Depression: What You Need to Know
Your doctor believes you have a depressive illness and wants you to
have this brief pamphlet to read and hold on to so that you can refer to
it as often as you need. It provides important information about
depressive illnesses. It may stimulate questions you may wish to discuss
with your doctor or a mental health professional. Or you may wish to
share it with a family member, friend, colleague, minister, school
official, or other community helpers.
What Is a Depressive Illness?
A depressive illness is an illness involving your body, mood,
thoughts and behavior. It affects the way you eat and sleep, the way you
feel about yourself, and the way you think about things. A depressive
illness is not a passing blue mood. It is not a sign of
personal weakness or a condition that can be willed or wished away.
People with a depressive illness cannot merely "pull themselves
together" and get better. Without treatment, symptoms can last for
weeks, months, or years. Appropriate treatment, however, can help over
80 percent of those who suffer from depression
Types of Depression
Depressive illnesses come in different forms just as do other
illnesses, such as heart disease. This pamphlet briefly describes three
of the most prevalent types of depressive illnesses. However, within
these types there are variations in the number of symptoms, their
severity, and persistence. Check with your doctor if you need more
information about your type of depressive illness.
Major depression is manifested by combination of symptoms (see
symptom list that interfere with the ability to work, sleep, eat, and
enjoy once pleasurable activities. These disabling episodes of
depression can occur once, twice, or several times in a lifetime.
Not everyone who is depressed or manic experiences every symptom.
Some people experience a few symptoms, some many. Also, severity of
symptoms varies with individuals.
Symptoms of Depression
- Persistent sad or "empty" mood
- Feelings of hopelessness, pessimism
- Feelings of guilt, worthlessness, helplessness
- Loss of interest or pleasure in hobbies and activities
that you once enjoyed, including sex
- Insomnia, early-morning waking or oversleeping
- Appetite and/or weight loss, or overeating and weight gain
- Decreased energy, fatigue, being "slowed down"
- Thoughts of death or suicide; suicide attempts
- Restlessness, irritability
- Difficulty concentrating, remembering, making decisions
- Excessive crying
- Persistent physical symptoms that do not respond to
treatment, such as headaches, digestive disorders, and
chronic pain
Symptoms of Mania
- Inappropriate elation
- Inappropriate irritability
- Severe insomnia
- Grandiose notions
- Increased talking
- Disconnected and racing thoughts
- Increased sexual drive
- Markedly increased energy
- Poor judgment
- Inappropriate social behavior
A less severe type of depression, dysthymia, involves
long-term, chronic symptoms that do not disable, but keep you from
functioning at "full steam" or from feeling good. Sometimes
people with dysthymia also experience major depressive episodes.
Another type of depressive illness is manic depressive illness
each year, also called bipolar depression. Not nearly as prevalent
as other forms of depressive illnesses, manic-depressive illness
involves cycles of depression and elation or mania. Sometimes the mood
switches are dramatic and rapid, but most often they are gradual. When
in the depressed cycle, you can have any or all of the symptoms of a
depressive illness. When in the manic cycle, any or all symptoms listed
under mania may be experienced. Mania often affects thinking, judgment,
and social behavior in ways that cause serious problems and
embarrassment. For example, unwise business or financial decisions may
be made when in a manic phase.
Causes of Depression
There is a risk for developing depression when there is a family
history, indicating that a biological vulnerability can be inherited.
The risk may be somewhat higher for those with bipolar depression.
However, not everybody with a genetic vulnerability develops the
illness. Apparently additional factors, possibly a stressful environment
and other psychosocial factors are involved in the onset of depression.
Though major depression seems to occur, generation after generation,
in some families, it can also occur in people who have no family history
of depression. Whether the disease is inherited or not, it is evident
that individuals with major depressive illness often have too little or
too much of certain neurochemicals.
Psychological makeup also plays a role in vulnerability to
depression. People who have low self-esteem, who consistently view
themselves and the world with pessimism, or who are readily overwhelmed
by stress are prone to depression.
A serious loss, chronic illness, difficult relationship, financial
problem or any unwelcome change in life patterns can also trigger a
depressive episode. Very often, a combination of genetic, psychological,
and environmental factors is involved in the onset of a depressive
illness.
Treatments
A variety of antidepressant medications and psychotherapies can be
used to treat depressive illnesses. Some people do well with
psychotherapy, some with antidepressants. Some do best with combined
treatment: medication to gain relatively quick symptom relief and
psychotherapy to learn more effective ways to deal with life's problems.
Depending on your diagnosis and severity of symptoms, you may be
prescribed medication and/or treated with one of the several forms of
psychotherapy that have proven effective for depression. It is important
to note that most people can be successfully treated for depression on
an outpatient basis.
On rare occasions, electroconvulsive therapy (ECT ) is useful,
particularly for individuals whose depression is severe or
life-threatening or who cannot take antidepressant medication. ECT often
is effective in cases where antidepressant medications do not provide
sufficient relief of symptoms.
Antidepressant
Medications
Three groups of antidepressant medications have been used to treat
depressive illnesses: tricyclics monoamine oxidase inhibitors (MAOIs),
and lithium. Lithium is the treatment of choice for manic-depressive
illness and some forms of recurring, major depression. Sometimes your
doctor will try a variety of antidepressants before finding the
medication or combination of medications most effective for you.
Sometimes the dosage must be increased to be effective.
There are now two new classes of antidepressants which are neither
tricyclics nor MAOIs, and which generally lack the side effects
associated with these two traditional classes of drugs. The first of
these is fluoxetine, a serotonin re-uptake inhibitor; the other is
bupropion, believed to act on the dopaminergic system.
