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DEPRESSION Created By: Coriann Thompson, Mikenna Cloward, Tia Field, & Avery Miyahara 1 Table of Contents What is Depression? 3 Major Depressive Disorder 3-4 Types of Depression 4-6 Clinical Depressive Disorder 7 Treatments 8-11 Dysthemia 11-13 Atipical 13-15 Bipolar 15-18 Seasonal 18-19 Depression Screen Test 19 Untreated Depression 19-21 Beating Depression 22-25 Helping a friend deal with Depression 25-30 Specifically Treating Depression 30-36 Medications 30-36 Psychotherapy 36-38 Healthy Living 38 TR Implications 38-39 Resources 39 2 WHAT IS DEPRESSION? Everyone occasionally feels blue or sad. But these feelings are usually short-lived and pass within a couple of days. When you have depression, it interferes with daily life and causes pain for both you and those who care about you. Depression is a common but serious illness. Depression is a strong mood involving sadness, discouragement, despair, or hopelessness that lasts for weeks, months, or even longer. Depression affects more than a person's mood. It drains the energy, motivation, and concentration a person needs for normal activities. It interferes with the ability to notice or enjoy the good things in life (kidshealth.org) Many people with a depressive illness never seek treatment. But the majority, even those with the most severe depression, can get better with treatment. Medications, psychotherapies, and other methods can effectively treat people with depression (National Institution of Mental Health). Major Depressive Disorder Major depressive disorder (MDD) (also known as recurrent depressive disorder, clinical depression, major depression, unipolar depression, or unipolar disorder) is a mental disorder characterized by an all-encompassing low mood accompanied by low self-esteem, and by loss of interest or pleasure in normally enjoyable activities. This cluster of symptoms (syndrome) was named, described and classified as one of the mood disorders in the 1980 edition of the American Psychiatric Association's diagnostic manual. The term "depression" is ambiguous. It is often used to denote this syndrome but may refer to other mood disorders or to lower mood states lacking clinical significance. Major depressive disorder is a disabling condition that adversely affects a person's family, work or school life, sleeping and eating habits, and general health. In the United States, around 3.4% of people with major depression commit suicide, and up to 60% of people who commit suicide had depression or another mood disorder.[1] The diagnosis of major depressive disorder is based on the patient's self-reported experiences, behavior reported by relatives or friends, and a mental status examination. There is no laboratory test for major depression, although physicians generally request tests for physical conditions that may cause similar symptoms. The most common time of onset is between the ages of 20 and 30 years, with a later peak between 30 and 40 years.[2] Typically, patients are treated with antidepressant medication and, in many cases, also receive psychotherapy or counseling, although the effectiveness of medication for mild or moderate cases is questionable.[3] Hospitalization may be necessary in cases with associated self-neglect or a significant risk of harm to self or others. A minority are treated with electroconvulsive therapy (ECT). The course of the disorder varies widely, from one episode lasting weeks to a lifelong disorder with recurrent major depressive episodes. Depressed individuals have shorter life expectancies than those without depression, in part because of greater susceptibility to medical illnesses and suicide. It is unclear whether or not medications affect the risk of suicide. Current and former patients may be stigmatized. 3 The understanding of the nature and causes of depression has evolved over the centuries, though this understanding is incomplete and has left many aspects of depression as the subject of discussion and research. Proposed causes include psychological, psycho-social, hereditary, evolutionary and biological factors. Certain types of long-term drug use can both cause and worsen depressive symptoms. Psychological treatments are based on theories of personality, interpersonal communication, and learning. Most biological theories focus on the monoamine chemicals serotonin, norepinephrine and dopamine, which are naturally present in the brain and assist communication between nerve cells. Types of Depression There are 9 different types of depression! 1. Major Depression The most common form of depression? Major depression. In fact, about 7 percent of the adult U.S. population has this debilitating mental health condition at any given time, according to the National Institute of Mental Health (NIMH). If you’re experiencing major depression, you may feel and see symptoms of extreme sadness, hopelessness, lack of energy, irritability, trouble concentrating, changes in sleep or eating habits, feelings of guilt, physical pain, and thoughts of death or suicide — and for an official diagnosis, your symptoms must last for more than two weeks. In some instances, a person might only experience one episode of major depression, but the condition tends to recur throughout a person’s life. The best treatment is usually with antidepressant medications, explains Dr. Halaris, but talk therapy may also be used to treat depression. And there’s good news: An estimated 80 to 90 percent of people with major depression respond well to treatment. 2. Dysthymia: The Common Depression Form You Haven't Heard Of About 2 percent of the American population has a form of depression that’s less severe than major depression, but still very real — dysthymia. Dysthymia is a type of depression that causes a low mood over a long period of time — perhaps for a year or more, explains Halaris. “People can function adequately, but not optimally.” Symptoms include sadness, trouble concentrating, fatigue, and changes in sleep habits and appetite. This depression usually responds better to talk therapy than to medications, though some studies suggest that combining medication with talk therapy may lead to the greatest improvement. People with dysthymia may also be at risk for episodes of major depression. 3. Postpartum Depression: Sadness After the Stork's Visit 4 A whopping 85 percent of new moms feel some sadness after their baby is born — but for about 13 percent women, that sadness is serious enough to be diagnosable. Postpartum depression is characterized by feelings of extreme sadness, fatigue, loneliness, hopelessness, suicidal thoughts, fears about hurting the baby, and feelings of disconnect from the child. It can occur anywhere from weeks to months after childbirth, and Halaris explains it most always develops within a year after a woman has given birth. "It needs prompt and experienced medical care," he says — that may include a combination of talk and drug therapy. 4. Seasonal Affective Disorder: Extreme Winter Weariness Would you prefer to hibernate during the winter than face those cold, dreary days? Do you tend to gain weight, feel blue, and withdrawal socially during the season? You could be one of 4 to 6 percent of people in the United States estimated to have seasonal affective disorder, or SAD. Though many people find themselves in winter funks, SAD is characterized by symptoms of anxiety, increased irritability, daytime fatigue, and weight gain. This form of depression typically occurs in winter climates, likely due to the lessening of natural sunlight. "We don't really know why some people are more sensitive to this reduction in light,” says Halaris. “But symptoms are usually mild, though they can be severe.” This depression usually starts in early winter and lifts in the spring, and it can be treated with artificial light treatment. 5. Atypical Depression: A Misunderstood Form of Depression Despite its name, atypical depression is not unusual. In fact, it may be the one of the most common types of depression — and some doctors even believe it is underdiagnosed. "This type of depression is less well understood than major depression," explains Halaris. Unlike major depression, a common sign of atypical depression is a sense of heaviness in the arms and legs — like a form of paralysis. However, a study published in the Archives of General Psychiatryfound that oversleeping and overeating are the two most important symptoms for diagnosing atypical depression. People with the condition may also gain weight, be irritable, and have relationship problems. Some studies show that talk therapy works well to treat this kind of depression. 6. Psychotic Depression: Losing Touch With Reality Psychosis — a mental state characterize by false beliefs, known as delusions, or false sights or sounds, known as hallucinations — doesn’t typically get associated with depression. But about 10 to 15 percent of people with depression have episodes so severe that they see or hear things that are not really there. 5 "People with this psychotic depression may become catatonic, not speak, or not leave their bed," explains Halaris. Treatment may require a combination of antidepressant and antipsychotic medications — and a recent review of 10 studies concluded that it may be best to start with an antidepressant drug alone and then add an antipsychotic drug if needed. 7. Bipolar Disorder: From High to Low (and Back to High Again) If your periods of extreme lows are followed by periods of extreme highs, you could have bipolar disorder (which is also sometimes called manic depressive disorder, as symptoms can alternate between depression and mania). Symptoms of mania include high energy, excitement, racing thoughts, and poor judgment. "Symptoms may cycle between depression and mania a few times per year or much more rapidly," Halaris says. "This disorder affects about 2 to 3 percent of the population and has one of the highest risks for suicide." There are two main subtypes of bipolar disorder: People with bipolar I have experienced at least one manic episode, while people with bipolar II experience hypomanic episodes — which are milder — along with depression. People with bipolar disorder are typically treated with drugs called mood stabilizers. 8. Premenstrual Dysphoric Disorder: When Depression Strikes Once a Month Premenstrual dysphoric disorder, or PMDD, is a type of depression that affects women during the second half of their menstrual cycles. Symptoms include depression, anxiety, and mood swings. Unlike premenstrual syndrome (PMS), which affects 75 percent of women and has milder symptoms, PMDD affects about 5 percent of women and is much more severe. "PMDD can be severe enough to affect a woman's relationships and her ability to function normally when symptoms are active," says Halaris. Treatment may include a combination of depression drugs as well as talk and nutrition therapies. 