DepressionHelp
Is there help for Depression?
YES,there is hope and help for depression! Please read the following articles onovercoming and beating depression.
Backgroundinformation on Depression
Inany given 1-year period, 9.5 percent of the population, or about 18.8 millionAmerican adults, suffer from a depressive illness. The economic cost for this disorder is high, but the cost in human sufferingcannot be estimated. Depressive illnesses often interfere with normalfunctioning and cause pain and suffering not only to those who have a disorder,but also to those who care about them. Serious depression can destroy familylife as well as the life of the ill person. But much of this suffering isunnecessary.
Mostpeople with a depressive illness do not seek treatment, although the greatmajority—even those whose depression is extremely severe—can be helped.Thanks to years of fruitful research, there are now medications and psychosocialtherapies such as cognitive/behavioral, "talk" or interpersonal thatease the pain of depression.
Unfortunately,many people do not recognize that depression is a treatable illness. If you feelthat you or someone you care about is one of the many undiagnosed depressedpeople in this country, the information presented here may help you take thesteps that may save your own or someone else's life.
Adepressive disorder is an illness that involves the body, mood, and thoughts. Itaffects the way a person eats and sleeps, the way one feels about oneself, andthe way one thinks about things. A depressive disorder is not the same as apassing blue mood. It is not a sign of personal weakness or a condition that canbe willed or wished away. People with a depressive illness cannot merely"pull themselves together" and get better. Without treatment, symptomscan last for weeks, months, or years. Appropriate treatment, however, can helpmost people who suffer from depression.
Depressivedisorders come in different forms, just as is the case with other illnesses suchas heart disease. This pamphlet briefly describes three of the most common typesof depressive disorders. However, within these types there are variations in thenumber of symptoms, their severity, and persistence.
Majordepression is manifested by a combination of symptoms (see symptom list) thatinterfere with the ability to work, study, sleep, eat, and enjoy oncepleasurable activities. Such a disabling episode of depression may occur onlyonce but more commonly occurs several times in a lifetime.
Aless severe type of depression, dysthymia, involves long-term, chronic symptomsthat do not disable, but keep one from functioning well or from feeling good.Many people with dysthymia also experience major depressive episodes at sometime in their lives.
Anothertype of depression is bipolar disorder, also called manic-depressive illness.Not nearly as prevalent as other forms of depressive disorders, bipolar disorderis characterized by cycling mood changes: severe highs (mania) and lows(depression). Sometimes the mood switches are dramatic and rapid, but most oftenthey are gradual. When in the depressed cycle, an individual can have any or allof the symptoms of a depressive disorder. When in the manic cycle, theindividual may be overactive, overtalkative, and have a great deal of energy.Mania often affects thinking, judgment, and social behavior in ways that causeserious problems and embarrassment. For example, the individual in a manic phasemay feel elated, full of grand schemes that might range from unwise businessdecisions to romantic sprees. Mania, left untreated, may worsen to a psychoticstate.
Noteveryone who is depressed or manic experiences every symptom. Some peopleexperience a few symptoms, some many. Severity of symptoms varies withindividuals and also varies over time.
Persistent sad, anxious, or "empty" mood
Feelings of hopelessness, pessimism
Feelings of guilt, worthlessness, helplessness
Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
Decreased energy, fatigue, being "slowed down"
Difficulty concentrating, remembering, making decisions
Insomnia, early-morning awakening, or oversleeping
Appetite and/or weight loss or overeating and weight gain
Thoughts of death or suicide; suicide attempts
Restlessness, irritability
Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain
Abnormal or excessive elation
Unusual irritability
Decreased need for sleep
Grandiose notions
Increased talking
Racing thoughts
Increased sexual desire
Markedly increased energy
Poor judgment
Inappropriate social behavior
Sometypes of depression run in families, suggesting that a biological vulnerabilitycan be inherited. This seems to be the case with bipolar disorder. Studies offamilies in which members of each generation develop bipolar disorder found thatthose with the illness have a somewhat different genetic makeup than those whodo not get ill. However, the reverse is not true: Not everybody with the geneticmakeup that causes vulnerability to bipolar disorder will have the illness.Apparently additional factors, possibly stresses at home, work, or school, areinvolved in its onset.
Insome families, major depression also seems to occur generation after generation.However, it can also occur in people who have no family history of depression.Whether inherited or not, major depressive disorder is often associated withchanges in brain structures or brain function.
Peoplewho have low self-esteem, who consistently view themselves and the world withpessimism or who are readily overwhelmed by stress, are prone to depression.Whether this represents a psychological predisposition or an early form of theillness is not clear.
Inrecent years, researchers have shown that physical changes in the body can beaccompanied by mental changes as well. Medical illnesses such as stroke, a heartattack, cancer, Parkinson's disease, and hormonal disorders can cause depressiveillness, making the sick person apathetic and unwilling to care for his or herphysical needs, thus prolonging the recovery period. Also, a serious loss,difficult relationship, financial problem, or any stressful (unwelcome or evendesired) change in life patterns can trigger a depressive episode. Very often, acombination of genetic, psychological, and environmental factors is involved inthe onset of a depressive disorder. Later episodes of illness typically areprecipitated by only mild stresses, or none at all.
Womenexperience depression about twice as often as men. Many hormonal factors may contribute to the increased rate of depression inwomen—particularly such factors as menstrual cycle changes, pregnancy,miscarriage, postpartum period, pre-menopause, and menopause. Many women alsoface additional stresses such as responsibilities both at work and home, singleparenthood, and caring for children and for aging parents.
Arecent NIMH study showed that in the case of severe premenstrual syndrome (PMS),women with a preexisting vulnerability to PMS experienced relief from mood andphysical symptoms when their sex hormones were suppressed. Shortly after thehormones were re-introduced, they again developed symptoms of PMS. Women withouta history of PMS reported no effects of the hormonal manipulation.
Manywomen are also particularly vulnerable after the birth of a baby. The hormonaland physical changes, as well as the added responsibility of a new life, can befactors that lead to postpartum depression in some women. While transient"blues" are common in new mothers, a full-blown depressive episode isnot a normal occurrence and requires active intervention. Treatment by asympathetic physician and the family's emotional support for the new mother areprime considerations in aiding her to recover her physical and mental well-beingand her ability to care for and enjoy the infant.
Althoughmen are less likely to suffer from depression than women, 3 to 4 million men inthe United States are affected by the illness. Men are less likely to admit todepression, and doctors are less likely to suspect it. The rate of suicide inmen is four times that of women, though more women attempt it. In fact, afterage 70, the rate of men's suicide rises, reaching a peak after age 85.
Depressioncan also affect the physical health in men differently from women. A new studyshows that, although depression is associated with an increased risk of coronaryheart disease in both men and women, only men suffer a high death rate.
