Archives for October 2007

I too am fighting depression, have been for a long time, but a strange thing happened to me at the weekend and now I feel as though I am getting better for the first time. Try the following test:Think of something that you want to see, feel or hear. It could be a certain colour balloon in the sky, a certain colour feather in your hand or to hear from somebody that you haven't heard of from a long time. Picture that thought in your mind, exactly how that object would look or the person you would like to hear from. You really must believe with all your might that it is happening, that you can see it, feel it or hear it. Think about how you would feel if this thing happened. Hold that thought, feeling and belief for as long as you can. Think about it as much as possible and how happy it would make you feel.Then see what happens. It could take a couple of hours, a couple of days or a couple of weeks. If something out of the extraordinary happens to you, as it did to me, please let me know.

        When one is depressed no doubt the patient wants to be left alone and remain in peace but if the disease is not treated then how will the individual going through a bad turmoil get well and be a part of the healthy portion of the society. Between 80-90% of all depressed people respond to treatment and almost all sufferers who are appropriately treated will experience at least some symptom relief.  The first aim of treatment is to ensure the safety of the patient for which hospitalisation may be required (i.e. suicidal/unable to care for self). Secondly, a complete diagnostic evaluation must be carried out. This includes a full personal and family history as well as a history of illnesses, medication and recreational drugs/alcohol used, activities, personality type and support system. A physical examination may also be required to evaluate underlying physical illness, which may cause or worsen depression e.g. thyroid illness. It is important to detect medical problems, as these require separate, appropriate treatment.  Thirdly, a treatment plan has to be formulated which takes into account both immediate symptoms and the patient’s future well being. This would include medication, psychotherapy, life-style changes and the addressing of stressors. Stressful life events are associated with an increased relapse rate in mood disorder sufferers.

Psychotherapy
Psychotherapy is also known as “talking therapy” and involves a verbal interaction between a trained mental health professional and a patient who may be experiencing emotional or behavioural problems. There are several different types of psychotherapy, which may differ in the techniques used on the psychological principles emphasised, but the underlying aim is to enable the patient to gain insight into him or herself and thereby change maladaptive thoughts, feelings and behaviour. Research has shown that some forms of psychotherapy are as effective as medication in treating mild to moderate depression. Medication tends to bring about results more rapidly, but the benefits of psychotherapy may be more enduring. It is generally agreed that the best form of treatment is a combination of both pharmacotherapy or psychotherapy.

Unlike most develped countries, the United States does not have universal health care. A new study by NAMI (The National Alliance on Mental Illness) has found that the cost for treating depression is three times higher in U.S. citizens with limited access to treatment. The annual "out-of-pocket costs" for medication, psychotherapy and other treatment costs averaged $4,312 for those with restricted access versus $1,496 for those with good health insurance.The irony is that those with limited access to treatment are often those with lower incomes. In effect lower income people pay more for their depression treatment. The study also found that:

Read the complete story

         Today’s life structure is so different from what it used to be or was way 10 years back at the present situation every second person is stressed out due to something or another it does not have to be official matters only women who are house wives are going through depression, children in educational institutions are going through stress due to their own reason in other words every person rich or poor is suffering from depression and we can blame the competition and fast paced life for this. But even then it does not seem the way it should be I think even now 80-90% people are not getting themselves treated because of major upcoming issue that is of STIGMA the society we live in is such that people are too concerned about what is going on in other people lives and if by chance they hear of someone being treated by a Psychologist or a Psychiatrist the news goes from one ear to another and in the end becomes a Chinese Whisper and the poor depressed person is even more depressed then before because he/she has been labeled as a depressed person. So in order to become a part of this fast paced society of ours people tend to hide that they are visiting a psychiatrist because sadly so such people are not accepted in our society and when receiving a medical help then it is not over yet when the doctors overlook the physical symptoms of the patient when these physical symptoms say a lot by showing that the person is depressed and needs help. So, why do only 30 percent of those suffering from depression seek help? Also, why are only half of those accurately diagnosed, and only 20 percent of those people treated appropriately? Because the headaches, fatigue, and aches and pains that are often the physical manifestations of depression go unrecognized in many primary-care doctors' offices, mental health experts said during a depression workshop in New York City. Add to that the lingering stigma of depression, and a managed-care system that's reluctant to pay for easy access to therapy.