9. Situational Depression: When Life Gets You Down Also called adjustment disorder, situational depression is triggered by a stressful or life-changing event, such as job loss, the death of a loved one, trauma — even a bad breakup. It’s about three times more common than major depression, and medications are rarely needed — that’s because tend to clear up over time once the event has ended. However, that doesn’t mean it should be ignored: Symptoms of situational depression may include excessive sadness, worry, or nervousness, and if they don’t go away, they may become warning signs of major depression. (Everydayhealth.com) Clinical Depressive Disorder 6 A person who suffers from a major depressive disorder (sometimes also referred to as clinical depression or simply depression) must either have a depressed mood or a loss of interest or pleasure in daily activities consistently for at least a 2 week period. This mood must represent a change from the person's normal mood. Social, occupational, educational or other important functioning must also be negatively impaired by the change in mood. For instance, a person who has missed work or school because of their depression, or has stopped attending classes altogether or attending usual social engagements. A depressed mood caused by substances (such as drugs, alcohol, medications) is not considered a major depressive disorder, nor is one which is caused by a general medical condition. Major depressive disorder generally cannot be diagnosed if a person has a history of manic, hypomanic, or mixed episodes (e.g., a bipolar disorder) or if the depressed mood is better accounted for by schizoaffective disorder and is not superimposed on schizophrenia, a delusion or psychotic disorder. Typically the diagnosis of major depression is also not made if the person is grieving over a significant loss in their lives (see note on bereavement below). Clinical depression is characterized by the presence of the majority of these symptoms: Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feeling sad or empty) or observation made by others (e.g., appears tearful). (In children and adolescents, this may be characterized as an irritable mood.) Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Insomnia or hypersomnia nearly every day Psychomotor agitation or retardation nearly every day Fatigue or loss of energy nearly every day Feelings of worthlessness or excessive or inappropriate guilt nearly every day Diminished ability to think or concentrate, or indecisiveness, nearly every day Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide In addition, for a diagnosis of major depression to be made, the symptoms must not be better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation. Treatments Depression Symptoms: When to Seek Treatment It can be hard to admit to yourself that you may be depressed, let alone ask for help. Here are two good reasons why you should consider depression treatment: Treatment works. Even people with severe depression can find relief, and so can you. 7 Early treatment is better. As with many other health problems, getting treatment early on can ease symptoms more quickly. If you wait to get help, your depression can become more severe and harder to treat. Talk to someone. There are many people willing to help you overcome depression, but the first step you have to take on your own is to let someone know how you are feeling. It may help to start by talking to a close friend or family member. Ask them for support in finding depression treatment. The sooner you get treatment, the sooner you will start to feel better. Don't hesitate -call your doctor or a medical health professional if: You think you may be depressed You notice symptoms of depression such as sadness, hopelessness, or emptiness, or if you have less obvious symptoms such as trouble sleeping or vague aches and pains Depression symptoms make it hard to function If you have thoughts about dying or committing suicide, seek immediate medical help. You may feel hopeless now, but treatment will give you hope -- and help you see that life is worth living. Once you have a depression diagnosis, your doctor will discuss the different depression treatment options with you. The kind of depression treatment that's best for you depends on the type of depression you have. For example, some patients with clinical depression are treated with psychotherapy, and some are prescribed antidepressants. Others are prescribed antidepressants and psychotherapy. Still others may undergo electroconvulsive therapy (ECT), also called electroshock therapy. This treatment may be used with patients who do not respond to standard depression treatment options Whatever depression treatment your doctor prescribes, it's important to understand that there are no "instant" solutions. You may have to try different antidepressants to find the most effective drug for you. In addition, you'll have to take the antidepressant for several weeks to see if it benefits you at all. Being patient is important. Trust your doctor to know your personal history. With that, he or she can find the best depression treatment options that help improve your mood. Depression Drugs: Depression drugs can help lift your mood and ease the sadness and hopelessness you feel. You'll need to work with your doctor to find the depression medicine that is most effective with the fewest side effects. How Do Antidepressants Work? It's thought that three chemical messengers are involved with depression. The three are norepinephrine, serotonin, and dopamine, which are neurotransmitters. Neurotransmitters transmit electrical signals between brain cells. 8 Researchers have found a link between chemical imbalance in these brain chemicals and depression. Antidepressant medications increase the availability of neurotransmitters or by changing the sensitivity of the receptors for these chemical messengers. It is believed that modifying these brain chemicals can help improve mood, although the exact ways they work is still unclear. Types of Antidepressants: There are several types of antidepressants. These drugs improve symptoms of depression. The major types of antidepressants include: Selective serotonin reuptake inhibitors (SSRIs). SSRIs work by altering the amount of a chemical in the brain called serotonin. Serotonin and norepinephrine reuptake inhibitors (SNRIs). SNRIs are another form of antidepressant medicine. They treat depression by increasing availability of the brain chemicals serotonin and norepinephrine. Tricyclic antidepressants (TCAs). TCAs primarily affect the levels of two chemical messengers in the brain, norepinephrine and serotonin. Although these drugs are effective in treating depression, they can have more side effects than other drugs. So they typically aren't the first drugs used. Monoamine oxidase inhibitors (MAOIs). MAOIs are most effective in people with depression who do not respond to other treatments. They are also effective for treating other mental illnesses. Substances in certain foods like cheese, beverages like wine, and medications can interact with an MAOI. So people taking this drug must adhere to strict dietary restrictions. For this reason these antidepressants also aren't usually the first drugs used. There are other antidepressants that are not members of these classes. Why Are Stimulants Prescribed for Depression? Doctors sometimes prescribe other medications such as stimulants and anti-anxiety drugs to use in conjunction with an antidepressant. This is especially likely if the patient has a co-existing mental or physical disorder. However, neither anti-anxiety medications nor stimulants are effective against depression when taken alone. Talk to your doctor about this type of treatment. Ask if it might boost the effect of your antidepressant. Psychotherapy's Role in Depression Treatment: The role of psychotherapy in treating depression is to help the person develop appropriate and workable coping strategies. These strategies help deal with everyday stressors and increase medication adherence. There are different types of psychotherapy, including individual, family, and group therapy. Your doctor will help you find the best type of psychotherapy for you. 9 Electroconvulsive therapy (ECT): Electroconvulsive therapy (ECT), also known as electroshock therapy, is typically used to treat severe depression. During ECT, a skilled doctor applies a brief electric current through the scalp to the brain. This current induces a seizure. ECT is very effective at treating depression. ECT is generally used when severe depression is unresponsive to other forms of therapy. Or it might be used when patients pose a severe threat to themselves or others and it is dangerous to wait until medications take effect. Vagus Nerve Stimulation (VNS): Vagus nerve stimulation (VNS) can be used to treat those with treatment-resistant depression, using a pacemaker-like device that is implanted in the body. Once implanted, this device delivers regular electrical impulses to the vagus nerve, one of the nerves that relays information to and from the brain. Transcranial Magnetic Stimulation (TMS) Device? The FDA has cleared the NeuroStar TMS device for treating depressed adults for whom one antidepressant has failed to work. While ECT uses an electric current to induce seizure, TMS creates a magnetic field to induce a much smaller electric current in a specific part of the brain without causing seizure or loss of consciousness. TMS is used to treat milder depression and works best in patients who have failed to benefit from one, but not two or more, antidepressant treatments. Also, unlike ECT, TMS does not require sedation and is administered on an outpatient basis. Patients undergoing TMS must be treated four or five times a week for four weeks. Depression Treatment: Give it Time to Work Certain medications and medical conditions such as thyroid problems can cause symptoms of depression, so your doctor may want to rule them out. If your doctor thinks you may be depressed, he or she can refer you to a mental health professional. Depression treatment involves either antidepressant medication, psychotherapy, or both. People with mild to moderate depression can benefit from therapy alone. People with more severe depression usually do better with medication and therapy. Note that once you start treatment, you may notice improvements in symptoms such as sleep or appetite before begin to you feel less depressed. Antidepressants work by affecting brain chemicals called neurotransmitters that regulate mood. Antidepressants effectively treat depression in most people who take them. However, they can 10 take four to six weeks to notice an effect, so it's important to be patient. Antidepressants can also have side effects, including weight gain and sexual problems. So it may take some time to find the right medication that works best for you with the fewest side effects. Psychotherapy treats depression by