Depressive disorders have been with man since the beginning of recorded history.
In the Bible, King David, as well as Job, suffered from this affliction.
Hippocrates referred to depression as melancholia, which literally means black
bile. Black bile, along with blood, phlegm, and yellow bile were the four
humors (fluids) that accounted for the basic medical physiology of that time.
Depression has been portrayed in literature and the arts for hundreds of years,
but what do we mean today when we refer to a depressive disorder? In the
nineteenth century, depression was seen as an inherited weakness of
In the 1950's and 60's, depression was divided into two types, endogenous and
neurotic. Endogenous means that the depression comes from within the body,
perhaps of genetic origin, or comes out of nowhere. Neurotic or reactive
depression has a clear environmental precipitating factor, such as the death of
a spouse, or other significant loss, such as the loss of a job. In the 1970's
and 80's, the focus of attention shifted from the cause of depression to its
effects on the afflicted people. That is to say, whatever the cause in a
particular case, what are the symptoms and impaired functions that experts can
agree make up a depressive disorder? Although there is some argument even
today, most experts agree that:
Types Of Depression:
A depressive disorder is a syndrome (group of symptoms) that reflects a sad
mood exceeding normal sadness or grief. More specifically, the sadness of
depression is characterized by a greater intensity and duration and by more
severe symptoms and functional disabilities than is normal.
Depression symptoms are characterized not only by negative thoughts, moods, and
behaviors, but also by specific changes in bodily functions (e.g., eating,
sleeping, and sexual activity). The functional changes are often called
Certain people with depressive disorder, especially bipolar depression (manic
depression), seem to have an inherited vulnerability to this condition.
Depressive disorders are a huge public health problem.
In a major medical study, depression caused significant problems in the
functioning of those affected more often than did arthritis, hypertension,
chronic lung disease, and diabetes, and in two categories of problems, as often
as coronary artery disease.
Depression can increase the risks for developing coronary artery disease, HIV,
asthma, and some other medical illnesses. Furthermore, it can increase the
morbidity (illness) and mortality (death) from these
Depression is usually first identified in a primary care setting, not in a
mental health practitioner's office. Moreover, it often assumes various
disguises, which causes depression to be frequently under-diagnosed.
In spite of clear research evidence and clinical guidelines regarding therapy,
depression is often under-treated. Hopefully, this situation can change for the
For full recovery from a mood disorder, regardless of whether there is a
precipitating factor or it seems to come out of the blue, treatments with
medications and/or electroconvulsive therapy (ECT) and psychotherapy are
Depressive disorders come in different forms, just as do other illnesses, such
as heart disease and diabetes. Most common types of depressive disorders are
discussed below. However, remember that within each of these types, there are
variations in the number, severity, and persistence of symptoms.
depression and mania
Major depression is characterized by a combination of symptoms,
including sad mood (see symptom list), that interfere with the ability to work,
sleep, eat, and enjoy once-pleasurable activities. Disabling episodes of
depression can occur once, twice, or several times in a lifetime.
Dysthymia is a less severe type of depression. It involves long-term
(chronic) symptoms that do not disable, but yet prevent the affected person
from functioning at "full steam" or from feeling good. Sometimes, people with
dysthymia also experience episodes of major depression. This combination of the
two types of depression is referred to as double-depression.
Bipolar Disorder Or
Another type of depression is bipolar disorder, which was formerly
called manic-depressive illness or manic depression. This condition shows a
particular pattern of inheritance. Not nearly as common as the other types of
depressive disorders, bipolar disorder involves cycles of depression and mania,
or elation. Bipolar disorder is often a chronic, recurring condition.
Sometimes, the mood switches are dramatic and rapid, but most often they are
When in the depressed cycle, the person can experience any or all of the
symptoms of a depressive disorder. When in the manic cycle, any or all of the
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 an individual is in a manic phase.A significant variant of bipolar
disorder is designated as bipolar II. (The usual form of bipolar disorder is
referred to as bipolar I.) Bipolar II is a syndrome in which the affected
person has repeated depressive episodes punctuated by what is called hypomania
(mini-highs). These euphoric states in bipolar II do not fully meet the
criteria for the complete manic episodes that occur in bipolar I.
Not everyone who is depressed or manic experiences every symptom. Some people
experience a few symptoms and some many symptoms. The severity of symptoms also
varies with individuals.