Patients often are tempted to stop medication too soon. It is important
to keep taking medication until your doctor says to stop, even if you
feel better beforehand. Some medications must be stopped gradually
to give your body time to adjust. In cases of manic-depressive illness
and chronic major depression, medication may have to become part of
everyday life to avoid disabling symptoms.
Antidepressant drugs are not habit-forming, so you need not be
concerned about that. However, as is the case with any type of
medication prescribed for more than a few days, antidepressants have to
be carefully monitored to see if you are getting the correct dosage.
Your doctor will want to check the dosage and its effectiveness regularly.
If you're taking MAO inhibitors, you will have to avoid certain
foods, such as cheeses, wines, and pickles. Be sure you get a complete
list of foods you should not eat from your doctor and always carry it
with you. Other forms of antidepressants require no food restrictions.
Never mix medications of any kind- prescribed,
over-the-counter, or borrowed- without consulting your doctor. Be
sure to tell your dentist or any other medical specialist who prescribes
a drug that you are taking antidepressants. Some of the most benign
drugs when taken alone can cause severe and dangerous side effects if
taken with others. Some drugs, like alcohol, reduce the effectiveness of
antidepressants and should be avoided. This includes wine, beer, and
hard liquor.
Antianxiety drugs or sedatives are not antidepressants. They are
sometimes prescribed along with antidepressants; however, they should
not be taken alone for a depressive illness. Sleeping pills and
stimulants, such as amphetamines, are also inappropriate.
Be sure to call your doctor if you have a question about any drug or
if you are having a problem you believe is drug related.
Side Effects
Antidepressants may cause mild and usually temporary side effects in
some people. Typically these are annoying? but not serious. However,
unusual side effects or those that interfere with functioning should be
reported to your doctor. The most common side effects usually associated
with tricyclic antidepressants and ways to deal with them, are:
The newer antidepressants have different types of side effects:
Headache - this will usually go away.Nausea - even when it occurs, it is
transient after each dose.-
Nervousness and insomnia - these may occur during the
first few weeks; dosage reductions or time will usually resolve
them.
Agitation - if this happens for the
first time after the drug is taken and is more than transient,
consult your doctor.
Psychotherapies
There are many forms of psychotherapy used to help depressed
individuals, including some short-term (10-20 weeks) therapies.
"Talking" therapies help patients gain insight into and
resolve their problems through verbal"give and-take" with the
therapist. "Behavioral" therapists help patients learn how to
obtain more satisfaction and rewards through their own actions and how
to unlearn the behavioral patterns that contribute to their depression.
Two of the short-term psychotherapies that research has shown helpful
for some forms of depression are Interpersonal and Cognitive/Behavioral
therapies. Interpersonal therapists focus on the patient's disturbed
personal relationships that both cause and exacerbate the depression.
Cognitive Behavioral therapists help patients change the negative styles
of thinking and behaving often associated with depression.
Psychodynamic therapies, sometimes used to treat depression focus
on resolving the patient's internal psychological conflicts that are
typically thought to be rooted in childhood.
In general, the severe depressive illnesses, particularly those that
are recurrent, will require medication (or ECT under special conditions)
along with psychotherapy for the best outcome.
Helping Yourself
Depressive illnesses make you feel exhausted, worthless, helpless and
hopeless. Such negative thoughts and feelings make some people feel like
giving up. It is important to realize that these negative views are part
of the depression and typically do not accurately reflect your
situation. Negative thinking fades as treatment begins to take effect.
In the meantime:
- Do not set yourself difficult goals or take on a great deal of
responsibility.
- Break large tasks into small ones, set some priorities, and do
what you can as you can.
- Do not expect too much from yourself. This will only increase
feelings of failure.
- Try to be with other people; it is usually better than being
alone.
- Participate in activities that may make you feel better. You might
try mild exercise, going to a movie, a ball game, or participating
in religious or social activities.
- Don't overdo it or get upset if your mood is not greatly improved
right away. Feeling better takes time.
- Do not make major life decisions, such as changing jobs, getting
married or divorced, without consulting others who know you well and
who have a more objective view of your situation. In any case, it is
advisable to postpone important decisions until your depression has
lifted.
- Do not expect to snap out of your depression. People rarely do.
Help yourself as much as you can, and do not blame yourself for not
being up to par.
- Remember, do not accept your negative thinking. It is part
of the depression and will disappear as your depression responds to treatment.
Family and Friends Can Help
Since depression can make you fee} exhausted and helpless, you will
want and probably need help from others. However, people who have never
had a depressive illness may not fully understand its effect. They won't
mean to hurt you, but they may say and do things that do. It may help to
share this pamphlet with those you most care about so they can better
understand and help you.
Helping the Depressed Person
The most important thing anyone can do for the depressed person is to
help him or her get appropriate diagnosis and treatment. This may
involve encouraging the individual to stay with treatment until symptoms
begin to abate (several weeks), or to seek different treatment if no
improvement occurs. On occasion, it may require making an appointment
and accompanying the depressed person to the doctor. It may also mean
monitoring whether the depressed person is taking medication.
The second most important thing is to offer emotional support. This
involves understanding, patience, affection, and encouragement. Engage
the depressed person in conversation and listen carefully. Do not
ignore remarks about suicide. Always report them to the doctor.
Invite the depressed person for walks, outings to the movies, and
other activities. Be gently insistent if your invitation is refused.
Encourage participation in some activities that once gave pleasure, such
as hobbies, sports, religious or cultural activities, but do not push
the depressed person to undertake too much too soon. The depressed
person needs diversion and company, but too many demands can increase
feelings of failure.
Do not accuse the depressed person of faking illness or of laziness,
or expect him or her "to snap out of it." Eventually, with
treatment, most depressed people do get better. Keep that in mind, and
keep reassuring the depressed person that with time and help he or she
will feel better.
Source: National Institute of Mental Health, National Institutes of Health
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