Download Types of Depression

DEPRESSION
Created By:
Coriann Thompson, Mikenna Cloward,
Tia Field, & Avery Miyahara
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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
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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.
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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
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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.
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"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
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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:
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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:
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Treatment works. Even people with severe depression can find relief, and so can you.
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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:
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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.
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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:
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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.
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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
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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:
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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.
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Feelings of hopelessness
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Too little or too much sleep
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Low energy or fatigue
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Low self-esteem
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Poor appetite or overeating
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Poor concentration
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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.
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Get enough sleep.
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Follow a healthy, nutritious diet.
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Take medicines correctly. Discuss any side effects with yourdoctor.
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Learn to watch for early signs that your dysthymia is getting worse. Have a plan for how
to respond if it does.
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Try to exercise regularly.
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Look for activities that make you happy.
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Talk to someone you trust about how you are feeling.
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Surround yourself with people who are caring and positive.
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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:
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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.
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Insight-oriented or psychotherapy, which can help people with dysthymia understand
factors that may be behind their depressive thoughts and feelings.
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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
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loss of enjoyment in things that were once pleasurable
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major change in weight (gain or loss of more than 5% of weight within a month) or
appetite
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insomnia or excessive sleep almost every day
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physically restless or rundown that is noticeable by others
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fatigue or loss of energy almost every day
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feelings of hopelessness or worthlessness or excessive guilt almost every day
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problems with concentration or making decisions almost every day
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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
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change in mood. In addition, diagnostic criteria call for at least two of the following symptoms to
accompany the mood reactivity:
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sleeping too much (hypersomnia)
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increased appetite or weight gain
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having a more intense reaction or increased sensitivity to rejection, resulting in problems
with social and work relationships
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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:
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a family history of depression
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a significant loss -- from death, divorce, or separation -- that results in grief
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interpersonal conflicts and related emotions such as guilt
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any type of abuse -- physical, sexual, or emotional
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any type of major life event such as moving, changing or losing a job, graduating, retiring
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any type of serious illness such as cancer, heart disease, stroke, or HIV
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drug or alcohol abuse
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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:
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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.
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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.
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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.
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Life changes such as childbirth
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Medications such as antidepressants or steroids
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Periods of sleeplessness
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Recreational drug use
SymptomsManic may last from days to months and their sypomtoms include:
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Easily distracted
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Little need for sleep
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Poor judgment
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Poor temper control
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Reckless behavior and lack of self control
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Binge eating, drinking, and/or drug use
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Poor judgment
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Sex with many partners (promiscuity)
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Spending sprees
Very elevated mood
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Excess activity (hyperactivity)
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Increased energy
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o
Racing thoughts
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Talking a lot
o
Very high self-esteem (false beliefs about self or abilities)
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Very involved in activities
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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:
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Daily low mood or sadness
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Difficulty concentrating, remembering, or making decisions
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Eating problems
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Loss of appetite and weight loss
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Overeating and weight gain
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Fatigue or lack of energy
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Feeling worthless, hopeless, or guilty
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Loss of pleasure in activities once enjoyed
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Loss of self-esteem
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Thoughts of death and suicide
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Trouble getting to sleep or sleeping too much
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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:
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Ask about your family medical history, such as whether anyone has or had bipolar
disorder
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Ask about your recent mood swings and for how long you've had them
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Perform a thorough examination to look for illnesses that may be causing the symptoms
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Run laboratory tests to check for thyroid problems or drug levels
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Talk to your family members about your behavior
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Take a medical history, including any medical problems you have and any medications
you take
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Watch your behavior and mood
Treatment- Often times depression and mania return even with treatment. Treatment looks for:
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Avoid moving from one phase to another
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Avoid the need for a hospital stay
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Help the patient function as well as possible between episodes
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Prevent self-injury and suicide
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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
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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
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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.
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





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
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(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
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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.
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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
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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
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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
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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.
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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.
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