helping you: Learn new, more positive ways of thinking Change habits or behaviors that may make your depression worse Work through relationship problems at home or work Help you see things in a more realistic way and face your fears Help you feel hopeful, positive, and more in control of your life It can take time to break old patterns of thinking and behavior, so give therapy some time to work. (www.webmd.com) Dysthymia Dysthymia is a chronic type of depression where a persons moods are low, but their sypmotoms are not as severe as major depression. Causes- The cause of dysthymis is unknown, but it does run in families, and is linked to women more often than men. It is also linked to people with long-term medical issues , or problems such as anxiety, alcoholism, or addiction to drugs. Although people with dysthymis do not have major depression, they often times will have an episode of major depression some time in their lives. Symptoms- The main symptom of dysthymia is a low, dark, or sad mood on most days for at least 2 years. In children and adolescents, the mood can be irritable instead of depressed and lasts for at least 1 year. Also, two or more of the following symptoms will typically be present all of the time with someone who has dysthymia. Feelings of hopelessness Too little or too much sleep Low energy or fatigue Low self-esteem Poor appetite or overeating Poor concentration 11 People who have dysthymia will often have a negative light on themselves, their future, other people, and their life events. Problems that may arise will also seem too difficult for them to solve. Tests- A healthcare provider will take a history and watch their moods. They may also take samples of blood and urine to rule out medical causes of depression. Treatment- Dysthymia there are many ways to try to control and treat dysthymia. Get enough sleep. Follow a healthy, nutritious diet. Take medicines correctly. Discuss any side effects with yourdoctor. Learn to watch for early signs that your dysthymia is getting worse. Have a plan for how to respond if it does. Try to exercise regularly. Look for activities that make you happy. Talk to someone you trust about how you are feeling. Surround yourself with people who are caring and positive. Avoid alcohol and illegal drugs. These can make your mood worse over time and impair your judgment. Medications are often effective for dysthymia, though they sometimes do not work as well as they do for major depression, and may takelonger to work. Don’t stop taking your medicine on your own, even if you feel better or have side effects. Always call your doctor first. When it is time to stop your medicine, you and your doctor will slowly reduce the dose instead of stopping suddenly. People with dysthymia may also be helped by some type of talk therapy. Talk therapy is a good place to talk about feelings and thoughts, and to learn ways to deal with them. Types of talk therapy include: Cognitive behavioral therapy (CBT), which helps you learn to be more aware of your symptoms and what makes them worse. You will be taught problem-solving skills. Insight-oriented or psychotherapy, which can help people with dysthymia understand factors that may be behind their depressive thoughts and feelings. 12 Joining a support group for people who are having problems like yours can also help. Ask your therapist or health care provider to recommend a group. Prognosis- Dysthymia is a chronic condition that can last for years. Though many people completely recover, others continue to have some symptoms, even with treatment. It may also increase the risk for suicide. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001916/ Atypical Depression Atypical depression is a type of depression that can have some symptoms that are similar to those of major depression, but it does not have the number of symptoms needed for a diagnosis of major depression. Common symptoms of atypical depression include increased appetite or weight gain, sleepiness or excessive sleep, and feeling extremely sensitive to rejection. Characteristics sadness or depressed mood most of the day or almost every day loss of enjoyment in things that were once pleasurable major change in weight (gain or loss of more than 5% of weight within a month) or appetite insomnia or excessive sleep almost every day physically restless or rundown that is noticeable by others fatigue or loss of energy almost every day feelings of hopelessness or worthlessness or excessive guilt almost every day problems with concentration or making decisions almost every day recurring thoughts of death or suicide, suicide plan, or suicide attempt In general, people with atypical depression don't have as many of the symptoms that people with classical depression may have. They tend to have first experienced depression at an early age, during their teenage years. Atypical depression is rather common. Some doctors believe that it is underdiagnosed. Symptoms- The main characteristic of atypical depression that distinguishes it from major depression is mood reactivity. A person with atypical depression will see his or her mood improve if something positive happens. In major depression, positive changes will not bring on a 13 change in mood. In addition, diagnostic criteria call for at least two of the following symptoms to accompany the mood reactivity: sleeping too much (hypersomnia) increased appetite or weight gain having a more intense reaction or increased sensitivity to rejection, resulting in problems with social and work relationships having a feeling of being weighed down, paralyzed, or "leaden" A doctor will also look at hypothyroidism; this is where low levels of thyroid hormone may increase depression and weight gain. Causes- The exact cause of depression is unknown, but it is believed to be linked to neurotransmitters that release serotonin, dopamine, and norepinephrine . There are also risk factors such as: a family history of depression a significant loss -- from death, divorce, or separation -- that results in grief interpersonal conflicts and related emotions such as guilt any type of abuse -- physical, sexual, or emotional any type of major life event such as moving, changing or losing a job, graduating, retiring any type of serious illness such as cancer, heart disease, stroke, or HIV drug or alcohol abuse isolation or exclusion from family, friends, or other social groups Treatments- Doctors are likely to recommend psychotherapy (talk therapy) and/or medications for atypical depression. There are different types of psychotherapy and medications available for treatment. You may be referred to a specialist such as a psychiatrist, psychologist, or other licensed professional for care. Bipolar- A condition where a persons mood goes back and forth between very good, and irritable moods, as well as depression and mania. Causes- It affects men and women equally between the ages of 15-25. The exact cause is unknown but it runs in families. Types of bipolar disorder: 14 People with bipolar disorder type I have had at least one manic episode and periods of major depression. In the past, bipolar disorder type I was called manic depression. People with bipolar disorder type II have never had full mania. Instead they experience periods of high energy levels and impulsiveness that are not as extreme as mania (called hypomania). These periods alternate with episodes of depression. A mild form of bipolar disorder called cyclothymia involves less severe mood swings. People with this form alternate between hypomania and mild depression. People with bipolar disorder type II or cyclothymia may be wrongly diagnosed as having depression. The following may trigger manic episodes in people with bipolar disorder. Life changes such as childbirth Medications such as antidepressants or steroids Periods of sleeplessness Recreational drug use SymptomsManic may last from days to months and their sypomtoms include: Easily distracted Little need for sleep Poor judgment Poor temper control Reckless behavior and lack of self control o Binge eating, drinking, and/or drug use o Poor judgment o Sex with many partners (promiscuity) o Spending sprees Very elevated mood o Excess activity (hyperactivity) o Increased energy 15 o Racing thoughts o Talking a lot o Very high self-esteem (false beliefs about self or abilities) Very involved in activities Very upset (agitated or irritated) These symptoms of mania occur with bipolar disorder I. In people with bipolar disorder II, the symptoms of mania are similar but less intense. The depressed phase of both types of bipolar disorder includes the following symptoms: Daily low mood or sadness Difficulty concentrating, remembering, or making decisions Eating problems o Loss of appetite and weight loss o Overeating and weight gain Fatigue or lack of energy Feeling worthless, hopeless, or guilty Loss of pleasure in activities once enjoyed Loss of self-esteem Thoughts of death and suicide Trouble getting to sleep or sleeping too much Pulling away from friends or activities that were once enjoyed There may also be a mixed state where manic and depressive symptoms can occur together or one right after another. Signs and TestsMany factors may apply to diagnosing bipolar: Ask about your family medical history, such as whether anyone has or had bipolar disorder 16 Ask about your recent mood swings and for how long you've had them Perform a thorough examination to look for illnesses that may be causing the symptoms Run laboratory tests to check for thyroid problems or drug levels Talk to your family members about your behavior Take a medical history, including any medical problems you have and any medications you take Watch your behavior and mood Treatment- Often times depression and mania return even with treatment. Treatment looks for: Avoid moving from one phase to another Avoid the need for a hospital stay Help the patient function as well as possible between episodes Prevent self-injury and suicide Make the episodes less frequent and severe Medication Carbamazepine Lamotrigine Lithium Valproate (valproic acid) Other antiseizure drugs may also be tried. Other drugs used to treat bipolar disorder include: Antipsychotic drugs and anti-anxiety drugs (benzodiazepines) for mood problems Antidepressant medications can be added to treat depression. People with bipolar disorder are more likely to have manic or hypomanic episodes if they are put on antidepressants. Because of this, antidepressants are only used in people who also take a mood stabilizer. Prognosis- Mood-stabilizing medications can help control symptoms, however patients often need help taking medications and controlling their moods asap. Stopping medications because patients feel better is common, but is very serious. 