PSYCHOLOGICAL DISORDERS - DEPRESSION

DEPRESSION 

There is often a confusion between having depression and feeling depressed.  Almost everyone feels down at certain times in their lives due to some problems they may have in their lives. It can be after having an argument with someone,  troubles at home or at work or anything that can cause a disappointment in one's life.  Then, circumstance get better and alls well and the depresses feeling goes away.  But sometimes feelings of depression don't go away. Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest.  According to the National Institute of Mental Health, an estimated 17 million adult Americans suffer from depression during any 1-year period.

 

Depression also has physical manifestations inside your brain, the smaller frontal lobe and the Hippocampus.  It is caused by the abnormal transmission or depletion of neurotransmitters, Serotonin, Norepinephrine and Dopamine. Changes in the REM can slow wave parts of your sleep cycle and hormone abnormalities such as high cortisol and deregulation of Thyroid Hormone. Cause seem to have to do with the complex interaction between Genes and Environment.  But there is no diagnostic tool that can accurately predict where and when it will show up.

Depression DSM-5 Diagnostic Criteria

The DSM-5 outlines the following criterion to make a diagnosis of depression. The individual must be experiencing five or more symptoms during the same 2-week period and at least one of the symptoms should be either (1) depressed mood or (2) loss of interest or pleasure.

• Depressed mood most of the day, nearly every day.
• Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.
• Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.
• A slowing down of thought and a reduction of physical movement (observable by others, not merely subjective feelings of restlessness or being slowed down).
• Fatigue or loss of energy nearly every day.
• Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
• Diminished ability to think or concentrate, or indecisiveness, nearly every day.
• Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

Depression has many different types. Here is a list of the types of depression.

• Major depressive disorder

Also clinical depression, affects how you feel, think and behave and can lead to a variety of emotional and physical problems. You may have trouble doing normal day-to-day activities, and sometimes you may feel as if life isn't worth living.

• Bipolar disorder

Bipolar depression is defined as an imbalance in brain chemistry causing extreme emotional highs and lows in a person. This disorder is a chronic, life long illness and untreated makes it difficult for the patient to lead a 'normal' life. Everyday tasks such as going to work, to school and sustaining relationships (personal and professional) can become challenging.  A proper diagnosis of bipolar depression can take anywhere from five to ten years after the first onset of symptoms.   While there is no known cure for this illness, proper medication along with psychotherapy can effectively manage the symptoms.  

       Four sub-types  of  Bipolar Disorder

     a) Bipolar I Disorder

        - where the individual has experienced a minimum of           one manic episode (lasting at least 7 days), it's not              necessary to experience a depressive episode to              diagnose Bipolar I

     b) Bipolar II Disorder 

        - where the individual has experienced at least one              major depressive episode (lasting two weeks) as              well as a hypomanic episode (lasting at least 4                  days)

     c) Cyclothymia 

        - where the individual has experienced a combination           of depressive and hypomanic episodes, the                          episodes are short but shift frequently

     d) Other 

        - when bipolar depression is present but does not fall           under the categories listed above.

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• Dysthymia

Also called  Persistent depressive disorder,  is a continuous long-term (chronic) form of depression. You may lose interest in normal daily activities, feel hopeless, lack productivity, and have low self-esteem and an overall feeling of inadequacy. These feelings last for years and may significantly interfere with your relationships, school, work and daily activities.

If you have persistent depressive disorder, you may find it hard to be upbeat even on happy occasions — you may be described as having a gloomy personality, constantly complaining or incapable of having fun. Though persistent depressive disorder is not as severe as major depression, your current depressed mood may be mild, moderate or severe.

Because of the chronic nature of persistent depressive disorder, coping with depression symptoms can be challenging, but a combination of talk therapy (psychotherapy) and medication can be effective in treating this condition.

• Psychotic depression

Psychotic depression is a subtype of major depressive disorder (MDD). It is also referred to as MDD with psychotic features.

Psychotic depression symptoms are the same as those of MDD, such as feeling sad, listlessness, and having sleep problems, but they also include symptoms of psychosis. The hallmark symptoms of psychosis are hallucinations and delusions.

Psychosis is not a condition in and of itself, but rather a symptom or an experience. Psychosis refers to the experience of losing touch with reality.    A person experiencing psychosis can have either hallucinations or delusions, or a combination of both.

• Hallucinations: Sensory experiences not based in reality, such as seeing, hearing, tasting, feeling (through touch), or smelling things that are not really there and that others cannot sense.

• Delusions: Persistent false beliefs that are not grounded in reality, such as paranoia, a sense that someone is trying to harm you.

Symptoms of psychosis (sometimes described as a psychotic episode) are generally part of a bigger condition such as schizophrenia, depression, or Parkinson's disease.

