Depression

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Depression is considered a medical illness, and affects over 350 million people worldwide, according to a report issued by the World Health Organization.

Lifetime prevalence of depressive disorders in developed countries is approximately 20%, and women are affected almost twice as often as men. The peak incidence occurs in the fifth decade of life, and incidence decreases in elderly population. Depression is the leading cause of disability in the United States among individuals aged 15 to 44 years and is a major risk factor for suicide. It most often presents in a primary care setting and remains underdiagnosed in patient populations. Depressive symptoms are frequently noticed in patients with chronic medical conditions as a result of illnesses such as hypothyroidism or as a response to disability caused by another illness. Screening for depression is underutilized and the US preventive task force advises screening all patients during primary care visits and ensuring there are adequate systems in place to confirm accurate diagnosis, treatment and appropriate follow-up.

As a method of general population screening, the PHQ2 (questionnaire) is effective and easy to use. A positive response to either of the two questions such as, “Over the past two weeks have you felt down depressed or hopeless?” and “over the past two weeks have you felt little interest or pleasure in doing things” indicates that further investigation for depression is warranted.

Someone who has depression has symptoms nearly every day, all day, for 2 weeks or longer. This is considered major depression. There are other forms of depression that may have less severe symptoms. All the various forms of depression share the same usual causes and often the same treatments.

Depression can affect people of all ages and is different for every person. A person who has depression cannot control his or her feelings. If you or your child, teen, or older relative is depressed, it’s not his or her fault, and if left untreated, depression can last for weeks, or even years.

Women are twice as likely as men to experience depression, and the cyclical changes in a woman’s hormone levels may be related to depression.

Symptoms of depression

Symptoms of depression are different for every person. You may have one or many of the symptoms listed below, and your symptoms may appear as emotional, physical, or a combination of both. The symptoms of depression may be different for children, teens, adults, and seniors.

Emotional symptoms include:

    Crying spells for no clear reason.

    Losing interest or pleasure in things you used to enjoy, including       intimacy.

    Feeling restless, irritated, and easily annoyed.

    Feeling numb, or hopeless.

    Feeling guilty or worthless.

    Thinking about death or suicide.

Physical symptoms of depression include:

    Changes in appetite

    Feeling exhausted all the time.

    Aches and pains which are nonresponsive to treatment.

    Inability to concentrate or recall things

    Headaches, backaches, or digestive problems.

    Sleeping too much, or having trouble sleeping.

    Unintended weight loss or gain.

What causes depression?

Depression is usually caused by one or more factors, including imbalances of chemicals in the brain. Sometimes there are not enough neurotransmitters in the brain. Neurotransmitters that affect your mood are serotonin, norepinephrine, and dopamine.

    Sometimes depression is hereditary, meaning you are at higher risk for having depression if you have a parent or sibling who has depression. Sometimes depression can be caused by a medical condition: problems with your thyroid or nutrient deficiencies may be associated with an increased risk of depression.

    Depression can also be triggered by stressful events in your life. These can include the death of a loved one, loss of a job, a divorce or a chronic illness. It can also be triggered by medicines, drugs, or alcohol. Taking certain medicines, or abusing drugs or alcohol, can also lead to depression.

Shortly after the birth of a child, it is fairly common for some mothers to have mood swings. They may experience depressive symptoms or have difficulty concentrating. They may lose their appetite or have difficulty sleeping. This is called the “baby blues” and generally goes away within 10 days after delivery. However, some women have more pronounced symptoms, or more prolonged symptoms that. This is referred to as postpartum depression.

Depression should not be considered a normal “side effect” of aging, and it should never be taken lightly. Unfortunately, depression often goes undiagnosed and untreated in older adults, and they are reluctant to ask for help. Symptoms of depression may be less obvious in the elderly, but may include:

Physical aches or pain

 Memory deficits or personality changes

 Fatigue, loss of appetite, sleep problems

 Choosing to stay at home, rather than socializing or trying new things.

