I just can't seem to get myself together these days.
I don't know what is worse: my moods or the weather outside!
Do any of these sound familiar? After all, you're only human and are "allowed" to have feelings that might be considered "down moods". Has someone recently died? Lost out on a job promotion? Going through marriage woes or thinking of a divorce? Are holidays being worse for you? Does the weather outside (especially the loss of sunshine) add to your misery? Any of these and many more trials and tribuations of daily life are bound to cause feelings of despair, helplessness, and the feeling of being lost in a sea of nothingness.
DEPRESSION AND ITS MANY FACES AND FORMS
Major Depression: a disorder of mood with severe and ongoing feelings of sadness or related symptoms that interfer with life and cause impairment in efficiency. Usually in episodes. Can have one in a lifetime or many. Symptoms become more significant and the women will eventually experience emotional pain, misery, distress and the loss of productivity in ALL relationships: home, family, friends and work environments.
Seasonal Affective Disorder (SAD):
appears seasonally with depression happening in the fall and winter seasons and diminishes in the spring season. During the summer, you feel normal. Research shows that women are more prone to this type. Key to this diagnosis is the seasonal re-appearance of symptoms.
SYMPTOMS OF DEPRESSION
Persistant sad, anxious, or "empty moods"
Feelings of hopelessness or pessimism
Feelings of guilt, worthlessness, helplessness
Loss of interest or pleasure in hobbies and activities
Loss of interest or pleasure in sex
Insommnia or over-sleeping
Appetite and/or weight loss
Overeating or weight gain
Decreased energy, feelings of fatigue
Complaints of being "slowed down"
Thoughts of death or suicide
Suicide attempts
Restlessness and irritability
Difficulty in concentrating
Memory loss
Persistant physical symptoms that DO NOT respond to treatment, which might include: headaches, GI complaints and chronic pain.
As you can see from the above list, many of the same symptoms occur in many different diseases and that is why it is IMPORTANT to have your medical or health provider aware if you are experiencing any of these. They can then evaluate you further.
Clinical depression as we will see affects much more than just the mind. Also affected are: mind, body and behavior. Because of this total body involvement, the KEY is recognizing there is a problem and getting reliable, expert help.
CAUSES OF DEPRESSION
There are a number of factors or causes seen in depression. Some of them include:
Genetic Factors: If there is a family history of depressive illness, there is a risk for inheriting the biological aspect. This is not seen in all cases as some members NEVER develop the illness.
Biochemical Factors: Research has shown that brain biochemistry is a significant factor in depressive illness. Neurotransmitters, which are brain chemicals, can be either too much OR too little in women with major depression. Depression can also be induced by certain medications and some hormones. These will be discussed further in this page.
Environmental Factors: Losses in life that are significant in nature such as: death of a loved one, financial difficulties and/or a major change in lifestyle (moving jobs, starting school, marriage, divorce) can all be contributors to depressive illness.
Other Factors: These include the feelings of low-self esteem, the sense of having little or no control for one's life, excessive worrying or fretting, and feelings of no self worth. During stressful situations, these factors can work against the mind and contribute to feelings of depression.
STATS REGARDING DEPRESSIVE ILLNESS
Statistics regarding Depression and how it affects women aren't pleasant but recent advancements in treatment can be encouraging. Women are experiencing depression at the rate of twice the rate of men. Thus far, research has been unable to explain this, but is continuing to explore areas and avenues of how the illness affects women and how better to understand the causes.
Some statistics regarding depression:
Almost 16% of the U.S. population suffers from a major mental illness or substance abuse.
Depression affects 5.2 per cent or 9.5 million Americans.
Severe mental illnesses are more common than: cancer, diabetes or heart disease.
20 per cent of families are affected by severe mental illness.
Depression can occur at any age and is one of the most common and treatable illnesses.
1 in 4 women can expect to develop depression during their lifetime.
Separated and divorced women have higher rates of depressive illness than married women.