Symptoms of Manic Depression
of Manic Depression
Persistently 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,
Insomnia, early-morning awakening, or oversleeping.
Decreased appetite and/or weight loss, or overeating and weight gain.
Fatigue, decreased energy, being "slowed down."
Thoughts of death or suicide, suicide attempts.
Difficulty concentrating, remembering, making decisions.
Persistent physical symptoms that do not respond to treatment, such as
headaches, digestive disorders, and chronic pain.
Causes Of Depression:
Increased talking speed and/or volume.
Disconnected and racing thoughts.
Increased sexual desire.
Markedly increased energy.
Inappropriate social behavior.
Some types of depression run in families, indicating that a biological
vulnerability to depression can be inherited. This seems to be the case
especially with bipolar disorder. Studies have been done of families in which
members of each generation develop bipolar disorder. The investigators found
that those with the illness have a somewhat different genetic makeup than those
who do not become ill. However, the reverse is not true. That is, not everybody
with the genetic makeup that causes vulnerability to bipolar disorder has the
illness. Apparently, additional factors, possibly a stressful environment, are
involved in its onset.
Major depression also seems to occur in generation after generation in some
families, although not as strongly as in Bipolar I or II. Indeed, major
depression can also occur in people who have no family history of depression.
An external event often seems to initiate an episode of depression. Thus, a
serious loss, chronic illness, difficult relationship, financial problem, or
any unwelcome change in life patterns can trigger a depressive episode. Very
often, a combination of genetic, psychological, and environmental factors is
involved in the onset of a depressive disorder.
Nothing in the universe is as complex and fascinating as the human brain. The
over 100 chemicals that circulate in the brain are known as neurochemicals or
neurotransmitters. Much of our research and knowledge, however, has focused on
four of these neurochemical systems:
In the new millennium, after new discoveries are made, it is possible that these
four neurochemicals will be viewed as the "black bile, yellow bile, phlegm, and
blood" of the twentieth century.
Different neuropsychiatric illnesses seem to be associated with an
over-abundance or a lack of some of these neurochemicals in certain parts of
the brain. For example, a lack of dopamine at the base of the brain causes
Parkinson disease. Alzheimer dementia seems to be related to lower
acetylcholine levels in the brain. The addictive disorders are under the
influence of the neurochemical dopamine. That is to say, drugs and alcohol work
by releasing dopamine in the brain. The dopamine causes euphoria, which is a
pleasant sensation. Repeated use of drugs or alcohol, however, desensitizes the
dopamine system, which means that the system gets used to the drugs and
alcohol. Therefore, a person needs more drugs or alcohol to achieve the same
high feeling. Thus, the addicted person takes more and more to feel less and
The different types of schizophrenia are associated with an imbalance of
dopamine (too much) and serotonin (poorly regulated) in certain areas of the
brain. Finally, the depressive disorders appear to be associated with altered
brain serotonin and norepinephrine systems. Both of these neurochemicals are
lower in depressed people. Please note that I specified, "associated with"
instead of, "caused by." I made this distinction because we really don't know
whether low levels of neurochemicals in the brain cause depression or whether
depression causes low levels of neurochemicals in the brain.
What we do know is certain medications that alter the levels of norepinephrine
or serotonin can alleviate the symptoms of depression. Some medicines that
affect both of these neurochemical systems appear to perform even better or
faster. Other medications that treat depression primarily affect the other
neurochemical systems. The most powerful treatment for depression,
electroconvulsive therapy (ECT), is certainly not specific to any particular
neurotransmitter system. Rather, ECT, by causing a seizure, produces a
generalized brain activity that probably releases massive amounts of all of the
Women are twice as likely to become depressed as men. However, scientists do not
know the reason for this difference. Psychological factors also contribute to a
person's vulnerability to depression. Thus, persistent deprivation in infancy,
physical or sexual abuse, clusters of certain personality traits, and
inadequate ways of coping (maladaptive coping mechanisms) all can increase the
frequency and severity of depressive disorders, with or without inherited
The effect of maternal-fetal stress on depression is currently an exciting area
of research. It seems that maternal stress during pregnancy can increase the
chance that the child will be prone to depression as an adult, particularly if
there is a genetic vulnerability. It is thought that the mother's circulating
stress hormones can influence the development of the fetus's brain during
pregnancy. This altered fetal brain development occurs in ways that predispose
the child to the risk of depression as an adult.
