Depression: The Invisible Disease
Depression
is a serious medical illness. In contrast to the normal emotional experiences
of sadness, loss, or passing mood states, clinical depression is persistent and
can interfere significantly with an individual’s ability to function.
Symptoms
of depression include sad mood, loss of interest or pleasure in activities that
were once enjoyed, change in appetite or weight, difficulty sleeping or
oversleeping, physical slowing or agitation, energy loss, feelings of
worthlessness or inappropriate guilt, difficulty thinking or concentrating, and
recurrent thoughts of death or suicide. A diagnosis of unipolar major depression (or major
depressive disorder) is made if a person has five or more of these symptoms
and impairment in usual functioning nearly every day during the same two-week
period. Major depression often begins between ages 15-30 or even earlier.
Episodes typically recur.
Some
people have a chronic but less severe form of depression, called dysthymia (or dysthymic disorder), that is diagnosed when depressed mood persists
for at least two years and is accompanied by at least two other symptoms of
depression. Many people with dysthymia also have major depressive episodes.
While unipolar major depression and dysthymia are the primary forms of
depression, a variety of other subtypes exist.
Depression
can be devastating to all areas of a person’s every day life, including family
relationships, friendships, and the ability to work or go to school. Many
people still believe that the emotional symptoms caused by depression are “not
real,” and that a person should be able to shake off the symptoms if only he or
she were trying hard enough. Because of these inaccurate beliefs, people with
depression either may not recognize that they have a treatable disorder or may
be discouraged from seeking or staying on treatment because of feelings of
shame and stigma. Too often, untreated or inadequately treated depression leads
to suicide.
* Depression
affects nearly 10 percent of adult Americans ages 18 and over in a given year,
or more than 19 million people in 1998.
* Unipolar
major depression is the leading cause of disability in the
* Nearly
twice as many women (12 percent) as men (7 percent) are affected by a
depressive illness each year.
* Evidence
from studies of twins supports the existence of a genetic component to risk of
depression. Across six studies, the average concordance rate in identical twins
(40%) for unipolar depression is more than twice the concordance rate in
fraternal twins (17%).
* Research
has shown that stress in the form of loss, especially death of close family
members or friends, may trigger major depression in
vulnerable individuals.
Treatment
Antidepressant
medications are widely used. Effective treatments for
depression. Existing antidepressant drugs are known to influence the
functioning of certain neurotransmitters (chemicals used by brain cells to
communicate), primarily serotonin, norepinephrine, and dopamine, known as
monoamines. Older medications - tricyclic antidepressants (TCAs) and monoamine
oxidase inhibitors (MAOIs) - affect the activity of both of these
neurotransmitters simultaneously. Their disadvantage is that they can be
difficult to tolerate due to side affects or, in the case of MAOIs, dietary and
medication restrictions. Newer medications, such as the selective serotonin
reuptake inhibitors (SSRIs), have fewer side effects than the older drugs,
making it easier for patients to adhere to treatment. Both generations of
medications are effective in relieving depression, although some people will
respond to one type of drug, but not another. Medications that take entirely
different approaches to treating depression are now in development.
Electroconvulsive
therapy (ECT), although not generally used as a first-line treatment, is an
effective and safe treatment for severe depression.
Psychotherapy
is also effective for treating depression. Certain types of psychotherapy,
cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT), have been shown to be particularly useful. More than 80
percent of people with depression improve when they receive appropriate
treatment with medication, psychotherapy, or the combination.
Recently
there has been enormous interest in herbal remedies for various medical
conditions including depression. One herbal supplement, hypericum or
Recent
Research Findings
Modern
brain imaging technologies are revealing that in depression, neural circuits
responsible for moods, thinking, sleep, appetite, and behavior fail to function
properly, and that the regulation of critical neurotransmitters is impaired.
Genetics research indicates that vulnerability to depression results from the
influence of multiple genes acting together with environmental factors. Studies
of brain chemistry, mechanisms of action of antidepressant medications, and the
cognitive distortions and disturbed interpersonal relationships commonly
associated with depression, continue to inform the development of new and
better treatments.
The hormonal system that regulates the body’s response to stress - the hypothalamic-pituitary-adrenal (HPA) axis - is overactive in many patients with depression. The hypothalamus, the brain region responsible for managing hormone release from glands throughout the body, increases production of a substance called corticotropin releasing factor (CRF) when a threat to physical or psychological well-being is detected. Elevated levels and effects of CRF lead to increased hormone secretion by the pituitary and adrenal glands which prepares the body for defensive action. The body’s responses include reduced appetite, decreased sex drive, and heightened alertness. Research suggests that persistent over activation of this hormonal system may lay the groundwork for depression. The elevated CRF levels detectable in depressed patients are reduced by treatment with anti-depressant drugs, and this reduction corresponds to improvement in depressive symptoms.
For more information about Mental Illnesses -
Contact:
The
NAMI of Greater
Phone: 312-563-0445