Friday, February 8, 2008

Depression - What you need to know

What is Depression?
Everyone feels down, blue or sad occassionally, but these feelings usually pass off or resolve within a couple of days or so. When these feelings become prolonged and are accompanied by other symptoms, then it can be said as depression. World Health Organisation (WHO) defines depression as "a common mental disorder that presents with depressed mood, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, low energy, and poor concentration."
When a person has a depressive disorder, it interferes with daily life, normal functioning, and causes pain for both the person with the disorder and those who care about him or her. Depression is a common but serious illness, and most who experience it need treatment to get better.

Many people with a depressive illness never seek treatment. But the vast majority, even those with the most severe depression, can get better with treatment. Intensive research into the illness has resulted in the development of medications, psychotherapies, and other methods to treat people with this disabling disorder.
Depression occurs just as commonly in developing countries like Malaysia as it does in other developed countries as well, with a lifetime occurence between 8% - 10%.

In 2006, WHO and World Bank assesed the level of disability that is brought about by this disorder and found that depression is the fourth most disabling disease in the world. It is also predicted to become the 2nd most disabling disease in the world by the year 2020. The World Health Organization also estimates that more people die from suicide than from Tuberculosis deaths in the Asia Pacific region. The most common cause for death by suicide is Depression.

Depression occurs more in women than in men in a ratio of 1:2. There are many postulates to this. Some of them include that women may be more willing to discuss their emotional issues and that women have hormonal changes that may increase the risk of depression. Men may self-medicate their depression with alcohol or drug use. Also the apathy that is accompanies depression often makes them not want to seek treatment or help.

What are the different forms of depression?

There are several forms of depressive disorders.

  • Major depressive disorder and dysthymic disorder.
    Major depression is characterized by a combination of symptoms that interfere with a person's ability to work, sleep, study, eat, and enjoy once–pleasurable activities. It is disabling and prevents a person from functioning normally. It may occur only once in a person's lifetime, but more often, it recurs throughout a person's life.
  • Dysthymic disorder or dysthymia, is a prolonged (two years or longer) and less severe disorder than major depression. Here, the disorder may not be as disabling as major depression. People with dysthymia may experience one or more episodes of major depression during their lifetime (more oftenly multiple).

Some forms of depressive disorder exhibit slightly different characteristics than those described above, or they may develop under unique circumstances. However, not all scientists agree on how to characterize and define these forms of depression. They include:

  • Psychotic depression, which occurs when a severe depressive illness is accompanied by some form of psychosis, hallucinations, and delusions.
  • Postpartum depression - if a new mother develops a major depressive episode within one month after delivery. It is estimated that 10 to 15 percent of women experience postpartum depression after giving birth.
  • Seasonal affective disorder (SAD) - is a depressive illness during the winter months, when there is less sunlight. Antidepressants and psychotherapy can reduce SAD symptoms, either alone or in combination with light therapy. It can also be treated with light therapy as a monotherapy, which is not as effective as combined therapy.
  • Bipolar disorder, which is also known as manic-depressive illness, is characterized by cycling mood changes-from extreme highs (e.g., mania) to extreme lows (e.g., depression).

What are the symptoms of Depression?

Symptoms of depression differ in severity, frequency and duration from person to person.

Symptoms include:

  • Persistant sad, anxious or "empty" feeling or low mood for a duration of more than 2 weeks
  • Loss of interest and enjoyment in aspects of life and anhedonia. (Anhedonia is when a person is unable to find pleasure from activities, even from activities that were pleasurable before, such as hobbies).
  • General feeling of tiredness, fatigue or lethargy.
  • Changes in weight

  • Loss of appetite or overeating

  • Sleep disturbances

  • Lack of interest in sex (decreased libido)

  • Irritability, anxiety and confusion,

  • Poor concentration,

  • Feeling of loneliness, hopelessness

  • Feelings of guit, uselessness, and worthlessness,

  • Thoughts of death, suicidal thoughts and suicide attempt

  • A variety of physical conditions like back pain, headaches, giddiness, gastic problems and chronic pain.
Depression as a diagnosis can only be made if a patient has at least five of the symptoms described above for at least two weeks.

