Depression
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Contents |
Introduction
What Is Depression
Most people throughout their lives report feeling off-form or low from time to time and sometimes describe it as 'the blues' or 'down in the dumps' or 'being demotivated'. For most people transient feelings such as these are quite common and usually pass in a few days or weeks. However for some people these feelings persist and do not pass. In fact they can become worse over time and become more and become more debilitating to the person as they try to go about daily life. It can reach the point where the person can not see any way forward and may contemplate suicide. This situation is called Clinical Depression[1] and is to be distinguished from the normal 'blues' or 'sadness' that all people suffer from time to time.
Within the general term of clinical depression there exists sub categories of depression.
Types of Depression - Classifications
A controversial subject, the classifications of depression and mood disorders has been pretty much standardised by the introduction of the Diagnostic and Statistical Manual (DSM) of Mental Disorders [1] and the ICD-10 [2] (the 10th version of the International Classification of Diseases, published by the World Health Organisation).
Major Depression
Major Depression is a change in mood that lasts for weeks or months. It is one of the most severe types of depression. It usually involves a low or irritable mood and/or a loss of interest or pleasure in usual activities. It interferes with one's normal functioning and often include physical symptoms. A person may experience only one episode of major depression, but often there are repeated episodes over an individual's lifetime.
Dysthymia
Dysthymia is less severe than major depression but usually goes on for a longer period, often several years. There are usually periods of feeling fairly normal between episodes of low mood. The symptoms usually do not completely disrupt one's normal activities.
Cyclothymia
Cyclothymic Disorder involves alternating hypomania and depressive episodes. Like bipolar, cyclothymia involves cycling between highs and lows, but it never reaches full mania or major depression. It was previously called cycloid personality. Over a lifetime, the chances of having Cyclothymic Disorder are from 0.4% to 1%. Since it can be so mild, it frequently goes undiagnosed.
Bipolar Disorder
Bipolar disorder involves episodes of depression, usually severe, alternating with episodes of extreme elation called mania. This condition is sometimes called by its older name, Manic Depression. The depression that is associated with bipolar disorder is often referred to as bipolar depression. When depression is not associated with bipolar disorder, it is called a unipolar depression. Bipolar Depression has also been split off in to Biploar 1 and Bipolar 2, where Biploar 2 is considered a lesser manic form of the condition but is a precursor for Biploar 1.
Seasonal Depression
Seasonal Affective Disorder or SAD, is depression that occurs only at a certain time of the year, usually winter, when the number of daylight hours is lower. It is sometimes called "winter blues." Although it is predictable, it can be very severe. It is thought to be related to a lack of sunlight which generates melatonin a 'feel good' chemical within the body.
Psychotic Depression
This refers to the situation when depression and hallucinations or delusions are experienced at the same time (co-occur). This may be the result of depression that becomes so severe that it results in the sufferer losing touch with reality. Individuals that primarily suffer from a loss of touch with reality (for example, schizophrenia) are thought to suffer from an imbalance of dopamine activity in the brain and to be at risk of subsequently becoming depressed.
Causes of Depression
The cause of depression is largely still unknown although several 'risk factors' have been identified. Depression has no single cause; often, it results from a combination of things. There is generally an emotional side to this as well as a physical side but as to what caused what i.e. did the physical cause the emotional or the emotional cause the physical, is still a matter of debate. Pure scientists stick with the biochemical neurotransmitter view that the cause can be purely explained in terms of chemistry. Others take a more holistic view and believe that stress either in the present (death of loved one, marriage break up etc) or some repressed stress event from the past (abuse, loosing a parent etc) can cause a physical biochemical imbalance (serotonin imbalance) and hence this is the root cause. Whatever its cause, depression is not just a state of mind, it is related to physical changes in the brain, and is a very real experience for the sufferer.
Some of the more common factors involved in depression are:
- Family History. Genetics play an important part in depression. It can run in families for generations.
- Trauma and stress. Things like financial problems, the breakup of a relationship, or the death of a loved one can bring on depression. People can become depressed after changes in their life, like starting a new job, graduating from school, or getting married.
- State of Mind. People who have low self-esteem and a negative outlook are at higher risk of becoming depressed. These traits may actually be caused by low-level depression (dysthymia).