Men'sdepression is often masked by alcohol or drugs, or by the socially acceptablehabit of working excessively long hours. Depression typically shows up in mennot as feeling hopeless and helpless, but as being irritable, angry, anddiscouraged; hence, depression may be difficult to recognize as such in men.Even if a man realizes that he is depressed, he may be less willing than a womanto seek help. Encouragement and support from concerned family members can make adifference. In the workplace, employee assistance professionals or worksitemental health programs can be of assistance in helping men understand and acceptdepression as a real illness that needs treatment.
Somepeople have the mistaken idea that it is normal for the elderly to feeldepressed. On the contrary, most older people feel satisfied with their lives.Sometimes, though, when depression develops, it may be dismissed as a normalpart of aging. Depression in the elderly, undiagnosed and untreated, causesneedless suffering for the family and for the individual who could otherwiselive a fruitful life. When he or she does go to the doctor, the symptomsdescribed are usually physical, for the older person is often reluctant todiscuss feelings of hopelessness, sadness, loss of interest in normallypleasurable activities, or extremely prolonged grief after a loss.
Recognizinghow depressive symptoms in older people are often missed, many health careprofessionals are learning to identify and treat the underlying depression. Theyrecognize that some symptoms may be side effects of medication the older personis taking for a physical problem, or they may be caused by a co-occurringillness. If a diagnosis of depression is made, treatment with medication and/orpsychotherapy will help the depressed person return to a happier, morefulfilling life. Recent research suggests that brief psychotherapy (talktherapies that help a person in day-to-day relationships or in learning tocounter the distorted negative thinking that commonly accompanies depression) iseffective in reducing symptoms in short-term depression in older persons who aremedically ill. Psychotherapy is also useful in older patients who cannot or willnot take medication. Efficacy studies show that late-life depression can betreated with psychotherapy.
Improvedrecognition and treatment of depression in late life will make those years moreenjoyable and fulfilling for the depressed elderly person, the family, andcaretakers.
Onlyin the past two decades has depression in children been taken very seriously.The depressed child may pretend to be sick, refuse to go to school, cling to aparent, or worry that the parent may die. Older children may sulk, get intotrouble at school, be negative, grouchy, and feel misunderstood. Because normalbehaviors vary from one childhood stage to another, it can be difficult to tellwhether a child is just going through a temporary "phase" or issuffering from depression. Sometimes the parents become worried about how thechild's behavior has changed, or a teacher mentions that "your childdoesn't seem to be himself." In such a case, if a visit to the child'spediatrician rules out physical symptoms, the doctor will probably suggest thatthe child be evaluated, preferably by a psychiatrist who specializes in thetreatment of children. If treatment is needed, the doctor may suggest thatanother therapist, usually a social worker or a psychologist, provide therapywhile the psychiatrist will oversee medication if it is needed. Parents shouldnot be afraid to ask questions: What are the therapist's qualifications? Whatkind of therapy will the child have? Will the family as a whole participate intherapy? Will my child's therapy include an antidepressant? If so, what mightthe side effects be?
TheNational Institute of Mental Health (NIMH) has identified the use of medicationsfor depression in children as an important area for research. The NIMH-supportedResearch Units on Pediatric Psychopharmacology (RUPPs) form a network of sevenresearch sites where clinical studies on the effects of medications for mentaldisorders can be conducted in children and adolescents. Among the medicationsbeing studied are antidepressants, some of which have been found to be effectivein treating children with depression, if properly monitored by the child'sphysician.
Thefirst step to getting appropriate treatment for depression is a physicalexamination by a physician. Certain medications as well as some medicalconditions such as a viral infection can cause the same symptoms as depression,and the physician should rule out these possibilities through examination,interview, and lab tests. If a physical cause for the depression is ruled out, apsychological evaluation should be done, by the physician or by referral to apsychiatrist or psychologist.
Agood diagnostic evaluation will include a complete history of symptoms, i.e.,when they started, how long they have lasted, how severe they are, whether thepatient had them before and, if so, whether the symptoms were treated and whattreatment was given. The doctor should ask about alcohol and drug use, and ifthe patient has thoughts about death or suicide. Further, a history shouldinclude questions about whether other family members have had a depressiveillness and, if treated, what treatments they may have received and which wereeffective.
Last,a diagnostic evaluation should include a mental status examination to determineif speech or thought patterns or memory have been affected, as sometimes happensin the case of a depressive or manic-depressive illness.
Treatmentchoice will depend on the outcome of the evaluation. There are a variety ofantidepressant medications and psychotherapies that can be used to treatdepressive disorders. Some people with milder forms may do well withpsychotherapy alone. People with moderate to severe depression most oftenbenefit from antidepressants. Most do best with combined treatment: medicationto gain relatively quick symptom relief and psychotherapy to learn moreeffective ways to deal with life's problems, including depression. Depending onthe patient's diagnosis and severity of symptoms, the therapist may prescribemedication and/or one of the several forms of psychotherapy that have proveneffective for depression.
Electroconvulsivetherapy (ECT) is useful, particularly for individuals whose depression is severeor life threatening or who cannot take antidepressant medication.ECT often is effective in cases where antidepressant medications do not providesufficient relief of symptoms. In recent years, ECT has been much improved. Amuscle relaxant is given before treatment, which is done under brief anesthesia.Electrodes are placed at precise locations on the head to deliver electricalimpulses. The stimulation causes a brief (about 30 seconds) seizure within thebrain. The person receiving ECT does not consciously experience the electricalstimulus. For full therapeutic benefit, at least several sessions of ECT,typically given at the rate of three per week, are required.
Thereare several types of antidepressant medications used to treat depressivedisorders. These include newer medications—chiefly the selective serotoninreuptake inhibitors (SSRIs)—the tricyclics, and the monoamine oxidaseinhibitors (MAOIs). The SSRIs—and other newer medications that affectneurotransmitters such as dopamine or norepinephrine—generally have fewer sideeffects than tricyclics. Sometimes the doctor will try a variety ofantidepressants before finding the most effective medication or combination ofmedications. Sometimes the dosage must be increased to be effective. Althoughsome improvements may be seen in the first few weeks, antidepressant medicationsmust be taken regularly for 3 to 4 weeks (in some cases, as many as 8 weeks)before the full therapeutic effect occurs.
Patientsoften are tempted to stop medication too soon. They may feel better and thinkthey no longer need the medication. Or they may think the medication isn'thelping at all. It is important to keep taking medication until it has a chanceto work, though side effects (see section on Side Effects on page 13) may appearbefore antidepressant activity does. Once the individual is feeling better, itis important to continue the medication for at least 4 to 9 months to prevent arecurrence of the depression. Some medications must be stopped gradually to givethe body time to adjust. Never stop taking an antidepressant without consultingthe doctor for instructions on how to safely discontinue the medication. Forindividuals with bipolar disorder or chronic major depression, medication mayhave to be maintained indefinitely.
