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What is depression?
Depression refers to feeling sad, "blue," and uninterested in the things that are normally a source of pleasure. It also refers to having negative or pessimistic thoughts. Depression becomes clinical (more severe) when physiological symptoms also occur, such as changes in sleep, appetite, concentration, energy, or sexual drive. In addition, the symptoms of a clinical depression make it difficult for you to function normally. A clinical depression lasts for at least two weeks and usually much longer without treatment.

How does it occur?
Changes in mood characterized by feelings of sadness, hopelessness, and worthlessness may be associated with:
  • a major depressive disorder or a chronic, milder depressive disorder
  • a complication of another psychiatric disease or medical illness
  • a reaction to a medication or drug
  • biochemical changes in the body (for example, after childbirth)
  • alcohol or drug abuse.

    The exact cause of depression is not known. but depression appears to be caused by a biochemical imbalance in certain parts of the brain. In many cases, genetic inheritance appears to be involved.

    Some people have a greater risk of depression, including those who:
  • have a family history of anxiety or depression
  • are anxious
  • are alcoholics
  • are drug addicts.

    What are the symptoms?
    The symptoms of major depression include having at least one of the two following symptoms most of the day every day for more than 2 weeks:
  • feeling sad or blue (may include crying spells, anxiety, agitation, irritability)
  • loss of interest or pleasure in usual activities.

    In addition, major depression involves having at least four of the following symptoms:
  • poor appetite and significant weight loss, or increased appetite and significant weight gain
  • inability to sleep (insomnia), increase in time spent sleeping (hypersomnia), or difficulty sleeping soundly
  • fatigue, loss of energy
  • increased physical activity (agitation) and restlessness
  • decreased sex drive
  • feelings of self-reproach or inappropriate guilt
  • difficulty in thinking clearly or concentrating
  • memory difficulties
  • thoughts of death or suicide or actual suicide plans or attempts.

    Depressed people have difficulty in maintaining normal relationships with other people. As a result, problems with relating to others often develop or worsen.

    How is it diagnosed?
    To diagnose depression, your doctor reviews your symptoms with you and with someone close to you. A physical exam may also be part of the evaluation. In addition to checking your overall physical condition, the doctor will try to determine whether alcohol abuse, hypothyroidism, some cancers, anemia, or an infection such as hepatitis or mononucleosis may be contributing to your depression.

    How is it treated?
    It is unwise to try to overcome depression by yourself. Depression is usually most successfully treated with psychotherapy and antidepressant medicine.

    Psychotherapy can provide support and help you feel less like you are out of control, a victim, or going crazy. One approach psychotherapists may use to treat depression is called cognitive therapy. This therapy usually lasts 12 to 20 weeks. During counseling sessions, the therapist can help you identify unrealistic views of yourself, the world, and the future. The therapy can help you recognize depressive thought processes and develop thought and behavior patterns that counteract depressive thought.

    Antidepressant medicines may not relieve your symptoms until 3 to 6 weeks after you start taking them. After an antidepressant has treated the symptoms of depression, you should continue to take the medication for at least 6 to 9 months to prevent a recurrence of the depression. It is important to keep taking your medication at the prescribed dose, even after symptoms go away, and not to stop until you and your doctor have decided that it is time to do so. When it is time to stop taking the medication, it is usually necessary to reduce the dosage gradually, rather than suddenly stopping the medication, to avoid adverse effects. If you have recurrent depressions or chronic depression, you may need to continue to take antidepressant medication indefinitely.

    There are many types of antidepressant medications, and they are not addictive.

    Hospitalization is usually not necessary if treatment is started soon enough. Hospitalization might be advised if:
  • The risk of suicide is high.
  • Your home environment is so stressful or chaotic that it is making the depression worse.
  • You are unable to take care of yourself at home.

    In cases of severe or prolonged depression, particularly if medication has not worked, electroconvulsive therapy (ECT, also called shock therapy) may be a very effective part of the treatment. While ECT has been maligned in the movies, this treatment is more likely than drug therapy to be helpful and it is safer. ECT may be the treatment of choice for psychotic depression or those who are severely suicidal because it brings relief much more quickly.

    How long will the effects last?
    Without treatment, most episodes of depression end within 6 to 12 months. However, these episodes often recur and some episodes may last much longer. Psychotherapy and antidepressant medication should help you feel better within a few weeks. Depression often recurs, however, even with treatment. If the symptoms of depression return, call your therapist or doctor immediately.

    You may experience some side effects from antidepressant medication, depending on the medication and dosage you are taking. However, most side effects are not severe or bothersome. Notify your doctor of any side effects so he or she can work with you to keep them to a minimum.

    How can I take care of myself?
    Follow the treatment recommended by your doctor, including antidepressant medication (if prescribed) and counseling. In addition, you can:
  • Identify the activities that make you feel somewhat better and try to focus on them. Do things for yourself. Participate in activities even when you may not want to.
  • Do not withdraw from others. Join a support group and talk to your family and friends. Call on your support group or therapist for help when you need it. Ask for assistance at home and work if the load is too great to handle.
  • Eat nutritious, well-balanced meals. Avoid drinking any alcohol or using illegal drugs.
  • Exercise on a regular basis, several times a week.
  • Get adequate rest and keep your sleep pattern as regular as possible.
  • Do progressive relaxation exercises daily and breathing exercises during times of high stress.
  • Perform frequent mental imaging of good life experiences. Develop and maintain an attitude that things will work out.
  • Learn new, positive problem-solving techniques.
  • Call your doctor or therapist if you feel suicidal.

    Certain medications such as reserpine, birth control pills, benzodiazepines, digitalis, and possibly beta-adrenergic blockers can add to the symptoms of depression. If you have been or are being treated for depression, it is important to check with your doctor before taking any new medications, either nonprescription drugs or drugs prescribed by other doctors.

    Developed by Phyllis G. Cooper, R.N., M.N., and Clinical Reference Systems.
    Copyright 1998 Clinical Reference Systems

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