Depression and depressive disorders

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Definition

Depression or depressive disorders (unipolar depression) are mental illnesses characterized by a profound and persistent feeling of sadness or despair and/or a loss of interest in things that were once pleasurable. Disturbance in sleep, appetite, and mental processes are a common accompaniment.

Description

Everyone experiences feelings of unhappiness and sadness occasionally. But when these depressed feelings start to dominate everyday life and cause physical and mental deterioration, they become what are known as depressive disorders. Each year in the United States, depressive disorders affect an estimated 17 million people at an approximate annual direct and indirect cost of $53 billion. One in four women is likely to experience an episode of severe depression in her lifetime, with a

Two false-colored positron emission tomography (PET) scans of human brains. At the top is the brain of a healthy person, and below that is the brain of a depressed person.

(NIH/Science Source, National Audubon Society Collection/ Photo Researchers, Inc. Reproduced by permission.) See color insert for color version.

Two false-colored positron emission tomography (PET) scans of human brains. At the top is the brain of a healthy person, and below that is the brain of a depressed person.

(NIH/Science Source, National Audubon Society Collection/ Photo Researchers, Inc. Reproduced by permission.) See color insert for color version.

10-20% lifetime prevalence, compared to 5-10% for men. The average age a first depressive episode occurs is in the mid-20s, although the disorder strikes all age groups indiscriminately, from children to the elderly.

There are two main categories of depressive disorders: major depressive disorder and dysthymic disorder. Major depressive disorder is a moderate to severe episode of depression lasting two or more weeks. Individuals experiencing this major depressive episode may have trouble sleeping, lose interest in activities they once took pleasure in, experience a change in weight, have difficulty concentrating, feel worthless and hopeless, or have a preoccupation with death or suicide. In children, the major depression may appear as irritability.

While major depressive episodes may be acute (intense but short-lived), dysthymic disorder is an ongo ing, chronic depression that lasts two or more years (one or more years in children) and has an average duration of 16 years. The mild to moderate depression of dysthymic disorder may rise and fall in intensity, and those afflicted with the disorder may experience some periods of normal, non-depressed mood of up to two months in length. Its onset is gradual, and dysthymic patients may not be able to pinpoint exactly when they started feeling depressed. Individuals with dysthymic disorder may experience a change in sleeping and eating patterns, low self-esteem, fatigue, trouble concentrating, and feelings of hopelessness.

Depression can also occur in bipolar disorder, a mood disorder that causes radical emotional changes and mood swings, from manic highs to depressive lows. The majority of bipolar individuals experience alternating episodes of mania and depression.

Some theories about the causes of depression

The causes behind depression are complex and not yet fully understood. While an imbalance of certain neu-rotransmitters—the chemicals in the brain that transmit messages between nerve cells— are thought to be key to depression, external factors such as upbringing (more so in dysthymia than major depression) may be as important. For example, it is speculated that, if an individual is abused and neglected throughout childhood and adolescence, a pattern of low self-esteem and negative thinking may emerge. From that, a lifelong pattern of depression may follow.

Depression is also associated with an imbalance of cortisol, the main hormone secreted by the adrenal glands. Other physiological factors sometimes associated with depression include viral infections, low thyroid hormone levels, and biological rhythms, including women's menstrual cycles—depression is a prominent symptom of premenstrual syndrome (PMS).

Heredity seems to play a role in the development of depressive disorders. Individuals with major depression in their immediate family are up to three times more likely to have the disorder themselves. It would seem that biological and genetic factors may make certain individuals pre-disposed or prone to depressive disorders, but environmental circumstances may often trigger the disorder.

External stressors and significant life changes, such as chronic medical problems, death of a loved one, divorce or estrangement, miscarriage, or loss of a job, can also result in a form of depression known as adjustment disorder. Although periods of adjustment disorder usually resolve themselves, occasionally they may evolve into a major depressive disorder.

ANTIDEPRESSANT DRUGS

Brand Name (Generic Name)

Possible Common Side Effects Include:

Desyrel (trazodone hydrochloride)

Allergic skin reactions, blurred vision, decreased appetite, fluid retention, headache

Effexor (venlafaxine hydrochloride)

Diarrhea, dizziness, gas, headache, insommia, rash, vomiting

Elavil (amitriptyline hydrochloride)

Constipation, dizziness, high blood pressure, fever, nausea, rash, weight gain or loss

Nardil (phenelzine sulfate)

Dry mouth, fatigue, headache, muscle spasms, tremors

Norpramin (desipramine hydrochloride)

Blurred vision, cramps, hallucinations, hair loss, vomiting

Pamelor (nortriptyline hydrochloride)

Diarrhea, fatigue, headache, decreased coordination

Paxil (paroxetine hydrochloride)

Cold symptoms, drowsiness, nervousness, stomach pain

Prozac (fluoxetine hydrochloride)

Bronchitis, drowsiness, fatigue, nausea, tremors

Sinequan (doxepin hydrochloride)

Bruising, constipation, fluid retention, itching, increased heartbeat

Surmontil (trimipramine maleate)

Disorientation, flushing, headache, nausea, vomiting

Tofranil (imipramine hydrochloride)

Bleeding sores, fever, hives, decreased coordination

Travil

Asthma, diarrhea, dizziness, fatigue, seizures

Wellbutrin (bupropion hydrochloride)

Agitation, dry mouth, headache, nausea, rash

Zoloft (sertraline)

Diarrhea, fainting, gas, headache, nervousness

Some of the antidepressant medications that may be prescribed and some of their potential side effects. (Stanley Publishing.)

Some of the antidepressant medications that may be prescribed and some of their potential side effects. (Stanley Publishing.)

Paula Anne Ford-Martin, M.A.

Desensitization see Systematic desensitiza-tion

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