Antidepressantdrugs are not habit-forming. However, as is the case with any type of medicationprescribed for more than a few days, antidepressants have to be carefullymonitored to see if the correct dosage is being given. The doctor will check thedosage and its effectiveness regularly.
Forthe small number of people for whom MAO inhibitors are the best treatment, it isnecessary to avoid certain foods that contain high levels of tyramine, such asmany cheeses, wines, and pickles, as well as medications such as decongestants.The interaction of tyramine with MAOIs can bring on a hypertensive crisis, asharp increase in blood pressure that can lead to a stroke. The doctor shouldfurnish a complete list of prohibited foods that the patient should carry at alltimes. Other forms of antidepressants require no food restrictions.
Medicationsof any kind—prescribed, over-the counter, or borrowed—should never be mixedwithout consulting the doctor. Other health professionals who may prescribe adrug—such as a dentist or other medical specialist—should be told of themedications the patient is taking. Some drugs, although safe when taken alonecan, if taken with others, cause severe and dangerous side effects. Some drugs,like alcohol or street drugs, may reduce the effectiveness of antidepressantsand should be avoided. This includes wine, beer, and hard liquor. Some peoplewho have not had a problem with alcohol use may be permitted by their doctor touse a modest amount of alcohol while taking one of the newer antidepressants.
Antianxietydrugs or sedatives are not antidepressants. They are sometimes prescribed alongwith antidepressants; however, they are not effective when taken alone for adepressive disorder. Stimulants, such as amphetamines, are not effectiveantidepressants, but they are used occasionally under close supervision inmedically ill depressed patients.
Questionsabout any antidepressant prescribed, or problems that may be related to themedication, should be discussed with the doctor.
Lithiumhas for many years been the treatment of choice for bipolar disorder, as it canbe effective in smoothing out the mood swings common to this disorder. Its usemust be carefully monitored, as the range between an effective dose and a toxicone is small. If a person has preexisting thyroid, kidney, or heart disorders orepilepsy, lithium may not be recommended. Fortunately, other medications havebeen found to be of benefit in controlling mood swings. Among these are twomood-stabilizing anticonvulsants, carbamazepine (Tegretol®) andvalproate (Depakote®). Both of these medications have gained wideacceptance in clinical practice, and valproate has been approved by the Food andDrug Administration for first-line treatment of acute mania. Otheranticonvulsants that are being used now include lamotrigine (Lamictal®)and gabapentin (Neurontin®): their role in the treatment hierarchyof bipolar disorder remains under study.
Mostpeople who have bipolar disorder take more than one medication including, alongwith lithium and/or an anticonvulsant, a medication for accompanying agitation,anxiety, depression, or insomnia. Finding the best possible combination of thesemedications is of utmost importance to the patient and requires close monitoringby the physician.
Antidepressantsmay cause mild and, usually, temporary side effects (sometimes referred to asadverse effects) in some people. Typically these are annoying, but not serious.However, any unusual reactions or side effects or those that interfere withfunctioning should be reported to the doctor immediately. The most common sideeffects of tricyclic antidepressants, and ways to deal with them, are:
Dry mouth—it is helpful to drink sips of water; chew sugarless gum; clean teeth daily.
Constipation—bran cereals, prunes, fruit, and vegetables should be in the diet.
Bladder problems—emptying the bladder may be troublesome, and the urine stream may not be as strong as usual; the doctor should be notified if there is marked difficulty or pain.
Sexual problems—sexual functioning may change; if worrisome, it should be discussed with the doctor.
Blurred vision—this will pass soon and will not usually necessitate new glasses.
Dizziness—rising from the bed or chair slowly is helpful.
Drowsiness as a daytime problem—this usually passes soon. A person feeling drowsy or sedated should not drive or operate heavy equipment. The more sedating antidepressants are generally taken at bedtime to help sleep and minimize daytime drowsiness.
Thenewer antidepressants have different types of side effects:
Headache—this will usually go away.
Nausea—this is also temporary, but even when it occurs, it is transient after each dose.
Nervousness and insomnia (trouble falling asleep or waking often during the night)—these may occur during the first few weeks; dosage reductions or time will usually resolve them.
Agitation (feeling jittery)—if this happens for the first time after the drug is taken and is more than transient, the doctor should be notified.
Sexual problems—the doctor should be consulted if the problem is persistent or worrisome.
Inthe past few years, much interest has risen in the use of herbs in the treatmentof both depression and anxiety. St. John's wort (Hypericum perforatum), an herbused extensively in the treatment of mild to moderate depression in Europe, hasrecently aroused interest in the United States. St. John's wort, an attractivebushy, low-growing plant covered with yellow flowers in summer, has been usedfor centuries in many folk and herbal remedies. Today in Germany, Hypericum isused in the treatment of depression more than any other antidepressant. However,the scientific studies that have been conducted on its use have been short-termand have used several different doses.
Becauseof the widespread interest in St. John's wort, the National Institutes of Health(NIH) conducted a 3-year study, sponsored by three NIH components—the NationalInstitute of Mental Health, the National Center for Complementary andAlternative Medicine, and the Office of Dietary Supplements. The study wasdesigned to include 336 patients with major depression of moderate severity,randomly assigned to an 8-week trial with one-third of patients receiving auniform dose of St. John's wort, another third sertraline, a selective serotoninreuptake inhibitor (SSRI) commonly prescribed for depression, and the finalthird a placebo (a pill that looks exactly like the SSRI and the St. John's wort,but has no active ingredients). The study participants who responded positivelywere followed for an additional 18 weeks. At the end of the first phase of thestudy, participants were measured on two scales, one for depression and one foroverall functioning. There was no significant difference in rate of response fordepression, but the scale for overall functioning was better for theantidepressant than for either St. John's wort or placebo. While this study didnot support the use of St. John's wort in the treatment of major depression,ongoing NIH-supported research is examining a possible role for St. John's wortin the treatment of milder forms of depression.
TheFood and Drug Administration issued a Public Health Advisory on February 10,2000. It stated that St. John's wort appears to affect an important metabolicpathway that is used by many drugs prescribed to treat conditions such as AIDS,heart disease, depression, seizures, certain cancers, and rejection oftransplants. Therefore, health care providers should alert their patients aboutthese potential drug interactions.
Someother herbal supplements frequently used that have not been evaluated inlarge-scale clinical trials are ephedra, gingko biloba, echinacea, and ginseng.Any herbal supplement should be taken only after consultation with the doctor orother health care provider.