There are various illnesses and medical conditions that can also cause or that may occur concurrently with depression

What causes depression?

1. Depression may be triggered by major life events such as the death of a relative or friend. Stressful situations such as divorce, financial difficulties or job loss can also trigger depression. Depression can sometimes be caused by a person’s lifestyle. Childbirth can also trigger post-natal depression in women, as can loneliness, especially in the elderly.

2. One of the chemicals in the brain known to affect a person's mood is serotonin – depressed people are often found to have an imbalance in the way that serotonin works in their brains.

3. Genetics predisposition

Some types of depression run in families, indicating that a biological vulnerability can be inherited. This seems to be the case with manic-depressive illness. Studies of families, in which members of each generation develop manic-depressive illness, found that those with the illness have a somewhat different genetic makeup than those who do not get ill. However, the reverse is not true: not everybody with the genetic makeup that causes vulnerability to manic-depressive illness has the disorder. Apparently additional factors, possibly a stress environment, are involved in its onset.Major depression also seems to occur, generation after generation, in some families. However, it can also ossur in people who have no family history of depression. Whether the disease is inherited or not, it is evident that individuals with major depressive disorder often have too little or too much of certain neurochemicals.

4. People with low self-esteem

Psychologic makeup also plays a role in vulnerability to depression. People who have low self-esteem, who consistently view themselves and the world with pessimism, or who are readily overwhelmed by stress are prone to depression.

5. Serious or chronic physical illness

Serious or chronic physical illness or major surgery may also trigger depression. Some commonly prescribed medications, including some cardiovascular drugs, hormones, birth control pills and drugs used to treat Parkinson’s disease, may also bring on depression, or make it worse.

6. Other causes include:

- Stressful environment

- Adverse life events

- Lack of a supporting relationship

Very often, a combination of genetic, psychologic and environmental factors is involved in the onset of a depressive disorder.Sometimes there are no known triggers at all. Depression can appear suddenly, for no apparent reason.Whatever the trigger, treatments are available that many have found to be safe and effective.Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help over 80% of those who suffer from depression.

What illnesses often co-exist with depression?

Depression often co–exists with other illnesses that may precede the depression, cause it, and/or be a consequence of it. These illnesses also need to be diagnosed and treated. Among them are:

  • Anxiety disorders, such as post–traumatic stress disorder (PTSD), obsessive–compulsive disorder, panic disorder, social phobia and generalized anxiety disorder, often accompany depression. People experiencing PTSD are especially prone to having co-occurring depression. PTSD is a debilitating condition that can result after a person experiences a terrifying event or ordeal, such as a violent assault, a natural disaster, an accident, terrorism or military combat.
    People with PTSD often re–live the traumatic event in flashbacks, memories or nightmares. Other symptoms include irritability, anger outbursts, intense guilt, and avoidance of thinking or talking about the traumatic ordeal. In a National Institute of Mental Health (NIMH) USA–funded study, researchers found that more than 40 percent of people with PTSD also had depression at one-month and four-month intervals after the traumatic event.
  • Alcohol and other substance abuse or dependence. Research has indicated that the co–existence of mood disorders and substance abuse is pervasive among the U.S. population.
  • Other medical illnesses such as heart disease, stroke, cancer, HIV/AIDS, diabetes, and Parkinson's disease. Studies have shown that people who have depression in addition to another serious medical illness tend to have more severe symptoms of both depression and the medical illness, more difficulty adapting to their medical condition, and more medical costs than those who do not have co–existing depression.Research has yielded increasing evidence that treating the depression can also help improve the outcome of treating the co–occurring illness.

Disclaimer: Although this website describes depression symptoms, it is meant to be used as information only—not as a diagnosis. Any suspected depression should be evaluated and controlled by a medical professional. Please, consult your doctor if you believe your might suffer from depression. Do not rely on advice from anonymous contacts you initiate from any web site.

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