Depression is a general, broad statement used to describe a mood. There are many kinds of depression such as post partum, menopausal, manic/bipolar, clinical, seasonal affective disorder (SAD), cyclothymia and dysthymia. Clinical depression is one of the most common types of depression and is very treatable yet many people still suffer from clinical depression because they don't recognize the symptoms. Most people think it's just a time of sadness and that it will pass; real depression is when a person can't function, but these assumptions are incorrect. Clinical depression is not diagnosed by the severity of the symptoms, only if the symptoms exist in the patient at all. CLINICAL DEPRESSION CAN HAPPEN TO ANYONE, REGARDLESS OF AGE, SEX, OR RACE.

Sometimes, clinical depression has multiple causes, a single cause or even no cause at all. Some examples of causes are biological (too much or too little of a brain chemicals called "neurotransmitters"), cognitive (having low self-esteem, being pessimistic, feeling without control in their lives), genetic (although depression can occur in people who have no family history of depression), situational (loss of a loved one, financial problems, divorce), co-occurring (occurring along with other medical problems such as heart disease, strokes, Alzheimer's, Parkinson's, diabetes), and medications (some medications can actually cause depression). A short checklist is used to determine whether or not someone exhibits signs of having clinical depression. Once again, it is not the severity of the symptoms, just whether or not the patient displays these symptoms at all.
  1. Feelings of sadness and/or irratibility.
  2. Loss of interest in activies or pleasures once enjoyed.
  3. Gain/loss of weight.
  4. Change in appetite.
  5. Changes in sleeping pattern (e.g. insomnia, too much sleeping).
  6. Feelings of guilt.
  7. Inability to concentrate, make decisions, or remember things.
  8. Fatigue or loss of energy.
  9. Restlessness or decreased activity.
  10. Feelings of hopelessness or worthlessness.
  11. Feelings or thoughts of suicide.

Treatment for clinical depression can include antidepressants, psychotherapy or both. There are many different types of antidepressants: SSRIs (selective serotonin reuptake inhibitors), TCAs (block both norepinephrine and serotonin, but have a higher toxicity rate), SNRIs (serotonin and norepinephrine reuptake inhibitors - designed to effect both seratonin and norepinephrine, it mainly effects serotonin unless taken in higher dosages which correlates with an increase in side effects), and NaSSAs (norepinephrine and specific serotonin antidepressants - these do not inhibit neurotransmitter reuptake although their net result is increasing norepinephrine and serotonin; these block certain serotonin receptors).

On a related sidenote, I was diagnosed with clinical depression about six months ago. I had most if not all of the symptoms listed above. It was one of the worst periods in my life. I had had it for about two years, but my clinical depression was due to multiple causes: genetics (mother's side), situations (broken up with an ex, had just moved to college away from my family and friends), biological (imbalance of neurotransmitters) and cognitive (coming out of Christian high school being a closeted lesbian doesn't help your self-esteem any). I was always irritable, I would sleep for 14 hours on end and then take a two hour nap later on in the day, I skipped classes, holed myself up in my dorm, watching movies by myself, my appetite was far from normal and I had absolutely no energy to see my friends or even answer their calls. Thank god, the university has a free psychiatric counseling service. I was diagnosed, put on Celexa then Effexor and am now feeling like I can live a normal life.

Most people think depression is something you can control. "Oh she'll snap out of it." At least that's what my mother thought, but it's not. Trust me, I've tried. I would've given up my soul to not sit there in front of the window just staring at the moon feeling like my insides were being scraped away. It already felt like I had lost my soul anyway, why not give it up?

I don't think taking a pill brings happiness, but in cases where your brain goes hay-wire and decides to stop acting like it should, you don't have a choice. It's not your fault; it's not anybody's fault. Some people are born with weak joints, some people have little pigmentation in their skin and for some of us...the chemicals in our brain aren't balanced.

labrys edge's has done well in communicating the basics of clinical depression in her writeup. Most of the information appears to have come from www.clinicaldepression.com. Some additional information will be helpful, I believe. In clinical practice, the term "clinical depression" almost alway refers to the condition described by the above listed symptoms, and caused by one or more neurotransmitter deficiencies. There is often a stigma attached to "depression". This is due to the lack of differentiation between "clinical depression" and "major depression".