Physical symptoms
A key to diagnosing depression is to know the disease exacts more than a psychological toll -- it has a strong physical component as well. It's often that physical pain that brings patients to their doctors. However, many primary-care doctors don't make the connection between a patient's aches and pains and a possible depression, panel members said.  "Eighty percent of patients with depression come to the doctor with exclusively physical symptoms," said Dr. David L. Dunner, a psychiatrist at the University of Washington in Seattle.  Headache, pain in the back, stomach, joints, muscles or chest, and fatigue are some of the most common physical symptoms that could indicate an underlying depression, he said. Other symptoms are significant appetite and weight changes, difficulty concentrating, feelings of worthlessness and guilt, and suicidal thoughts. Depression also often has a genetic component -- if some family members suffer from the disease you're more susceptible to it. Depression can also be "episodic," meaning it can come and go. Finally, while depression can strike early in one's life, it's often not diagnosed until much later when it is harder to treat, panel members said. "There is so much complexity between the physical and mental symptoms that they're hard to separate," said Dr. Thomas L. Schwenk, a primary-care physician at the University of Michigan at Ann Arbor.

According to American researchers smoking cigarettes may make teens more prone to depression, alcohol abuse and illegal drug use.In a new report based on data from a government drug use survey, researchers have found that teenagers who smoke are 9 times more likely to abuse alcohol and 13 times more likely to abuse illegal drugs than those who don't smoke.The report "Tobacco: The Smoking Gun" which was funded by the anti-tobacco group Citizen's Commission to Protect the Truth, also says twice as many teen smokers suffer symptoms of depression than nonsmokers.The report by the Columbia University's National Center on Addiction and Substance Abuse (CASA), was headed by former U.S. Health, Education and Welfare commissioner Joseph A. Califano Jr. and he advises parents to be alert if a teenager smokes as they are far more likely to abuse alcohol or use illegal drugs.Despite a plethora of government campaigns and warnings about the dangers of smoking, on a daily basis another 4,000 teens in the U.S. light up for the first time.Califano says the report was issued to make parents, teachers, and physicians aware that the dangers of teen smoking are immediate as well as long-term.Other research also suggests that smoking at an early age is linked to panic attacks and general anxiety disorders and though the report does not prove smoking causes depression and other mental illness, according to Califano the evidence points in that direction.Califano says smoking is clearly linked to substance abuse and depression, and this report shows that the statistical relationship is very powerful.The CASA analysis reveals that teenagers who smoke are 13 times more likely to use marijuana than nonsmoking teens, and are twice as likely to have suffered from symptoms of depression over the course of a year.Califano says the earlier a child begins smoking, the greater the risk; compared to children who never smoked, children who start smoking before age 13 are three times as likely to binge drink, 15 times as likely to use marijuana, and 7 times more likely to use other illegal drugs such as heroin or cocaine.Califano says there is growing evidence that nicotine has a more profound effect on young brains than on the brains of adults, increasing their vulnerability to cigarettes and possibly other addictive substances.This includes effects on the brain chemicals dopamine and serotonin and changes to brain receptors associated with an increased desire for other addictive drugs.The CASA report calls on the government for greater restrictions to be placed on the advertising and marketing of all types of tobacco products.Califano says tobacco companies continue to actively market their products to children regardless of legislation banning it and he points to such products as lime, coconut and pineapple flavored cigarettes.Califano says regardless of how it is justified selling candy-flavored cigarettes is targeting children.

                     Between 10% and 40% of women develop Postnatal Depression (PND). If one takes the lowest figure of 10%, there are at least 50 000 new cases of PND per year in South Africa.
A recent study in Khayelitsha showed that more than 30% of new mothers in that community are suffering from PND. This is according to the Post Natal Depression Support Association (PNDSA).What are the three types of postnatal emotional disorders? According to the PNDSA, PND can present in three ways. These vary in time of onset, duration of illness, and severity of symptoms.

