major depression

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Hello, My name Is and I have major depression and panic/anxiety

disorder.

What are the symptoms of major depression? The onset of the first episode of

major depression may not be obvious if it is gradual or mild. The symptoms of

major depression characteristically represent a significant change from how a

person functioned before the illness. The symptoms of depression include:

persistently sad or irritable mood

pronounced changes in sleep, appetite, and energy

difficulty thinking, concentrating, and remembering

physical slowing or agitation

lack of interest in or pleasure from activities that were once enjoyed

feelings of guilt, worthlessness, hopelessness, and emptiness

recurrent thoughts of death or suicide

persistent physical symptoms that do not respond to treatment, such as

headaches, digestive disorders, and chronic pain

When several of these symptoms of depressive illness occur at the same time,

last longer than two weeks, and interfere with ordinary functioning,

professional treatment is needed.

What are the causes of major depression? There is no single cause of major

depression. Psychological, biological, and environmental factors may all

contribute to its development. Whatever the specific causes of depression,

scientific research has firmly established that major depression is a

biological, medical illness.

Norepinephrine, serotonin, and dopamine are three neurotransmitters (chemical

messengers that transmit electrical signals between brain cells) thought to be

involved with major depression. Scientists believe that if there is a chemical

imbalance in these neurotransmitters, then clinical states of depression result.

Antidepressant medications work by increasing the availability of

neurotransmitters or by changing the sensitivity of the receptors for these

chemical messengers.

Scientists have also found evidence of a genetic predisposition to major

depression. There is an increased risk for developing depression when there is a

family history of the illness. Not everyone with a genetic predisposition

develops depression, but some people probably have a biological make-up that

leaves them particularly vulnerable to developing depression. Life events, such

as the death of a loved one, a major loss or change, chronic stress, and alcohol

and drug abuse, may trigger episodes of depression. Some illnesses such as heart

disease and cancer and some medications may also trigger depressive episodes. It

is also important to note that many depressive episodes occur spontaneously and

are not triggered by a life crisis, physical illness, or other risks.

How is major depression treated? Although major depression can be a

devastating illness, it is highly treatable. Between 80 and 90 percent of those

diagnosed with major depression can be effectively treated and return to their

usual daily activities and feelings. Many types of treatment are available, and

the type chosen depends on the individual and the severity and patterns of his

or her illness. There are three well-established types of treatment for

depression: medications, psychotherapy, and electroconvulsive therapy (ECT). For

some people who have a seasonal component to their depression, light therapy may

be useful. These treatments may be used alone or in combination. Additionally,

peer education and support can promote recovery. Attention to lifestyle,

including diet, exercise, and smoking cessation, can result in better health,

including mental health.

Medication. . It often takes two to four weeks for antidepressants to start

having an effect, and 6-12 weeks for antidepressants to have their full effect.

The first antidepressant medications were introduced in the 1950s. Research has

shown that imbalances in neurotransmitters like serotonin, dopamine, and

norepinephrine can be corrected with antidepressants. Four groups of

antidepressant medications are most often prescribed for depression:

Selective serotonin reuptake inhibitors (SSRIs) act specifically on the

neurotransmitter serotonin. They are the most common agents prescribed for

depression worldwide. These agents block the reuptake of serotonin from the

synapse to the nerve, thus artificially increasing the serotonin that is

available in the synapse (this is functional serotonin, since it can become

involved in signal transmission, the cardinal function of neurotransmitters).

SSRIs include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil),

citalopram (Celexa), escitalopram (Lexapro), and fluvoxamine (Luvox).

Serotonin and norepinephrine reuptake inhibitors (SNRIs) are the second-most

popular antidepressants worldwide. These agents block the reuptake of both

serotonin and norepinephrine from the synapse into the nerve (thus increasing

the amounts of these chemicals that can participate in signal transmission).

SNRIs include venlafaxine (Effexor) and duloxetine (Cymbalta).

Bupropion (Wellbutrin) is a very popular antidepressant medication classified

as a norepinephrine-dopamine reuptake inhibitor (NDRI). It acts by blocking the

reuptake of dopamine and norepinephrine.

Mirtazapine (Remeron) works differently from the compounds discussed above.

Mirtazapine targets specific serotonin and norepinephrine receptors in the

brain, thus indirectly increasing the activity of several brain circuits.

