What is major depression?
Major depression is an illness that is
typified by its most prominent symptom – a severe and persistent low mood,
profound sadness, or a sense of despair.
The mood can sometimes appear as irritability
or an inability to take pleasure in activities that usually are enjoyable.
Major
depression is more than just a passing blue mood, a “bad day” or temporary
sadness over a specific event.
The mood changes that occur in major
depression are defined as lasting at least 2 weeks but usually they go on much
longer – months or even years.
A variety of symptoms usually accompany the
mood change, and the symptoms can vary significantly among different people.
Many people with depression also have
anxiety and tend to worry more than average about their physical health. They
may have excessive conflict in their relationships and may function poorly at
work. Sexual functioning may be a problem. People with depression are
susceptible to abusing alcohol or other substances.
Depression probably involves changes in the
areas of the brain that control mood. Neuroscientists are continuing to work
out the details, but there are several places where problems can occur.
Chemical reaction inside nerve cells may be altered. Communication between
nerve cells or nerve circuits can make it harder for a person to regulate their
mood. Changes in hormones may play a role. How vulnerable a person is to
hiccups in these functions is almost certainly influenced by genetic variations.
An episode of depression can be triggered
by a stressful life event, such as the death of a loved one. But in many cases,
depression does not appear to be related to a specific event.
Major depression may occur just once in a
person’s life or may return periodically. Some people who have repeated
episodes of major depression who have long pattern of a milder depressed mood
called dysthymia. When major depression alternates with periods of great
exuberance and energy, the illness is called bipolar disorder. If a woman has a major depressive episode within
the first 2 or 3 months after giving birth to a baby, it is called postpartum depression.
Depression that occurs mainly during the winter months is called seasonal affective disorder, or SAD.
Episodes of depression can occur at any
age. Depression is diagnosed in women twice as often as in men. People who have
a family member with major depression are more likely to develop depression or
drinking problems.
What are the symptoms of major depression?
A depressed person may gain or lose weight,
eat more or less than usual, have difficulty concentrating, or have trouble
sleeping or sleep more than usual. He or she may feel tired and have no energy
for work or play. Small burdens or obstacles may appear impossible to manage.
The person can appear slowed down or agitated and restless. The symptoms can be
quite noticeable to others.
A particular painful symptom of this
illness is an unshakable feeling of worthlessness and guilt. The person may
feel guilty about a specific life experience or may feel general guilt not
related to anything specific.
If pain and self-criticism become great
enough, they can lead to feelings of hopelessness, self-destructive behaviour,
or thoughts of death and suicide. The vast majority of people who suffer severe
depression do not attempt or commit suicide, but they are more likely to do so
than people who are not depressed.
The thought of people with major depression
are often irrationally coloured by their dark mood. For example, pessimistic
ideas may be out of proportion with the reality of the situation. Sometimes,
the depressed thinking is distorted enough to be called “psychotic”, that is,
the person has great difficulty recognising reality. Sometimes, depressed
people develop delusions (false beliefs) or hallucinations (false perceptions).
Symptoms of major depression include:
- Distinctly depressed or irritable mood
- Loss of interest or pleasure
- Decreased or increased weight or appetite
- Increased or decreased sleep
- Appearing slowed or agitated
- Fatigue or loss energy
- Feeling worthless or guilty
- Poor concentration
- Indecisiveness
- Thoughts of death, suicide attempts or plans
What is the expected duration of major
depression?
Episodes of major depression last an
average of 4 to 8 months, but they can last for any length of time. Symptoms
can vary in intensity during an episode. If depression is not treated, it can
become chronic (long-lasting). Treatment can shorten the length and severity of
a depressive episode.
How is it diagnosed?
A primary care physician or a mental health
professional usually can diagnose depression by asking questions about medical
history and symptoms. Major depression is diagnosed when a person has many of
the symptoms listed above for at least 2 weeks. Many people with depression do
not seek treatment because of society’s attitudes about depression. The person
may feel the depression is his or her fault or may worry about what others will
think. Also, the depression itself may distort a person’s ability to recognize
the problem.
What is the treatment of major depression?
A combination of psychotherapy and
medication is most helpful. The most commonly prescribed antidepressants are
known as selective serotonin reuptake inhibitors (SSRIs). They include
fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil) and citalopram
(Celaxa). They are fairly easy to take and relatively safe compared with
previous generations of antidepressants.
No medication is without side effects.
SSRIs are known to cause problems with sexual functioning, some nausea, and an
increase in anxiety in the early stages of treatment.
Other relatively new and effective
antidepressants are bupropion (Wellbutrin), venlafaxine (Effexor), mirtazapine
(Remeron) and duloxetin (Cymbalta). The older classes of antidepressants,
trycyclic antidepressants and monoamine inhibitors, are still in use, are as
effective as the newer ones, and can be very useful when someone does not feel
better in response to other treatments.
It usually takes at least 2 to 6 weeks of
taking any antidepressant to see improvement. Once the right medication is
found, it may take up to a few months to find a proper dose and for the full
positive effect to be seen.
In the past few years, investigators have
raised concerns about an increased risk of suicide in people taking
antidepressants. This problem has remained a focus for researchers, but the
evidence is hard to interpret. Many experts believe that antidepressants reduce
the number of suicides overall, but a very small number of people taking these
medications probably do have an unusual reaction and end up feeling much worse
rather than better. Therefore, it is important to have treatment monitored
closely and to report any troubling symptoms or worsening mood to the doctor
immediately.
Sometimes, 2 different antidepressants are
prescribed together. Or a mood stabilizer, such as lithim (sold under different
brand names) or valproic acid (Depakene, Depakote), is added. If psychotic
symptoms are present, an antipsychotic medication is usually prescribed. These
include haloperidol (Haldol), risperidone (Risperdal), olanzapine (Zyprexa,
Zydis), ziprasidone (Geodon) and aripiprazole (Abilify).
A number of psychotherapy techniques have
been demonstrated to be helpful, depending on the causes of the depression, the
availability of family and other social support, and personal style and
preference. A technique called cognitive
behaviour therapy is designed to help a depressed person recognize fearful
thinking and teaches techniques for controlling symptoms. Psychodynamic,
insight-oriented or interpersonal psychotherapy can help depressed people to
sort out conflicts in important relationships or explore the history behind the
symptoms.
If you know anyone who suffers from
depression, it helps to learn more about it and find out what support is
available to such ones in the community.
In some situations, a treatment called electroconvulsive therapy (ECT) can be
a life-saving option. This treatment is controversial, but very effective. In
ECT, an electrical impulse is applied to the person’s scalp and passes to the
brain, causing a seizure. The patient is under anaesthesia and is monitored
carefully.
Medication is given before the procedure to prevent any outward
signs of convulsions, which helps to prevent injury. Improvement is seen
gradually over a period of days to weeks after the treatment. ECT is the
quickest and most effective treatment for the most severe forms of depression,
and in most people, it is not more risky than other antidepressant treatments.
What is the prognosis of major depression?
Treatment of depression has become quite
sophisticated and effective. The prognosis with treatment is excellent. The
intensity of symptoms and the frequency of episodes often are significantly
reduced. Many people recover quickly.
When treatment is successful, it is
important to stay in close touch with your doctor or therapist, because
maintenance treatment is often required to prevent depression from returning.
There
are no specific tests for depression. However, it
is important to be evaluated by a primary care physician to make sure the
problems are not being caused by a medical condition or medication.
How can one prevent major depression?
There is no way to prevent major
depression, but detecting it early can diminish symptoms and help prevent the
illness from returning.
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