Postnatal “Blues”
Postnatal Depression (PND) & Anxiety
Postnatal Psychosis or Puerperal Psychosis
The Blues
Blues are commonly described as weepiness and emotional fluctuations that begin shortly after childbirth, and continue for only a few days. The onset is typically three to five days postpartum. The most commonly reported symptoms are tearfulness, tiredness, anxiety, over-emotional reactions, up and down mood swings, feeling low, and muddled thinking. The Blues affect between 30-80% of women – mean incidence across studies is 55.75%. Research has shown that severe Blues may be predictors of PND. Usually re-assurance and sympathetic management is sufficient treatment. It is generally thought that the causes of the Blues may be associated with the changes in hormonal levels associated with childbirth.

Postnatal Depression and anxiety (PND)
Postnatal Depression is a more serious illness than the Blues, and the symptoms are more severe and last longer. The disorder is insidious and debilitating, and can develop at any time during the first year postpartum. Antenatal Depression is often found during pregnancy (10%), and is a good predictor of subsequent PND.Between 10-40% of women develop Postnatal Depression. The range of these prevalence figures may partly be due to differences in diagnostic measurement and in differences in definition of the depression. Duration is a minimum of two weeks, but usually much longer. (It is thought that it may continue as a low-grade chronic depression if left untreated, becoming more severe with each subsequent pregnancy).Symptoms may include tearfulness, despondency, feelings of inadequacy, numbness, suicidal ideation, sadness, reduced appetite and interest, insomnia, over-sensitivity, feelings of helplessness and hopelessness, excessive dependency, anxiety and despair, intense irritability, irrational fears and fantasies about her self or baby, feeling out of control. A relationship has been found between the Blues and later-developing PND. This suggests that for some women there may be a hormonal component of postnatal depression and anxiety. Many of the symptoms of the Blues are also found in Postnatal Depression, but in a more severe form. Full recovery may take a long time, as the causes for the depression may lie in deep-seated past psychological traumas. Treatment may require medication, and professional advice needs to be sought regarding what drugs can be safely taken during breastfeeding. “Talk therapy” is extremely helpful, and almost all women find great comfort in attending support groups, where they can share their painful feelings with others, knowing that they will not be judged as bad mothers.

Postnatal Psychosis
Postnatal (Puerperal) Psychosis is the most severe of the postpartum illnesses. Onset is typically within two to four weeks, but may be as late as eight weeks postpartum. Duration depends on speed of diagnosis and appropriate treatment. Symptoms include heightened or reduced motor activity, hallucinations, marked deviation in mood, severe depression, mania, or both, confusion, and delirium. Incidence is one or two per 1 000 postpartum women. The three most common diagnoses are unipolar depression, bipolar depression and schizophrenia.

         Many of us equate the word “retirement” with relaxation, holidays and sleeping late. But for some, it can be the start of depression. Depression after retirement is a common problem. Many people, especially those who have invested a lot in their careers and neglected other areas of their lives, suddenly feel emptiness and despair when they retire. People whose sense of self esteem and worth is dependent on the work they do are particularly at risk. They may feel that they have lost their purpose for living, that they are worthless and do not have a role to play in society.  For people who are frequently in the spotlight, the problem may be more complicated. They often don’t realise the impact of attention and admiration on their sense of self worth. To be deprived of that can easily lead to feelings of rejection and emptiness.  Men appear to be more at risk as they are still regarded by many as primary breadwinners and their status in society is still measured to a great extent by their income and success. Even though women have become more career orientated, many do not face a similar risk as their time is also occupied by other responsibilities such as raising a family and running the household. How can you prevent depression after retirement? Lead a balanced lifestyle and cultivate interests outside of work.
Don’t wait until retirement to plan what to do with your time. Plan ahead.
Prevent isolation by getting involved in activities where you can socialise and meet people with the same interests or in a similar position. If you are worried that you may be suffering from depression, seek help as soon as possible.
How do I know when I am depressed?