Manyforms of psychotherapy, including some short-term (10-20 week) therapies, canhelp depressed individuals. "Talking" therapies help patients gaininsight into and resolve their problems through verbal exchange with thetherapist, sometimes combined with "homework" assignments betweensessions. "Behavioral" therapists help patients learn how to obtainmore satisfaction and rewards through their own actions and how to unlearn thebehavioral patterns that contribute to or result from their depression.
Twoof the short-term psychotherapies that research has shown helpful for some formsof depression are interpersonal and cognitive/behavioral therapies.Interpersonal therapists focus on the patient's disturbed personal relationshipsthat both cause and exacerbate (or increase) the depression.Cognitive/behavioral therapists help patients change the negative styles ofthinking and behaving often associated with depression.
Psychodynamictherapies, which are sometimes used to treat depressed persons, focus onresolving the patient's conflicted feelings. These therapies are often reserveduntil the depressive symptoms are significantly improved. In general, severedepressive illnesses, particularly those that are recurrent, will requiremedication (or ECT under special conditions) along with, or preceding,psychotherapy for the best outcome.
Depressivedisorders make one feel exhausted, worthless, helpless, and hopeless. Suchnegative thoughts and feelings make some people feel like giving up. It isimportant to realize that these negative views are part of the depression andtypically do not accurately reflect the actual circumstances. Negative thinkingfades as treatment begins to take effect. In the meantime:
Set realistic goals in light of the depression and assume a reasonable amount of responsibility.
Break large tasks into small ones, set some priorities, and do what you can as you can.
Try to be with other people and to confide in someone; it is usually better than being alone and secretive.
Participate in activities that may make you feel better.
Mild exercise, going to a movie, a ballgame, or participating in religious, social, or other activities may help.
Expect your mood to improve gradually, not immediately. Feeling better takes time.
It is advisable to postpone important decisions until the depression has lifted. Before deciding to make a significant transition—change jobs, get married or divorced—discuss it with others who know you well and have a more objective view of your situation.
People rarely "snap out of" a depression. But they can feel a little better day-by-day.
Remember, positive thinking will replace the negative thinking that is part of the depression and will disappear as your depression responds to treatment.
Let your family and friends help you.
Themost important thing anyone can do for the depressed person is to help him orher get an appropriate diagnosis and treatment. This may involve encouraging theindividual to stay with treatment until symptoms begin to abate (several weeks),or to seek different treatment if no improvement occurs. On occasion, it mayrequire making an appointment and accompanying the depressed person to thedoctor. It may also mean monitoring whether the depressed person is takingmedication. The depressed person should be encouraged to obey the doctor'sorders about the use of alcoholic products while on medication. The second mostimportant thing is to offer emotional support. This involves understanding,patience, affection, and encouragement. Engage the depressed person inconversation and listen carefully. Do not disparage feelings expressed, butpoint out realities and offer hope. Do not ignore remarks about suicide. Reportthem to the depressed person's therapist. Invite the depressed person for walks,outings, to the movies, and other activities. Be gently insistent if yourinvitation is refused. Encourage participation in some activities that once gavepleasure, such as hobbies, sports, religious or cultural activities, but do notpush the depressed person to undertake too much too soon. The depressed personneeds diversion and company, but too many demands can increase feelings offailure.
Donot accuse the depressed person of faking illness or of laziness, or expect himor her "to snap out of it." Eventually, with treatment, most people doget better. Keep that in mind, and keep reassuring the depressed person that,with time and help, he or she will feel better.
Ifunsure where to go for help, check the Yellow Pages under "mentalhealth," "health," "social services," "suicideprevention," "crisis intervention services,""hotlines," "hospitals," or "physicians" for phonenumbers and addresses. In times of crisis, the emergency room doctor at ahospital may be able to provide temporary help for an emotional problem, andwill be able to tell you where and how to get further help.
Listedbelow are the types of people and places that will make a referral to, orprovide, diagnostic and treatment services.
Family doctors
Mental health specialists, such as psychiatrists, psychologists, social workers, or mental health counselors
Health maintenance organizations
Community mental health centers
Hospital psychiatry departments and outpatient clinics
University- or medical school-affiliated programs
State hospital outpatient clinics
Family service, social agencies, or clergy
Private clinics and facilities
Employee assistance programs
Local medical and/or psychiatric societies
| "I am now the most miserable man living. If what I feel were equally distributed to the whole human family, there would be not one cheerful face on earth. Whether I shall ever be better, I cannot tell. I awfully forebode I shall not. To remain as I am is impossible. I must die or be better it appears to me." ----Abraham Lincoln
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Imagineattending a party with these prominent guests: Abraham Lincoln, TheodoreRoosevelt, Robert Schumann, Ludwig von Beethoven, Edgar Allen Poe, Mark Twain,Vincent van Gogh, and Georgia O'Keefe. Maybe Schumann and Beethoven are at thedinner table intently discussing the crescendos in their most recent scores,while Twain sits on a couch telling Poe about the plot of his latest novel.O'Keefe and Van Gogh may be talking about their art, while Roosevelt and Lincolndiscuss political endeavors.
Butin fact, these historical figures also had a much more personal commonexperience: Each of them battled the debilitating illness of depression.
Itis common for people to speak of how "depressed" they are. However,the occasional sadness everyone feels due to life's disappointments is verydifferent from the serious illness caused by a brain disorder. Depressionprofoundly impairs the ability to function in everyday situations by affectingmoods, thoughts, behaviors, and physical well-being.
Twenty-seven-year-oldAnne (not her real name) has suffered from depression for more than 10 years."For me it's feelings of worthlessness," she explains. "Feelinglike I haven't accomplished the things that I want to or feel I should have andyet I don't have the energy to do them. It's feeling disconnected from people inmy life, even friends and family who care about me. It's not wanting to get outof bed some mornings and losing hope that life will ever get better."
Depressionstrikes about 17 million American adults each year--more than cancer, AIDS, orcoronary heart disease--according to the National Institute of Mental Health (NIMH).An estimated 15 percent of chronic depression cases end in suicide. Women aretwice as likely as men to be affected.
Manypeople simply don't know what depression is. "A lot of people still believethat depression is a character flaw or caused by bad parenting," says MaryRappaport, a spokeswoman for the National Alliance for the Mentally Ill. Sheexplains that depression cannot be overcome by willpower, but requires medicalattention.
Fortunately,depression is treatable, says Thomas Laughren, M.D., team leader for psychiatricdrug products in FDA's division of neuropharmacological drug products.
Inthe past 13 years, the Food and Drug Administration has approved several newantidepressants, including Wellbutrin (bupropion), Prozac (fluoxetine), Zoloft (sertraline),Paxil (paroxetine), Effexor (venlafaxine), Serzone (nefazodone), and Remeron (mirtazapine).
