Depression

Clinical Depression is a common, real and treatable illness.

Basic Facts About Clinical Depression:

• Clinical depression is one of the most common mental illnesses, affecting more than 19 million Americans each year. This includes major depressive disorder, manic depression and dysthymia, a milder, longer-lasting form of depression.
• Depression causes people to lose pleasure from daily life, can complicate other medical conditions, and can even be serious enough to lead to suicide.
• Depression can occur to anyone, at any age, and to people of any race or ethnic group.  Depression is never a “normal” part of life, no matter what your age, gender or health situation.
• Unfortunately, although about 70% of individuals with depression have a full remission of the disorder with effective treatment, fewer than half of those suffering from this illness seek treatment. Too many people resist treatment because they believe depression isn’t serious, that they can treat it themselves or that it is a personal weakness rather than a serious medical illness.

Treatments for Clinical Depression:

Clinical depression is very treatable, with more than 80% of those who seek treatment showing improvement. The most commonly used treatments are antidepressant medication, psychotherapy or a combination of the two.  The choice of treatment depends on the pattern, severity, persistence of depressive symptoms and the history of the illness.  As with many illnesses, early treatment is more effective and helps prevent the likelihood of serious recurrences.  Depression must be treated by a physician or qualified mental health professional.

Symptoms of Clinical Depression:

• Persistent sad, anxious or “empty” mood
• Sleeping too much or too little, middle of the night or early morning waking
• Reduced appetite and weight loss, or increased appetite and weight gain
• Loss of pleasure and interest in activities once enjoyed, including sex
• Restlessness, irritability
• Persistent physical symptoms that do not respond to treatment (such as chronic pain or digestive disorders)
• Difficulty concentrating, remembering or making decisions
• Fatigue or loss of energy
• Feeling guilty, hopeless or worthless
• Thoughts of suicide or death

If you have five or more of these symptoms for two weeks or more, you could have clinical depression and should see your doctor or a qualified mental health professional for help.

Causes of Clinical Depression:

Many things can contribute to clinical depression.  For some people, a number of factors seem to be involved, while for others a single factor can cause the illness.  Oftentimes, people become depressed for no apparent reason.

• Biological – People with depression typically have too little or too much of certain brain chemicals, called “neurotransmitters.”  Changes in these brain chemicals may cause or contribute to clinical depression.
• Cognitive – People with negative thinking patterns and low self-esteem are more likely to develop clinical depression.
• Gender – Women experience clinical depression at a rate that is nearly twice that of men.  While the reasons for this are still unclear, they may include the hormonal changes women go through during menstruation, pregnancy, childbirth and menopause.  Other reasons may include the stress caused by the multiple responsibilities that women have.
• Co-occurrence – Clinical depression is more likely to occur along with certain illnesses, such as heart disease, cancer, Parkinson’s disease, diabetes, Alzheimer’s disease and hormonal disorders.
• Medications – Side effects of some medications can bring about depression.
• Genetic – A family history of clinical depression increases the risk for developing the illness.
• Situational – Difficult life events, including divorce, financial problems or the death of a loved one can contribute to clinical depression.

Everyone gets down from time to time, but feelings of sadness that last two or more weeks may be a sign of clinical depression.  It is a real and serious health condition that affects more than 20 million American adults each year.

These are signs and symptoms of depression:

• Persistent sad, anxious, or empty mood
• Feelings of hopelessness or pessimism
• Feelings of guilt, worthlessness, or helplessness
• Loss of pleasure or interest in once-enjoyable activities, including sex
• Little or no appetite and weight loss, or overeating and weight gain
• Restlessness and/or irritability
• Difficulty concentrating, remembering things, or making decisions
• Loss of energy, fatigue, or being “slowed down”
• Insomnia, early-morning awakening, or oversleeping.

Dealing with Treatment-resistant Depression:

What to Do When Treatment Doesn’t Seem to Work

Can depression be treated?
Depression is highly treatable with treatments such as therapy, medicine, and lifestyle changes.  But it may not always be easily treated. For many people, depression may continue despite treatment. They may have treatment-resistant depression or TRD.  This happens when medicine partly relieves their symptoms or does not help at all.