Look out for the following symptoms:

Persistent sad, anxious or empty mood
Feelings of hopelessness or pessimism
Loss of pleasure or interest in ordinary activities
Problems with sleep (sleeping too much or too little)
Loss of appetite or overeating
Decreased energy
Restlessness or irritability
Difficulty concentrating, remembering or making decisions
Inappropriate feelings of guilt
Thoughts of death or suicide.

                     Depression is not one a one-size-fits-all condition. Mental health professionals have long recognized that patients tend to display reasonably distinct clusters of clinical symptoms, and they increasingly regard such clusters as subtypes of depression. The boundaries between subtypes are often fuzzy, with some overlap of symptoms, and not every depression expert agrees on the classification system. But clinical research suggests that parsing depression into subtypes is useful in guiding treatment and in gauging the long-term outcome for patients.  At a symposium presented at the recent meeting of the American Psychiatric Association, doctors discussed five depression subtypes that together encompass the majority of depressed persons. These include:

• Atypical depression, which studies show accounts for 23% to 36% of all cases and is under-recognized.

• Anxious depression, which afflicts 40% of patients with major depressive disorder and poses many treatment challenges.

• Melancholic depression, a severe form of disorder that is most common among persons hospitalized for depression

• Vascular depression, a newly recognized variety that reflects the existence of silent cardiovascular disease and is most common among persons over the age of 60.

• Psychotic depression, a severe form of disorder distinguished by mood-congruent delusions and accompanied by specific changes in brain tissue. The distinctions first emerged several decades ago on the basis of variations in response to then-available treatments. But clinicians and researchers suggest that dissecting depression into subtypes may be even more valuable today. The subtypes may represent distinct biological pathways of disorder and may ultimately provide clues to the multiple ways depression can arise as well as express itself.

• Atypical depression can manifest in both bipolar and unipolar depression, psychiatrist Jonathan W. Stewart. M.D., of Columbia University reported. Patients with this variety of disorder--about 10 million Americans--have what physicians label mood reactivity: they can be cheered up at least 50% in response to positive events in their life, albeit temporarily. In contrast to patients with classical depression, those with atypical depression overeat regularly and binge often, gaining sometimes-substantial amounts of weight. They also sleep a lot, and experience a leaden paralysis and overwhelming fatiguefor much of the day, feeling as if they cannot even lift themselves out of a chair. In addition to such physical manifestations, atypical depression is marked by a longstanding pattern of extreme sensitivity to perceived interpersonal rejection that affects functioning at work, in love, and with friends. With a trail of stormy relationships patients are either never married or divorced, and are unemployed or underemployed. Given their fear of rejection, many withdraw from relationships entirely and refuse to go on job interviews. This variety of depression begins early--median age of onset is 17--and takes a chronic course. Depression afflicts many family members, and it tends to be of the same chronic type. Perhaps the landmark feature of a typical depression is its responsiveness to one class of antidepressants, the MAO inhibitors. While they are no longer considered a first-line treatment because of their onerous side effects, they are regarded especially useful for people with atypical depression who fail to respond to other drugs. Cognitive therapy in conjunction with drug treatment is also effective and helps restore function. A biology of a typical depression has not been delineated, as patients appear normal on most physiologic tests. But patterns of response to mixed-up images of faces suggests that parts of the brain that interpret emotion are not working normally.