  Suicidal thoughts or feelings, particularly in older men

Depression statistics in America

    17.3 million adults (7.1% of the adult population) have had at least one major depressive episode. (National Institute of Mental Health, 2017)

    Of those with major depressive episodes, 63.8% of adults and 70.77% of adolescents had severe impairment. (National Institute of Mental Health, 2017)

    Women are nearly twice as likely as men to have depression. (Centers for Disease Control, 2017)

    Major depressive episodes were most prevalent among adults (11.3%) and adolescents (16.9%) reporting two or more races. (National Institute of Mental Health, 2017)

Depression statistics by age

    Adolescents aged 12 to 17 years old had the highest rate of major depressive episodes (14.4%) followed by young adults 18 to 25 years old (13.8%). (Substance Abuse and Mental Health Services Association, 2018)

    Older adults aged 50 and older had the lowest rate of major depressive episodes (4.5%). (Substance Abuse and Mental Health Services Association, 2018)

    11.5 million adults had a major depressive episode with severe impairment in the past year as of 2018. (Substance Abuse and Mental Health Services Association, 2018)

    Severe depression among college students rose from 9.4% to 21.1% from 2013 to 2018. (Journal of Adolescent Health, 2019)

    The rate of moderate to severe depression rose from 23.2% to 41.1% from 2007 to 2018. (Journal of Adolescent Health, 2019)

Postpartum depression statistics

Postpartum depression is depression suffered by a mother who has recently undergone childbirth, typically occurring within three months to a year after giving birth. This may be due to hormonal changes, changes in lifestyle, and parenthood fatigue.

    About 70% to 80% of women will experience the “baby blues” characterized by negative feelings or mood swings after childbirth. (American Pregnancy Association, 2015)

    10% to 20% of new mothers experience clinical postpartum depression. (Arizona Behavioral Health Associates, P.C, Flagstaff Psychologists & Counselors)

    1 in 7 women may experience PPD within a year of giving birth. (JAMA Psychiatry, 2013)

    Paternal depression ranged from 24% to 50% in men who had partners with postpartum depression. (Journal of Advanced Nursing, 2004)

    Women with a history of depression, anxiety disorders, or serious mood disorders are 30% to 35% more likely to develop postpartum depression. (Johns Hopkins Medicine, 2013)

Holiday depression

Although the “holiday season” during the months of November and December are typically thought of as joyful, this is not the reality for everyone. Some develop depressive symptoms during these months.

    Stress levels reportedly increase during the holiday season for 38% of people. (American Psychological Association, 2006)

    Of people with mental illness, 64% report holidays make their symptoms worse. (National Alliance on Mental Illness, 2014)

    Of those who reported feeling sad or dissatisfied during the holidays, more than two-thirds of them felt financially stressed and/or lonely. (National Alliance on Mental Illness, 2014)

Suicide and depression

   Two-thirds of those who commit suicide struggle with depression. (American Association of Suicidology, 2009)

    Of those diagnosed with depression, 1% of women and 7% of men commit suicide. (American Association of Suicidology, 2009)

    The risk of suicide is about 20 times greater among those diagnosed with major depression in comparison to those without major depression. (American Association of Suicidology, 2009)

    Suicide is one of the leading causes of death for 15- to 19-year-olds. (Centers for Disease Control, 2017)

    Reports of suicide attempts among college students increased from 0.7% to 1.8% from 2013 to 2018. (Journal of Adolescent Health, 2019)

How is depression diagnosed?

Discuss your symptoms with your doctor, as he or she can’t guess that you’re depressed just by looking at you. It may be hard to imagine treatment will help. Don’t delay talking to your doctor, as the earlier you seek treatment, the earlier your depression will begin to alleviate.

Once you notify your doctor about how you’re feeling, he or she may ask you about your symptoms, your health, and your family history. This may also involve a physical exam and some tests. It is very important to tell your doctor about all medicines that you are taking.