Accordingto the American Psychiatric Association (APA), 80 to 90 percent of all cases canbe treated effectively. However, two-thirds of the people suffering fromdepression don't get the help they need, according to NIMH. Many fail toidentify their symptoms or attribute them to lack of sleep or a poor diet, theAPA says, while others are just too fatigued or ashamed to seek help.
Leftuntreated, depression can result in years of needless pain for both thedepressed person and his or her family. And depression costs the United Statesan estimated $43 billion a year, due in large part to absenteeism from work,lost productivity, and medical costs, according to the National Depressive andManic Depressive Association.
ThreeTypes
Thethree main categories of depression are major depression, dysthymia, and bipolardepression (sometimes referred to as manic depression).
Majordepression affects 15 percent of Americans at one point during their lives,according to the U.S. Department of Health and Human Services. Its effects canbe so intense that things like eating, sleeping, or just getting out of bedbecome almost impossible.
Majordepression "tends to be a chronic, recurring illness," Laughrenexplains. Although an individual episode may be treatable, "the majority ofpeople who meet criteria for major depression end up having additional episodesin their lifetime."
Unlikemajor depression, dysthymia doesn't strike in episodes, but is insteadcharacterized by milder, persistent symptoms that may last for years. Althoughit usually doesn't interfere with everyday tasks, victims rarely feel like theyare functioning at their full capacity. According to the National Alliance forthe Mentally Ill, almost 10 million Americans may experience dysthymia eachyear.
Finally,bipolar disorder cycles between episodes of major depression and highs known asmania. Bipolar disorder is much less common than the other types, afflictingabout 1 percent of the U.S. population. Symptoms of mania include irritability,an abnormally elevated mood with a decreased need for sleep, an exaggeratedbelief in one's own ability, excessive talking, and impulsive and oftendangerous behavior.
Genesand Environment
Studyafter study suggests biochemical and genetic links to depression. A considerableamount of evidence supports the view that depressed people have imbalances inthe brain's neurotransmitters, the chemicals that allow communication betweennerve cells. Serotonin and norepinephrine are two neurotransmitters whose lowlevels are thought to play an especially important role. The fact that womenhave naturally lower serotonin levels than men may contribute to women's greatertendency to depression.
Familyhistories show a recurrence of depression from generation to generation. Studiesof identical twins confirm that depression and genes are related, finding thatif one twin of an identical pair suffers from depression, the other has a 70percent chance of developing the disease. For fraternal twins or siblings, therate is just 25 percent.
Environmentalfactors, however, may also play a role in depression. When combined with abiochemical or genetic predisposition, life stressors (such as relationshipproblems, financial difficulties, death of a loved one, or medical illness) maycause the disease to manifest itself.
John(not his real name), 25, was diagnosed with depression for the first time lastyear when he and his girlfriend ended their three-year relationship. "Icouldn't do anything because I was totally absorbed with the whole break-upissue," he says. "It was impossible for me to sleep, and I would wakeup at 3 or 4 in the morning and literally shake. And when it was time to wakeup, I just couldn't get out of bed."
Inaddition, substance abuse and side effects from prescription medication may alsolead to a depressive episode. And research shows that people battling seriousmedical conditions are especially prone to depression. According to the U.S.Department of Health and Human Services, those who have had a heart attack, forexample, have a 40 percent chance of being depressed.
Seasonalaffective disorder, often called "SAD," is a striking example of anenvironmental factor playing a major role in depression. SAD usually starts inlate fall, with the decrease in daylight hours and ends in spring when the daysget longer.
Thesymptoms of SAD, which include energy loss, increased anxiety, oversleeping, andovereating, may result from a change in the balance of brain chemicalsassociated with decreased sunlight. The exact reason for the association betweenlight and mood is unknown, but research suggests a connection with the sleepcycle. Several studies have suggested that light therapy, which involves dailyexposure to bright fluorescent light, may be an effective treatment for SAD.
Diagnosingthe Disease
Medicalprofessionals generally base a diagnosis of depressive disorder on the presenceof certain symptoms listed in the American Psychiatric Association's Diagnosticand Statistical Manual. The DSM (presently in the fourth edition) lists thefollowing symptoms for depression:
depressed mood
loss of interest or pleasure in almost all activities
changes in appetite or weight
disturbed sleep
slowed or restless movements
fatigue, loss of energy
feelings of worthlessness or excessive guilt
trouble in thinking, concentrating, or making decisions
recurrent thoughts of death or suicide.
Thediagnosis depends on the number, severity and duration of these symptoms.
Evenwith this list of symptoms, diagnosing depression is not simple. According tothe National Alliance for the Mentally Ill, it takes an average of eight yearsfrom the onset of depression to get a proper diagnosis.
Inmaking a diagnosis, a health professional should also consider the patient'smedical history, the findings of a complete physical exam, and laboratory teststo rule out the possibility of depressive symptoms resulting from anothermedical problem.
Thesymptoms of the depressive part of bipolar disorder are the same as thoseexpressed in major (unipolar) depression. Because of the similarities insymptoms and the fact that manic episodes usually don't appear until themid-20s, some people with bipolar disorder may mistakenly be diagnosed withunipolar depression. This may lead to improper treatment because antidepressantscarry the risk of triggering a manic episode. (For information about treatingbipolar disorder, see "EveningOut the Ups and Downs of Manic-Depressive Illness" in the June 1996 FDAConsumer.)
AntidepressantDrugs
Onemajor approach for treating depression is the use of antidepressant medications.The older antidepressants include tricyclic antidepressants such as Tofranil (imipramine)and monoamine oxidase inhibitors such as Nardil (phenelzine). Antidepressantsapproved more recently include the selective serotonin reuptake inhibitorsProzac, Paxil and Zoloft, and the other newer antidepressants Wellbutrin,Effexor, Serzone, and Remeron.
Theeffects of antidepressants on the brain are not fully understood, but there issubstantial evidence that they somehow restore the brain's chemical balance.These medications usually can control depressive symptoms in four to eightweeks, but many patients remain on antidepressants for six months to a yearfollowing a major depressive episode to avoid relapse.
Differentdrugs work for different people, and it is difficult to predict which peoplewill respond to which drug or who will experience side effects. So it may takemore than one try to find the appropriate medication.
Sincethe mid-1950s, tricyclic antidepressants have been the standard against whichother antidepressants have been measured. Monoamine oxidase inhibitors werediscovered around the same time as tricyclic antidepressants, but wereprescribed less because, if mixed with certain foods or medications, the drugssometimes resulted in a fatal rise in blood pressure.
Laughrendescribes Prozac as the "first of a new type of more selectiveantidepressants." The older antidepressants had unpleasant and sometimesdangerous side effects, such as insomnia, weight gain, blurred vision, sexualimpairment, heart palpitations, dry mouth, and constipation. Prozac, otherselective serotonin reuptake inhibitors, and other recently approvedantidepressants have had generally safer side effect profiles.