• Anxious depression covers the large gray area where symptoms of depression and anxiety co-exist or overlap. Patients typically have feelings of worthlessness and pessimism, excessive worrying and guilt, and are unable to enjoy things. The disorder is expressed physically in diminished appetite, poor sleep with frequent awakenings, and restlessness and psychomotor agitation. In one study of 255 depressed outpatients that he conducted, psychiatrist Maurizio Fava, M.D., of Harvard reported at the symposium, 51% were found to have anxiety along with their depression. It's not clear whether the anxiety follows on the heels of feelings of worthlessness. But in 40% of the anxiously depressed, the anxiety disorder started first. Among those whose anxiety takes the form of social phobia and generalized anxiety disorder, the anxiety tends to precede major depressive disorder. But in the case of panic disorder it usually follows the onset of the depressive disorder. Patients are young--average age 20.6 versus 28.4 among those with major depression alone--significantly functionally impaired, and take more time to recover. They are less likely to respond to treatment and more likely to relapse, and experience less change in their depressive symptoms with treatment. The disorder may have its origins early in life among children of a distinct temperament type who are frightened by novelty. Both the anxiety and depression may be the outcome of abnormality high levels of hormones driving the body's stress response system. Anxious depression typically poses a treatment dilemma for doctors. Many seek to use antidepressants that have sedating properties, although it's not clear that they need to, said Dr. Fava. Studies show that all of the antidepressants work equally well against this type of depression, although high doses may be needed. Still, in practice physicians tend to prescribe a combination of drugs for such patients, usually a tranquilizer along with an antidepressant. Given their anxiety quotient, depressives of this type are unusually sensitive to bodily sensations. As a result, common drug side effects--such as gastrointestinal distres--are often cause for discontinuing treatment. Even when treatment continues, remission can be a long time coming. Cognitive therapy can be very helpful.

• Melancholic depression is often a synonym for severe depression, and it is far more common among those hospitalized for depression than among those in the community. Affected persons lack pleasure in almost all activities and do not react to pleasurable stimulation. They may experience extreme slowness of movement or agitation. Their depression is regularly worse in the morning and is accompanied by lack of appetite and weight loss. Melancholic depressives may also ruminate over the same thoughts and experiences, and feel excessive guilt. Their depression takes on a life of its own: the more episodes they have, the more autonomous such episodes seem, less likely to be set off by stressful events. And patients do not respond to psychotherapy, at least not before successful drug treatment, reported J. Craig Nelson, M.D., of Yale. Studies he and others have conducted show that the most helpful drugs for this type of disorder are not the SSRIs but agents that block the reuptake of norepinephrine as well as of serotonin. "Some drugs," he said, referring to dual-action agents like venlafaxine and mirtazapine, "may treat more symptoms."

• Psychotic depression was once another term for severe depression, but the more refined the tools scientists apply to dissect the disorder, the more distinctive this variety appears, especially biologically. Not only is this type of depression severe, life-impairing and marked by suicide attempts, it is accompanied by delusions that reflect the depressed mood and guilt patients feel. Biological tests show the patients have a distinct abnormality in the system that controls production of stress hormones, said Linda L. Carpenter, M.D., of Brown University. Imaging studies reveal significant brain atrophy. The decrease in brain tissue likely reflects the toxic effects of excess stress hormones, namely cortisol. Despite the proliferation of antidepressant drugs, the best treatment for psychotic depression is electroshock therapy. But drugs now in development may offer some advantage. Dr. Carpenter specifically cites agents that interfere with cortisol by blocking receptors for it.

                    You've taken the responsible step to tackle your depression head-on and to seek treatment. However, it's a few weeks down the line and you are still not feeling better. If you are tempted to throw in the towel and give up hope, consider the following first. There may be good reasons why you are not feeling better yet. 
  Incorrect dosage:
There is no standard, correct dosage for all people. You and your doctor need to establish the right dosage for you. If your dosage is too low, you may not be getting the therapeutic benefit of the drug. If it is too high, you may be suffering from side effects unnecessarily which may tempt you to stop taking your medication altogether. In most cases, doctors start at a low dosage to give your body a chance to get used to the medication. The dosage should be increased gradually until the right therapeutic dosage is reached. In the early days, it may be useful to keep a "mood and side effect diary". This way you could track your progress and discuss it with your doctor.

(a) Impatience:
Most antidepressants don't give instant results. Some may take two to four weeks before you feel better. Others can take up to six or eight weeks before you see results. Ask your doctor what you could expect from the medication he/she prescribed and at what point you should reconsider the type or dosage of medication. Hang in there!

(b) Drug interactions:
Many types of medication (including natural remedies) interfere with antidepressants – some could reduce the effect of your medication, others could even lead to toxicity. Make sure to tell your doctor what you are taking. Read what you need to tell your doctor.