Psychosis can also occur with certain medications, substance use, or other health problems.

• Situational depression

Situational depression is a short-term, stress-related type of depression. It can develop after you experience a traumatic event or series of events.  It can make it hard for you to adjust to your everyday life following a traumatic event.  Some symptoms are, hopelessness, feelings of low mood and sadness, tearfulness,  lack of motivation, loss of pleasure, withdrawing from normal activities, loneliness or social isolation, thoughts of suicide.

• Seasonal affective disorder  (SAD)

Seasonal affective disorder (SAD) is a mood disorder subset in which people who have normal mental health throughout most of the year exhibit depressive symptoms at the same time each year, most commonly in winter. Common symptoms include sleeping too much, having little to no energy, and overeating. The condition in the summer can include heightened anxiety.

• Postpartum depression

Postpartum depression (PPD), also called postnatal depression, is a type of mood disorder associated with childbirth, which can affect both sexes. Symptoms may include extreme sadness, low energy, anxiety, crying episodes, irritability, and changes in sleeping or eating patterns. Onset is typically between one week and one month following childbirth. Postpartum depression can also negatively affect the newborn child.

TREATMENT FOR DEPRESSION

Unfortunately, depression won't just go away on its own.  Depression isn't a form of weakness.  It is considered an a sickness just as any other physical sickness and the individual will need to talk to their doctor about treatment.  

So there is always hope because the good news is that there is treatment available.  Antidepressants may help ease your symptoms such as feeling down and exhausted by balancing the chemicals,  neurotransmitters in your brains to ease your depression symptoms.  They are meant to make you feel emotionally stable again and help you to follow a normal daily routine. They are also taken to relieve symptoms such as restlessness, anxiety and sleep problems, and to prevent suicidal thoughts. Antidepressants must only be prescribed by a doctor.

      SSRI -  Selective serotonin reuptake inhibitors 

Depression may be caused by low levels of  serotonin (also called the feel good chemical)  in the brain that causes individual's to feel relaxed. Serotonin circulates in the brain before being absorbed by the bloodstream.  SSRIs work by preventing your blood from absorbing some of the serotonin from your brain. Therefore leaves more serotonin available to work in your brain which can relieve depression.  Some examples are sertraline (Zoloft), fluoxetine (Prozac),  citalopram (Cilift),  escitalopram (Cipramil), paroxetine (Paxil), fluvoxamine (Luvox). However these can cause  some side effects example, diarrhoea, weight gain,  sexual dysfunction, tiredness, nausea, dry mouth, headache,  rash,   sweating, nervousness,  trouble sleeping. 

SNRI -  Serotonin and norepinephrine reuptake inhibitors 

SNRIs help improve the level of  two important brain chemicals  serotonin and norepinephrine (related to alertness and energy) by keeping these two chemical levels up in your brain and stop them from going back into the cells that released them. . These drugs are sometimes called dual reuptake inhibitors or dual-acting antidepressants.   This may reduce depression symptoms. Some examples of these area Desvenlafaxine, ( Exsira 50mg), Duloxetine (Cymbalta) and Venlafaxine (Effexor XR). Duloxetine may also relieve pain. This is important because chronic pain can lead to depression or make it worse. In some cases, people with depression become more aware of aches and pains. A drug that treats both depression and pain, such as duloxetine, can be helpful to these people.  But there can be some side effects example drowsiness, nausea,  dry mouth. 

TCA - Tricyclic antidepressants 

Tricyclic antidepressants increase levels of norepinephrine and serotonin, two neurotransmitters, and block the action of acetylcholine, another neurotransmitter.  Some examples of TCA are amitriptyline Trepiline), clomipramine (Anafranil), imipramine (Tofranil).  Some side effects are dry mouth, blurred vision, rash, hives,  constipation, weight gain or loss, low blood pressure on standing,  and increased heart rate.

COUNSELLING

Counselling is often the first form of treatment recommended for depression. The  person with depression talks to a licensed and trained mental healthcare professional example a psychologist who helps the person identify and work through the factors that may be triggering the depression through psychotherapy.

Sometimes these factors work in combination with heredity or chemical imbalances in the brain to trigger depression. Taking care of the psychological and psychosocial aspects of depression are just as important as treating its medical cause.  Psychotherapy helps the client to regain a sense of control and pleasure in life again by understanding and identifying the life problems and events that contribute to their depression.  This can help them to understand which aspects of those problems they may be able to solve or improve. They also help in understanding the behaviours, emotions, and ideas that contribute to his or her depressed state.   By gaining all this understanding, the individuals learn coping techniques and problem-solving skills.

 

Depression may require long-term treatment. But don't get discouraged. Most people with depression feel better with medication, psychotherapy or both.