Postpartum depression (PPD) is a condition that describes a range of physical
and emotional changes that many mothers can have after having a baby. PPD can
be treated with medication and counseling. Talk with your health care provider
right away if you think you have PPD.
There are three types of PPD women can have after giving birth:
Diagnosis Of Depression:
The so called 'baby blues' happen in many women in the days right after
childbirth. A new mother can have sudden mood swings, such as feeling very
happy and then feeling very sad. She may cry for no reason and can feel
impatient, irritable, restless, anxious, lonely, and sad. The baby blues may
last only a few hours or as long as 1 to 2 weeks after delivery. The baby blues
do not always require treatment from a health care provider. Often, joining a
support group of new moms or talking with other moms helps.
Postpartum depression (PPD) can happen a few days or even months after
childbirth. PPD can happen after the birth of any child, not just the first
child. A woman can have feelings similar to the baby blues - sadness, despair,
anxiety, irritability - but she feels them much more strongly than she would
with the baby blues. PPD often keeps a woman from doing the things she needs to
do every day. When a woman's ability to function is affected, this is a sure
sign that she needs to see her health care provider right away. If a woman does
not get treatment for PPD, symptoms can get worse and last for as long as 1
year. While PPD is a serious condition, it can be treated with medication and
Postpartum psychosis is a very serious mental illness that can affect
mothers. This illness can happen quickly, often within the first 3 months after
childbirth. Women can lose touch with reality, often having auditory
hallucinations (hearing things that aren't actually happening, like a person
talking) and delusions (seeing things differently from what they are). Visual
hallucinations (seeing things that aren't there) are less common. Other
symptoms include insomnia (not being able to sleep), feeling agitated
(unsettled) and angry, and strange feelings and behaviors. Women who have
postpartum psychosis need treatment right away and almost always need
medication. Sometimes women are put into the hospital because they are at risk
for hurting themselves or someone else.
The first step to obtaining appropriate treatment is a complete physical and
psychological evaluation to determine whether the person may have a depressive
illness, and if so, what type. Certain medications, as well as some medical
conditions, can cause symptoms of depression. Therefore, the examining
physician should rule out (exclude) these possibilities through an interview,
physical examination, and laboratory tests.
A systematic diagnostic evaluation includes a complete history of the
When did the symptoms start?
How long have they lasted?
How severe are they?
Have the symptoms occurred before, and, if so, were they treated and what
treatment was received?
The doctor should ask about alcohol and drug use, and whether the patient has
had thoughts about death or suicide. Further, the history should include
questions about whether other family members have had a depressive illness, and
if treated, what treatments they received and which were effective.
A diagnostic evaluation also includes a mental status examination to determine
if the patient's speech, thought pattern, or memory has been affected, as often
happens in the case of a depressive or manic-depressive illness. As of today,
there is no laboratory test, blood test, or X-ray that can diagnose a mental
disorder. Even the powerful CT, MRI, SPECT, and PET scans, which can help
diagnose other neurological disorders, such as stroke or brain tumors, cannot
detect the subtle and complex brain changes in psychiatric illness. However,
these techniques are currently useful in research on mental health and perhaps
in the future they will be useful for diagnosis as well.
In the past few years, much interest has risen in the use of herbs in the
treatment of both depression and anxiety. St. John's wort (Hypericum
perforatum), an herb used extensively in the treatment of mild to moderate
depression in Europe, has recently aroused interest in the United States. St.
John's wort, an attractive bushy, low-growing plant covered with yellow flowers
in summer, has been used for centuries in many folk and herbal remedies. Today
in Germany, Hypericum is used in the treatment of depression more than any
other antidepressant. However, the scientific studies that have been conducted
on its use have been short-term and have used several different doses.
Some other herbal supplements frequently used that have not been evaluated in
large-scale clinical trials are ephedra, gingko biloba, echinacea, and ginseng.
Any herbal supplement should be taken only after consultation with the doctor
or other health care provider.
Treatments For Depression:
Selective serotonin reuptake inhibitors (SSRIs) are
medications that increase the amount of the neurochemical serotonin in the
brain. (Remember that brain serotonin levels are low in depression.) As their
name implies, the SSRIs work by selectively inhibiting (blocking) serotonin
reuptake in the brain. This block occurs at the synapse, the place where brain
cells (neurons) are connected to each other. Serotonin is one of the chemicals
in the brain that carries messages across these connections (synapses) from one
neuron to another.