(c) Incorrect type of medication
There are many different kinds of antidepressants and you and your doctor need to find the right one for you. If you are not seeing any results, it does not mean that antidepressants are not for you. Your doctor may try a different kind of antidepressant or may add a different type to your existing medication. Have a look at our section on antidepressants for a break-down of the different options available.

(d) Side effects getting to you?
Most medication has side effects and antidepressants are no exception. Side effects are common during the early days of treatment and usually disappear with time. It may be helpful to keep notes on whether there are any side effects, including when you have them and when you take your medication (time of day; before or after meals). In many cases, side effects can be avoided or minimised by taking them at a different time of the day or before or after meals. If you continue to battle with side effects, discuss this with your doctor. He or she may be able to change to dosage or prescribe a different antidepressant.

(e) Incorrect diet:
What you eat and drink can interfere with your medication. Ask your doctor if there are any foods that need to be avoided. MAO Inhibitors in particular can have serious interactions with certain foods. Alcohol should be taken in moderation. Some antidepressants can make you feel drowsy and alcohol will make matters worse. Alcohol could also slow the metabolism of some antidepressants.

(f) Stopping prematurely or without supervision:
You may be tempted to skip a dose or stop taking your medication altogether. Never stop treatment or lower the dosage without discussing it with your doctor, even if you feel better. Stopping prematurely may lead to a relapse.

(g) Not taking medication regularly:
It is vitally important to take your medication at the right time and not to skip a dose. If you find it difficult to remember to take your medication, think of ways in which you can be reminded to take your medication. Some people find it helpful to take it with a specific meal of the day and some keep their medication next to their toothbrush. You may also buy a pill box which will help you to keep track of what you have taken. Star charts may be helpful for children. The most important thing is not to give up hope. If you work closely with your doctor, you will soon reap the benefits of treatment.

                       Here's a bit of advice that could save your life: If you're depressed, don't drink.
The same lack of inhibitions that can lead a drinker to wear a lampshade as a hat can have consequences that are far more tragic for people with suicidal thoughts, a recent study suggests.  "We've always known that there is a relationship between alcoholism and suicide," says study co-author Ronald Kessler, a professor of healthcare policy at Harvard Medical School. "But the previous research sort of stopped there, suggesting that it was just heavy-duty substance abusers who would have the problem. "I think the surprise for us," he adds, "was the finding that even non-problem drinkers had an elevated risk." Kessler and his associates confirmed the link between alcoholism and suicide in their study: alcoholics were found to be more than three times as likely to try to kill themselves as people who don't drink. But the study also found that your odds of attempting suicide are almost two times greater if you drink than if you are a teetotaller - even if you don't drink to excess and are not an alcoholic "It appears that there's something about alcohol that has a dis-inhibiting effect on people who have been thinking about killing themselves and makes them impetuously act on that impulse in a way they wouldn't if they hadn't been drinking," Kessler says.

Alcohol not the only culprit
According to Kessler's research, however, users of other drugs are also just as likely to try to kill themselves as those who drink alcohol. The risks are about the same for users of marijuana, inhalants and heroin as they are for users of alcohol. The study also found that the risk of suicide increased dramatically when someone is a user of more than one drug. While smoking marijuana may be just as likely to provoke a suicide attempt as drinking alcohol, for example, someone doing both is in significantly greater danger. In fact, someone using two drugs is 4.2 times more likely than a nonuser to attempt suicide, and the odds go up from there, depending on the number of drugs being abused, according to the study. One of the most important implications of the study is that even relatively casual drinking or drug taking is dangerous for people who are thinking of killing themselves. The researchers also noted that among the sample, those exhibiting alcohol and substance dependence exhibited a higher likelihood of attempting suicide. The problem, Kessler says, is that people who are depressed or suicidal are often among those most likely to turn to alcohol or drugs.  "We've become a pill-taking society, and of course there is a lot of illicit drug use as well," he adds. "More and more people are using medication - and alcohol is a kind of medication - to deal with their problems." That's a dead end, Berman agrees.  Alcohol or drugs have never solved anyone's problems," he says. "Instead they make those problems worse.