I view depression as a serious but treatable mental illness. Treating major depression is as much an art as it is a science and requires discernment and experience in arriving at the proper diagnosis and treatment. Depression is most often a medical condition, not a personal weakness, character, or psychological issue. Insomnia is sometimes thought of as a disorder; however, often insomnia is a symptom of depression or generalized anxiety disorder, and sometimes bipolar disorder. What is depression? Oddly many people don’t know the differences between depression and anxiety; or if they are even depressed! Major depression affects a substantial segment of our population. Everybody at one point or another will feel sadness as a reaction to loss, grief, or injured self-esteem; but major depressive disorder or major depression is a serious medical illness that needs professional diagnosis and treatment. We still don’t know the exact causes of the chemical imbalances and how much of a role DNA or the environment plays in mental illness: Read this article is anxiety genetic which discusses the environmental link to a genetic predisposition to anxiety or depression? Depression often manifests with other illnesses as well; this is known as comorbid depression and anxiety and is important to discern between the primary and secondary illness for proper treatment. Genetic mental illnesses are the subject of many studies and are showing some enlightening results. Other studies claim to have isolated several of the genes that may be the cause of depression. Depression can also mimic schizophrenia when depression is accompanied with psychotic features. Again determining the differences between these two illnesses will take a psychiatric evaluation and a medical doctor who is experienced in treating depression.
Depression in children is different from the normal blues and everyday emotions that are typical in children and teens. Children who are depressed experience changes in their behavior that are persistent and disruptive to their normal lifestyle, usually interfering with relationships with friends, schoolwork, special interests, and family life. It may also occur at the same time as (or be hidden by) attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), or conduct disorder (CD).
Possible Causes or Triggers of Depression
Lack of sleep alone cannot cause depression, but it does play a role. Lack of sleep resulting from another medical illness or the presence of personal problems can intensify depression. Chronic inability to sleep is also an important clue that someone may be depressed. And one sleepless night begets another and another and becomes a downward spiral. Depression can also manifest in loss of appetite, loss in sex drive, irritability, suicidal thoughts, extreme unhappiness, and many other symptoms that occur within a given period of time. Other common triggers and indicators include:
- Family history of depression
- Grief over the loss of a loved one through death, divorce, or separation
- Interpersonal disputes
- Physical, sexual, or emotional abuse
- Major life events such as moving, graduating or retiring, etc.
- Serious illness, chronic and terminal illnesses often contribute to depression. These include diabetes, cancer, heart disease, stroke, HIV, Parkinson’s disease, and others
- Substance abuse, substance abuse will either affect the neurotransmitters in the brain which are responsible for mood, or they are indicators that someone is self-medicating an underlying mental disorder such as depression, bipolar disorder, or anxiety
- Being socially isolated or excluded from family, friends, or other social groups
- Menopause and post menopausal changes in hormones
Illnesses such as Thyroid conditions and diabetes are known to cause depression; when an illness is causing depression, there is often long-term pain present or there is a sudden change in lifestyle.
The reverse is also true in that depression causes illness. Depression can weaken the immune system (cells involved in fighting disease and keeping you healthy) allowing a person to get more colds or the flu. There is often a notable presence of “aches and pains” with no particular cause, this is sometimes the cases with fibromyalgia. Having depression may also cause the symptoms of an illness to last longer and intensify its symptoms, but the true relationship of depression-induced illness, in terms of major disease, has not been thoroughly defined. It is important to seek the advice of your doctor if you think you or someone you know may have depression.
Drug Interactions and Medications to Treat Depression
MAOIs or monoamine oxidase inhibitors are effective antidepressant medicines that have been used for years. Typically prescribed for people with severe depression, MAOIs improve mood by increasing the number of chemicals in the brain that pass messages between brain cells. They have proven to work just as well as other antidepressant drugs, but they have more possible food and drug interactions. MAOI’s are seldom prescribed and not much of an issue today; however, sometimes they are the medication of last resort that will have an impact on the symptoms.
