to be in place, but scientists are working to fill huge gaps
Many people feel sad when summer wanes, but some actually develop depression
with the season's change. Known as seasonal affective disorder (SAD), this form
of depression affects about 1%–2% of the population, particularly women and
young people. Symptoms are similar to general depression and include lethargy,
loss of interest in once-pleasurable activities, irritability, inability to
concentrate, and a change in sleeping patterns, appetite, or both.
But can say the causes of depression are not entirely clear. Sometimes an
event will bring it on, but other times it will not. There is also evidence
that genetic and biochemical factors may play a role in the development of depression,
but that role remains to be more thoroughly researched. Also, some people may
be more prone to being depressed than others. This predisposition involves a
person's development, motivations for action, and his/her needs. When needs
become excessive, extreme, or distorted, the behavior that is exhibited to fill
them may be abnormal and depression producing.
Many experts believe that depression grows out of a combination of these
factors. They say that the body chemistry of some people gives them the tendency
toward depression, and then something in the life situation happens to trigger
that depression. This triggering event is different in different people, but
is often linked to some kind of loss, such as the loss of a loved one or of
a job, or the loss of roots when people move or leave home for the first time.
How drugs help depression
The brain communicates thoughts and feelings through special chemicals that
send messages. Two important chemical messengers, called neurotransmitters,
are serotonin and norepinephrine.
There is a strong connection between the amount of these chemicals in the
brain and mood. If levels of serotonin and norepinephrine get too low, people
usually feel depressed. Drugs can help improve levels of these brain chemicals.
The newer antidepressants, such as the selective serotonin reuptake inhibitors
(SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs), are popular
because they have fewer side effects than older medications, which include tricyclics
and monoamine oxidase inhibitors (MAOIs). Although both generations of drugs
help relieve depression, some people will respond to one type of drug, but not
Certain antidepressants can interact with other prescription and over-the-counter
medications, herbs, alcohol and even foods. Talk with your doctor or pharmacist
before starting treatment to find out about taking them with other substances
and other important precautions.
Children, teens and adults being treated with antidepressants, particularly
anyone being treated for depression, should be watched closely for worsening
of depression and for increased suicidal thinking or behavior. Close watching
may be especially important early in treatment or when the dose is changed -
either increased or decreased. Bring up your concerns immediately with a doctor.
Paxil may increase the risk for birth defects, particularly heart defects,
when women take it during the first three months of pregnancy, according to
a 2005 advisory from the Food and Drug Administration (FDA). The FDA is waiting
for the results of recent studies to better understand the higher risk. Discuss
with your doctor about the health risks of Paxil if you plan to become pregnant
or are in the first three months of pregnancy. You may want to consider taking
a different antidepressant. Do not stop taking the drug without first talking
to your doctor.
Tricyclics are an older class of antidepressants that work against depression,
but are more likely than SSRIs to cause side effects such as drowsiness, dry
mouth and constipation. Tricyclics work on the neurotransmitters called norepinephrine
Although some people begin to notice improvement in the first week or two
of treatment, most require four to six weeks of taking the medication before
they begin to feel better. Keep taking your medication, even if symptoms don't
improve right away. If after some time has passed and you don't feel any better,
a change in medication or adjustment in dose may be needed only with a doctor's
When treatment starts, your doctor may want to see you as often as every
week. This is to check dosage (how much and how often you take the medicine),
to watch for side effects (problems caused by the medicine) and to see how well
treatment is working. Once you start feeling better, you probably will visit
the doctor less often.
If you take antidepressants, keep all appointments whether you feel better
or worse so your doctor can check your progress and watch for side effects.
Write down your symptoms to help your doctor keep track of how you are doing.
Even though any antidepressant can cause side effects, not everyone gets
them or the same ones. Let your doctor know about any problems that you may
be having with medications. Whether you have problems or feel better with antidepressants,
do not stop your medication without talking to your doctor. Some medications
need to be tapered off slowly. If you stop antidepressants too soon, you increase
the chance of your depression returning.