Tricyclic antidepressants (TCAs) are older agents seldom used now as

first-line treatment. They work similarly to the SNRIs, but have other

neurochemical properties which result in very high side effect rates, as

compared to almost all other antidepressants. They are sometimes used in cases

where other antidepressants have not worked. TCAs include amitriptyline (Elavil,

Limbitrol), desipramine (Norpramin), doxepin (Sinequan), imipramine (Norpramin,

Tofranil), nortriptyline (Pamelor, Aventyl), and protriptyline (Vivactil).

Monoamine oxidase inhibitors (MAOIs) are also seldom used now. They work by

inactivating enzymes in the brain which catabolize (chew up) serotonin,

norepinephrine, and dopamine from the synapse, thus increasing the levels of

these chemicals in the brain. They can sometimes be effective for people who do

not respond to other medications or who have “atypical” depression with marked

anxiety, excessive sleeping, irritability, hypochondria, or phobic

characteristics. However, they are the least safe antidepressants to use, as

they have important medication interactions and require adherence to a

particular diet. MAOIs include phenelzine (Nardil), isocarboxazid (Marplan), and

tranylcypromine sulfate (Parnate).

Non-antidepressant adjunctive agents. Often psychiatrists will combine the

antidepressants mentioned above with each other (we call this a “combination”)

or with agents which are not antidepressants themselves (we call this

“augmentation”). These latter agents can include the atypical antipsychotic

agents [aripiprazole (Abilify), olanzapine (Zyprexa), quetiapine (Seroquel),

ziprasidone (Geodon), risperidone (Risperdal)], buspirone (Buspar), thyroid

hormone (triiodothyonine, or “T3”), the stimulants [methylphenidate (Ritalin),

dextroaphetamine (Aderall)], dopamine receptor agonists [pramipexole (Mirapex),

ropinirole (Requipp)], lithium, lamotrigine (Lamictal), s-adenosyl methionine

(SAMe), pindolol, and steroid hormones (testosterone, estrogen, DHEA).

Consumers and their families must be cautious during the early stages of

medication treatment because normal energy levels and the ability to take action

often return before mood improves. At this time - when decisions are easier to

make, but depression is still severe - the risk of suicide may temporarily

increase.

Psychotherapy. There are several types of psychotherapy that have been shown

to be effective for depression including cognitive-behavioral therapy (CBT) and

interpersonal therapy (IPT). Research has shown that mild to moderate depression

can often be treated successfully with either of these therapies used alone.

However, severe depression appears more likely to respond to a combination of

psychotherapy and medication.

Cognitive-behavioral therapy (CBT) – helps to change the negative thinking

and unsatisfying behavior associated with depression, while teaching people how

to unlearn the behavioral patterns that contribute to their illness.

Interpersonal therapy (IPT) – focuses on improving troubled personal

relationships and on adapting to new life roles that may have been associated

with a person’s depression.

Electroconvulsive therapy (ECT). ECT is a highly effective treatment for

severe depressive episodes. In situations where medication, psychotherapy, and a

combination of the two prove ineffective, or work too slowly to relieve severe

symptoms such as psychosis or thoughts of suicide, ECT may be considered. ECT

may also be considered for those who for one reason or another cannot take

antidepressant medications.

What are the side effects of the medications used to treat depression?

Different medications produce different side effects, and people differ in the

type and severity of side effect they experience. About 50 percent of people who

take antidepressant medications experience some side effects, particularly

during the first weeks of treatment. Side effects that are particularly

bothersome can often be treated by changing the dose of the medication,

switching to a different medication, or treating the side effect directly with

additional medications. Rarely, serious side effects such as fainting, heart

problems, or seizure may occur, but they are almost always treatable.

Tricyclic antidepressants (TCAs) cause side effects that include dry mouth,

constipation, bladder problems, sexual problems, blurred vision, dizziness,

drowsiness, skin rash, and weight gain or loss.

Monoamine oxidase inhibitors (MAOIs). Individuals taking MAOIs may have to be

careful about eating certain smoked, fermented, or pickled foods, drinking

certain beverages, or taking some medications because they can cause severe high

blood pressure in combination with the medication. A range of other, less

serious side effects occur including weight gain, constipation, dry mouth,

dizziness, headache, drowsiness, insomnia, and sexual side effects (problems

with arousal or satisfaction).

SSRIs, and SNRIs tend to have fewer and different side effects, such as

nausea, nervousness, insomnia, diarrhea, rash, agitation, or sexual side effects

(problems with arousal or orgasm).

Bupropion generally causes fewer common side effects than TCAs and MAOIs. Its

side effects include restlessness, insomnia, headache or a worsening of

preexisting migraine conditions, tremor, dry mouth, agitation, confusion, rapid

heartbeat, dizziness, nausea, constipation, menstrual complaints, and rash.

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