The SSRIs work by keeping the serotonin present in high concentrations in the
synapses. These drugs do this by preventing the reuptake of serotonin back into
the sending nerve cell. The reuptake of serotonin is responsible for turning
off the production of new serotonin. Therefore, the serotonin message keeps on
coming through. This, in turn, helps arouse (activate) cells that have been
depression, and relieves the depressed person's symptoms.
In the United States, SSRIs have been used successfully for a decade to treat
SSRIs are generally well tolerated and side effects are usually mild. The most
common side effects are nausea, diarrhea, agitation, insomnia, and headache.
However, these side effects generally go away within the first month of SSRI
use. Some patients experience sexual side effects, such as decreased sexual
desire (decreased libido), delayed orgasm, or an inability to have an orgasm.
Some patients experience tremors with SSRIs. The so-called serotonergic
(meaning caused by serotonin) syndrome is a serious neurologic condition
associated with the use of SSRIs. It is characterized by high fevers, seizures,
and heart rhythm disturbances. This condition is very rare and has been
reported only in very ill psychiatric patients taking multiple psychiatric
All patients are unique biochemically. Therefore, the occurrence of side
effects or the lack of a satisfactory result with one SSRI does not mean that
another medication in this group will not be beneficial. However, if someone in
the patient's family has had a positive response to a particular drug, that
drug would be the preferable one to try first.
Dual Action Antidepressants:
The biochemical reality is that all classes
of medications that treat depression (MAOIs, SSRIs, TCAs, and atypical
antidepressants) have some effect on both norepinephrine and serotonin, as well
as on other neurotransmitters. However, the various medications affect the
different neurotransmitters in varying degrees.
Some of the newer antidepressant drugs, however, appear to have particularly
robust effects on both the norepinephrine and serotonin systems. These drugs
seem to be very promising, especially for the more severe and chronic cases of
depression. (Psychiatrists, rather than family practitioners, see such cases
most frequently.) Venlafaxine (Effexor) is one of these dual action compounds.
It is a serotonin reuptake inhibitor that, at lower doses, shares many of the
safety and low side effect characteristics of the SSRIs. At higher doses, this
drug appears to block the reuptake of norepinephrine. Thus, venlafaxine can be
considered an SNRI, a serotonin and norepinephrine reuptake inhibitor.
Another newer antidepressant, mirtazapine (Remeron), is a tetracyclic compound
(four-ring chemical structure). It works at somewhat different biochemical
sites and in different ways than the other drugs. It affects serotonin, but at
a post-synaptic site (after the connection between nerve cells.) It also
increases histamine levels, which can cause drowsiness. For this reason,
mirtazapine is given at bedtime and is often prescribed for people who have
trouble falling asleep. Like venlafaxine, it also works by increasing levels in
the norepinephrine system. Other than causing sedation, this medication has
side effects that are similar to those of the SSRIs, but to a lesser degree in
Atypical antidepressants are so named because they work in a variety of
ways. Thus, atypical antidepressants are not TCAs or SSRIs, but they act like
them. More specifically, they increase the level of certain neurochemicals in
the brain synapses (where nerves communicate with each other). Examples of
atypical antidepressants include nefazodone (Serzone), trazodone (Desyrel),
venlafaxine (Effexor), and bupropion (Wellbutrin). The United States Food and
Drug Administration (FDA) has also approved bupropion for use in weaning from
addiction to cigarettes. This drug is also being studied for treating attention
deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD).
These problems affect many children and adults and restrict their ability to
focus or concentrate on one thing at a time.
Lithium (Eskalith, Lithobid), valproate (Depakene, Depakote) carbamazepine
(Epitol, Tegretol), neurontin (Gabapentin), and lamictal (Lamotrigine) are mood
stabilizers and anticonvulsants. They have been used to treat bipolar
depression. Certain antipsychotic medications, such as ziprasidone (Geodon),
risperidone (Risperdal), and quetiapine (Seroquel), have sometimes also been
used to treat bipolar depression, usually in combination with other
antidepressants and/or the mood stabilizers.
Monoamine oxidase inhibitors (MAOIs) are the earliest developed
antidepressants. Examples of MAOIs include phenelzine (Nardil) and
tranylcypromine (Parnate). MAOIs elevate the levels of neurochemicals in the
brain synapses by inhibiting monoamine oxidase. Monoamine oxidase is the main
enzyme that breaks down neurochemicals, such as norepinephrine. When monoamine
oxidase is inhibited, the norepinephrine is not broken down and, therefore, the
amount of norepinephrine in the brain is increased.
