Depression is a more common word for the mental health disorder – Major Depressive Disorder. It is a mental health disorder that affects a large number of individuals.

Is also known as the following: Major Depression, Unipolar Depression, and Clinical Depression.

It is classified as an Axis I clinical disorder with a cluster of symptoms that often can be related to mood and behavior changes.

Situational Depression begins because of life changes and usually last for only a few days to a few weeks.

Clinical Depression usually lasts longer than Situational Depression and may or may not be surrounded by life changes.

Often, there are changes in family situations, sleep schedule, eating, school, work and life.

The clinical diagnosis of depression is based on a variety of symptoms and there is not a specific laboratory test to confirm.

Signs and Symptoms

– Low or change in mood
– Difficulty to experience pleasure
– Feelings of worthlessness
Insomnia –  80% of the time
– Hypersomnia –  small number
– Withdrawal from others
– Overwhelming feeling of guilt or regret
– Self-hatred
– Decreased sex drive
– Fatigue
– Decreased desire to do things they once enjoyed
– Decreased appetite
– Weight loss or Weight gain (Depends on case)
– Suicidal thoughts

Severe Cases

– Psychosis
– Delusions
– Hallucinations
– Anger
– Violence
– Suicidal thoughts and actions

Symptoms in Children

* Children may have emotional changes that are normal. Moments of depression are normal. Children can be difficult to diagnose

– Excessive Sadness
– Irritable for week and/or months at a time.
– Sleeping habit changes
– Appetite changes
– Lost of interest in school
– Decline of academic performance
– May coexist with Attention-Deficit Hyperactivity Disorder  (ADHD)
– Suicidal thoughts
– Talk about death
– Suicidal attempts

Symptoms in the Elderly

– Similar to other ages
– Forgetfulness
– Irritability
– Decreased movement
– Decreased desire to live
– Decreased desire to thrive
– Change in sleeping and eating patterns

 

Causes of Depression

Complexity of this medical condition is apparent.

Probable causes may have mixtures of psychological changes, biological changes, and social factors.

There appears to be a genetic component where family members all exhibit different levels of severity.

But in other cases, it can occur without any known genetic support.

Decreased Serotonin activity has been largely studied and is a central medication that replaces Serotonin.

Serotonin acts in the brain to help regulate neurotransmitters

Studies have also looked at actual brain changes in those with depression and without.

Again the problem is that in some cases there are changes, and in other cases there aren’t.

Behavior changes such as job lost, bullies, significant fear or threat, death of a loved one, incarceration, and many many other changes can affect or stimulate depression.

Mental health changes or emotional breakdowns can induce depression

Low-self esteem can also be a cause factor

Drug and Alcohol use can be a cause of depression in some cases or try to mask the symptoms.

 

Drug and Alcohol Abuse

Depression because of Substance Abuse, according to the DSM-IV cannot be the sole symptom to receive a diagnosis of Depression

But Alcoholism is a risk factor in getting Deprssion

Other medications such as benzodiazepines, pain medications, elicit drug abuse and other medications can be taken in excess in those with depression.

 

Diagnosis

An assessment by be done by a general practitioner, a psychiatrist or a psychologist.

A review of mental health history is done, along with current symptoms, drug history, current social circumstances, and family history.

A discussion of suicide thoughts, plans, history, and current state are done.

Blood work is needed to be done to rule out other medical causes that can have similar symptoms

– TSH
– Thyroxine
– Electrolytes
– Calcium levels
– Blood count
– Testosterone
– Hormones as needed
– And others as seen needed

 

Major Depressive Episode

Severe symptoms that last for more than two weeks

Episode may be recurrent or isolated.

Mild Episode – few symptoms

Moderate – Several symptoms

Severe  – Difficulty functioning

Psychotic features – Falls under the category of Severe

 

Subtypes of Depression

1.) Postpartum Depression
2.) Seasonal affective Disorder
3.) Catatonic Depression  –  very rare.  The person does not speak and may have bizarre movement
4.) Melancholic Depression
5.) Atypical Depression

 

Management

Depending on severity, status, or social responsibilities or concerns – management will mean something different to everyone.

Options:

– Psychotherapy
– Behavior
– Medications
– Electroconvulsive

 

Psychotherapy

–  Can be given in families, groups, or individually
–  Should be done by health care professionals
–  Social workers are a great source of psychotherapy
–  This may be done in combination with medications

Cognitive Behavioral Therapy

–  Has the most research for children and adolescents
–  Is a talking therapy
–  Aims to solve problems, solve behavioral problems, and solves cognitive concerns
–  It is believed to be a combination of Behavior therapy and Cognitive therapy

 

Antidepressants

–  None to minimal improvement for those with mild or moderate depression
–  Significant improvement with those with severe disease

Selective Serotonin Reuptake Inhibitors (SSRIs)

.  Citalopram (Celexa)
.  Dapoxetine (Priligy)
.  Escitalopram  (Lexapro)
.  Fluoxetine  (Prozac)
.  Paroxetine  (Paxil)
.  Sertraline  (Zoloft)

Serotonin-Norepinephrine Reuptake Inhibitors  (SNRIs)

.  Desvenlafaxine  (Pristiq)
.  Venlafaxine  (Effexor)
.  Milnacipran  (Ixel, Savella)
.  Duloxetine  (Cymbalta)

Serotonin-Antagonist and Reuptake Inhibitors  (SARIs)

.  Trazadone  (Desyrel)
.  Etoperidone  (Axiomin, Etonin)
.  Lubazodone
.  Nefazodone  (Serzone, Nefadar)

Norepinephrine Reuptake Inhibitors  (NRIs)

.  Reboxetine  (Edronax)
.  Atomoxetine (Strattera)
.  Viloxazine  (Vivalan)

Norepinephrine-Dopamine Reuptake Inhibitors  (NDRIs)

.  Bupropion  (Wellbutrin, Zyban)
.  Dexmethylphenidate  (Focalin)
.  Methylphenidate  (Ritalin, Concerta)

Norephinephrine-Dopamine Releasing Agents  (NDRAs)

.  Amphetamine  (Adderall)
.  Dextroamphetamine  (Dexedrine)
.  Dextromethamphetamine  (Desoxyn)
.  Lisdexamfetamine  (Vyvanse)

Tricyclic Antidepressants  (TCAs)

.  Amitriptyline  (Elavil)
.  Clomipramine  (Anafranil)
.  Desipramine  (Norpramin, Pertofrane)
.  Doxepin  (Adapin, Sinequan)
.  Nortriptyline  (Pamelor)

Tetracyclic Antidepressants  (TeCAs)

.  Amoxapine  (Asendin)
.  Maprotiline  (Ludiomil)
.  Mirtazapine  (Remeron)

5-HT1A Receptor Agonist

.  Buspirone  (Buspar)
.  Aripiprazole  (Abilify)
.  Quetiapine  (Seroquel)

Mood Stabilizers

.  Carbamazepine  (Tegretol)
.  Lamotrigine  (Lamictal)
.  Lithium  (Lithane)
.  Valproic Acid  (Depakote)

 

Electroconvulsive Therapy

This is a procedure that sends electricity though the brain via pulses.

The patient is often under a period of general anesthesia

Often only approved for Severe major depression that has not seen improvement by medication

Can be done in catatonic depression where patient has stopped eating or drinking

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