17 http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001924/ Seasonal- Also known as SAD is a type of depression that happens at the same time each year, usually from October until April. Anyone can get SAD but it is most common in people with: People who live in areas where winter days are very short or there are big changes in the amount of daylight in different seasons. Women. People between the ages of 15 and 55. The risk of getting SAD for the first time goes down as you age. People who have a close relative with SAD. Causes- The exact cause is not known, but it may be caused by lack of sunlight Symptoms Feel sad, grumpy, moody, or anxious. Lose interest in your usual activities. Eat more and crave carbohydrates, such as bread and pasta. Gain weight. Sleep more and feel drowsy during the daytime Diagnosis- Many of the symptoms are the same as nonseasonal depression so a doctor may ask: You have been depressed during the same season and have gotten better when the seasons changed for at least 2 years in a row. You have symptoms that often occur with SAD, such as being very hungry (especially craving carbohydrates), gaining weight, and sleeping more than usual. A close relative-a parent, brother, or sister-has had SAD. Treatment- Doctors often prescribe light therapy to treat SAD. There are two types of light therapy: Bright light treatment. For this treatment, you sit in front of a "light box" for half an hour or longer, usually in the morning. Dawn simulation. For this treatment, a dim light goes on in the morning while you sleep, and it gets brighter over time, like a sunrise. Light therapy works well for most people with SAD, and it is easy to use. You may start to feel better within a week or so after you start light therapy. But you need to stick with it 18 and use it every day until the season changes. If you don't, your depression could come back. Other treatments that may help include: Antidepressants. These medicines can improve the balance of brain chemicals that affect mood. Counseling. Some types of counseling, such as cognitive-behavioral therapy, can help you learn more about SAD and how to manage your symptoms. http://www.webmd.com/depression/tc/seasonal-affective-disorder-sad-topic-overview Depression Screening Test- Is a test made up of questions to help determine a psychiatrist if a person may have symptoms of depression. Untreated Depression Untreated clinical depression is a serious problem. Untreated depression increases the chance of risky behaviors such as drug or alcohol addiction. It also can ruin relationships, cause problems at work, make it difficult to overcome serious illnesses, and even result in. Clinical depression, also known as major depression, is an illness that involves the body, mood, and thoughts. Clinical depression affects the way you eat and sleep. It affects the way you feel about yourself and those around you. It even affects your thoughts. People who are depressed cannot simply “pull themselves together” and be cured. Without proper treatment, including antidepressants and/or psychotherapy, untreated clinical depression can last for weeks, months, or years. Appropriate treatment, however, can help most people with depression. There is mounting evidence that clinical depression takes a serious toll on physical health. The most recent studies exploring health and major depression have looked at patients with stroke or coronary artery disease. Results have shown that people with major depression who are recovering from strokes or heart attacks have a more difficult time making health care choices. They also find it more difficult to follow their doctor's instructions and to cope with the challenges their illness presents. Another study found that patients with major depression have a higher risk of death in the first few months after a heart attack. One of the most telling symptoms of clinical depression is a change in sleep patterns. Though the most common problem is insomnia (difficulty getting adequate sleep), people sometimes feel an increased need for sleep and experience excessive energy loss. Lack of sleep can cause some of the same symptoms as depression -- extreme tiredness, loss of energy, and difficulty concentrating or making decisions. 19 In addition, untreated depression may result in weight gain or loss, feelings of hopelessness and helplessness, and irritability. Treating the depression helps the person get control over all of these depression symptoms. Common signs of insomnia include: Daytime fatigue Irritability and difficulty concentrating Sleep that never feels like "enough" Trouble falling asleep Trouble going back to sleep after waking up during the night Waking up at all hours of the night Waking up before the alarm clock goes off Alcohol and drug abuse are common among people with clinical depression. They’re especially common among teens and among young and middle-age males. It is very important to encourage these people to get help because they are more likely to attempt suicide. Signs of drug and alcohol abuse include: Inability to maintain personal relationships Secretive alcohol use Self-pity Tremors Unexplained memory loss Unwillingness to talk about drugs or alcohol Those who suffer depression and abuse drugs or alcohol may need very specialized treatment. Are the signs of untreated depression in men different from those in women? Men who have untreated clinical depression may exhibit more anger, frustration, and violent behavior than women. In addition, men with untreated depression may take dangerous risks such as reckless driving and having unsafe sex. Men are not aware that physical symptoms, such as headaches, digestive disorders and chronic pain, can be symptoms of male depression. Why is untreated depression considered to be a disability? Depression can render people disabled in their work life, family life, and social life. Left untreated, clinical depression is as costly as heart disease or AIDS to the U.S. economy. Untreated depression is responsible for more than 200 million days lost from work each year. The annual cost of untreated depression is more than $43.7 billion in absenteeism from work, lost productivity, and direct treatment costs. 20 How does untreated depression affect my family? Living with a depressed person is very difficult and stressful for family members and friends. It’s often helpful to have a family member involved in the evaluation and treatment of a depressed relative. Sometimes marital or even family therapy is indicated. Can untreated depression lead to suicide? Depression carries a high risk of suicide. This is the worst but very real outcome of untreated or under-treated depression. Anybody who expresses suicidal thoughts or intentions should be taken very, very seriously. Do not hesitate to call your local suicide hotline immediately. Call 800SUICIDE (800-784-2433) or 800-273-TALK (800-273-8255) -- or the deaf hotline at 800-7994889. Most people who suffer from clinical depression do not attempt suicide. But according to the National Institute of Mental Health, more than 90% of people who die from suicide have depression and other mental disorders, or a substance abuse disorder. Men commit almost 75% of suicides, even though twice as many women attempt it. The elderly experience more depression and suicide than you might think. Forty percent of all suicide victims are adults over the age of 60. Older adults suffer more frequently from depression because of the frequent loss of loved ones and friends as they age. They also experience more chronic illnesses, more major life changes like retirement, and the transition into assisted living or nursing care. Are there certain risk factors for suicide with untreated depression? The risk factors for suicide associated with untreated depression include: Family history of mental or substance abuse disorder Family history of physical or sexual abuse Having attempted suicide previously Having family members or friends who have attempted suicide Having mental and substance abuse disorders Keeping a firearm in the home If you or someone you know has risk factors for suicide and has also displayed warning signs, seek the help of a mental health care professional right away. Also, do not leave the person alone. People often talk about suicide before they attempt it, so pay close attention to what the person is saying. What are warning signs of suicide with untreated depression? 21 Warning signs of suicide include: Talking, writing, or thinking about killing or hurting oneself or threatening to Depression (deep sadness, loss of interest, trouble sleeping and eating) that gets worse Having a "death wish," tempting fate by taking risks that could lead to death -- for example, driving through red lights Losing interest in things one used to care about Making comments about being hopeless, helpless, or worthless Putting affairs in order, tying up loose ends, or changing a will Saying things like "it would be better if I wasn't here" or "I want out" A sudden switch from being very sad to being very calm or appearing to be happy Suddenly visiting or calling people one cares about Talking about suicide Increase in drinking alcohol or using drugs Writing a suicidal note Watching well publicized murder and/or suicide reports in the media Conducting on-line searches on ways to commit suicide Seeking methods to kill oneself such as getting a gun or pills. For in depth information, see WebMD’s Depression and Suicide. Who can be treated successfully for clinical depression? More than 80% of people with clinical depression can be successfully treated with early recognition, intervention, and support. Depression affects almost 19 million people each year, including a large portion of the working population. People with untreated depression can usually get to work. But once there, they may be irritable, fatigued, and have difficulty concentrating. Untreated depression makes it difficult for employees to work well. Most people do best with depression treatment using psychotherapy, medications, or a combination of both. (http://www.webmd.com/depression/guide/untreated-depression-effects?page=3) Fighting Depression 5 Ways to Fight Depression If you feel depressed, it's best to do something about it — depression doesn't just go away on its own. In addition to getting help from a doctor or therapist, here are 5 things you can do to feel better. 1. Exercise. Take a 15- to 30-minute brisk walk every day — or dance, jog, or bike if you prefer. People who are depressed may not feel much like being active. But make yourself 22 do it anyway (ask a friend to exercise with you if you need to be motivated). Once you get in the exercise habit, it won't take long to notice a difference in your mood. In addition to getting aerobic exercise, some yoga poses can help relieve feelings of depression. Try downward-facing dog or legs-up-the-wall pose (you can find these poses on yoga websites). Two other aspects of yoga — breathing exercises and meditation — can also help people with depression feel better. 