MAOIs also impair the ability to break down tyramine, a substance found in aged
cheese, wines, most nuts, chocolate, and some other foods. Tyramine, like
norepinephrine, can elevate blood pressure. Therefore, the consumption of
tyramine-containing foods by a patient taking an MAOI drug can cause elevated
blood levels of tyramine and dangerously high blood pressure. In addition,
MAOIs can interact with over-the-counter cold and cough medications to cause
dangerously high blood pressures. The reason for this is that these cold and
cough medications often contain drugs that likewise can increase blood
pressure. Because of these potentially serious drug and food interactions,
MAOIs are usually only prescribed after other treatment options have failed.
Tricyclic antidepressants (TCAs) were developed in the 1950's and 60's
to treat depression. They are called tricyclic antidepressants because their
chemical structures consist of three chemical rings. TCAs work mainly by
increasing the level of norepinephrine in the brain synapses, although they
also may affect serotonin levels. Doctors often use TCAs to treat moderate to
severe depression. Examples of tricyclic antidepressants are amitriptyline
(Elavil), protriptyline (Vivactil), desipramine (Norpramin), nortriptyline
(Aventyl, Pamelor), trimipramine (Surmontil), and perphenazine (Triavil).
Tetracyclic antidepressants are similar in action to tricyclics, but their
structure has four chemical rings. Examples of tetracyclics include maprotiline
(Ludiomil) and mirtazapine (Remeron), a drug that was discussed above under
dual action antidepressants.
TCAs are safe and generally well tolerated when properly prescribed and
administered. However, if taken in over-dose, TCAs can cause life-threatening
heart rhythm disturbances. Some TCAs can also have anti-cholinergic side
effects, which are due to the blocking of the activity of the nerves that are
responsible for control of the heart rate, gut motion, and saliva production.
Thus, some TCAs can produce dry mouth, constipation, and dizziness upon
standing. The dizziness results from low blood pressure that occurs upon
standing (orthostatic hypotension). Anti-cholinergic side effects can also
aggravate narrow angle glaucoma, urinary obstruction due to benign prostate
hypertrophy, and cause delirium in the elderly. TCAs should also be avoided in
patients with seizure disorders and a history of strokes.
Stimulants such as methylphenidate (Ritalin) or dextroamphetamine (Dexedrine)
are used primarily for the treatment of depression that is resistant to other
medications. The stimulants are most commonly used along with other
antidepressants or other medications, such as mood stabilizers,
anti-psychotics, or even thyroid hormone. They are sometimes used alone, but
rarely. The reason they are usually used with other medications for depression
is that unlike the other medications, they induce a rush and a high in both
depressed and non-depressed people. Therefore, the stimulants are highly
In the ECT procedure, an electric current is passed through the brain to produce
controlled convulsions (seizures). ECT is useful for certain patients,
particularly for those who cannot take or are not responding to
antidepressants, have severe depression, or are at a high risk for suicide. ECT
often is effective in cases where antidepressant medications do not provide
sufficient relief of symptoms. This procedure probably works, as previously
mentioned, by a massive neurochemical release in the brain due to the
controlled seizure. Highly effective, ECT relieves depression within 1 to 2
weeks after beginning treatments. After ECT, some patients will continue to
have maintenance ECT, while others will return to antidepressant medications.
In recent years, the technique of ECT has been much improved. The treatment is
given in the hospital under anesthesia so that people receiving ECT do not feel
pain. Most patients undergo 6 to 10 treatments. An electrical current is passed
through the brain to cause a controlled seizure, which typically lasts for 20
to 90 seconds. The patient is awake in 5 to 10 minutes. The most common side
effect is short-term memory loss, which resolves quickly. After the initial
course of treatment, ECT can be safely done as an outpatient procedure.
Many forms of psychotherapy are effectively used to help depressed individuals,
including some short-term (10 to 20 weeks) therapies. Talking therapies help
patients gain insight into their problems and resolve them through verbal
give-and-take with the therapist. Behavioral therapists help patients learn how
to obtain more satisfaction and rewards through their own actions. These
therapists also help patients to unlearn the behavioral patterns that
contribute to their depression.
