Depression

Everyone can feel sad, particularly when faced with loss or grief. Depression, however, is more than low mood and sadness at a loss. It is a serious medical illness. It is the result of chemical imbalances in the brain. The sufferer feels extremely sad, dejected and unmotivated.

Depression is common

One in four women and one in six men suffer from depression at some time in their life.

The symptoms of depression

Some of the symptoms of depression can include:

• Feeling sad or depressed

• A loss of interest and pleasure in normal activities

• Loss of appetite or weight

• Inability to get to sleep or waking up early

• Feeling tired all the time

• Having trouble concentrating

• Feeling restless, agitated, worthless or guilty

• Feeling that life isn't worth living.

WHAT CAUSES DEPRESSION:

A combination of factors

Depression results from a combination of physical and psychological factors, which cause chemical imbalances in the brain. Diagnosis in every case needs a careful analysis of causes.

Biochemistry : Abnormalities in two chemicals in the brain, serotonin and norepinephrine, might contribute to symptoms of depression, including anxiety, irritability and fatigue. Other brain networks

undoubtedly are involved as well; scientists are actively seeking new knowledge in this area.

Genetics : Depression can run in families. For example, if one identical twin has depression, the other has a 70% chance of having the illness sometime in life.

Personality : People with low self-esteem, who are easily overwhelmed by stress, or who are generally pessimistic appear to be vulnerable to depression.

Environmental factors : Continuous exposure to violence, neglect, abuse or poverty may make people who are already susceptible to depression all the more vulnerable to the illness.

Also, a medical condition (e.g., a brain tumour or vitamin deficiency) can cause depression, so it is important to be evaluated by a psychiatrist or other physician to rule out general medical causes.

Diagnostic Evaluation and Treatment

Certain medications as well as some medical conditions such as a viral infection can cause the same symptoms as depression, and they should be ruled out through examination, interview, and lab tests. If a physical cause for the depression is ruled out, a detailed psychological evaluation should be done.

A good diagnostic evaluation will include a complete history of symptoms, i.e., when they started, how long they have lasted, how severe they are, whether the patient had them before and, if so, whether the symptoms were treated and what treatment was given. Enquiry should be made about alcohol and drug use, and if the patient has thoughts about death or suicide. Further, a history should include questions about whether other family members have had a depressive illness and, if treated, what treatments they may have received and which were effective.

Last, a diagnostic evaluation should include a mental status examination to determine if speech or thought patterns or memory have been affected, as sometimes happens in the case of a depressive or manic-depressive illness.

Treatment choice will depend on the outcome of the evaluation. There are a variety of antidepressant medications and psychotherapies that can be used to treat depressive disorders. Some people with milder forms may do well with psychotherapy alone. People with moderate to severe depression most often benefit from antidepressants. Most do best with combined treatment: medication to gain relatively quick symptom relief and psychotherapy to learn more effective ways to deal with life's problems, including depression. Depending on the patient's diagnosis and severity of symptoms, the therapist may prescribe medication and/or one of the several forms of psychotherapy that have proven effective for depression.

Electroconvulsive therapy (ECT) is useful, particularly for individuals whose depression is severe or life threatening or who cannot take antidepressant medication. ECT often is effective in cases where antidepressant medications do not provide sufficient relief of symptoms. In recent years, ECT has been much improved.

Medications

There are several types of antidepressant medications used to treat depressive disorders. These include newer medications chiefly the selective serotonin reuptake inhibitors (SSRIs) the tricyclics, and the monoamine oxidase inhibitors (MAOIs). Sometimes the dosage must be increased to be effective. Although some improvements may be seen in the first few weeks, anti-depressant medications must be taken regularly for 3 to 4 weeks (in some cases, as many as 8 weeks) before the full therapeutic effect occurs.