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Description: Depression by Amy Scholten, MPH Definition Although all people feel sad or blue sometimes, a persistent low mood that interferes with the ability to function and appreciate things in life is referred to as depression. Depression is a mental illness characterized by feelings of profound sadness and lack of interest in enjoyable activities. It may cause a wide range... More

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Depression by Amy Scholten, MPH Definition Although all people feel sad or blue sometimes, a persistent low mood that interferes with the ability to function and appreciate things in life is referred to as depression. Depression is a mental illness characterized by feelings of profound sadness and lack of interest in enjoyable activities. It may cause a wide range of symptoms, both physical and emotional. Depression is not the same as a blue mood. It can last for weeks, months, or years. People with depression rarely recover without treatment.

Causes The precise cause of depression is not known. Causes may be mental, physical, or environmental, including:

Altered brain structure and function Chronic pain Chronic stress Genetic predisposition Heart disease and heart surgery Imbalances in brain chemicals and hormones Lack of control over circumstances (helplessness and hopelessness) Low self-esteem Negative thought patterns and beliefs Seasonal affective disorder is a type of depression or a worsening of symptoms thought to be due to the decreased exposure to sunlight that occurs during winter months, especially in northern climates with longer winters Stressful life events (usually in combination with one or more of the following causes) Risk Factors A risk factor is something that increases your chance of getting a disease or condition.

Age: Elderly Anxiety Certain medications, including medications used to treat asthma, high blood pressure, arthritis, high cholesterol, heart problems Chronic physical or mental illness, including thyroid disease, headaches, chronic pain, stroke Family history of depression (parent or sibling) Feelings of helplessness Insomnia Lack of personal control over circumstances Little or no social support Low self-esteem Major life changes or stressful life events (i.e., bereavement, trauma) Personality disorders Post-partum depression Previous episode of depression Sex: Female Smoking Symptoms Symptoms of depression are highly variable from person to person. Some people have only a few symptoms, while others have many. Symptoms also vary over time.

Symptoms can change over time and may include:

Eating more or less than usual Feeling guilty, worthless, or helpless Feeling tired Hopelessness Loss of interest in hobbies and activities Loss of interest in sex Persistent feelings of sadness, anxiety, or emptiness Physical symptoms that defy standard diagnosis and do not respond well to medical treatments Restlessness or irritability Thoughts of death or suicide with or without suicide attempts Trouble concentrating, remembering, or making decisions Trouble sleeping, waking up too early, or oversleeping Weight gain or weight loss Diagnosis There is no blood test or diagnostic test for depression. The doctor will ask about your symptoms and medical history, giving special attention to:

Alcohol and drug use Family members who have or have had depression Sleep patterns Thoughts of death or suicide The doctor may also perform a mental status examination or neuropsychiatric evaluation to obtain detailed information about your speech, thoughts, memory and mood. Questionnaires called depression inventories may be administered. A physical examination and other diagnostic tests can help rule out other causes for your symptoms.

Treatment Treatment usually includes medication, psychotherapy, or a combination of the two. Medicine helps relieve symptoms. Psychotherapy helps you learn more effective ways to deal with problems or to identify and resolve the conflicts contributing to your depression.

Antidepressant Medications Up to 70% of depressed patients find relief from their symptoms with antidepressants. These medications, which can take 2–6 weeks to reach their maximum effectiveness, include:

Selective serotonin reuptake inhibitors (SSRIs) Citalopram (Celexa) Fluoxetine (Prozac) Fluvoxamine (Luvox) Paroxetine (Paxil) Sertraline (Zoloft) ***Please note: In March, 2004, the Food and Drug Administration (FDA) issued a Public Health Advisory that cautions physicians, patients, families and caregivers of patients with depression to closely monitor both adults and children receiving certain antidepressant medications. The FDA is concerned about the possibility of worsening depression and/or the emergence of suicidal thoughts, especially among children and adolescents at the beginning of treatment, or when there’s an increase or decrease in the dose. The medications of concern—mostly SSRIs (Selective Serotonin Re-uptake Inhibitors)—are: Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine), Luvox (fluvoxamine), Celexa (citalopram); Lexapro (escitalopram), Wellbutrin (bupropion), Effexor (venlafaxine), Serzone (nefazodone), and Remeron (mirtazapine). Of these, only Prozac (fluoxetine) is approved for use in children and adolescents for the treatment of major depressive disorder. Prozac (fluoxetine), Zoloft (sertraline), and Luvox (fluvoxamine) are approved for use in children and adolescents for the treatment of obsessive compulsive disorder. For more information, please visit http://www.fda.gov/cder/drug/antidepressants.

Tricyclic antidepressants Clomipramine (Anafranil) Doxepin (Adapin, Sinequan) Imipramine (Tofranil, Janimine) Monoamine oxidase inhibitors (MAOIs) Phenelzine (Nardil) Tranylcypromine (Parnate) Other antidepressants Buproprion (Wellbutrin) Mirtazapine (Remeron) Nefazodone (Serzone) Venlafaxine (Effexor) Psychotherapy Short-term (10–20 week) therapy can help some depressed people. Psychotherapy is designed to help you:

Change negative thinking and behavior patterns Cope with difficulties in relationships Resolve difficult feelings Herbal Therapy St. John's wort is an herb that is available without prescription. It is widely used in Europe for the treatment of mild to moderate depression. There is conflicting evidence as to its effectiveness, however. Always discuss the use of herbal supplements with your health care provider.

Electroconvulsive Therapy (ECT) ECT may be used in people with severe or life-threatening depression. It is also used for people who cannot take or do not respond to antidepressants. It is considered a safe and effective procedure.

Exercise Regular exercise has been shown to relieve some of the symptoms of depression. In the absence of physical restrictions, exercise should play an integral role in the overall management of depression.

Phototherapy Phototherapy involves sitting under special fluorescent lights for a prescribed amount of time per day, usually about 30 minutes every morning.

Dietary Manipulations Research suggests that diets high in tryptophan, certain B vitamins, and containing fish oil may be helpful in relieving or preventing depression. Always discuss the use of such supplements with your health care provider.

Prevention Strategies to reduce your chance of becoming depressed include:

Being aware of your personal risk Developing social supports Exercising regularly Getting adequate sleep, rest and recreation Having a psychiatric evaluation and psychotherapy if needed Learning stress management techniques Last reviewed: December 2003 by Rosalyn Carson-DeWitt, MD.

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