Fraying Edges | Depression Help

Major Depression is a type of mood disorder and a severe one at that. Most of us get ‘the blues’ at one time or another, but Major Depression is much more than that. It completely takes over a person’s life and their relationships with others.

Symptoms of Major Depression, include profound sadness, loss of interest or pleasure in activities normally enjoyed and other symptoms that impair a person’s ability to function and can even effect their physical health.

Episodes of Major Depression may occur suddenly or develop gradually. Either way, once Major Depression occurs it usually last several months. It is also common for episodes to recur.

Suicide is a major risk with Major Depression, so if you know someone who you think may be suffering from this illness please take any talk of ‘life not being worth living’ very seriously and encourage them to seek help.

All the Causes of Major Depression are still not known, but the following factors are seen by many researchers as perhaps forming a part of its development:

• Genetic (Depression often runs in families).

• Environmental (stress of living in particular conditions).

• Abuse.

• Grief. The death of a loved one or some other form of personal separation (like divorce).

• Chronic medical conditions.

• Statistics at the moment show that Depression is more common in women than in men (although the difference between sexes is also said to be narrowing).

Many people suffering from Depression may not realise that they are. Instead they may visit their physician because they are feeling exceptionally tired, or have headaches and other physical pains which do not respond to medication.

Conversely, when a patient visits his or her physician because they think they are suffering from Depression, the physician will carry out a series of tests to establish that no physical illness is present before completing a diagnosis of Depression (or referring the patient for more specialist diagnosis by a mental health professional).

Tests to determine whether Depression or a physical factor is the cause of the illness include:

• Blood tests to check for thyroid deficiences, anaemia and low vitamin B12 levels, all of which can cause similar symptoms to Depression.

• Other physical tests and examinations depending on symptons.

• Questions about alcohol and drug use.

• Questions about the onset, duration and severity of symptoms.

• Questions about the patient’s lifestyle and environment and any changes which have recently taken place..

• Questions about the patient’s family history to determine whether there is any genetic likelehood of Depression. If there is a family history of depression, the practitioner will ask how it was treated and how effective the patient considers this was.

• The patient will be asked whether he or she has experienced these symptoms before and, if so, whether and how they were treated and whether they considered the treatment to be effective

• The doctor will also ask the patient whether they have thought about death or suicide.

When a health professional diagnoses a patient as having Major Depression, he or she will look for at least five out of nine recognised primary symptoms of Major Depression. These are:

• Sad or depressed mood (including profound sadness, anxiety, anger, irritability or apathy).

• Anhedonia - a reduction or loss of interest in activities previously enjoyed.

• Significant change in appetite or weight (loss or gain).

• Changes in sleep patterns (sleeping too much or too little or at different times of day to the usual pattern).

• Physical or verbal activity (increased agitation, unable to keep still, talking quickly or, conversely, inability to move quickly and quieter in speech than previously).

• Fatigue and decreased energy levels (and the inability to drag oneself up out of this lethargy).

• Feelings of worthlessness, excessive feelings of guilt or remorse.

• Lack of concentration and the inability to stay focused on a subject.

• Recurring thoughts of death and death wishes.

Major Depression can occur in people of all ages, including children and the elderly.

It is important that the physician does not diagnose an elderly person as suffering from senile dementia when their confusion may be caused by Major Depression.

With children and adolescents it is sometimes difficult to ascertain whether they are depressed, especially as they may well not wish to admit to anyone that this is the cause. Many adolescents may also be seen as ‘moody’ rather than depressed.

Although statistics show that women are more likely than men to be diagnosed with Depression, this may, in some part, be due to the fact that women are often more willing to seek help for Depression. Men may be more reluctant to talk about emotional problems or be more fearful of the social stigma attached to being diagnosed as depressed. Luckily, this is changing, but not quickly enough for many sufferers.

Treatment and prevention of major depression:

It is usually considered that the best outcome is achieved with a combination of psychotherapy and medication.

Psychotherapy:

• Increasingly the form of psychotherapy used to treat Major Depression is Cognitive behavioral therapy (CBT), which is an to change the negative patterns of thought or behavior that are associated with depression through lessons and ‘homework’ devised between the patient and the therapist,

• Interpersonal therapy may be used instead or as a supplement to CBT. Interpersonal therapy focuses on the patient’s personal relationships and the problems in these relationships that may cause or worsen depression. If the problems involve the patient’s family, they may also be asked to get involved in a ‘Family Therapy’ course of sessions.

• Psychodynamic therapy can be very effective in the treatment of some forms of Major Depression and is considered good for solving problems of recurrence, but because of its nature, it is usually not undertaken until the patient is already showing signs of significant imporvement. The analyst and the patient will ‘talk out’ some of the reasons behind the depression and any conflicts in a patient’s feelings. However, psychodynamic therapy can produce further stress on the patient until these feelings are resolved, therefore it should always be undertaken with great care.