Diagnosis

According to the DSM5, the criteria for diagnosis of major depressive disorder require at least five of the following symptoms outlined during the same two-week period of depressed moods for most of the day, almost every day:

loss of interest or pleasure in nearly all activities almost all the time

poor or excessive sleep almost every day

significant change in body weight or appetite nearly every day

decreased energy or fatigue nearly every day

cycle motor agitation (slow movement) almost every day

decreased ability to concentrate almost all the time.

feelings of worthlessness or excessive or inappropriate guilt nearly every day

recurrent thoughts of death or suicidal ideation with or without a specific plan or an actual suicide attempt

The diagnosis of major depressive disorder should not be attributed to a medical condition, medication, or substance use and must cause significant functional impairment.

Depression treatment

Depression can be treated with medications, counseling, or with both. Lifestyle changes can help. This includes a nutritious diet, regular exercise, and avoiding alcohol, drugs, and too much caffeine.

Depression usually can be treated through visits to your doctor. You may need in-hospital treatment if you have other medical conditions that could affect your treatment. In-hospital treatment is also required if you are at high risk of suicide.

Your physician may prescribe antidepressants which increase the number of chemical messengers such as. serotonin, norepinephrine and dopamine in the brain.

Different antidepressants work differently for different people, and they also have different side effects. So, even if one medicine does not suit you or does not work for you, another one may helpful. You may notice improvement as soon as 1 week after you start taking the medicine. But you probably will not see the full effects for about 6-8 weeks. You may have side effects at first. They tend to decrease after a couple of weeks. Do not stop taking the medications without notifying your doctor first.

As stated, there are many antidepressant medications, and each is different in method of treatment and possible side effects.

Selective serotonin reuptake inhibitors (SSRIs)

    Citalopram (Celexa, Cipramil)

    Escitalopram (Lexapro, Cipralex)

    Fluoxetine (Prozac, Sarafem)

    Fluvoxamine (Luvox, Faverin)

    Paroxetine (Paxil, Seroxat)

    Sertraline (Zoloft, Lustral)

Serotonin–norepinephrine reuptake inhibitors (SNRIs)

    Desvenlafaxine (Pristiq)

    Duloxetine (Cymbalta)

    Levomilnacipran (Fetzima)

    Milnacipran (Ixel, Savella)

    Venlafaxine (Effexor)

Serotonin modulator and stimulators (SMSs)

    Vilazodone (Viibryd)

    Vortioxetine (Trintellix)

Serotonin antagonist and reuptake inhibitors (SARIs)

    Nefazodone (Dutonin, Nefadar, Serzone) – withdrawn/discontinued in most countries.

    Trazodone (Desyrel)

Norepinephrine reuptake inhibitors (NRIs)

    Reboxetine (Edronax)

    Teniloxazine (Lucelan, Metatone) – also a 5-HT2A receptor antagonist

    Viloxazine (Vivalan) – also a 5-HT2B receptor antagonist and 5-HT2C receptor agonist

Although marketed as an antidepressant, a meta-analysis found that reboxetine was ineffective and potentially harmful.

Atomoxetine (Strattera) is an NRI approved to treat ADHD which may be used off-label for depression although evidence of efficacy is poor.

Norepinephrine–dopamine reuptake inhibitors (NDRIs)

    Bupropion (Wellbutrin) – weak NDRI, although its dopaminergic actions are controversial; may act as a norepinephrine–dopamine releasing agent (NDRA) alternatively or additionally; also a non-competitive antagonist of nicotinic acetylcholine receptors[6]

Tricyclic antidepressants (TCAs)

    Amitriptyline (Elavil, Endep)

    Amitriptylinoxide (Amioxid, Ambivalon, Equilibrin)

    Clomipramine (Anafranil)

    Desipramine (Norpramin, Pertofrane)