Medicines to avoid when taking MAOIs include all SSRIs (a group of antidepressants that includes Prozac and Paxil) and certain pain medicines including Demerol. There are also some cough medicines and blood pressure medicines that must not be taken with MAOIs. Foods to avoid when taking MAOIs include aged cheeses and meats, avocado, pickled or smoked foods like sauerkraut or meat, and foods that include yeast extracts like beer and wine. It is important to tell your doctor about any medicines you are currently taking. Be sure to discuss the limitations, interactions, and possible side effects of MAOIs. There are some side effects of serotonin reuptake inhibitors SSRIs.
Women are More Likely to get Depression than Men
Women develop depression twice as often as men. One reason may be the various changes in hormone levels that women experience. For example, depression is common during pregnancy and menopause, post menopause for 2 years, as well as after giving birth, suffering a miscarriage, or having a hysterectomy. These are all times when women experience huge fluctuations in hormones. Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD), an extreme form of PMS, may also cause depression. Environmentally or psychologically speaking, women are prone to stuff or hold in their emotions, especially anger, they have also been in the past less athletic than men these lifestyle issues might contribute to their propensity to be effected by depression more than men.
Depression and Suicide
Most people who suffer from depression do not attempt suicide, but according to the National Mental Health Association, 30-70% of suicide victims have suffered from some form of depression. This figure demonstrates the importance of seeking professional treatment for yourself or someone you love if you suspect depression. If you are ever on an antidepressant and begin to have thoughts of suicide, go immediately to the nearest ER.
The Recurrences of Depression
Having experienced an episode of major depression puts a person at greater risk for future episodes, but not everyone who has recovered from depression will experience it again. Sometimes depression is triggered by a major life event, illness, or a combination of factors particular to a certain place and time. Getting the proper treatment for the correct amount of time is crucial to recovery and in helping prevent or identify any future depression. The effects of exercise on depression and mental health should not be overlooked as well. The cause of depression will determine the recurrence rate; if the depressive episode is brought on by a stressor(s) in one’s life, then avoiding these will most likely repulse future depressive episodes. If the source of depression is organic and due to a chemical imbalance, than future episodes are likely to occur. There is a difference between clinical depression and situational depression. Is depression curable? Maybe down the road after genetic engineers isolate parts of the brain or genes; and then find a way to repair them, we might see a cure for depression. Many studies are being conducted with genetic mental illnesses today. We have a lot of evidence to justify the link between depression and a genetic predisposition.
Depression should not be left untreated Research has shown that if depression is left untreated, it kills the neurons in the hippocampus region of the brain. SSRI antidepressants have been shown to act as a catalyst in taking stem cells from the brain and transforming them and replacing the dead cells in the hippocampus. Various types of depressive disorders can last from 6 months to years. A major depressive episode is characterized by a set of symptoms that last for more than two weeks and may last for months. Seasonal depression, or SAD, usually extends throughout the winter months and continues to improve during spring and summer; SAD is often a symptom of bipolar disorder. Bipolar disorder is characterized as “ups” (periods of mania) and “downs” (periods of extreme depression). Though these phases may change rapidly or slowly, bipolar depression may last until an effective treatment is found. Dysthymia is mild and more difficult to identify and may last for years if left untreated. Most mental illnesses are typically chronic and life-long issues; however, there are promising studies that seem to show that we are getting closer to identifying the genes responsible for depression and other illnesses and then perform “gene repair”. We might have a cure for depression in the future these studies and uses of DBS deep brain stimulation are in the early stages and still questionable, yet they give us reason for hope. The gold standard for depression is ECT electro convulsive therapy; this however, is not performed as often as it used to be since the advent of the newer SSRI’s, yet a very effective therapy. I hope this article and others on this site will answer the question what is depression, and how effective are the current treatments for this illness. Click here to read more on what is depression. If you are seeking a psychiatrist in Scottsdale, or a Phoenix psychiatrist, and are in need of depression treatment please contact my office to schedule an appointment.