But, the highest rates for depressive illness are seen in UNHAPPILY, MARRIED women.
TREATMENT
The goal of treatment is to reduce the episodes and severity of depression and enable you to lead a normal life.This is usually accomplished by the use of medications and psychotherapy. Lifestyle management is also seen as cruical in maintaining recovery from depressive illness.
MEDICATIONS
The list of medications used in the treatment of depression are many. All of these summations are taken from various sources: The PDR Guide, Merck Manual, Physicians Desk Reference 1997 and the internet. Some medications and their classifications include the following:
ANTIDEPRESSANTS
Used to help relieve tension, improve sleep, elevate moods, increase energy and generally ease the feelings of worry, guilt, fear and apprehension that many people face in daily life. Effectiveness is noted in patients whose depression is caused by psychological factors, associated with alcoholism or is the result of another illness such as cancer or chronic illness.
1.Cyclic and Tricyclic Antidepressants: This classification of medications can cause weight gain. They include the following:
a.Doxepin hydrochloride (Adapin, Sinequan) DO NOT use in conjunction with MAO inhibitors. Most common side effect is drowsiness. Take as prescribed. May take a few weeks to feel better. Inform your health professional if you have GLAUCOMA OR DIFFICULTY IN URINATING" Also do not drink any form of alcohol while taking this medication. Usual starting dosage is 2 times a day in divided doses.
b.Bupropion hydrochloride (Wellbutrin) is given to relieve various forms of major depression. This med unlike many others has a somewhat STIMULATING effect. Can cause weight gain but the most common side effect is weight loss, (28% of people will lose 5 pds or more). In the beginning of treatment you should not drive or operate machinery UNTIL it is established how the medication affects you. Is least sedating of the many meds available. Usual starti dosing is 3 times per day with equal spacing between the doses. Inform your health professional if you have ever had a seizure, currently have an eating disorder or currently take MAO Inhibitors.
c.Trazodone hydrochloride (Desyrel) Use for depression. Does not provide immediate reief and may take several weeks to notice any improvements. May cause you to have a "dry mouth"> some remedies include: chewing gum, sucking on hard candy or eating small ice chips. This medication may cause you to become "drowsy" and thus interfer with your judgement. Until it has been established how the medication affects you, it is important not to drive or use heavy machinery. An important issue is to tell your dentist you are using this medication before any dental treatment or if you are admitted to any health facility for any medical treatment. This medication may also cause "intensification of the effects of alcohol", so it is IMPERATIVE not to drink. Usual starting dosage is 1-2 times per day in divided doses.
d.Amitriptyline hydrochloride (Elavil, Endep) This medication is used in the treatment of depression but can be also used in the treatment of bulimia, to control pain, prevention of migraines,and some syndromes of multiple sclerosis (MS). You need to take this medication for several weeks before becoming fully effective. You may experience "dry mouth" which can be relieved with chewing gum, sucking on hard candy or eating small ice chips. this medication may make your skin "more sensitive to sunlight" and thus, you should ALWAYS wear a sunscreen cream or lotion or other sunblocking agent. INFORM your health professional if you have experienced any of the following: seizures, urinary retention, glaucoma, heart or circulation problems or liver disease. Also, tell your dentist prior to dental treatment and any medical facility treating you. Mild drowsiness is a common side effect in early treatment. Usual starting dosage is 2 or more doses per day.
e.Nortriptyline hydrochoride (Pamelor, Aventyl) This medication is used in the treatment of depression and also, chronic hives, PMS of depression, bedwetting and ADHD (attention deficient hyperactivity disorder)in children. This medication MUST BE USED AS PRESCRIBED for EFFECTIVENESS. Can also cause "dry mouth" so use of chewing gum, sucking on hard candy or eating small ice chips are some remedies. Inform your health professional of any seizures, difficult urination, diabetes, glaucoma, heart disease, thyroid disease,or high blood pressure problems. May cause skin sensitivity so wear protective clothing and also wear a sunblock or sunscreen lotion. Usual dosage is 3 or more times per day in divided doses.
f. Venlafaxine hydrochloride (Effexor) This medication is for treatment of depression. This should not be used in conjunction with MAO Inhibitors. Take this medication with food as prescribed by your health provider. Inform your health providor if you have: high blood pressure, heart, liver or kidney disease, seizure disorder or mania. This medication may cause marked drowsiness and thus until the known medication affects, you should NOT drive or operate machinery.