    Dibenzepin (Noveril, Victoril)

    Dimetacrine (Istonil)

    Dosulepin (Prothiaden)

    Doxepin (Adapin, Sinequan)

    Imipramine (Tofranil)

    Lofepramine (Lomont, Gamanil)

    Melitracen (Dixeran, Melixeran, Trausabun)

    Nitroxazepine (Sintamil)

    Nortriptyline (Pamelor, Aventyl)

    Noxiptiline (Agedal, Elronon, Nogedal)

    Opipramol (Insidon)

    Pipofezine (Azafen/Azaphen)

    Protriptyline (Vivactil)

    Trimipramine (Surmontil)

Tetracyclic antidepressants (TeCAs)

    Amoxapine (Asendin)

    Maprotiline (Ludiomil)

    Mianserin (Tolvon)

    Mirtazapine (Remeron)

    Setiptiline (Tecipul)

Mianserin, mirtazapine, and setiptiline are also sometimes described as noradrenergic and specific serotonergic antidepressants (NaSSAs).

Monoamine oxidase inhibitors (MAOIs)

Irreversible

Non-selective

    Isocarboxazid (Marplan)

    Phenelzine (Nardil)

    Tranylcypromine (Parnate)

Selective for MAO-B

    Selegiline (Eldepryl, Zelapar, Emsam)

Reversible Non-selective

Caroxazone (Surodil, Timostenil) was formerly used as an antidepressant, but has been discontinued.

Selective for MAO-A

    Metralindole (Inkazan)

    Moclobemide (Aurorix, Manerix)

    Pirlindole (Pirazidol)

    Toloxatone (Humoryl)

Counseling or therapy may be a good treatment option for mild to moderate depression. For major depression and for some people with minor depression, counseling may not be enough. A combination of medicine and talk therapy is usually the most effective way of treating more severe depression. If you continue the combination treatment for at least a year, you are less likely to have depression recur.

In psychotherapy, you talk with a trained therapist or counselor about things that are going on in your life. The focus may be on your thoughts and beliefs, on things that happened in your past, or on your relationships. Or, the focus may be on your behavior, how it is affecting you, and what you can do differently. Psychotherapy usually lasts for a limited time, such as 8 to 20 visits.

The most important part of living with depression is not giving up. If you stay focused and are consistent with treatment, your mood will improve gradually.

Tips and pitfalls   

   Avoid drugs and alcohol. Both make depression worse. Both can cause dangerous side effects with antidepressant medicines.

    Get involved in activities that make you feel good or feel like you’ve achieved something. This includes volunteering or joining a club.

    Exercise regularly. It makes your body feel better. Exercise causes a chemical reaction in the body that can boost your mood. You should plan to exercise at least 4 times a week for at least 30 minutes each time.

    Eat well balanced meals and healthy foods. Avoid junk food.

    Keep your sleep routine consistent, waking up and going to bed at the same time each day.

    Take your medicine, go to counseling as directed by your doctor recommends. Your medicine will not work if you only take it occasionally. Take it exactly as prescribed.

    Set small goals for yourself if you have low energy.

    Stay in touch with friends, family and your doctor.

    Do not allow negative thoughts linger in your mind. Do not talk badly about yourself. Do not expect to fail. This type of thinking is typical of depression. These thoughts will go away as your depression lifts.

    Don’t blame yourself for your depression. You did not cause it.

    Do not make major life decisions while you are depressed. This includes marriage, divorce, separation, quitting your job, etc.

    Don’t expect to do everything you normally can. Set a realistic schedule.

    Do not give up.

People with depression sometimes think about suicide. This is a common symptom of depression. If you have thoughts about hurting yourself, tell someone. Tell your doctor, your friends, or your family. Or you could call your local suicide hotline, such as the National Suicide Prevention Lifeline at 1-800-273-8255.

Get help right away. There are people who can help you. Depression can be successfully treated.

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