Arecent study funded by NIMH suggested that Prozac may be as effective intreating children and teens as adults, but the drug is not yet approved by FDAfor use in this population.
Othertypes of therapy, such as natural substances extracted from plants, arecurrently being studied. Although not approved by FDA, some people believe St.John's wort, for example, is extremely helpful in alleviating their depressivesymptoms. (See "An Herbal Alternative?")
Whenpeople are unresponsive to antidepressant medications or can't take them becauseof their age or health problems, electroconvulsive therapy (ECT), or "shocktherapy," can offer a lifesaving alternative. Like antidepressants, ECT isbelieved to affect the chemical balance of the brain's neurotransmitters.
BeforeECT, the patient is given anesthesia and a muscle relaxant to prevent injury orpain. Then electrodes are placed on the person's head, and a small amount ofelectricity is applied. This procedure is usually done three times a week untilthe patient improves. Some patients may experience a temporary loss ofshort-term memory.
TalkingIt Out
Forsevere depressive episodes, medications are often the first step because of therelatively quick relief they can bring to physical symptoms. For the long term,however, psychotherapy may be needed to address certain aspects of the illnessthat drugs cannot. "Although the biological features of depression mayrespond better to drugs," Laughren says, "people may need to relearnhow to interact with their environment after the biological part of thedepression is controlled."
"Iwanted to talk things out and get better in that way," John says. "Andeven after the first couple of times I saw my therapist, I could do a little bitmore. Talking with her gave me some reality that how I was feeling wasn't soabnormal, so unusual, or so terrible."
Anneexplains, "It's just comforting sometimes to share the little day-to-dayhappenings in my life with someone who doesn't get to see them first-hand."
Somefind support groups to be invaluable in helping them cope with their depression."It's through talking with others with similar experiences," says MaryRappaport, "that you can better understand what you're going through."
Changesin lifestyle are also important in the management of depression. Exercise, evenin moderate doses, seems to enhance energy and reduce tension. Some researchsuggests that a rush of the hormone norepinephrine following exercise helps thebrain deal with stress that often leads to depression and anxiety. A similareffect may be obtained through meditation, yoga, and certain diets.
ABright Future
Likemany others who have not had to face depression themselves, John's friendslacked knowledge about the disease. "I think the whole thing reallyaffected my relationships with people," he says. "I was pretty much ajerk all of the time. I didn't want to talk to anybody. I just wanted them toleave me alone."
Withthe growing awareness of the seriousness of the disorder and the biologicalcauses, the understanding and support of family and friends may be easier tocome by. "The future looks very bright for individuals who in the past haveoften had to suffer alone," says Rappaport. "More and more people arecoming out, which encourages people to talk about it." Among those who have"come out" recently to publicly discuss their personal bouts withdepression are comedian Drew Carey and "60 Minutes" correspondent MikeWallace.
Expertssay that no one, young or old, has to accept feelings of depression as anecessary part of life. The National Depressive and Manic Depressive Associationand other organizations offer medical information and referrals. By tryingdifferent options for facing their personal challenges, Anne and others havelearned what treatments help them most. "All in all," Anne says,"I think my ability to weather the ups and downs of life has gottenbetter."
Researcherscontinue to make great strides in understanding and treating depression. Forexample, scientists are beginning to learn more about the chromosomes whereaffective disorder genes appear to be located. "While there is a long wayto go in coming up with even more effective drugs," Laughren says,"there's much ongoing research and reason for optimism."
LioraNordenberg is a freelance writer in Harrisburg, Pa.
St.John the Baptist's birthday is celebrated on June 24. It is also around thistime that the pretty yellow flowers of St. John's wort, the plant named in hishonor, bloom in Germany. The plant may be more than just beautiful. Hypericum,the concentrated extract of flowers and leaves, is thought by some to beeffective in treating depression.
Whilethe herb is the most-prescribed antidepressant in Germany, in the United States,St. John's wort is not an approved drug. Many health food stores in this countrysell it as a dietary supplement, but FDA does not allow any antidepressantclaims because it has not been proven to be a safe and effective drug for thisuse. "There's no particular reason to doubt that it might have biologicaleffects," says Thomas Laughren, M.D., in FDA's division ofneuropharmacological drug products. "Whether or not it is an effectiveantidepressant remains to be seen."
TheNational Institutes of Health is sponsoring studies to determine if St. John'swort is safe and effective as a treatment for mild to moderate cases ofdepression. One issue of concern is how the herb interacts with certain drugs,especially antidepressants that affect the brain chemical serotonin.
--L.N.
Accordingto the National Institute of Mental Health, to help someone recover fromdepression:
Encourage the person to make an appointment with a doctor, or make the appointment yourself. You may want to go along for support.
Encourage the person to stick with the treatment plan, including taking prescribed medicine. Improvement may take several weeks. If no improvement occurs, encourage the person to seek a different treatment rather than giving up.
Give emotional support by listening carefully and offering hope.
Invite the person to join you in activities that you know he or she used to enjoy, but keep in mind that expecting too much too soon can lead to feelings of failure.
Do not accuse the person of faking illness or expect them to "snap out of it."
Take comments about suicide seriously, and seek professional advice.
| Diagnosis | Percentage |
|---|---|
| Hypertension | 5.0 |
| Otitis Media | 2.4 |
| Routine Child Health Exam | 2.3 |
| Acute Upper Respiratory Infection | 2.1 |
| Diabetes Mellitus | 2.0 |
| Routine Pregnancy Exam | 1.7 |
| Acute Pharyngitis | 1.7 |
| Chronic Sinusitis | 1.6 |
| Bronchitis | 1.6 |
| Surgery follow-up | 1.3 |
| Depressive Disorder | 1.1 |
| Asthma | 1.1 |
| Depression is one of the most common medical problems in the United States. (Source: Scott-Levin, Newtown, Pa.) | |
FDAConsumer magazine (July-August 1998)
Thirty-three-year-oldSaritza Velilla of Frisco, Tex., was just 7 years old when she first startedfeeling worthless. As the years went by, these feelings intensified and shebecame more withdrawn from social activities. But it wasn't until 1996 thatVelilla was diagnosed with clinical depression, and only recently that she foundrelief from her ongoing symptoms.
"Ialways felt outside the mainstream," she remembers. "I could feelalone in a roomful of people." Velilla grew up for the most part with agreat void in what she calls "that important emotional need" forparental care, affection, or attention. "Without those bonds inplace," she says, "I did not develop emotionally and had troublerelating to others."
Velillais not alone in grappling with the consequences of mental illness. An estimated22 percent of Americans 18 and older--about 1 in 5 adults--have a diagnosablemental disorder in any given year, according to the National Institute of MentalHealth (NIMH). To complicate matters, many people struggle with more than onemental disorder at a time. The pain and suffering that goes along with theseillnesses is felt not only by those who have a disorder, but also by the peoplewho care about them.