Interpersonal and cognitive/behavioral therapies are two of the short-term
psychotherapies that research has shown to be helpful for some forms of
depression. 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 that are often associated with depression.
Psychodynamic therapies are sometimes used to treat depression. They focus on
resolving the patient's internal psychological conflicts that are typically
thought to be rooted in childhood. Long-term psychodynamic therapies are
particularly important if there seems to be a life-long history and pattern of
inadequate ways of coping (maladaptive coping mechanisms) in negative or
General Approach To Treating Depression:
In general, the severe depressive illnesses, particularly those that are
recurrent, will require antidepressant medications (or ECT under special
conditions) along with psychoanalysis for the best outcome. If a person suffers
one major depressive episode, he or she has a 50% chance of a second episode.
If the individual suffers two major depressive episodes, the chance of a third
episode is 75 to 80%. If the person suffers three episodes, the likelihood of a
fourth episode is 90 to 95%. Therefore, after a first depressive episode, it
might make sense for the patient to gradually come off medication. However,
after a second and certainly after a third episode, most clinicians will have a
patient remain on a maintenance dosage of the medication for an extended period
of years, if not permanently.
Sometimes, the doctor will need to try a variety of antidepressants before
finding the medication or combination of medications that is most effective for
the patient. Sometimes, the dosage must be increased to be effective. Also, new
types of antidepressants are being developed all the time, and one of these may
be the best for a particular patient.
If the depressed person is taking more than one drug for depression or drugs for
any other medical problem, all of the patient's doctors should be made aware of
the other prescriptions. Many of these medications are cleared from the body
(metabolized) in the liver. This means that the multiple drugs can interact
competitively with the liver's biochemical clearing systems. Therefore, the
actual blood levels of the drugs may be higher or lower than would be expected
from the dosage. This information is especially important if the patient is
taking anti-coagulants (blood thinners), anticonvulsants (seizure medications),
or heart medications, such as digitalis. Although multiple medications do not
necessarily pose a problem, all of the patient's doctors need to be in close
contact to adjust dosages accordingly.
Patients often are tempted to stop their medication too soon. It is important
to keep taking medication until the doctor says to stop, even if the patient
feels better beforehand. Some medications must be stopped gradually to give the
body time to adjust. For individuals with bipolar disorder or chronic major
depression, medication may have to become a part of everyday life in order to
avoid disabling symptoms.
Antidepressant drugs are not habit-forming, so there need not be concern about
that. However, as is the case with any type of medication prescribed for more
than a few days, antidepressants must be carefully monitored to ensure that the
patient is getting the correct dosage. The doctor will want to check the dosage
and its effectiveness regularly.
If the patient is taking MAOIs, certain aged, fermented, or pickled foods must
avoided. The patient should obtain a complete list of prohibited foods from the
doctor and keep it available at all times. The other types of antidepressants
require no food restrictions. Remember that some over-the-counter cold and
cough medicines can also cause problems when taken with MAOIs.
People should never mix medications of any kind (prescribed, over-the counter,
or borrowed) without consulting their doctor. The dentist or any other medical
specialist who prescribes a drug should be informed that the patient is taking
antidepressants. Some drugs that are harmless when taken alone can cause severe
and dangerous side effects when taken with other drugs. Some drugs, such as
alcohol (including wine, beer, and hard liquor), reduce the effectiveness of
antidepressants and should be avoided.
Finally, the doctor should be consulted concerning any questions about a drug
or problem that the patient believes is drug related.
Depressive disorders make those afflicted 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 the actual situation. It
should be remembered that negative thinking fades as treatment begins to take
effect. In the meantime, the following are helpful guidelines and advice for
the depressed pereson:
can someone help a person who is depressed?
Do not set difficult goals for yourself or take on a great deal of
Break large tasks into small ones, set some priorities, and do what you can
when you can.
Do not expect too much from yourself too soon, as this will only increase
feelings of failure.
Try to be with other people, which is usually better than being alone.
Participate in activities that may make you feel better.
You might try exercising mildly, going to a movie or a ball game, or
participating in religious or social activities.
Don't rush or overdo it. Don't 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 or getting married or
divorced without consulting others who know you well. These people often can
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 the affected person feel
exhausted and helpless, he or she will want and probably need help from others.
However, people who have never had a depressive disorder may not fully
understand its effect. Although unintentional, friends and loved ones may
unknowingly say and do things that may be hurtful to the depressed person. It
may help to share the information in this article with those you most care
about so they can better understand and help you.
