Depression Treatment Guide

Depression Treatment Guide

Introduction:

It is likely that depression is one of the most common illnesses for which people seek out help and treatment. If you have ever been depressed, you know that the feelings involved go far beyond just having a bad day or feeling down in the dumps. People often use the word depression to describe moods and emotions that are much less intense and debilitating. The American Psychological Association (APA) defines depression as the following: "Depression is more than just sadness. People with depression may experience a lack of interest and pleasure in daily activities, significant weight loss or gain, insomnia or excessive sleeping, lack of energy, inability to concentrate, feelings of worthlessness or excessive guilt, and recurrent thoughts of death or suicide. Depression is the most common mental disorder. Fortunately, depression is treatable. A combination of therapy and antidepressant medication can help ensure recovery" (APA, 2010).

The purpose of this guide is to offer a much more accurate representation of what true depression actually entails. It is hoped that the information provided in this guide can serve to help people understand that there is nothing shameful in being depressed, in seeking help, and subsequently being treated for depression.


Background:

Although it might seem hard to believe, especially when in the midst of a depressive episode, you are not alone and need not feel inadequate or abnormal when facing the painful challenges experienced while going through depression. The National Center for Health Statistics (under the auspices of the Centers for Disease Control and Prevention) conducted a survey to determine just how prevalent depression is in the United States. Between 2005 and 2006, the following conclusions were established:

• More than one in 20 Americans over the age of 12 currently experience depression.
• More than one out of seven poor Americans has had depression.
• Depression is associated with functional impairment in many areas of life.
• The percentage of persons who have had contact with a mental health professional has increased as depression severity increased (Pratt & Brody, CDC, 2009).
• Depression can almost be considered a type of umbrella category that actually consists of a number of different depressive disorders. Some of the most reported and perhaps most problematic cases are often described as follows: (Mayo Clinic, 2009).

1. Major Depressive Disorder: In order for a diagnosis of Major Depressive Disorder to be made, patients generally have a constellation of symptoms such as feeling pessimistic, sad, worthless, hopeless, changes in sleeping and/or eating behaviors, difficulty concentrating, isolation and withdrawal, irritability, agitation, and marked decrease in energy.
2. Bipolar Depression (formerly known as Manic Depressive Illness): This mood disorder is characterized by episodes of being highly energized (manic) mixed intermittently with episodes of severe depression. In between the mood swings, the person may experience periods of normalcy.
3. Dysthymic Disorder: This disorder tends to be related to depression that renders the person to be regularly or chronically in a low mood. Feelings of sadness, lowness, and darkness are most prominent. This type of depression is considered to be less severe than some of the other categories.
4. Psychotic Depression: Along with the kind of extreme depressive episodes seen in Major Depressive Disorder and Bipolar Disorder, patients diagnosed with Psychotic Depression are often delusional and often have visual and/or auditory hallucinations. Paranoia may also emerge in the presentation of Psychotic Depression.
5. Postpartum Depression: This is commonly and erroneously referred to as “the baby blues.” Although women going through the baby blues often have shifts in mood, loss of appetite, insomnia, etc., these symptoms generally fade within weeks, if not days. Postpartum Depression, by contrast, is a much more serious disorder and lasts much longer than the "baby blues." A woman can be affected by Postpartum Depression for up to 12 months following the birth of a baby. In addition to the more commonplace depressive symptoms, women with Postpartum Depression may have a lack of interest in their baby, concerns that if they are left alone with the baby, they might harm the infant; finally, some women with Postpartum Depression think about hurting themselves as well. One only has to remember the case of Andrea Yates, who in the throes of a psychotic depression following childbirth, drowned her five young children in the bathtub, in order to see the stark comparison between a bout of the baby blues and sever Postpartum Depression.
6. Seasonal Affective Disorder (SAD) – As the name implies, depressive episodes of this nature generally coincide with the coldness and darkness of the winter season. Quite often these people will have no difficulty with depression during the other times of the year. With the onset of winter, however, depressive symptoms emerge.
7. Anxiety Depression – Although anxiety is generally in a classification of its own, some people struggling with depression can also be vulnerable to bouts of anxiety with seemingly no specific cause or logical rationale.
8. Reactive or Situational Depression – This type of depression tends to be in response to an external (or exogenous) event. People might struggle with depression of this nature following the loss of a job, the break-up of a relationship, or the death of a loved one. There tends to be a specific trigger that elicits depression in the person. While people are often able to go through a period of grief or bereavement in a relatively reasonable period of time, there are times when the grief sets off a more major depression.

