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Depression: What You Need To Know

Your doctor believes you have a depressive illness and wants you to have this brief pamphlet to read and hold on to so that you can refer to it as often as you need. It provides important information about depressive illnesses. It may stimulate questions you may wish to discuss with your doctor or a mental health professional. Or you may wish to share it with a family member, friend, colleague, minister, school official, or other community helpers.
What Is a Depressive Illness?
A depressive illness is an illness involving your body, mood, thoughts and behavior. It affects the way you eat and sleep, the way you feel about yourself, and the way you think about things. A depressive illness is not a passing blue mood. It is not a sign of personal weakness or a condition that can be willed or wished away. People with a depressive illness cannot merely "pull themselves together" and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help over 80 percent of those who suffer from depression
Types of Depression
Depressive illnesses come in different forms just as do other illnesses, such as heart disease. This pamphlet briefly describes three of the most prevalent types of depressive illnesses. However, within these types there are variations in the number of symptoms, their severity, and persistence. Check with your doctor if you need more information about your type of depressive illness.
Major depression is manifested by combination of symptoms (see symptom list that interfere with the ability to work, sleep, eat, and enjoy once pleasurable activities. These disabling episodes of depression can occur once, twice, or several times in a lifetime.
Not everyone who is depressed or manic experiences every symptom. Some people experience a few symptoms, some many. Also, severity of symptoms varies with individuals.
Symptoms of Depression
Persistent sad or "empty" mood
Feelings of hopelessness, pessimism
Feelings of guilt, worthlessness, helplessness
Loss of interest or pleasure in hobbies and activities that you once enjoyed, including sex
Insomnia, early-morning waking or oversleeping
Appetite and/or weight loss, or overeating and weight gain
Decreased energy, fatigue, being "slowed down"
Thoughts of death or suicide; suicide attempts
Restlessness, irritability
Difficulty concentrating, remembering, making decisions
Excessive crying
Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain

A less severe type of depression, dysthymia, involves long-term, chronic symptoms that do not disable, but keep you from functioning at "full steam" or from feeling good. Sometimes people with dysthymia also experience major depressive episodes.
Another type of depressive illness is manic depressive illness each year, also called bipolar depression. Not nearly as prevalent as other forms of depressive illnesses, manic-depressive illness involves cycles of depression and elation or mania. Sometimes the mood switches are dramatic and rapid, but most often they are gradual. When in the depressed cycle, you can have any or all of the symptoms of a depressive illness. When in the manic cycle, any or all symptoms listed under mania may be experienced. Mania often affects thinking, judgment, and social behavior in ways that cause serious problems and embarrassment. For example, unwise business or financial decisions may be made when in a manic phase.
Causes of Depression
There is a risk for developing depression when there is a family history, indicating that a biological vulnerability can be inherited. The risk may be somewhat higher for those with bipolar depression. However, not everybody with a genetic vulnerability develops the illness. Apparently additional factors, possibly a stressful environment and other psychosocial factors are involved in the onset of depression.
Though major depression seems to occur, generation after generation, in some families, it can also occur in people who have no family history of depression. Whether the disease is inherited or not, it is evident that individuals with major depressive illness often have too little or too much of certain neurochemicals.
Psychological 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.
A serious loss, chronic illness, difficult relationship, financial problem or any unwelcome change in life patterns can also trigger a depressive episode. Very often, a combination of genetic, psychological, and environmental factors is involved in the onset of a depressive illness.
A variety of antidepressant medications and psychotherapies can be used to treat depressive illnesses. Some people do well with psychotherapy, some with antidepressants. Some 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. Depending on your diagnosis and severity of symptoms, you may be prescribed medication and/or treated with one of the several forms of psychotherapy that have proven effective for depression. It is important to note that most people can be successfully treated for depression on an outpatient basis.

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Antidepressant Medications
Three groups of antidepressant medications have been used to treat depressive illnesses: tricyclics monoamine oxidase inhibitors (MAOIs), and lithium. Lithium is the treatment of choice for manic-depressive illness and some forms of recurring, major depression. Sometimes your doctor will try a variety of antidepressants before finding the medication or combination of medications most effective for you. Sometimes the dosage must be increased to be effective.

There are now two new classes of antidepressants which are neither tricyclics nor MAOIs, and which generally lack the side effects associated with these two traditional classes of drugs. The first of these is fluoxetine, a serotonin re-uptake inhibitor; the other is bupropion, believed to act on the dopaminergic system.

Patients often are tempted to stop medication too soon. It is important to keep taking medication until your doctor says to stop, even if you feel better beforehand. Some medications must be stopped gradually to give your body time to adjust. In cases of manic-depressive illness and chronic major depression, medication may have to become part of everyday life to avoid disabling symptoms.