2. Nurture yourself with good nutrition. Depression can affect appetite. One person may not feel like eating at all, but another might overeat. If depression has affected your eating, you'll need to be extra mindful of getting the right nourishment. Proper nutrition can influence a person's mood and energy. So eat plenty of fruits and vegetables and get regular meals (even if you don't feel hungry, try to eat something light, like a piece of fruit, to keep you going). 3. Identify troubles, but don't dwell on them. Try to identify any situations that have contributed to your depression. When you know what's got you feeling blue and why, talk about it with a caring friend. Talking is a way to release the feelings and to receive some understanding. If there's no one to tell, pouring your heart out to a journal works just as well. Once you air out these thoughts and feelings, turn your attention to something positive. Take action to solve problems. Ask for help if you need it. Feeling connected to friends and family can help relieve depression. (It may also help them feel there's something they can do instead of just watching you hurt.) 4. Express yourself. With depression, a person's creativity and sense of fun may seem blocked. Exercise your imagination (painting, drawing, doodling, sewing, writing, dancing, composing music, etc.) and you not only get those creative juices flowing, you also loosen up some positive emotions. Take time to play with a friend or a pet, or do something fun for yourself. Find something to laugh about — a funny movie, perhaps. Laughter helps lighten your mood. 5. Look on the bright side. Depression affects a person's thoughts, making everything seem dismal, negative, and hopeless. If depression has you noticing only the negative, make an effort to notice the good things in life. Try to notice one thing, then try to think of one more. Consider your strengths, gifts, or blessings. Most of all, don't forget to be patient with yourself. Depression takes time to heal. (http://kidshealth.org/teen/your_mind/problems/depression_tips.html) Being depressed can make you feel helpless. You're not. Along with therapy and sometimes medication, there's a lot you can do on your own to fight back. Changing your behavior -- your physical activity, lifestyle, and even your way of thinking -- are all natural depression treatments. Do you want to learn natural depression treatments that can help you feel better -- starting right now? Here are some tips. 23 Fending Off Depression Symptoms in Winter While some people look forward to the brisk days of fall and winter, anticipating family dinners and cozy nights by the fire, others dread the cooler temperatures and shorter days. If history repeats, they know that the winter season will bring, like clockwork, worsening symptoms of depression. Up to 3% of the population in the U.S. may suffer from winter depression, which experts term seasonal affective disorder, or SAD. Some of the 6.7% Americans who suffer depression year-round find... Read the Fending Off Depression Symptoms in Winter article > > 1. Get in a routine. If you’re depressed, you need a routine, says Ian Cook, MD, a psychiatrist and director of the Depression Research and Clinic Program at UCLA. Depression can strip away the structure from your life. One day melts into the next. Setting a gentle daily schedule can help you get back on track. 2. Set goals. When you're depressed, you may feel like you can't accomplish anything. That makes you feel worse about yourself. To push back, set daily goals for yourself. "Start very small," says Cook. "Make your goal something that you can succeed at, like doing the dishes every other day." As you start to feel better, you can add more challenging daily goals. 3. Exercise. Exercise temporarily boosts feel-good chemicals called endorphins. It may also have long-term benefits for people with depression. Regular physical activity seems to encourage the brain to rewire itself in positive ways, Cook says. How much exercise do you need? You don’t need to run marathons to get a benefit. Just walking a few times a week can help. 4. Eat healthy. There is no magic diet that fixes depression, but watching what you eat is a good idea. If depression tends to make you overeat, getting in control of your eating will help you feel better. Although nothing is definitive, Cook says there's evidence that foods with omega-3 fatty acids -- such as salmon and tuna -- and folic acid -- such as spinach and avocado -- could help ease depression. 5. Get enough sleep. Depression can make it hard to get enough sleep, and not getting enough sleep can make depression worse. What can you do? Start by making some changes to your lifestyle. Go to bed and get up at the same time every day. Try not to nap. Take all the distractions out of your bedroom -- no computer and no TV. In time, you may find your sleep improves. 6. Take on responsibilities. When you’re depressed, you may want to pull back from life and give up your responsibilities at home and at work. Don't. Staying involved and having daily responsibilities can work as a natural depression treatment. They ground you and give you a sense of accomplishment. If you're not up to full-time school or work, that’s fine. Think about part-time. If that seems like too much, consider volunteer work. 7. Challenge negative thoughts. In your fight against depression, a lot of the work is mental -- changing how you think. When you're depressed, you leap to the worst possible conclusions. The next time you're feeling terrible about yourself, use logic as a natural depression treatment. You might feel like no one likes you, but is there real evidence for that? You might feel like the most worthless person on the planet, but is that really 24 likely? It takes practice, but in time you can beat back those negative thoughts before they get out of control. 8. Check with your doctor before using supplements. "There's promising evidence for certain supplements for depression," says Cook, such as fish oil, folic acid, and SAMe. However, more research needs to be done before we'll know for sure. Always check with your doctor before starting any supplement, especially if you’re already taking medications. 9. Do something new. When you’re depressed, you’re in a rut. Push yourself to do something different. Go to a museum. Pick up a used book and read it on a park bench. Volunteer at a soup kitchen. Take a language class. "When we challenge ourselves to do something different, there are chemical changes in the brain," says Cook. "Trying something new alters the levels of dopamine, which is associated with pleasure, enjoyment, and learning." 10. Try to have fun. If you’re depressed, make time for things you enjoy. What if nothing seems fun anymore? "That's just a symptom of depression," says Cook. You have to keep trying anyway. (http://www.webmd.com/depression/features/natural-treatments) How to help a friend through depression Depression. We've all heard of it. Most of us will come into contact with it at some point in our lives. Depression is a very difficult serious illness and miserable experience for someone to go through, and it's something that either you or someone you care about will have to deal with. However, it isn't just the victims who are impacted. What about their friends? Victims of depression need steady, supportive friends to rely on in their times of need. If you're the friend of a depression victim and are confused and don't know what to do or how to help them best, then worry no longer. This article is for you. 1. Acknowledge. Tell the person suffering from depression that you've noticed that they seem down or depressed lately. (Unless they have already told you that they are suffering from depression.) If so, tell them that since you now know that they're sad that you want to help. This will be very re-assuring to them. Sometimes the depressed don't even feel like telling anyone because of the stigma associated with depression. Also, make them feel like they are needed. Talk to them when you are upset about something or when you want to vent. Trust them with things that you wouldn't tell just anyone else. This makes them feel very important to you. Depression lies to them and makes them feel like they aren't needed by anyone. This acknowledgment that you know how bad they feel may be the little "push" they need to start talking What not to do: Pretend like it is not there or that this is not a serious condition. This is debilitating for a person. They can't help it. This will make them feel like they are insignificant and that you don't even take their problem seriously. 2. Find out why your friend is depressed. Did they just have a bad break-up or did their parents get divorced? Or are they just simply mad or disappointed with life and the 25 world? Ask them what you can do to help. Ask carefully and gently, and don't get upset if they're slow to tell you. Some people take longer than others to talk. If they do tell you a list of things you can do, then do them. Usually if they answer a question like this in full they absolutely genuinely need those things from you. What not to do is to ask that and they answer and not carry those things out. This will just send them back into a deeper state of their depression because once again, they have been let down. Especially since it would be by someone so close as their best friend, it could be very damaging. 3. What not to do: If they tell you why they are depressed, or why they think they are. (sometimes people don't even know what causes their symptoms.) Be sure to take those reasons seriously. Don't joke around with them. Do not bring them up in a light hearted conversation, because this can cause a wave of emotions associated with that topic, altering their mood for the worst. Do not bring up what they have told you in trust, in front of other people. This is very very damaging to the friendship and to the person. 