Presentation of Symptoms:

Most of the subcategories of depression have a number of common denominators in terms of the symptoms that are likely to emerge. For the purposes of this guide, however, it is perhaps more productive to examine two or three of these depressive disorders in detail, which will serve to offer a clear distinction between specific conditions. Certain symptoms seem to be something of a hallmark of depression. Moreover, symptoms that were once thought to be solely or primarily emotional or psychological in nature have been expanded to also include a number of physiological symptoms as well. Losing interest in or taking pleasure from one’s life, contrary to a person’s usual involvement, is perhaps the most notable aspect of depressive illness.

Other symptoms may include, but are not necessarily limited to (Mayo Clinic, 2009):

• Loss of interest in normal daily activities
• Feeling sad or down
• Feeling hopeless
• Crying spells for no apparent reason
• Problems sleeping
• Trouble focusing or concentrating
• Difficulty making decisions
• Unintentional weight gain or loss
• Irritability
• Restlessness
• Being easily annoyed
• Feeling fatigued or weak
• Feeling worthless
• Loss of interest in sex
• Thoughts of suicide or suicidal behavior
• Unexplained physical problems, such as back pain or headaches


Causes of Depression:

The manner in which depressive symptoms are experienced and subsequently expressed by people clearly shares certain characteristics. The types of treatment options available may also have certain elements in common. However, attempting to understand the course that a depressive illness may take or the type of medication that is most appropriate to use when addressing a specific patient’s illness, can show variations based on the root cause or triggering factor of the depressive illness. As briefly mentioned previously in the case of reactive depression, causes can be quite different from one type of depression to another. Depression that is set off by external aspects or events in a person’s life is referred to as exogenous. Depressive illness that is based on a person’s genetics or biochemistry is considered to be endogenous (i.e. coming from within) in nature. Some of the more severe depressive disorders such as Major Depressive Disorder, Bipolar Disorder, and Psychotic Depressive Disorder are generally considered to have some basis in heredity or brain chemistry. Situational Depression, Anxiety Depression, or adjustment disorders are perhaps somewhat more likely to be viewed as having a cause that is external to the person. The latter are often able to be somewhat more readily resolved with the appropriate treatment and time. However, the former, more severe disorders can take quite a long period of time. The prescribed use of a wide variety of psychiatric medications such as antidepressants, antipsychotic medications, MAO inhibitors, and mood stabilizers, are some of the drugs prescribed for bipolar disorder, which often require that the patient remain on the medication for life. This may often be the case with people who develop chronic depression. While the depression may seem moderate in nature, it may become exacerbated when faced with life’s unexpected and problematic complications.

Treatment:

Unlike previous generations who might have struggled with depression, society today has an abundance of medications that are being used successfully in the treatment of depressive disorders. Some medications may have the capacity to cure, while others can be used to properly contain and manage a disease that might otherwise take over a person’s life. The problem with some of the earlier drugs, such as antidepressants and antipsychotics, is that they generally involve the development of side effects that patients found particularly unpleasant and unwanted. Early tricylic antidepressants such as Elavil were used to help balance chemicals of the brain. However, it often caused rapid weight gain, constipation, excessive drowsiness, confusion, agitation, aggression, self-injurious thoughts and behaviors. Antipsychotic drugs such as Haldol and Thorazine, often left patients in a sedated fog and rendered them with an impaired ability to think. A number of earlier generations of psychotropic medications could also cause tics and movement disorders, if taken over a long period of time (Breggin, 1999).
Fortunately, people who are now faced with the challenges of depressive disorders have a much better chance of getting relief for their symptoms without having to put up with some of the very difficult side effects that used to accompany most of the earlier medications. However, it should be noted that any given patient might develop unwanted effects from any given prescription medication. Having said that, The Agency for Healthcare Research and Quality (AHRQ), which operates under the U.S. Department of Health & Human Services, provides some pertinent information about these drugs:

• Most people can find an antidepressant that works for them.
• Six out of every 10 people feel better with the first antidepressant they try. The rest will need to try different antidepressants to find the one that is right for them (2007).

And while the AHRQ notes that there are certain side effects to many of these medications (nausea, dry mouth, daytime drowsiness, dizziness, sexual problems, and weight gain for example) oftentimes many, if not most, of these effects will subside after several weeks. However, some people may need to have their doctor discontinue a particular drug if the side effects are too unpleasant and do not diminish after a reasonable period of time. As stated, there are numerous drugs that serve the same function but may have a different impact on any given patient. If Prozac doesn’t work, your doctor might prescribe Zoloft, Wellbutrin, Celexa, or Paxil.

Today patients have a much larger body of information regarding antidepressant medications, their effects, and the length of time needed to experience improvement. Information about depression seems as though it can be found almost anywhere these days: the Internet, talk shows, newspapers, and magazines are all functioning in such a way as to make depression much less stigmatized than it once was. Additionally, it is much more acceptable for people to admit being depressed and have ready access to seek the help they need in order to regain a manageable and satisfying life.