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About Depression

For years I have suffered from depression, at different levels, some of them being major episodes and some more on a dysthymic (low-grade chronic) level.

What is depression?

There is a tendency to use the word depression to describe periods or episodes of sadness that each of us experience from time to time. And for many of us, during these periods it is not always easy to discern where normal sorrow ends and clinical depression begins. Yet, anyone who has ever experienced an episode of major depression knows – at least after the depression has lifted – that what they feel is more than just ongoing or persistent sadness.

Clinical depression is an illness characterized by a cluster of feelings, thoughts and behaviors that are remarkably distinct from a person’s normal range of feelings and functioning. Caused by a complex interaction of biologic, psychological and social factors, a major depressive disorder can make a person extremely sensitive to life circumstances, the least of which can throw him/her into total loss of hope.

During a major depression, someone can become surrounded by feelings of sadness, hopelessness, helplessness, and emptiness, and these feelings can distort every thought and experience, making life seem hopeless and unworthy. Feelings of being deeply and continually deprived, unworthy, insignificant, and guilt-ridden build on feelings of sadness. At the same time, a person may feel chronically irritable, often exploding into anger and frustration.

While a major depression may be triggered by some life event or circumstance, a person’s mood reaction may seem greatly exaggerated. However, depression has less to do with life’s events than with an individual’s existing vulnerability to the condition.

In some cases, someone may experience a major depression as a single episode, but in most cases, clinical depression tends to recur periodically, reactively or cyclically. A major depressive episode could possibly last up to 2 or more years.

When someone experiences milder depressive episodes, this is called dysthymia. For someone suffering from dysthymia, certain life circumstances, such as loss of a job, divorce, or relocating to a new environment, may provoke a much deeper depression.

For some individuals, there is a seasonal component to their depression called Seasonal Affective Disorder (SAD). This is a form of reactive depression that is more prevalent in northern parts of the country where climatic extreme changes are greater. SAD usually affects people in the fall or winter and is characterized by fatigue, carbohydrate cravings, overeating, lack of energy or motivation to do activities normally enjoyed, and oversleeping. While the exact etiology or cause of SAD is not certain, it is possible that it may be related to the way in which the light responsive pineal gland in the brain functions.

Defining Depression:

The difficulty with many mental disorders, it is hard to tell when you need more than just a positive attitude to manage your feelings. Depression is a common problem that many people simply think they need to live with, something they need to ‘tough out’ in order to come out better for it. But this is not necessarily the best treatment plan for this mental illness. Here’s what you should know.

What’s difficult about dealing with depression is that it can manifest itself in a number of different ways. For some people, depression is merely a short bout of sadness that resolves on its own. But for others, it’s a long running presence that makes them feel ineffective, as well as hopeless. Some of the more common symptoms of depression include:

  • Feeling sad
  • Feeling hopeless
  • Becoming irritated for no reason
  • Anger and frustration
  • Loss of interest in favorite activities
  • Change in eating habits
  • Change in sleeping habits
  • Thoughts about suicide

Diagnosing depression is tricky because it requires that you have these symptoms for extended periods of time – normally for at least two weeks continuously. And while some people can easily identify their down times, others might not recognize symptoms like anger as being consistent with depression.

When you have depression, what can you do?

During the time that you feel despondent, seek the emotional support from family and friends. For milder episodes of depression of short duration, the support of loved ones may be able to help you work through it. But in most cases, you will not be able to fight depression on you own, and you should not try to. Like diabetes or asthma, depression is an illness and requires medical attention so it can be managed effectively and appropriately. If you are suffering from depression, it is imperative that you seek professional help.

If you suffer from SAD (Seasonal Affective Disorder), you may very well respond to spending at least an hour a day outdoors, even during the wintertime. Increasing the amount of natural light in your house may also help. Some psychiatrists even recommend obtaining a special light to put in your room that kind of resembles sunlight. Whenever possible, take trips in winter to warmer and sunnier climates.

When to seek treatment for depression:

If you are in a major bout of depression, you may feel like you are beyond help. However, depression can be treated and managed. If you state of gloom persists more than two weeks, you feel that you cannot get out of bed, you are increasingly isolated from family and friends, and you have lost any sense of enjoyment or interest in your usual activities, call your doctor right away. Also, if you find yourself ruminating about death and the meaningless of life and you are considering suicide, SEEK HELP IMMEDIATELY.

Treatment of Depression:

Mild depression can be treated effectively through psychotherapy. Even short-term therapy can help you understand your natural inclination towards more negative and low moods. Also, you can learn to cope better with life’s disappointments and triumphs. When depression is triggered by a seasonal change, light therapy, which extends exposure to bright light for measurable periods of time, may work to relieve symptoms.

In cases of more severe depression, medication will provide the main avenue for treatment. At the same time, psychotherapy is usually an important complement to medication. By restoring chemical balances within the brain, psychotropic medications will help lift the “veil of sorrow.” The most commonly used anti-depressant medications are SSRIs (selective serotonin reuptake inhibitors), which include fluoxetine, sertraline, paroxetine and fluvoxamine, and TCAs (tricyclic anti-depressants), which include imipramine, nortriptyline, amitriptyline, and desipramine. Although general practitioners can usually prescribe these types of medications, it is usually best to consult with a psychiatrist or psychopharmacologist, who is specially trained to evaluate and monitor the need for and use of anti-depressant medicines.

For lots of different reasons, treatment with anti-depressants takes time to work. Because every person and his depression differ, finding the most effective medication is often a process of trial and error. While the process may be frustrating, you and your doctor will eventually find the right treatment.

During a severe episode of depression, there may be severe paranoid persecutory delusions or even hallucinations. There may even be suicidal behavior. When these occur, hospitalization, antipsychotic medication or electroconvulsive therapy (ECT) may be necessary. After the acute phase has subsided, psychopharmacologic treatment should be continued to decrease the likelihood of relapse or future recurrence.

Unlike medications for physical illness, psychotropic medicines do not work to cure the depressive illness; rather, they work to relieve acute episodes and prevent recurrences. For many people, medications work most effective in conjunction with psychotherapy. Insight-oriented therapy can allow you to consider how such contributing factors as early experiences of loss and cumulative negative life circumstances and disappointments have colored your disposition. Cognitive techniques can also provide significant relief insofar as they address the negative and distorted thinking that typically characterizes depression.

Prognosis for Depression:

Prognosis is good. Recent progress in the development of new medicines that act directly on specific parts of the brain make the treatment of depression even more positive. SAD responds well to light therapy.

In some instances, one course of treatment is sufficient to manage or remedy major depressive illness. However, for many others, depression is a chronic lifelong condition that requires continued or episodic intervention. Ever after a successful round of treatment, it is important that you remain sensitive to stresses that are likely to trigger a depression. If you are able to recognize early signs, you will be able to contact your physician or clinician before you find yourself deep into another depressive episode. Learning to manage depression through therapy, medications and lifestyle will lessen the likelihood that it will take over your life.

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