How is TRD treated?
If treatment hasn’t yet worked for you, do not give up!  Try to stay hopeful that you will get well and even recover. Consider these options and talk to your doctor about which treatments may be right for you.

• Medicine.  Medicine can ease depression symptoms.  But the first medicine you take may not be the right one for you.  If you still have symptoms after initial antidepressant treatment, you should not give up.  It may take some time for the medicine to start working, or it might help to change the amount you take.  Or you may need to try several different medicines, take more than one medicine, or add other forms of treatment, such as psychotherapy.  Keep in mind that finding the right medicine(s), or combination of treatments for TRD, can take some time.
• Psychotherapy. A trained mental health professional helps you talk about your moods and behaviors. Therapy can offer you new ways to manage stress and avoid negative events that can set off depressive symptoms.
• Support Groups. Talking with other people who also have depression may help you feel less alone and more informed about your illness and treatments. There are many local support groups for people with depression.
• Neurostimulation. Neurostimulation is becoming an option for people who have tried a variety of antidepressants, but they didn’t work, only partly worked, or stopped working.   

Vagus Nerve Stimulation (VNS) is one type of neurostimulation that has been approved as an additional treatment for long-term or recurrent depression in adults who have not had success with four or more antidepressant medicines. A device is put into the chest and sends an electrical current to the brain.

Electroconvulsive Therapy (ECT) is another type of neurostimulation. ECT can be helpful for people whose depression is severe or life-threatening and for people who cannot take antidepressant medicine. Electrodes are placed on the head to deliver electrical impulses. ECT has been controversial, but has improved in recent years.  It can help when antidepressant medicines do not work well enough.  Researchers are also looking at other neurostimulation treatments, such as transcranial magnetic stimulation (TMS), magnetic stimulation therapy (MST), and deep brain stimulation (DBS).

Research Update
Researchers at the National Institute of Mental Health, part of the National Institutes of Health, are looking at the effectiveness of different treatments for people who still have symptoms from depression after they have already tried an antidepressant.  The study has multiple phases.  So far, they have released these results:

• One in three people were symptom-free with the first medicine they used.
• One in three people became symptom-free with the help of an additional medicine.
• One in four people became symptom-free after switching to a different medicine.
• For those people who tried switching to a second medicine and still had symptoms, one in five of them then became symptom-free when they switched medicines again.

The study shows that people who have tried antidepressants, but still have symptoms from depression, have a variety of medication options.  For more information specific to depression, click here.

Tracy’s Story
For many weeks, I felt tired but couldn’t sleep.  I didn’t feel like eating and felt sad all of the time.  I stopped seeing friends and felt hopeless about my life.  I knew something was wrong and talked to my doctor, who gave me a prescription for an antidepressant and suggested counseling.  I started taking medicine and was in counseling, but after four months, I still didn’t feel a lot better.  But I continued to work with my doctors, and as a team, we found a medicine that helped me.  Gradually, I began to feel better.  It was a long process, but with help, I was able to get through it.

Remember

• If treatment doesn’t work right away, don’t give up.
• You may need to change the amount of medicine you take, take more than one medicine or switch medicines, or try more than one treatment.
• If you’re taking medicine, don’t stop taking it on your own. Talk to you doctor first.
• Work closely with your doctor to find the best treatment for you.

References

National Institute of Mental Health: “The Numbers Count: Mental Illness in America,”Science on Our Minds Fact Sheet Series. Accessed August 1999. Netscape:  http://www.nimh.nih.gov/publicat/numbers.cfm

Rupp A, Gause E, Regier D: “Research Policy Implications of Cost-of-Illness Studies for Mental Disorders,” British Journal of Psychiatry Suppl 1998; 36:19-25.

National Institute of Mental Health, D/ART Campaign, “Depression:  What Every Woman Should Know,” (1995). Pub No. 95-3871.

National Institute of Mental Health 
Phone: (866) 615-6464
www.nimh.nih.gov

Depression and Bipolar Support Alliance
Phone: (800) 826-3632
www.dbsalliance.org

Families for Depression Awareness
Phone: (781) 890-0220
www.familyaware.org