The most important thing anyone can do for the depressed person is to help him
or her get an appropriate diagnosis and treatment. This help may involve
encouraging the individual to stay with treatment until symptoms begin to go
away (usually 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. Always report a worsening depression to
the patient's physician or therapist.
The second most important way to help is to offer emotional support. This
support involves understanding, patience, affection, and encouragement. Engage
the depressed person in conversation and listen carefully. Do not disparage
feelings expressed, but point out realities and offer hope. Do not ignore
remarks about suicide. Always report them to the depressed person's therapist.
Invite the depressed person for walks, outings, and to the movies and other
activities. Be gently insistent if your invitation is refused. Encourage
participation in activities that once gave pleasure, such as hobbies, sports,
or religious or cultural activities. However, do not push the depressed person
to undertake too much too soon. The depressed person needs company and
diversion, but too many demands can increase feelings of failure.
Do not accuse the depressed person of faking illness or of laziness. Do not
expect him or her "to snap out of it." Eventually, with treatment, most
depressed people do get better. Keep that in mind. Moreover, keep reassuring
the depressed person that, with time and help, he or she will feel better.
one seek help for depression?
A complete physical and psychological diagnostic evaluation by professionals
will help the depressed person decide the type of treatment that might be best
for him or her. However, if the situation is urgent because a suicide seems
possible, taking the patient to the emergency room is the appropriate course of
action. If the patient makes a suicide gesture or attempt, a 911 call is
warranted. The patient might not realize how much help he or she needs. In
fact, he or she might feel undeserving of help because of the negativity and
helplessness that is a part of depressive illness.
Listed below are the types of people and places that will make a referral or
provide diagnostic and treatment services.
Future For Depression:
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.
Private clinics and facilities.
Employee assistance programs.
Local medical and/or psychiatric societies.
The future is very bright for the treatment of depression. We are close to
having genetic markers for bipolar disorder. Soon after, we hope to also have
them for major depression. That way, we can know of a child's vulnerability to
depression from birth and try to create preventive strategies. For example, we
can teach parents early warning signs so that they can get treatment for their
children, if necessary, to ward off future problems.
The new world of pharmacogenetics holds the promise of actually keeping the
genes responsible for depression turned off so as to avoid the illnesses
completely. Also, by studying genes, we are learning more about the matching of
patients with treatment. This kind of information will be able to tell us which
patients do well on which types of drugs and psychotherapy regimens.
We are learning more about the interactions of the neurochemicals in the brain.
Moreover, new categories of neurochemicals, such as neuropeptides and substance
P, are being studied. As a result, we will soon be able to develop new drugs
that should be more effective with fewer side effects. Finally, we are learning
startling things about how maternal stress early in pregnancy can profoundly
affect the developing fetus. For example, we now know that maternal stress can
greatly increase the risk for the fetus to develop depression as an adult.
While sadness will always be part of the human condition, hopefully we will be
able to lessen or eradicate the more severe mood disorders from the world to
the benefit of all of us.
Depression At A Glance
A depressive disorder is a syndrome (group of symptoms) that reflects a sad
mood exceeding normal sadness or grief.
Depressive disorders are characterized not only by negative thoughts, moods,
and behaviors, but also by specific changes in bodily functions (e.g., eating,
sleeping, and sexual activity).
One in 10 people will have a depressive disorder in their lifetime, and in 1 of
10 cases, the depression is a fatal disease as a result of suicide.
Some types of depression, especially bipolar depression, run in families.
Depression is diagnosed only clinically in that there is no laboratory test or
x-ray for depression. Therefore, it is crucial to see a health practitioner as
soon as you notice symptoms of depression in yourself, your friends, or family.
The first step in getting appropriate treatment is a complete physical and
psychological evaluation to determine whether the person, in fact, has a
Depression is not a weakness, but a serious illness with biological,
psychological, and social aspects to its cause, symptoms, and treatment. A
person cannot will it away. Untreated, it will worsen. Under-treated, it will
There are many safe and effective medications, particularly the SSRIs, that can
be of great help in depression.
For full recovery from a mood disorder, regardless of whether there is a
precipitating factor or it seems to come out of the blue, treatments with
medications and/or electroconvulsive therapy (ECT) and psychotherapy are
In the future, through depression research and education, we will continue to
improve our treatments, decrease society's burden, and hopefully develop