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Conservative use of drug therapy
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A psychological approach that emphasizes the present and future of the patient, rather than the past.
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Emphasis on nutrition and physical exercise
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Family participation, if appropriate
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Psychoeducation for patients and relatives
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What is Depression?
Clinical depression (Major Depression) is a multifaceted disorder characterized by mood disturbance in combination with behavioral difficulties (social isolation, sleep and appetite disturbance) and cognitive dysfunction (poor concentration and memory).
What are the Symptoms?
Clinical depression goes beyond the normal reaction to negative life circumstances, such as divorce, illness or loss of a significant other. It is a mood disorder, which requires professional intervention.
Clinical depression is most often defined by the DSM-IV diagnostic criteria and involves five or more of the following symptoms for a period of at least two weeks.
- Depressed mood during most of the day nearly every day.
- Lack of enthusiasm and pleasure in the majority of daily activities.
- Excessive or insufficient sleep.
- Psychomotor agitation or retardation.
- Increased or decreased appetite.
- Fatigue/loss of energy.
- Thoughts and/or plans of suicide.
- Difficulties concentrating/memory impairment.
- Feelings of worthlessness or guilt.
- Another type of depression is Dysthymia, which is characterized by long term (a period of at least two years) of chronic depressed mood. Additionally, there is the presence of at least two of the symptoms associated with Major Depression. Dysthymic disorder may be less disabling overall, but may keep a person from functioning at their optimal level. Some people with dysthymia also suffer from episodes of major depression.
Bipolar Disorder
In Bipolar Disorder a patient experiences mood swings of uncontrollable mania alternating with episodes of severe depression.
During mania a person may exhibit:
- Grandiose notions
- Decreased need for sleep
- Excessive/pressured speech
- Racing thoughts/distractibility
- Increased hyperactivity
- Impulsivity
- High risk behaviors, such as excessive spending or high risk sexual encounters
There are many different forms of bipolar disorder, some involving episodes of depression alternating with episodes of mania. In other cases, individuals may never have a full manic episode, instead they may suffer from episodes of hypomania alternating with episodes of less severe depression. A hypomanic episode involves many of the same symptoms as a manic episode, but does no interfere with functioning to the same degree as a manic episode. Hypomanic episodes also don't involve any psychotic features.
Bipolar disorder usually develops into a chronic pattern of one episode followed by the other if left untreated.
Who Suffers from Depression?
Persons of all ages can suffer from depression, including adults, children and the elderly. Studies estimate the prevalence rates of depression for adult women to be between 5-9% and for adult men 2-3%.
Estimates also suggest that 3-6 million children suffer from depression although the disorder may be vastly under identified and under treated, especially when symptoms overlap with other disorders, such as hyperactivity, school problems or somatic concerns. Depression in children may be indicated by symptoms similar to those seen in adults, such as hopelessness, and even suicidal thoughts. Some symptoms are more characteristic of childhood depression such as excessive dependency on adults, difficulties in school, behavioral problems, listlessness, bed-wetting, fatigue and bodily complaints.
Some data suggests that depression in older adults is also grossly underestimated. Symptoms of depression in the elderly are frequently incorrectly diagnosed as senility and other disorders associated with advanced age because of symptoms such as memory loss, confused thinking or apathy. Additionally, inconsistent sleeping patterns and reduced appetite, often occurring in this age group independent of depression, may in fact be signs of depression. Depression in the elderly may also manifest via multiple physical complaints, such as aches and pains.
What Treatment are Available?
A significant number of patients respond to a combination of antidepressant drugs and psychotherapy.
Research demonstrates that the most effective psychotherapeutic approach is Cognitive Behavioral Therapy. This is a structured approach, which is based on the premise that people's emotions and behaviors are determined by how they view their world and interpret their experiences. Depressed mood is the result, therefore, of distorted conceptualizations of the self, the future and one's experiences. Cognitive therapy is aimed at reassessing and correcting such thinking patterns. Behavioral techniques are used to alter behaviors associated with depression, such as withdrawal or physical and social inactivity, as well as the impulsive behavior found in manic episodes. Behavioral techniques are focused on restoring the patient's functioning by addressing the behaviors which interfere in the person's life.
The general principles of treatment of adults with depression apply as well to children and elderly patients. With regard to antidepressant drugs, medical management of these special populations is essential since they metabolize these drugs differently than adults.
There are three classes of antidepressant drugs currently in use:
| Tricyclic Antidepressants |
Monamine Oxidate Inhibitors (MAOIs) |
Serotonin Reuptake Inhibitors (SRIs) |
| Elavil |
Nardil |
Prozac |
| Tofranil |
Parnate |
Effexor |
| Pamelor |
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Celexa |
| Anafranil |
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Lexapro |
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Zoloft |
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Paxil |
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Luvox |
Mood stabilizing drugs are often effective for treatment of bipolar disorder:
| Lithium |
Tegretol |
Neurontin |
| Lamictal |
Depakote |
Olanzapine |
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Consultations