Helping people understand clinical depression:

The first thing that helps people come to grips with this condition is differentiating the condition from the symptoms. If you explain it by comparing it with diabetes, where the disease is the sugar imbalance, and the symptoms are the drowsiness, weight gain, blurry vision, etcetera, then people have something more familiar with which to compare the depression. This also helps them understand that the symptoms aren't somehow their fault. Most commonly, a history of family members with conditions that signify a predisposition toward imbalances of neurotransmitters can be elicited. Asking a depressed person if they have any family members or close relatives with depression, alcoholism, "nervous breakdowns", or suicide attempts will very frequently bring a positive response, and this can help them understand that it is a medical condition, not a psychiatric one.

The second thing that helps is explaining what clinical depression is not, and that is major depression. I really wish that whoever came up with this term hadn't. It would be much better referred to as "clinical dysthymia/dysphoria" or "serotonin deficiency syndrome". The confusion with major depression is unfortunate. Explaining briefly that major depression is a psychiatric disorder, brought on by strong conditioning in a person's past that predisposes them to see the world, events, or their chances of happiness or success in life in a negative or pessimistic way, helps to distinguish it from the medical condition. (There is much more to major depression - it is basically that, but much more complex.)

The more information people have about their condition, the better the success rate in treating that condition. The recent study results relating the surprising lack of improved efficacy of antidepressants vs. placebo is, in my opinion, a reflection of the over-prescribing of good medicine for conditions that are truly not clinical depression. Used appropriately by experienced clinicians, the current medications for depression have show very good results in treating this condition, and I would encourage anyone who feels like they may be suffering from clinical depression to seek reputable medical help to see if treatment is appropriate for them.

Causes and Treatments of Clinical Depression

Research has taught us much about clinical depression recently, although it is still unknown what triggers the depressive episodes.  However, it is believed that there is not one single trigger that causes the depression to surface, but it is usually a combination of triggers and researchers hope to find out what these are.

Genetics

Through research, scientists feel that you may inherit traits of depression.  Scientists also feel that they are closing in on which traits lead to this depression.  For example, in identical twins that were studied, research shows that if one twin suffers from depression, there is better than a 70% chance that the other twin will suffer from depression, also.  This same study also tested siblings where one of the children was adopted into the family and the rate of depression in the adopted child was greatly decreased, unless the adopted child's biological parents suffered from depression.

Chemical Imbalances in the Body

Research shows us that if someone has an imbalance of neurotransmitters, chances are they are suffering from clinical depression.  Neurotransmitters are like telephone lines in the brain that allow cells to interact with one another.  Two of the major neurotransmitters related to clinical depression are norepinephrine and serotonin.  If your body lacks the proper amount of serotonin, it will cause problems such as insomnia, extreme irritability, and high anxiety.  If your body has a decreased level of norepinephrine, you may feel tired, depressed, and feel less alert than usual.

Other Factors That May Cause Clinical Depression

There are other chemicals in the body that are known to be altered in people who suffer from depression.  A hormone named cortisol is produced when the body is reacting to situations such as, fear, anger or stress.  People who do not suffer from depression have a peak in their cortisol level usually in the morning, and their cortisol level will decrease as the day goes on.  Those who suffer from clinical depression have a cortisol peak much earlier in the day and their cortisol level does not go down until the early evening.

It is unknown if these differences in cortisol levels are what causes the depression or if the depression leads to the imbalance in the cortisol levels.  However, it is known that the cortisol level in the body increases in people who are constantly under stress. 

There are other factors that lead to depression.  Many medications have been known to cause certain forms of depression.  In the 1970s doctors realized that patients who were taking Reserpine for their high blood pressure had developed many symptoms associated with depression.

Diagnosis

Clinical depression is said to be among the most treatable of mental illnesses.  Over 80% of people who suffer from clinical depression have had great success with treatment, and most all people with depression have seen at least a small measure of improvement with proper treatment.  Scientists are getting closer to finding out how to properly treat this illness and are hopeful that they will find better treatments in the future.