4. Listen. Although you may think that the last thing your friend wants to do is talk to you about depression, you could be wrong. Sometimes a friend just needs someone to talk to. Actively listen to them without judging or giving advice. Depression is an issue that people sometimes feel they must hide, in order to maintain their usual life. Because people see it as a weakness or a cry for attention they feel like not telling anyone. This is wrong though, the depressed person would like nothing better than to feel happy again and be themselves. Either that or they are only just coming to terms with it, let alone the idea of letting other people in on it. However, from time to time, your friend may open up, or express the desire to talk to you. Sometimes they just want to vent. Don't start spitting out possible solutions until you know the full extent of the problem. A good listener can sometimes be vastly more helpful than someone who tries to offer solutions. When this happens, be understanding and kind and willing to listen. This means a lot to them. This also should mean a lot to you because they are trusting you with something so personal that's affecting them. Don't interrupt, don't try to convince them they're wrong, don't give advice and try not to react in horror. It can be difficult to hear about how terrible your friend feels, but remember that they're trusting you. Value this trust, don't break it and keep it close. Just be there to listen. That's the number 1 thing they need right now. 5. What not to do: Don't make jokes when they are talking to you. This makes them feel like you don't see their feelings as legitimate or serious. You may be trying to help by lightening the mood but it is not good for the depressed person. Do not tell them just to "Be happy." Or "Why can't you just be happy for once?" or "Lighten up." "Will you ever stop being like this?" "It's getting annoying." This will not encourage them at all. Once again this makes them feel like you aren't even listening and it makes them feel like their 26 issues don't matter which could lead to them feeling like their whole self doesn't matter to you. Don't tell you friend to stop being depressed or be happier. This is out of their control. A depressed mind is the most sensitive mind. Remember that. 6. Try to understand. Every person's story is different, and so it is impossible to completely understand. Depression is a very complex and complicated disease. So it is ok for you not to understand where they are coming from. However, keeping an open mind and putting yourself in your friend's shoes can help you come closer to them. Once you've done your research on depression, you should know a lot more about the illness. Apply the symptoms and emotions to yourself, and contemplate how you would feel if this was happening to you. Call upon things your friend has done or told you, and try to understand why and what they mean. In times of need, having someone understand or try too, can be all the relief in the world. 7. What not to do. Don't tell your friend that life is still worth living and that this situation will improve and the sadness will get better. This trivializes their pain and will not help. Do not try to make them feel better by reminding them how much better their lives are than other people's. They know that and it makes them feel guilty about their condition because they feel like they should just be able to be grateful for life because they have it better than a lot of people yet they can't seem to do it. Don't ask them to "cheer up" or "snap out of it". People with depression aren't capable of just doing it so simply, so be sensitive to that. It'll only make them feel more guilty about their condition. NEVER tell them that their problems are stupid or that there is nothing to worry about. They'll stop talking. This can lead them to more suicidal tendencies. 8. Be There. Most importantly is to just be there for your friend. Be very genuine and don't lie to them. Don't tell them things and not truly mean it. Sometimes they can tell and this will hurt them greatly. This a time when they are their lowest point in life. Especially if they are a teen battling with depression. Because they are wasting away their most precious years, and this also makes them sad and guilty because they feel like they can't just enjoy their life. Things you can do to make them know that you are there is to obviously tell them that. You could say something like "I am here for you and whenever you feel like talking I'll always be willing to listen and to try & understand." Sometimes, the thing they need most is just a simple hug and a "I am here for you. Everything is going to be ok." Also let them know that you value their friendship and that you care about their life. The depression can cause them to feel worthless and not needed. They need to be re-assured that they matter to you and that you want to help them through this. Let them know that they aren't weak or worthless because they may feel like this because of society and it's view on this serious illness. If you honestly mean it and can do so with an open heart, offer to be there 24/7. Tell them that you welcome their phone calls at all hours. You will rarely, if ever, receive a middle of the night call. But a sincere offer sends a message of support that will be heard. If you see them in public places, make sure to say hi and notice them. Don't pretend like everything is ok though, always remember that. 27 Ask them how they feel today and be sure to pay attention to them from time to time because they feel alienated from people when out in the world. Do these things because they feel completely alone and isolated. This is a major side effect of depression and causes lots of suicidal thoughts and tendencies, especially in teenagers. Hug them, hold their hand, physical contact is good for people that are suffering from depression. It makes them feel better and comforted, and safe, so do those things as often as you can. Tell them that you love them and care for them. Give them a shoulder to cry on. Be there. 9. What not to do: Don't say you will be there for them and then not be there. This will be very damaging to them. Because they have been let down once again. Also, do not ignore them. If they want to talk just to chat or want to talk heart-to-heart, respond! They feel like you don't care in the least when they get nothing from you. If you can't talk or are tired, say that. Don't ever leave them in the dark. This causes them to worry even more than they already are. And takes a toll on their insecurity. Don't do things half-heartedly. One of the main reasons people get depressed is because they seem to feel like they care too much or they love people too hard. And they get sad because they feel like they are the only ones being genuine. So do not do things in vain with them. It will damage them greatly. 10. Be patient. Because depression is heavy, slow moving and unpredictable, it can frustrate and even anger those who are trying to help. Remember that depression is a complex disorder, and try to understand that the depressed person is not herself or himself right now. If your friend doesn't seem to appreciate your efforts, or is pushing you away, don't walk off in a temper. Give them space or give them comfort if they need it, and be there for them, no matter how much they believe you don't need to be. 11. Don't push too hard. If it makes your friend feel worse to face up to their problems, do not force them to continue. Sometimes analyzing a person's past can make them feel worse about themselves and dredge up past traumas. In this case, focus on how they feel now and how they want to be in future, and forget whatever caused them to feel depressed. Leave it in the past until they are ready to either deal with it or let it go.Be gentle. Depression can be dark, confusing and angry, but it can also be tender, hurtful and full of sensitive tears. Don't yell or be rough-keep your voice and body language soft and don't force your friend into anything. 12. Stay in contact. Check in. Call them just to call them. Check up on them occasionally, esp. at night when the depression is at its worst. Text them occasionally just to say you are thinking about them and ask how they feel today. This means the world to them and 28 makes them feel like they matter and re-assures them that you care and causes them to feel more at ease. Support them and ask what you can do to help, of course. When they have severe depression, often times they will confess to you that they sometimes want to just die. But they actually don't. Most of these happen while driving. So asking them a quick "Are you home and ok?" Will make them feel very cared for. You don't want to be that person finding out something terrible just because you aren't worrying about them. Maybe even give them a card or bring them lunch or take them to a movie. This means so much to someone who is depressed. You won't believe how it will uplift their mood. It makes them feel significant. 13. What not to do: Is ignore them or blow them off. If you can't do something tell them. And don't say you will do things and not do it. For example: "I will call you later tonight." and then not. or "I am going to get you something!" and then not. This makes them feel like you are just saying that in the moment and don't even bother to do it later. 14. Take care of yourself. You have to be mindful of yourself and your mind to in helping this friend. It can take a toll especially if they are very needy. If you need to take breaks then tell them that. Remember though, do not ignore them. Go have fun with other friends, and enjoy your life too. But you have to remember that depression is not them. Your friend will eventually come out of this, and become the person you've grown to love and have fun with. Just give them time and have patience. 15. It is ok to have fun! Not everything has to be so serious all the time, even with depression. Especially if they are already on medication. Sometimes they feel completely up to just doing anything and having mindless fun. Just be aware that their mood can alter for no reason, and do not get mad at them for it. They can't help it. Just be there for them if that happens. 16. Encourage your friend not to abuse drugs. People with depression can be much more vulnerable to the negative effects that occur when recreational drugs wear off. If your friend is taking antidepressant or anti-anxiety medication, encourage them not to make any changes without talking to their doctor or psychiatrist. Taking more than they were prescribed can be dangerous, and going off the medication suddenly may make them feel much worse. Avoid alcohol as well - nobody is going to conquer depression with a hangover. 17. Advise them to seek professional help. They may deny that they need it, or tell you that "it's okay" or they'll be "fine". If they react this way, stop pestering them about it for a while. Over time, the idea might grow on them. Depression is not something that goes 29 away by itself after a while. This is probably the most difficult step. Be sensible. If you friend is sounding like they are harming themselves or are thinking of suicide, you need to alert somebody. Listen out for suicidal like comments when they are talking to you. Such as " I wish I were dead." or "I don't want to life anymore. I feel useless." These should be taken seriously. 