MAO INHIBITORS are NOT TO BE COMBINED with any foods or drugs containing the substance TYRAMINE : the following substances are to be avoided during MAO therapy and for 2 weeks following the discontinuation of the drug:
a partial list of avoidances include: Beer, caffeine in excessive amounts, all cheeses except cottage cheese and cream cheese, chocolate in excessive amounts, any dry sausages, fava bean pods, liver, meat extracts, pickled herring, sauerkraut, wine, yogurt, yeast extract, avocadoes, bananas, eggplant, orange pulp, raisins, spinach, tomatoes and soy sauce.
Disregarding the previously written dietary restrictions may lead to headaches, stiff neck, sweating, nausea, vomiting or a hypertensive crisis.
Medications to avoid include the following:(a partial list)
Amphetamines, appetite suppressants, anti-depressants, asthma inhalants, cold and cough preparations, hay fever medications, nasal decongestants, sinus medications and weight-loss medications.
MAO Inhibitors are not anticholinergic agents, but the side effects may resemble those symptoms. This classification of medications has the capacity to induce weight gain. These include:
a. Phenelzine sulfate (Nardil) This medication is used to treat depression as well as anxiety and phobias mixed with depression. By inhibiting MAO, Nardil helps to restore normal moods.
Therapy should be discontinued immediately upon the occurance of palpitations (chest pains) or frequent headaches. These may be signs of a serious reaction. You are instructed to alert your physician or health provider of these or any other symptoms. In general, you should avoid protein foods in which ageing or protein breakdown is used to increase flavor. And also caffeine in excessive amounts in any form. Alert your physician or health provider if you have liver disease, liver damage or a blood disorder. The usual starting dosage is 10mg in the am and 10mg in the afternoon.
SSRIs
It is thought that these drugs work by adjusting the balance of the brain's natural chemical messengers (neurotransmitters). This class of drugs work by specially blocking the reabsorption of serotonin, a neurotransmitter in the brain. These include:
a.Fluoxetine hydrochloride (Prozac) This medication is prescribed for the treatment of depression, obesity, eating disorders and obsessive-complusive disorders. This medication is NOT to be used in conjuction with MAO Inhibitors. Inform your health provider of ALL medications you are taking including over the counter and prescriptions. This medication needs to be taken as prescribed by your health provider to be effective. Inform your health provider if you have: had a heart attack and are recovering, liver or kidney disease, seizure disorder or diabetes. If you develop a skin rash or hives, contact your health provider immediately!! Usual starting disage is once a day.
b.Sertraline (Zoloft) This medication is used to treat major depression and obsessive-compulsive disorders. Zoloft is thought to work by adjusting the balance of the brain's natural chemical messengers (neurotransmitters). Inform your health provider if you have taken a MAO Inhibitor within the past 2 weeks. Improvement might take up to a few weeks for full effectiveness, so it is IMPERATIVE you take the prescibed medication exactly as written. This medication may cause "dry mouth" effective remedies include: chewing gum, sucking on hard candy and eating small ice chips. Inform your health provider if you have either kidney or liver disease. You should not drink alcohol while taking this medication. Usual starting dosage is once a day, either morning or evening.
COPING WITH SIDE EFFECTS
As important as it is to take your medication, it is also important to understand the side effects and how to cope with them. If ever in doubt, question your medical or health professional!