Familymembers often watch their loved ones cycle in and out of treatment, on and offmedications, and, in some cases, in and out of jail. Pete Earley of Fairfax,Va., says that if medical experts had responded to his son's mental condition asquickly as law enforcement reacted to his criminal behavior, his son would bereceiving therapy instead of facing a possible prison term.
Earley'sson has bipolar disorder--also called manic-depressive illness--a form of mentalillness different from Velilla's that can cause extreme shifts in mood, energyand functioning. Earley says his son is frequently delusional, paranoid, andpsychotic. If he discontinues his medications, he exhibits bizarre, irrationalbehavior.
Accordingto the NIMH, most people with a depressive illness do not get the help theyneed, although the great majority--even those whose depression is severe--can behelped. Without treatment, the symptoms of depression can last for weeks,months, or even years. With treatment, many people can find relief from theirsymptoms and lead a normal, healthy life.
Clinicaldepression, one of the more common categories of mental illnesses, is a seriousbrain disorder that affects the way nearly 19 million American adults feel,think, and interact. In contrast to the normal emotional experiences of sadness,loss, or passing mood states, clinical depression is extreme and persistent andcan interfere significantly with a person's ability to function. People withdepression cannot merely "pull themselves together" and get better.Depression cannot be willed or wished away.
Thereare three main types of clinical depression: major depressive disorder;dysthymic disorder; and bipolar depression, the depressed phase of bipolardisorder. Within these types are variations in the number of associated mentalsymptoms, and their severity and persistence.
Aperson experiencing major depressive disorder suffers from, among othersymptoms, a depressed mood or loss of interest in normal activities that lastsmost of the day, nearly every day, for at least two weeks. Such episodes mayoccur only once, but more commonly occur several times in a lifetime.
Unlikemajor depressive disorder, dysthymic disorder--a chronic but less severetype--doesn't strike in episodes, but is instead characterized by milder,persistent symptoms that may last for years. Although it usually doesn'tinterfere with everyday tasks, people with this milder form of depression rarelyfeel like they are functioning at their full capacities.
Bipolardisorder cycles between episodes of major depression, similar to those seen inmajor depressive disorder, and highs known as mania. In a manic phase, a personmight act on delusional grand schemes that could range from unwise businessdecisions to romantic sprees. Mania left untreated may deteriorate into apsychotic state.
ForEarley, one of his son's recent psychotic episodes played out in a burglarycharge. The pair was headed home from a local hospital where doctors had refusedto treat him involuntarily. Earley's son suddenly leapt from their moving car,ran away, and broke into a stranger's house. After throwing a potted plantthrough a glass door and smashing some furniture, he then ran upstairs and drewhimself a bubble bath. Earley says his son has never been in trouble with thelaw before and that he did not take anything from the house.
Becausethe symptoms, course of illness, and response to treatment vary so much amongpeople with depression, doctors believe that depression may have a number ofcomplex and interacting causes.
Somefactors include another medical illness, losing a loved one, stressful lifeevents, and drug or alcohol abuse. Any of these factors also may contribute torecurrent major depressive episodes.
Modernbrain imaging technologies are revealing that neural circuits responsible forthe regulation of moods, thinking, sleep, appetite, and behavior fail tofunction properly in people with depression. Imaging studies also indicate thatcritical neurotransmitters--chemicals used by nerve cells to communicate--areout of balance.
Moreover,genetics research suggests that vulnerability to depression results from theinfluence of multiple genes acting together with environmental factors. Thehormonal system that regulates the body's response to stress also is overactivein many depressed people.
Researchconducted in the fields of psychiatry, behavioral science, neuroscience,biology, and genetics, including studies of twins, lead scientists to believethat the risk of developing mental illness increases if another family member issimilarly affected, suggesting a hereditary component.
Thiswas the case for 34-year-old Susan Poage of Thornton, Colo. She recently wasdiagnosed with clinical depression, like her mother before her. Poage recalls adismal childhood.
"Therewas a lot of silent crying, promiscuity, alcohol and drugs," she says,"and I don't remember having any good times." With the help of herdoctor and a five-year struggle with drug therapy, Poage today is managing hersymptoms of depression, including thoughts of suicide.
Despitestrong evidence for genetic susceptibility, scientists still don't know thenumber of genes that might be involved in making someone more likely to developa mental disorder. Identification of these genes has proved to be extremelydifficult.
Similarly,the role of environmental effects in the development of mental illness remainslargely unknown.
Medicalprofessionals generally base a diagnosis of mental illness on the presence ofcertain symptoms listed in the 4th edition of the American PsychiatricAssociation's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).The symptoms listed for a major depressive episode include:
sadness
loss of interest or pleasure in activities once enjoyed
change in appetite or weight
difficulty sleeping or oversleeping
physical slowing or agitation
energy loss
feelings of worthlessness or inappropriate guilt
difficulty thinking or concentrating
recurrent thoughts of death or suicide.
Aperson is clinically depressed if he or she has five or more of these symptomsand has not been functioning normally for most days during the same two-weekperiod.
Dysthymicdisorder is diagnosed when depressed mood persists for at least two years (oneyear in children) and is accompanied by at least two other symptoms ofdepression.
Theepisodes of depression that occur in people with bipolar disorder alternate withmania, which is characterized by abnormally and persistently elevated mood orirritability. Symptoms of mania include overly inflated self-esteem, decreasedneed for sleep, increased talkativeness, racing thoughts, distractibility,physical agitation, and excessive risk-taking. Because bipolar disorder requiresdifferent treatment than major depression or dysthymia, obtaining an accuratediagnosis is extremely important.
Findingthe right treatment for depression can be as difficult as convincing someonethat they need help. However, according to the NIMH, clinical depression is oneof the most treatable of all medical illnesses.
Becauseit is currently against the law in Virginia, where the Earleys live, to forcesomeone into medical treatment, Earley must rely on his son's willingness totake his medicines. Typically, bipolar patients periodically stop taking theirmedications.
"Partof my son's illness," Earley explains, "is believing he is perfectlyfine when he goes off his medicines.
"Eventhough it was obvious that my son was clearly out of his mind, the law stillinsisted that he was capable of deciding whether or not he neededtreatment," says Earley. "In these cases, you are asking an irrationalperson to make a rational decision. It's like expecting a person with a brokenleg to run a marathon."
Today,most people with depression can be treated successfully with antidepressantmedications, "talk" therapy (psychotherapy), or a combination of thetwo. (See "Classification of Antidepressants".)Experts agree that successful treatment also hinges on early intervention.And early treatment increases the likelihood of preventing serious recurrences.