Before anybody suffering from clinical depression starts a treatment program, they should undergo a thorough evaluation by their physician.  Since this is a very intricate illness, it has been found that there are many factors that contribute to their depression.  These factors may be the following:

The evaluation should include, not just your psychiatric history but your complete medical history.  This will allow your physician to detail your emotional and physical history.  Your physician may also order a mental status examination to find any changes in your moods, thoughts, or speech patterns that may be manifestations of depression.  Usually, a complete physical exam is ordered to make sure there are no medical problems that have been undiagnosed that may be causing the depression.

Medications Used to Treat Depression

In the early 1950s, research taught us about the effects that medications have on depression.  How well the medications work depends on factors such as:

Medications may be adjusted up and down in dose until the proper level is reached.  Often, the psychiatrist will prescribe a combination of medications until they find out which combination works best for the patient, since each patient is different.  Usually, after the patient starts taking the antidepressant medications, they notice a difference after four to six weeks.

 Physicians generally prescribe one of four major types of medications used to treat depression: 

Psychotherapy

This usually involves communication between a therapist and a person that suffers from behavioral or emotional problems.  The therapist uses techniques that are based on psychological principles geared towards helping the patient gain insight about themselves and to help change their thoughts, feelings, and behaviors.  There are many forms of psychotherapy that have proven useful in helping people with depression. 

In the 1980s, scientists announced the results of research on the effectiveness of short-term psychotherapy in the treatment of depression.  The results show that for some categories of patients, under certain circumstances, that cognitive behavioral therapy and interpersonal therapy were just as effective as medications.  Although the medications relieved the symptoms of depression more quickly, the patients who received psychotherapy instead of medication had just as much relief from depression after 16 weeks.  In general, psychiatrists are in agreement about severely depressed patients benefiting from a combination of medications and psychotherapy.

Interpersonal Psychotherapy

This form of therapy is based on the theory that personal relationships can cause depression.  The depression may make these relationships more problematic.  The therapist tries to help the patient understand their depression and how the interpersonal conflicts are related to the depression.

Cognitive and Behavioral Therapy

This method of treatment is based on the belief that people's emotions are being controlled by their outlook on life and their opinions of the world.  Depression in this form results when the patient is harsh on themselves, believes that they will fail in whatever they attempt, and make inaccurate assessments of how others perceive them.  They feel hopeless and have a negative outlook on the future.  The therapist, in this case, would use a variety of techniques called "talk therapy" and behavioral modification in trying to alleviate the person's negative thought process and beliefs.

Psychoanalysis

Psychoanalysis is based on the concept that depression is related to a conflict in the person's past that they have buried in their unconscious.  The patient will meet with their therapist on an average of 3 to 5 times a week, in hopes to identify and resolve these past conflicts that have caused their depression.

Psychodynamic Psychotherapy

This form of therapy is based on psychoanalysis and is less intense due to the fact that the patient only meets with their therapist once or twice a week, over a shorter period of time.  It is based on the belief that human behavior is determined by genetics, past experience, and current reality.  It recognizes the significant effect that our emotions and unconscious motivation can have on our behavior.

Electroconvulsive Therapy (ECT)

ECT works by affecting the same transmitters in the brain that are affected by medication.  As medications have grown more effective, ECT, as a form of treatment for depression has been decreased.  However, for patients who cannot take medication for reasons such as, heart disease, old age, malnutrition, or patient's like myself, who have difficulty or do not respond to antidepressant medications, or are suffering from a very severe case of manic depression, ECT has been found to be very effective.  For people like myself, ECT can be a life-saving treatment when all other treatments and therapies have failed, or when a person has been deemed suicidal.

Recently, it has been found through research that a sub-type of depression, called seasonal affective disorder exists.  Research suggests that this newly found disorder comes from some people's sensitivity to seasonal changes and the amount of daylight.  A therapeutic session of being covered in light from what scientists call a "light box", has proven to be a highly effective form of treatment for this type of depression.


Source:  John's Hopkins Medical Handbook, 2000

 

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