Depression

Depression is typically described as feelings of sadness, irritability, loss of interest in usual activities, not able to experience pleasure, feelings of guilt or worthlessness, and can include thoughts of death or suicide.

Generally, depression is a combination of genetic, biological, environmental, and psychological factors.

Lisa Williams, ARNP, BC is a psychiatric nurse practitioner for WestBridge Community Services in New Hampshire, described accepted theory of depression as a decrease in serotonin, dopamine, and norepinephrine neurotransmitters.

Neurotransmitters are chemicals carrying messages between different nerve cells.

"Treatment for depression is multifaceted," said Williams. "Medication for depression blocks the receptors, allowing for an increase in these neurotransmitters for the brain to utilize."

Some types of depression can be hereditary and genetics can play a role. Environmental factors and traumatic events can trigger depressive episodes. Depressive episodes can occur with or without being triggered.

"Many are predisposed to depression, but does not develop as the person may have developed the coping skills through life to deal with it," said Williams.

Women are more likely to take medication for depression than males, for any level of severity, according to the Centers for Disease Control and Prevention (CDC).

"Often people who have a proper diet, exercise regularly, and get proper sleep, do not develop depression symptoms," said Williams.

Symptoms of depression can be occasional, lasting only a day or two. Research indicates depression, an illness, is a disorder of the brain.

The rate of antidepressant use in the United States among all ages increased nearly 400 percent, according to the National Center for Health Statistics (NCHS), as reported in the years from 1988 to 1994 through 2005 to 2008.

Americans who are age 12 and older, 11 percent take antidepressant medication, according to a report released by the CDC. From the 11 percent, females are more likely to take antidepressants compared to males. Non-Hispanic white persons are more likely to take antidepressants than are non-Hispanic black and Mexican-American persons.

While the majority of antidepressants are taken to treat depression, antidepressants can be prescribed to treat anxiety disorders.

When depression begins to interfere with daily life, it should be treated seriously.

Unfortunately, many who have depressive tendencies never seek treatment, many who experience depression need treatment to get better, according to the National Institute of Mental Health (NIMH).

Researchers found that more than 40 percent of people with post traumatic stress disorder or PTSD also had depression four months after the traumatic event. Alcohol and other substance abuse or dependence may also co-exist with depression. Research shows that mood disorders and substance abuse commonly occur together.

"Alcohol is a depressant and illegal drugs cause depression symptoms," said Williams. "Those who drink as a coping mechanism when depressed generally are harder to treat. Illegal drugs affect the central nervous system causing unpredictability and mood swings."

Some prescription medications can increase a person's risk to being depressed, added Williams.

"Many prescription medications have warnings of depression as a potential side effect when taking the medication," said Williams. "Be aware of the symptoms and speak to the prescribing physician, should symptoms develop."

A third of persons with severe depressive symptoms take antidepressant medication, according to the CDC.

Antidepressants were the third most common prescription drug taken by Americans of all ages in 2005–2008 and the most frequently used by persons aged 18–44 years, according to the NCHS.

The majority of individuals with mild to severe depression who seek treatment are able to get better from medications, psychotherapies, and other effective methods developed to treat depression symptoms.

More than 60 percent of Americans who take antidepressants are taking the medication for two years or more, according the report from the CDC. Additionally, 14 percent have been taking antidepressants for more than 10 years.

Less than one-third, who take one antidepressant and less than one-half who take multiple antidepressants have seen a mental health professional in the past year, reported the CDC.

Cognitive symptoms of depression as related to intuition or perception, and the ability to reason can be affected due to the inability to concentrate or make decisions.

Physical symptoms can include loss of appetite, sleep or activity. Additional symptoms include fatigue, lack of energy, restlessness or slowed down.

Types of depression

There are various types of depression. Generally, those with major depression have symptoms that interfere and disable the person's ability to function normally. Some experience these episodes only once in a lifetime, while others may have multiple episodes.

Other types include dysthymic disorder, minor depression, and bipolar disorder.

Those diagnosed with a dysthymic disorder, it is long-term, two years or more, with symptoms not severe enough to interfere with daily life, but can prevent the person from feeling well. People diagnosed with this disorder may experience one or more major depressive episodes.

"Often therapy and learning coping mechanisms are treatment enough, without the need to prescribe medication," said Williams.

Minor depression is described as being not long-term, less than two years, but can last two weeks or more. Those who are not treated for minor depression are at risk for developing a major depressive disorder.

Forms of minor depression can be psychotic depression, postpartum depression and seasonal affective disorder.

Psychotic depression can be associated to a person experiencing a break in reality, such a delusions or hallucinations which can be hearing or seeing upsetting things other people cannot.

"When treating a person with psychotic depression, the psychosis is the serious condition and is treated first," said Williams. "Sometimes the depression will resolve after the psychosis clears, but continued treatment with therapy and medications may be needed."

Postpartum depression occurs as a more serious form of "baby blues" for women who have recently given birth. This occurs when the hormonal and physical changes, combined with the responsibility of caring for a newborn gets overwhelming.

"Postpartum depression has become more recognized, which is wonderful for new moms to be aware and seek treatment should she experience symptoms of depression," said Williams.

Approximately 10 to 15 percent of women after giving birth, experience postpartum depression, according to a study published by the Journal of Clinical Psychiatry.

Seasonal affective disorder or SAD occurs generally in the winter months when there is less natural sunlight. These depression symptoms usually subside in the spring and summer months.

Therapies for SAD include light therapy and are most effective when combined with psychotherapy and antidepressant medication.

Bipolar disorder or manic-depressive illness is a cycling of mood changes and there are two types. Generally a person with this disorder experience extreme highs (manic) and lows (depression).

"Within bipolar, those who have bipolar II experience more frequent lows, depression, and an infrequent manic state," said Williams. "For bipolar disorders, often a mood stabilizer and antidepressant are prescribed."

Treatment

Those who are experience depression symptoms should seek help from a medical professional.

According to the NIMH, certain medications or medical conditions can cause the same symptoms as depression, for example, viruses or a thyroid disorder.

A primary care physician can rule out other medical conditions with a physical exam, discussion and lab tests. The physician will refer the person for a psychological evaluation with a mental health professional.

During the evaluation with a mental health professional, a discussion occurs with you. The patient will need to provide a family history, including mental disorders with a complete history of symptoms and should include any current or past history with alcohol or drugs, and thoughts about death or suicide.

Depression can be treated in several ways, with the most common being psychotherapy and prescribing medication.

WestBridge Community Services specializes in co-occurring mental illness and substance use disorders.

For more information about WestBridge Community Services visit www.WestBridge.org. The new facility in Hernando County is currently under construction and is planned to open in the Spring of 2012.