In most cases of Major Depression medication will accompany psychotherapy to obtain more beneficial results.

Medications for Major Depression are usually antidepressants:

• Selective serotonin reuptake inhibitors (SSRIs). These are usually the antidepressant of choice, having less side effects than older antidressants and less risk from overdose. They work on the basis of increasing the level of serotonin in the brain as a lack of serotonin is seen as a major source of chemical imbalance and a likely cause of chemical depression.

• Tricyclic antidepressants (TCAs) are older forms of antidepressants and are often used nowadays only when a patient is resistant to SSRIs. TCAs alter the levels of several chemicals in the brain and can be effective in many forms of Major Depression. However, these tend to have more side effects than SSRIs and are also highly dangerous if an overdose is taken. They are therefore only prescribed if no form of SSRI is found to be suitable.

• Monoamine oxidase inhibitors (MAOIs) can be very effective in the treatment of Major Depression but they are only diagnosed nowadays in cases where no other form of antidepressant has proved to be effective. Patients taking MAOIs have to be monitored very closely and have to maintain a strict diet, because several forms of food and drink plus other medications could have a potentially fatal effect when mixed with these powerful drugs. A patient changing from or to any form of MAOI medication will always have to wait until the previous antidepressant is completely cleared from their system (at least two full weeks) because a severe reaction could occur between the two types of drug.

• Serotonin and norepinephrine reuptake inhibitors are being prescribed more often nowadays than previously. Still relatively new, very long term studies on these antidepressants is still awaited. Serotonin and norepinephrine reuptake inhibitors work on a number of different brain chemicals and are sometimes found to be effective when other antidepressants are not. Side effects to these drugs do vary according to brand and they do not suit everyone, but they are seen as effective in many cases of Major Depression and will be recommended if, for example, SSRIs are not seen as working effectively enough.

• Other forms of antidepressants are under development, including the antidepressant skin patch, approved by The U.S. Food and Drug Administration (FDA) in 2006. However, this is not available in all countries as each country has to provide its own tests for antidressants before they are available for prescription.

Antidepressants will usually take several weeks for their full effects to become apparent. They are not a ‘quick fix’. The patient will be monitored and levels of antidepressant may be adjusted or the drug may even be changed for another if proving ineffective. The patient will also be monitored with regular visits to his or her physician to ascertain there are no suicidal tendencies present.

Once an effective antidepressant is found, it will usually be taken for at least four to nine months or longer. In some case the antidepressant may be taken indefinitely to prevent recurrence of Major Depression.

Other Medications for Major Depression:

Other medications may be used in combination with antidepressants if the physician decides these will help the patient.

• Anti-anxiety drugs may be prescribed for the patient suffering from Anxiety and Depression. These will be closely monitored as some can be addictive if taken for a length of time. Lithium may also be prescribed in more hard to treat cases.

• In some cases, antipsychotics will also be prescribed if the Depression is manifesting psychotic tendencies.

Other treatments for Depression:

• Herbal and dietary supplements (e.g., St. John’s wort) may also be used to treat major depression, but these will only be recommended with extreme caution. The patient will always be advised not to take any herbal or dietry supplement without talking to their physician first. Some supplements, when taken alongside prescribed medication can have severe side effects. It has also been discovered that some herbal supplements, including St. John’s wort, may induce mania in people with bipolar disorder (which can often manifest itself as Major Depression and be treated as such).

• Exercise, particularly some form of aerobic activity has been shown to be useful in helping to treat mild to moderate depression as is to be recommended to a sufferer from Major Depression once they feel well enough to undertake it.

• Sunlight (or a special ’sunlight lamp’) is also often recommended in cases of mild to moderate depression (or in the case of chronic depression or Dysthymia) as Seasonal Affective Disorder (SAD) has been demonstrated as one cause of depression in countries with long periods of little sunlight.

When nothing else works and the patient is still suffering from Major Depression:

• In rare cases, electroconvulsive therapy (ECT), may be recommended when nothing else has worked and when the patient is still in distress from Major Depression. ECT is also sometimes recommended when a patient has severe reactions to medication. ECT involves the use of an electrical current to cause a brief convulsion in the patient. Some patients say it has cured their depression completely. However, ECT is an extremely controverial treatment, especially as no one appears to know exactly why it works when it works. There are also side effects to consider, including confusion and memory loss and there is some debate as to the long term effectiveness of ECT.

Major Depression and its recurrence is not always preventable. However, research shows that there are some things you can do to alleviate its occurence and effects. Eating a balanced diet and trying to maintain a healthy lifestyle with exercise and good social interraction is suggested as helpful.

Nevertheless, if you are doing all these things and you still experience Depression, remember it is not your fault. This is an illness like any other. Millions of people suffer from Depression each year. You are not the only one, so please don’t feel ashamed. Go and seek help.

Further Reading:

Depression Definition and further links
Major Depression
Depression and Bipolar Information
Depression Myths and Realities

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