- Physical conditions. Serious medical conditions like heart disease, cancer, and HIV can contribute to depression, partly because of the physical weakness and stress they bring on. Depression can make medical conditions worse, since it weakens the immune system and can make pain harder to bear. In some cases, depression can be caused by medications used to treat medical conditions.
Other psychological disorders. Anxiety disorders, eating disorders, schizophrenia, and (especially) substance abuse often appear along with depression.
How Many People Are Affected?-Statistics
- Clinical depression affects about 19 million Americans annually.
- It is estimated to contribute to half of all suicides.
- About 5%-10% of women and 2%-5% of men will experience at least one major depressive episode during their adult life.
- Depression affects people of all races, incomes, ages, and ethnic and religious backgrounds,
- Depression is three to five times more common in the elderly than in young people.
- Men in general have up to 3 times the rates of suicide of women
Interventions and Challenges
There are various treatments for depression and will vary depending on the severity. Some of these include;
Anti Depressive Medications
Medication for depression has been the treatment of choice right up the 1980s where alternative therapies were not available and were viewed in general terms as 'quackery'. The mainline medical view of depression was that of a chemical imbalance that needed correction by some form of other chemical i.e. drug. As a result drugs such as Valium, were overprescribed and many were left with an almost bigger problem that the original depression i.e. they became addicted to the drugs. Other anti-depressive drugs include;
- Selective Serotonin Reuptake Inhibitors (SSRIs) [3] such as Prozac, Lexapro and Seroxat. These drugs take up to 1 month to build up sufficient levels within the system to be effective.
- Monoamine oxidase inhibitors (MAOIs) [4] Due to the potential for serious dietary and drug interactions these are prescribed less frequently than other classes of antidepressant medications, such as Selective Serotonin Reuptake Inhibitors (SSRIs) or Trycyclics. However, in some cases where individuals prove unresponsive to other treatments, MAOIs have been tried with marked success. examples include Marplan, Phenylzine and Nardil.
Other 'herbal' remedies for depression are common including St Johns Wort , Kava and 5HTP. Many of these are unregulated and therefore their availability varies depending on country. For instance St Johns Wort is unavailable in Ireland yet in Germany is prescribed more often by GPs than Prozac.
Psychotherapy and Counseling
More widely accepted these days is the area of psychotherapy and counseling. 'Talk Therapies' are very common and it is generally accepted that these (sometimes in conjnction with medication) can be very effective. There are different approaches to psychotherapy from the Freudian/Jungian based childhood analysis that concentrates on earlier often childhood experiences and traumas to the so called here-and-now Humanistic (Rogerian) Talk therapies. Others include Cognitive Behavioral Therapy (CBT) and Gestalt Therapy which are focused on re-organising the thought system and essentially 're-programming' the psyche. In Japan, counseling is also used, sometimes including the patient's family as part of the process. There are also companies that provide counseling face-to-face, by telephone, and via the internet, such as Peacemind.
Holistic Body Treatments
These treatments are based on the energy lines of the body (meridians and chakras) and come from the Eastern traditions where strong belief exists in the purity of these energy centres. Therapies aimed at 'unblocking' these centres include Acupuncture, Reiki healing, Reflexology, and Indian Head Massage.
Electro Convulsive Therapy (ECT)
A very controversial therapy that is not so widely practised these days, ECT [5] involves the passing of an electric current between the two frontal lobes of the brain, while the patient is under anaesthetic. This treatment is only used for severe cases of depression where drugs and other therapies have completely failed and the patient is contemplating or has attempted suicide. Through the film industry ECT has received a very bad name, however the data shows that it can be effective as a last line when all other approaches have failed. Typically patients need two to three treatments for a number of weeks during the treatment period. Patients report being 'confused' for periods prior to the treatment and suffer short term memory loss.
Related Interventions in CAPSIL:
References
- ↑ "Diagnostic and Statistical Manual of Mental Disorders", Fourth Edition - Text Revision (DSMIV-TR). American Psychiatric Association (Pub.)
- ↑ http://en.wikipedia.org/wiki/ICD
- ↑ http://www.emedicinehealth.com/ssris_and_depression/article_em.htm
- ↑ http://www.mayoclinic.com/health/maois/MH00072
- ↑ http://www.medicinenet.com/electroconvulsive_therapy/article.htm
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