18. Depression is complicated. This is a lot to take in. But if you use this as a tool to help your best friend in need, you will be surprised at how much little steps and things you can do for them will greatly affect their illness. When they make it out of their depression, they will be so grateful that you played a part in help guiding them out of it. Specific Treatment for depression Treatments and drugs Numerous depression treatments are available. Medications and psychological counseling (psychotherapy) are very effective for most people. In some cases, a primary care doctor can prescribe medications to relieve depression symptoms. However, many people need to see a doctor who specializes in diagnosing and treating mental health conditions (psychiatrist). Many people with depression also benefit from seeing a psychologist or other mental health counselor. Usually the most effective treatment for depression is a combination of medication and psychotherapy. If you have severe depression, a doctor, loved one or guardian may need to guide your care until you're well enough to participate in decision making. You may need a hospital stay, or you may need to participate in an outpatient treatment program until your symptoms improve. Here's a closer look at your depression treatment options. Medications A number of antidepressant medications are available to treat depression. There are several different types of antidepressants. Antidepressants are generally categorized by how they affect the naturally occurring chemicals in your brain to change your mood. Types of antidepressants include: Selective serotonin reuptake inhibitors (SSRIs). Many doctors start depression treatment by prescribing an SSRI. These medications are safer and generally cause fewer bothersome side effects than do other types of antidepressants. SSRIs include fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa) and escitalopram (Lexapro). The most common side effects include decreased sexual desire and delayed orgasm. Other side effects may go away as your body adjusts to the medication. They can include digestive problems, jitteriness, restlessness, headache and insomnia. 30 Serotonin and norepinephrine reuptake inhibitors (SNRIs). These medications include duloxetine (Cymbalta), venlafaxine (Effexor XR) and desvenlafaxine (Pristiq). Side effects are similar to those caused by SSRIs. These medications can cause increased sweating, dry mouth, fast heart rate and constipation. Norepinephrine and dopamine reuptake inhibitors (NDRIs). Bupropion (Wellbutrin) falls into this category. It's one of the few antidepressants that doesn't cause sexual side effects. At high doses, bupropion may increase your risk of having seizures. Atypical antidepressants. These medications are called atypical because they don't fit neatly into another antidepressant category. They include trazodone (Oleptro) and mirtazapine (Remeron). Both of these antidepressants are sedating and are usually taken in the evening. In some cases, one of these medications is added to other antidepressants to help with sleep. The newest medication in this class of drugs is vilazodone (Viibryd). Vilazodone has a low risk of sexual side effects. The most common side effects associated with vilazodone are diarrhea, nausea, vomiting and insomnia. Tricyclic antidepressants. These antidepressants have been used for years and are generally as effective as newer medications. But because they tend to have more numerous and more-severe side effects, a tricyclic antidepressant generally isn't prescribed unless you've tried an SSRI first without an improvement in your depression. Side effects can include dry mouth, blurred vision, constipation, urinary retention, fast heartbeat and confusion. Tricyclic antidepressants are also known to cause weight gain. Monoamine oxidase inhibitors (MAOIs). MAOIs — such as tranylcypromine (Parnate) and phenelzine (Nardil) — are usually prescribed as a last resort, when other medications haven't worked. That's because MAOIs can have serious harmful side effects. They require a strict diet because of dangerous (or even deadly) interactions with foods, such as certain cheeses, pickles and wines, and some medications including decongestants. Selegiline (Emsam) is a newer MAOI that you stick on your skin as a patch rather than swallowing. It may cause fewer side effects than other MAOIs. These medications can't be combined with SSRIs. Other medication strategies. Your doctor may suggest other medications to treat your depression. These may include stimulants, mood-stabilizing medications, anti-anxiety medications or antipsychotic medications. In some cases, your doctor may recommend combining two or more antidepressants or other medications for better effect. This strategy is known as augmentation. Finding the right medication Everyone's different, so finding the right medication or medications for you will likely take some trial and error. This requires patience, as some medications need eight weeks or longer to take full effect and for side effects to ease as your body adjusts. If you have bothersome side effects, don't stop taking an antidepressant without talking to your doctor first. Some antidepressants can cause withdrawal symptoms unless you slowly taper off your dose, and quitting suddenly may cause a sudden worsening of depression. Don't give up until you find an antidepressant or medication that's suitable for you — you're likely to find one that works and that doesn't have intolerable side effects. If antidepressant treatment doesn't seem to be working, your doctor may recommend a blood test to check for specific genes that affect how your body uses antidepressants. The cytochrome P450 31 (CYP450) genotyping test is one example of this type of exam. Genetic testing of this kind can help predict how well your body can or can't process (metabolize) a medication. This may help identify which antidepressant might be a good choice for you. These genetic tests may not be widely available, so they're an option only for people who have access to a clinic that offers them. Antidepressants and pregnancy If you're pregnant or breast-feeding, some antidepressants may pose an increased health risk to your unborn child or nursing child. Talk to your doctor if you become pregnant or are planning on becoming pregnant. Antidepressants and increased suicide risk Although most antidepressants are generally safe, be careful when taking them. The Food and Drug Administration (FDA) now requires that all antidepressant medications carry black box warnings. These are the strictest warnings that the FDA can issue for prescription medications. The antidepressant warnings note that in some cases, children, adolescents and young adults under 25 may have an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting an antidepressant or when the dose is changed. Because of this risk, people in these age groups must be closely monitored by loved ones, caregivers and health care providers while taking antidepressants. If you — or someone you know — have suicidal thoughts when taking an antidepressant, immediately contact your doctor or get emergency help. Again, make sure you understand the risks of the various antidepressants. Working together, you and your doctor can explore options to get your depression symptoms under control. Psychotherapy Psychological counseling is another key depression treatment. Psychotherapy is a general term for a way of treating depression by talking about your condition and related issues with a mental health provider. Psychotherapy is also known as therapy, talk therapy, counseling or psychosocial therapy. Through these talk sessions, you learn about the causes of depression so that you can better understand it. You also learn how to identify and make changes in unhealthy behavior or thoughts, explore relationships and experiences, find better ways to cope and solve problems, and set realistic goals for your life. Psychotherapy can help you regain a sense of happiness and control in your life and help ease depression symptoms such as hopelessness and anger. It may also help you adjust to a crisis or other current difficulty. There are several types of psychotherapy that are effective for depression. Cognitive behavioral therapy is one of the most commonly used therapies. This type of therapy helps you identify negative beliefs and behaviors and replace them with healthy, positive ones. It's based on the idea that your own thoughts — not other people or situations — determine how you feel or behave. Even if an unwanted situation doesn't change, you can change the way you think and 32 behave in a positive way. Interpersonal therapy and psychodynamic psychotherapy are other types of counseling commonly used to treat depression. Electroconvulsive therapy (ECT) In ECT, electrical currents are passed through the brain. This procedure is thought to affect levels of neurotransmitters in your brain. Although many people are leery of ECT and its side effects, it typically offers immediate relief of even severe depression when other treatments don't work. It's unclear how this therapy relieves the signs and symptoms of depression. The most common side effect is confusion, which can last from a few minutes to several hours. Some people also have memory loss, which is usually temporary. ECT is usually used for people who don't get better with medications and for those at high risk of suicide. ECT may be an option if you have severe depression when you're pregnant and can't take your regular medications. It can also be an effective treatment for older adults who have severe depression and can't take antidepressants for health reasons. Hospitalization and residential treatment programs In some people, depression is so severe that a hospital stay is needed. Inpatient hospitalization may be necessary if you aren't able to care for yourself properly or when you're in immediate danger of harming yourself or someone else. Getting psychiatric treatment at a hospital can help keep you calm and safe until your mood improves. Partial hospitalization or day treatment programs also are helpful for some people. These programs provide the support and counseling you need while you get symptoms under control. Other treatments for depression If standard depression treatment hasn't been effective, your psychiatrist may consider whether you might benefit from a less commonly used procedure, such as: Vagus nerve stimulation. This treatment uses electrical impulses with a surgically implanted pulse generator to affect mood centers of the brain. This may be an option if you have chronic, treatment-resistant depression. Transcranial magnetic stimulation. These treatments use powerful magnetic fields to alter brain activity. A large electromagnetic coil is held against your scalp near your forehead to produce an electrical current in your brain. Transcranial magnetic stimulation may be an option for those who haven't responded to antidepressants. (http://www.mayoclinic.com/health/depression/DS00175/DSECTION=treatments-and-drugs) Medications Antidepressants to Treat Depression There are several types of depression medications (antidepressants) used to treat depression and conditions that have depression as a component of the disease, such as bipolar disorder. These drugs improve symptoms of depression by increasing the availability of certain brain chemicals called neurotransmitters. It is believed that these brain chemicals can help improve emotions. 