Antidepressant drugs are not habit-forming, so you need not be concerned about that. However, as is the case with any type of medication prescribed for more than a few days, antidepressants have to be carefully monitored to see if you are getting the correct dosage. Your doctor will want to check the dosage and its effectiveness regularly.

If you're taking MAO inhibitors, you will have to avoid certain foods, such as cheeses, wines, and pickles. Be sure you get a complete list of foods you should not eat from your doctor and always carry it with you. Other forms of antidepressants require no food restrictions.

Never mix medications of any kind- prescribed, over-the-counter, or borrowed- without consulting your doctor. Be sure to tell your dentist or any other medical specialist who prescribes a drug that you are taking antidepressants. Some of the most benign drugs when taken alone can cause severe and dangerous side effects if taken with others. Some drugs, like alcohol, reduce the effectiveness of antidepressants and should be avoided. This includes wine, beer, and hard liquor.

Antianxiety drugs or sedatives are not antidepressants. They are sometimes prescribed along with antidepressants; however, they should not be taken alone for a depressive illness. Sleeping pills and stimulants, such as amphetamines, are also inappropriate.

Be sure to call your doctor if you have a question about any drug or if you are having a problem you believe is drug related.
There are many forms of psychotherapy used to help depressed individuals, including some short-term (10-20 weeks) therapies. "Talking" therapies help patients gain insight into and resolve their problems through verbal"give and-take" with the therapist. "Behavioral" therapists help patients learn how to obtain more satisfaction and rewards through their own actions and how to unlearn the behavioral patterns that contribute to their depression.

Two of the short-term psychotherapies that research has shown helpful for some forms of depression are Interpersonal and Cognitive/Behavioral therapies. Interpersonal therapists focus on the patient's disturbed personal relationships that both cause and exacerbate the depression. Cognitive Behavioral therapists help patients change the negative styles of thinking and behaving often associated with depression.

Psychodynamic therapies, sometimes used to treat depression focus on resolving the patient's internal psychological conflicts that are typically thought to be rooted in childhood.

In general, the severe depressive illnesses, particularly those that are recurrent, will require medication (or ECT under special conditions) along with psychotherapy for the best outcome.

Helping Yourself
Depressive illnesses make you feel exhausted, worthless, helpless and hopeless. Such negative thoughts and feelings make some people feel like giving up. It is important to realize that these negative views are part of the depression and typically do not accurately reflect your situation. Negative thinking fades as treatment begins to take effect. In the meantime:

Do not set yourself difficult goals or take on a great deal of responsibility.

Break large tasks into small ones, set some priorities, and do what you can as you can.

Do not expect too much from yourself. This will only increase feelings of failure.

Try to be with other people; it is usually better than being alone.

Participate in activities that may make you feel better. You might try mild exercise, going to a movie, a ball game, or participating in religious or social activities.

Don't overdo it or get upset if your mood is not greatly improved right away. Feeling better takes time.

Do not make major life decisions, such as changing jobs, getting married or divorced, without consulting others who know you well and who have a more objective view of your situation. In any case, it is advisable to postpone important decisions until your depression has lifted.

Do not expect to snap out of your depression. People rarely do. Help yourself as much as you can, and do not blame yourself for not being up to par.

Remember, do not accept your negative thinking. It is part of the depression and will disappear as your depression responds to treatment.

Family and Friends Can Help
Since depression can make you fee} exhausted and helpless, you will want and probably need help from others. However, people who have never had a depressive illness may not fully understand its effect. They won't mean to hurt you, but they may say and do things that do. It may help to share this pamphlet with those you most care about so they can better understand and help you.

Helping the Depressed Person
The most important thing anyone can do for the depressed person is to help him or her get appropriate diagnosis and treatment. This may involve encouraging the individual to stay with treatment until symptoms begin to abate (several weeks), or to seek different treatment if no improvement occurs. On occasion, it may require making an appointment and accompanying the depressed person to the doctor. It may also mean monitoring whether the depressed person is taking medication.

The second most important thing is to offer emotional support. This involves understanding, patience, affection, and encouragement. Engage the depressed person in conversation and listen carefully. Do not ignore remarks about suicide. Always report them to the doctor.

Invite the depressed person for walks, outings to the movies, and other activities. Be gently insistent if your invitation is refused. Encourage participation in some activities that once gave pleasure, such as hobbies, sports, religious or cultural activities, but do not push the depressed person to undertake too much too soon. The depressed person needs diversion and company, but too many demands can increase feelings of failure.

Do not accuse the depressed person of faking illness or of laziness, or expect him or her "to snap out of it." Eventually, with treatment, most depressed people do get better. Keep that in mind, and keep reassuring the depressed person that with time and help he or she will feel better.


Source: National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892

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