Existingantidepressant drugs are known to influence the functioning primarily of eitheror both of two neurotransmitters in the brain--serotonin and norepinephrine.Older medications--tricyclic antidepressants (TCAs) and monoamine oxidaseinhibitors (MAOIs)--affect the activity of both of these neurotransmitterssimultaneously. Their disadvantage is that they can be difficult to tolerate dueto significant side effects, or, in the case of MAOIs, dietary and medicationrestrictions.
Newermedications, such as the selective serotonin reuptake inhibitors (SSRIs), havefewer side effects than the older drugs, making it easier for people, includingolder adults, to adhere to treatment. Both generations of medications areeffective in relieving depression, although some people will respond to one typeof drug, but not another.
"Clinicianstell us that different drugs seem to work for different people," saysThomas Laughren, M.D., team leader for the review of psychiatric drugs in theFood and Drug Administration's Division of Neuropharmacological Drug Products."And it's difficult to predict which people will respond to which drug orwho will experience what side effects." So, Laughren says, it may take morethan one try to find the appropriate medication. "Now that we've made adistinction between different depression subtypes, this seems to have stimulatedadditional drug research. Drug companies are also conducting more longer-termstudies in depression, and this is important since depression tends to be achronic illness."
Althoughsome improvement may be seen in the first few weeks, antidepressants usuallymust be taken regularly for three to four weeks (and sometimes longer) beforefull therapeutic benefits occur. "If we had a better understanding of thebiological basis for depression, it would help in the discovery of newerantidepressants that hopefully would work faster and better," says Laughren."Unfortunately we do not really understand the mechanism for theantidepressant drugs."
Themedication most often used to treat bipolar disorder is lithium (Eskalith,Lithane, Lithobid, Cibalith-S). Lithium evens out mood swings in bothdirections--from mania to depression, and depression to mania. It is used notjust for manic attacks or flare-ups of the illness, but also as an ongoingmaintenance treatment for bipolar disorder.
Inpsychotherapy, also called "talk therapy," a person discusses with amental health professional the feelings, thoughts and behaviors that seem tocause difficulty. The goal of psychotherapy is to help people understand andmanage their problems so that they can function better.
"Findinga therapist who believes in recovery is the first step," says Velilla."Someone who can teach you to think differently and learn newbehaviors." She believes that her feelings of neglect, coupled with theeventual divorce of her parents, ultimately triggered many of her bouts withdepression. Her own divorce some years later, she says, only heightened herfeelings of worthlessness. "My therapist finally put a name to what I'dbeen feeling since I was 7 years old."
Psychotherapycan help people with bipolar disorder, and their families, identify earlywarning signs and manage emotional stress, which may help prevent a bipolarepisode.
RichardO'Connor, Ph.D., a psychotherapist in Canaan, Conn., and the author of severalbooks on depression, believes that people need to help themselves "breakthe bad habits in their lives that set them up for depression." Waking upand going to sleep at the same time each day, for example, might help thosepeople prone to bouts of insomnia due to irregular sleep patterns.
Adepression sufferer himself, O'Connor came to this belief after many of thepeople he was treating "thought it was too late for them to helpthemselves, and they wanted us to pick up the pieces," he says."People are responsible for their own recovery. They must learn to takecare of themselves and structure their lives so that they're less likely totrigger an episode."
Whenpeople are unresponsive to psychotherapy and medications, or the combination ofthe two works too slowly to relieve severe symptoms, such as psychosis orrecurring thoughts of suicide, electroconvulsive therapy (ECT) may beconsidered. Electrodes are placed at precise locations on the head to deliverelectrical impulses. The stimulation causes a 30-second seizure within thebrain; however, the person does not consciously feel the stimulus. Threesessions per week typically are given for full therapeutic benefit. Likeantidepressants, ECT is believed to affect the chemical balance of the brain'sneurotransmitters.
Interestis rapidly growing as well in the use of herbs for treating depression. But,according to a study published in the April 10, 2002, issue of the Journal ofthe American Medical Association, an extract of the popular herb St. John'swort was no more effective for treating major depression of moderate severitythan an inactive pill (placebo). The multi-site trial, involving 340 people,also compared the FDA-approved antidepressant drug Zoloft (sertraline) to aplacebo as a way to measure how sensitive the trial was to detectingantidepressant effects. Since Zoloft was also found to be no different than theplacebo in that study, Laughren says it can best be thought of as a "failedstudy" that isn't informative about the antidepressant effectiveness of St.John's wort.
TheNIMH cautions people who think they may be depressed not to use dietarysupplements without first being evaluated by a psychiatrist or examined by aphysician. The risks, according to the institute, can outweigh any potentialbenefits.
Antidepressantdrugs are not considered to be candidates for abuse. However, as is the casewith any type of medication, use of antidepressants must be carefully monitoredto make sure the correct dosage is being given. Care also is needed whenantidepressants are discontinued.
Asis often seen with antibiotics, people may be tempted to stop antidepressantstoo soon. They may feel better and think they no longer need the medication, orthey may believe the medication isn't working. But quickly stopping certainantidepressants is linked to side effects ranging from flu-like symptoms tosensory disturbances. As a result, new labeling, as specified by the FDA,recommends that patients taper off these medications slowly. If a personencounters problems going off a drug, he or she is advised to consult aphysician rather than reduce dosage without supervision.
Afterspending 11 days in the hospital following the burglary, Earley's son wasreleased to his parents. He is currently awaiting trial on two counts of felonybreaking and entering and destruction of property. He is attending a 15-weektreatment program that includes routine medications, and he now has a job andhopes to return to college to finish his education.
"Hedoesn't want to be delusional," says Earley. "He's embarrassed andashamed about what happened. But now he's got no choice but to admit that he issick and always will be. The question is, will that be enough to keep him takinghis medications?"
Whena patient and the health-care provider think that medication can be discontinuedor scaled back, they will discuss how best to ease off the medication gradually.
TheNIMH says it is important to keep taking prescribed medication until it has hada chance to work, even though side effects may appear before antidepressantactivity does.
Asfor Velilla, "I'm still not taking any medication," she says,"but I think I may not need it after all. I continue to read books thatwill inspire and give me tools to deal with life. I feel like I am makingprogress in counseling and in all areas of my life and that makes me feel prettygood and optimistic about recovering."
NationalInstitute of Mental Health (NIMH)
Public Inquiries
6001 Executive Blvd.,
Rm. 8184, MSC 9663
Bethesda, MD 20892-9663
301-443-4513
www.nimh.nih.gov
NationalFoundation for Depressive Illness, Inc.
PO Box 2257
New York, NY 10116
1-800-239-1265
www.depression.org
NationalMental Health Association (NMHA)
2001 N. Beauregard St., 12th Floor
Alexandria, VA 22311
1-800-969-NMHA (1-800-969-6642)
TTY: 1-800-443-5959
www.nmha.org
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