Many of the antidepressants have the unfortunate side effect of loss of libido. This seems to occur mostly with MAO Inhibitors(MAOIs) and SSRIs like Nardil, Parnate and Prozac. Your medical or health professional can determine if the medication OR the underlying depression is the cause.
Feelings of dizziness, being drugged or feeling medicated should be fully investigated by your medical or health professional. They can determine if the dizziness is caused by low blood pressure, if the feeling of being drugged is a cognitive disruption and if the medicated feeling is due to over-sedation.
You cannot determine this on your own!
Anticholinergic side effects include: dry mouth, impaired ability to focus at close range, constipation and urinary hesitation.
PSYCHOTHERAPY
Psychotherapies that have been effective in treating depression include: interpersonal, cognitive-behavioral and others.
ECT (shock treatments) are an effective treatment for major depression when medications have been ineffective OR when medications cannot be used because of medical problems. As a society, we need to understand fully the rationale behind ETC and the positiviness that can be added to a patient's well-being. New procedures are currently available and need to be discussed in detail with your physician and or health care provider.
LIFESTYLE MANAGEMENT
Life style management is very critical in maintaining recovery and subsequent success in treating depression. Some important objectives to follow include:
1. Maintain a consistent daily schedule.
2. Take your medications as prescribed.
3. After an episode of depression, slowly resume your normal activities and responsibilities.
4. Set REALISTIC goals and objectives to reach the goal.
5. Ask for help when you need it. **this cannot be stressed enough, no one expects you to be a "super woman" except you.
6. Meet with your therapist at regular, scheduled appointments.
7. Eat a well-balanced diet, using all the food groups each day.
8. Get enough sleep which will reduce fatige and give you more energy to do your daily tasks.
9. Try and exercise each day: even if it just walking up the stairs, walking around the block, or do yoga. The slow movements will still produce a positive effect on the body.
IS THERE A CURE OUT THERE?
Research is unsure of any cures as major depression is an illness that may re-appear. For this reason, planning between patient and medical/health professional SHOULD include what to do if symptoms should reappear.
ST.JOHN'S WORT:CURE OR HYPE?
St. John's Wort seems to be the godsend of the moment! Is it all hype or is there some truth to the claims? St. John's Wort(Hypercium perforatum) is a herbal extract widely used in Germany for episodes of depression. In 1994, German physicians prescribed the herb a total of 66 million doses. 23 separate clinical trials which involved 1,757 patients with mild to moderately severe depression was the basis for their recommendation of the herb. Patients used between 500 and 900mg daily of the herb which contains 0.75 to 2.7% hypericin(the active ingredient in the herb).
Their conclusion was that St. John's Wort was three (3) times more effective than a placebo (nonactive substance used for the comparision) AND as effective as standard antidepressants currently in use.
More impressive was their conclusion that the herb produced only mild side effects in only 19 per cent(19%) of the users compared to 52.8 per cent (52.8%) of antidepressant users who experienced mild to severe side effects. No toxic reactions have been noted NOR unfavorable interactions with other medications.
In conclusion, you should discuss the possibility of taking St. John's Wort with your medical/health professional and SHOULD NOT decide yourself to change your current medication regime.
LINKS TO OTHER SITES ON THE WEB Dr. John Grohol's Mental Health Page Mental Health Source Happiness Home Page Does the Change of Seasons Make you SAD? Alt.Support.Depression FAQ
As important as it is to take your medication, it is also important to understand the side effects and how to cope with them. If ever in doubt, question your medical or health professional!
Many of the antidepressants have the unfortunate side effect of loss of libido. This seems to occur mostly with MAO Inhibitors(MAOIs) and SSRIs like Nardil, Parnate and Prozac. Your medical or health professional can determine if the medication OR the underlying depression is the cause.
Feelings of dizziness, being drugged or feeling medicated should be fully investigated by your medical or health professional. They can determine if the dizziness is caused by low blood pressure, if the feeling of being drugged is a cognitive disruption and if the medicated feeling is due to over-sedation.
You cannot determine this on your own!
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