33 Major types of antidepressants include: Tricyclic antidepressants (TCAs) are some of the first antidepressants used to treat depression. They primarily affect the levels of two chemical messengers (neurotransmitters), norepinephrine and serotonin, in the brain. Although these drugs are effective in treating depression, they have more side effects, so they usually aren't the first drugs used. Monoamine oxidase inhibitors (MAOIs) are another early form of antidepressant. These drugs are most effective in people with depression who do not respond to other treatments. Substances in certain foods, like cheese, beverages like wine, and medications can interact with an MAOI, so these people taking this medication must adhere to strict dietary restrictions (see below). For this reason these antidepressants also aren't usually the first drugs used. Selective serotonin reuptake inhibitors (SSRIs) are a newer form of antidepressant. These drugs work by altering the amount of a chemical in the brain called serotonin. Serotonin and norepinephrine reuptake inhibitors (SNRIs) are another newer form of antidepressant medicine. They treat depression by increasing availability of the brain chemicals serotonin and norepinephrine. Examples of effective medications commonly prescribed for depression or depression-related problems are listed in the chart below. Drug Name Type of Medication Potential Side Effects Anafranil These medicines are tricyclic antidepressants (TCAs) which work by increasing the available amount of serotonin and/or norepinephrine in the brain. Dry mouth, blurred vision, increased fatigue and sleepiness, weight gain, muscle twitching (tremors), constipation, bladder problems such as urine retention, dizziness, daytime drowsiness, increased heart rate, sexual problems. Adapin Aventyl Elavil Endep Norpramin Pamelor Pertofrane Sinequan 34 Surmontil Tofranil Vivactil Zonalon Emsam Eldepryl Nardil Marplan Monoamine oxidase inhibitors Must avoid certain foods and (MAOIs) increase the amount medications to avoid dangerous interactions* of norepinephrine and serotonin in the brain Serious side effects may include: headache, heart racing, chest pain, neck stiffness, nausea and vomiting. If you experience any of these symptoms, seek medical care immediately. Parnate Zelapar Celexa Lexapro Luvox Selective serotonin reuptake inhibitors, or SSRIs, work by increasing the amount of serotonin, a neurotransmitter found in the brain. Sexual problems including low sex drive or inability to have an orgasm are common but reversible, dizziness, headaches, nausea right after a dose, insomnia, feeling jittery. Paxil Pexeva Prozac Sarafem Zoloft Aplenzin Bupropion may increase the amounts of the Budeprion neurotransmitters norepinephrine and dopamine Buproban in the brain. Forfivo Weight loss, decreased appetite, restlessness, insomnia, anxiety, constipation, dry mouth, diarrhea, dizziness, seizures. Wellbutrin 35 Cymbalta Effexor Pristiq Remeron Desyrel Ludiomil Oleptro These drugs increase the levels of the neurotransmitters serotonin and norepinephrine in the brain. Drowsiness, blurred vision, lightheadedness, strange dreams, constipation, fever/chills, headache, increased or decreased appetite, tremor, dry mouth, nausea. Remeron can be sedating. Cymbalta may increase sweating and blood pressure and also cause fatigue and reduced energy. Desyrel and Oleptro may cause These drugs block various neurotransmitter chemicals to drowsiness, fatigue, tremor, headache, dry mouth, nausea, and some degree. vomiting. Ludiomil may cause headache, dizziness, dry mouth, fatigue, daytime sleepiness, and sweating. *When taking an MAOI, you must avoid taking certain medications (including some over-thecounter medicines like Sudafed) and eating certain foods such as aged cheese, wine and beer, avocados, bananas, canned meats, yogurt, soy sauce, packaged soups and sour cream. It is important to note that you should not drink alcoholic beverages while taking antidepressant medicines, since alcohol can seriously interfere with their beneficial effects. In October 2004, the FDA determined that antidepressant medications may increase the risk of suicidal thinking and behavior in children and adolescents with depression and other psychiatric disorders. If you have questions or concerns, discuss them with your health care provider. (http://www.webmd.com/depression/symptoms-depressed-anxiety-12/antidepressants?page=2) Psychotherapy Psychotherapy is an example of treatment that includes counseling or psychosocial therapy. This can help the patient learn causes, make changes, and find better ways to cope and handle their problems. Counseling consists of talking through these specific individuals problems. A therapist facilitates a trusting environment where a patient is able to talk about his other problems and be confidential about it. The 36 therapists listen and help the patient work through the problems on his or her own as well as intervening whenever the therapist feels need. This helps the patient learn healthy and helpful thoughts and learn to make unhealthy thoughts be absent. Along with one-on-one visits with the therapist, the patient may also attend a group therapy session which proves to be helpful in some cases. In these situations the patient is able to gain a support system and become part of a support system for others. It helps many people to know they are not alone in their problems during hard times. Group therapy is facilitated by a therapist who guides the group along on topics that will help the group as a whole as well as the individual. If one person is trying to dominate the session, the therapist is there to control and lead the group in a way that will benefit the group. This safe, confidential environment is made to help the patient feel accepted and comfortable. Another form of psychotherapy is CBT, or cognitive behavior therapy), which helps you identify negative beliefs and behaviors and replace them with healthy positive ones. In studies throughout the years, this technique has been proven to be most effective. Because of this, it is one of the most commonly used ways to treat depression. CBT is based on the idea that your thoughts are what can heal you. By encouraging and steering the patient in the right directions, the idea is to let the patient come up with his or her own plan to improve his or her life. If you can change the way you think, you can change the way you behave which will ultimately change your life for the better. Electroconvulsive Therapy (ECT) sends electric shocks through the brain to regulate emotions. For those who don’t get better with medications, this offers immediate relief. However, there are side effects such as confusion, maybe only for a few minutes, and memory loss which may be long term. Hospitalization and residential treatment centers are usually used when a patient is harming self or others. Putting a patient is a hospital or other treatment center helps keep the patient calm and safe until the mood improves and they can be discharged and put into a therapy program and go on with their normal life. Vegus nerve stimulation uses electrical impulses with a surgically implanted pulse generator to affect mood centers of brain. This treatment is for Chronic, treatmentresistant depression and is usually not used in less severe cases. 37 The best way treatments can be effective is lifestyle changes and home remedies. This may not be easy at first for the depressed patient, but after a few sessions with a therapist and learned will-power, these life-style changes can immensely improve the patient’s life. Depression is often tamed with a strict schedule of exercise and a healthy diet. Also, patients often do not feel like they accomplish much and therefore get discouraged. But if the patient can create a scheduled life, he or she can accomplish things and maintain a positive outlook on life. Some suggestions for this lifestyle are to stick to the treatment plan, educate yourself, exercise, have a healthy diet, avoid alcohol and illicit drugs, get plenty of sleep, gain social support, and to take measures to decrease stress by learning stress-relieving activities. Healthy Living Having a healthy lifestyle is a great and simple way to help improve the depression on a patient. This will help each person work on their specific issues they need to improve in their life. This will allow the person to recognize their environment. When you become familiar with when and where they begin to have certain feelings of depression they become educated with how to handle everyday life. There are some simple things that each person can do in order to live this healthy life. There are two examples focused on is being active and being social. Being active is a broad topic this can includes, sports, games, walks, runs, or even dancing. These activities in any for can allow someone to keep the blood going and feeling good about this aspect of their lives. Being social provides a way for laughter, challenge, and social situations uplift. TR Implications Therapeutic recreation can help anyone at anytime with almost any problem. Not everyone likes the same type of recreation or activities. Because of this variety of activities that people like it is crucial to be creative. When deciding what activities to do it is important to be knowledgeable about depression and what each person feel and what can trigger certain feelings. It helps to choose something that will alleviate the patient’s stress which will then decrease the depressed feeling. When stress and anxiety is calmed the real healing in depression patients begin. The patient can think clearer and understand better and will show interest in things once more. Exercise is a great way to relieve anxiety and is often prescribed to those 38 with depression, so sports are always a positive option for a recreational activity for such patients. Other great options are those that require concentration as to take their mind off of the depressed and anxious feelings. Anything can be an option for those who have depression symptoms. Getting to know each patient is crucial to treat them. As a TR we need to find out their passion, likes, and dislikes. The activity needs to be something that will help build their confidence. Starting moderate and working your way up to something more strenuous. This will allow the person to completely forget about their depression and depressed thoughts. As TR people know, this is client-based and client-focused. TR needs to be creative, be energetic, and be professional. The possibilities are endless. Resources Local -BYU counseling and career center: offer free personal counseling for full time students. -LDS family services -IHC Utah Balley Regional Medical Clinic Hot Lines -National Suicide Prevention Lifeline: 1-800-273-TALK -National Youth Crises: 1-800-448-4663 -Support Groups are also a great resource and in every state online. 39