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