Major Depression: A disease with certain characteristic signs and symptoms that interferes with the ability to work, sleep, eat, and enjoy once pleasurable activities.
The characteristic signs and symptoms of major depression include loss of interest in activities that were once interesting or enjoyable, including sex; loss of appetite (anorexia) with weight loss or overeating with weight gain; loss of emotional expression (flat affect); a persistently sad, anxious or empty mood; feelings of hopelessness, pessimism, guilt, worthlessness, or helplessness; social withdrawal;
unusual fatigue, low energy level, a feeling of being slowed down; sleep disturbance with insomnia, early-morning awakening, or oversleeping; trouble concentrating, remembering, or making decisions; unusual restlessness or irritability; persistent physical problems such as headaches, digestive disorders, or chronic pain that do not respond to treatment; thoughts of death or suicide or suicide attempts. Alcohol or drug abuse may be signs of depression.
Feeling sad and helpless? It's possible you have major depression, also known as clinical depression. People with major depression feel a profound and constant sense of hopelessness and despair.
With major depression, you may have symptoms that make it difficult to work, study, sleep, eat, and enjoy friends and activities. Some people have clinical depression only once in their life. Others may have it several times in a lifetime.
There are several different types of clinical depression (mood disorders that include depressive symptoms):
Major Depression is an episode of change in mood that lasts for weeks or months. It is one of the most severe types of depression. It usually involves a low or irritable mood and/or a loss of interest or pleasure in usual activities. It interferes with one's normal functioning and often includes physical symptoms. A person may experience only one episode of major depressive disorder, but often there are repeated episodes over an individual's lifetime.
Dysthymia, often commonly called melancholy, is less severe than major depression but usually goes on for a longer period, often several years. There are usually periods of feeling fairly normal between episodes of low mood. The symptoms usually do not completely disrupt one's normal activities.
Bipolar disorder involves episodes of depression, usually severe, alternating with episodes of extreme elation called mania. This condition is sometimes called by its older name, manic depression. The depression that is associated with bipolar disorder is often referred to as bipolar depression. When depression is not associated with bipolar disorder, it is called unipolar depression.
Seasonal Depression, which medical professionals call seasonal affective disorder, or SAD, is depression that occurs only at a certain time of the year, usually winter, when the number of daylight hours is lower. It is sometimes called "winter blues." Although it is predictable, it can be very severe.
Psychotic Depression refers to the situation when depression and hallucinations or delusions are experienced at the same time (co-occur). This may be the result of depression that becomes so severe that it results in the sufferer losing touch with reality. Individuals who primarily suffer from a loss of touch with reality (for example, schizophrenia) are thought to suffer from an imbalance of dopamine activity in the brain and to be at risk of subsequently becoming depressed.
Medication
There are more than 20 antidepressant drugs currently available. Antidepressants correct the chemical imbalance in the brain. Because a variety of drugs target different neurotransmitters and imbalances of these neurotransmitters can vary from patient to patient, some drugs may be more effective than others for any individual. Sometimes a combination of drugs is best.
There are four (4) groups of antidepressant medications most commonly used to treat depression:
Tricyclic antidepressants (TCAs), which include:
amitriptyline (Elavil)
imipramine (Trofanil,Janimine)
nortryptyline (Pamelor)
despiramine (Norpramin)
TCAs work by slowing the rate at which neurotransmitters (chemical messengers) re-enter brain cells. This increases the concentration of the neurotransmitters in the central nervous system which relieves depression.
Monoamine oxidase inhibitors (MAOIs) include phenelzine (Nardil) and tranylcypromine (Parnate). MAO is an enzyme responsible for breaking down certain neurotransmitters in the brain. MAOIs inhibit this enzyme and restore more normal mood states.
Lithium carbonates, including Eskalith and Lithobid. Lithium reduces excessive nerve activity in the brain by altering the chemical balance within certain nerve cells. This drug has been used to improve the benefit of SSRIs and alone is effective in treating bipolar disorder.
Selective serotonin reuptake inhibitors (SSRIs) include:
fluoxetine (Prozac)
fluvoxamine (Luvox)
paroxetine (Paxil)
sertraline (Zoloft)
citalopram (Celexa)
escitalopram oxalate (Lexapro)
SSRIs act specifically on serotonin, making it more available for nerve cells, thus easing the transmission of messages without disrupting the chemistry of the brain. Two other antidepressants that affect two neurotransmitters, serotonin and norepinephrine, are venlafaxine (Effexor) and nefazodone (Serzone). Another of the newer antidepressants, bupropion (Wellbutrin), is chemically unrelated to the other antidepressants. It has more effect on norepinephrine and dopamine than on serotonin.
Medication usually produces a marked improvement by six weeks, but may require up to 12 weeks for full effect.
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