Types of Depression and Treatment
What Is Depression?
Depression isn't just a brief blue mood or a passing sadness that lifts
in a few hours or even a few days. People who have depression - or, in
more formal clinical terms, major depressive disorder - experience at
least five of the following symptoms, which must include the first or
second, nearly every day, all day, for at least two weeks:
* Persistent depressed mood, including feelings of sadness or
emptiness
* Loss of interest or pleasure in activities or hobbies that were
once enjoyed, including sex
* Feelings of hopelessness and pessimism
* Feelings of guilt, worthlessness, and helplessness
* Insomnia, early-morning awakening, or oversleeping
* Loss of appetite accompanied by weight loss or overeating
accompanied by weight gain
* Decreased energy, fatigue, and feeling "slowed down"
* Restlessness and irritability
* Difficulty concentrating, remembering, and making decisions
* Thoughts of suicide or death (not just fear of dying) or suicide
attempts
* Persistent physical symptoms, such as headaches, digestive
disorders, or chronic pain, that do not respond to medical treatment and
for which no physical cause can be found.
Are There Different Types of Depression?
Yes. In addition to major depressive disorder, which is what people are
usually referring to when they talk about depression, there are other
types of depressive disorders as well.
Bipolar Disorder
Bipolar disorder (or manic-depressive disorder) is a condition in which
an individual experiences severe "lows" (depression) alternating with
extreme, inappropriate "highs" (mania). Each cycle can last from several
days to a few months. Depressed cycles are characterized by any or all
of the symptoms of major depressive disorder, while manic episodes are
characterized by the following symptoms, at least three of which last at
least one week:
* Inflated self-esteem or grandiosity
* Decreased need for sleep
* Rapid speech or excessive talkativeness
* Agitation; increase in activity (either socially, at work or
school, or sexually)
* Distractibility by unimportant stimuli; inability to sustain
concentration
* Intense involvement in high-risk activities, such as excessive
spending or sexual promiscuity, with no recognition of the potential for
painful consequences.
Mania often affects thinking and judgment, and while the inappropriate
nature of manic behavior may be quite obvious to outside observers,
manic individuals themselves are often completely unaware that their
behavior is extreme. They may even deny vehemently that their behavior
is out of the ordinary. Moreover, some manic individuals may enjoy the
sense of euphoria that often accompanies a manic cycle. It is,
therefore, particularly important that friends and loved ones can
recognize the symptoms of bipolar disorder.
Dysthymia
Unlike major depressive disorder, which is characterized by the
occurrence of one or more depressive episodes that are clearly
distinguishable from the individual's usual functioning, dysthymia is a
chronic, lowgrade depressive state. A patient is diagnosed as dysthymic
if this state persists for at least two years. The long-term, chronic
symptoms of dysthymia are usually not completely disabling, but they
keep the individual from feeling good and from functioning at "full
steam." Dysthymic individuals may experience episodes of major
depression on top of their dysthymia - a condition often referred to as
"double depression." Individuals with double depression may be less
likely to recover completely than are those who have major depressive
disorder without dysthymia.
What Treatments Are Available?
Most patients are best treated with a combination of antidepressant
medication and psychotherapy. Medications are used to relieve the
symptoms of depression, while psychotherapy can help people to cope with
the effects of depression on their lives.
How Do Antidepressant Medications Work?
Chemicals produced and stored in the brain send messages between the
brain cells ("neurons"). These chemicals, called "neurotransmitters,"
are released by signal-sending neurons.
The neurotransmitters cross the space ("synapse") between the neurons
and deliver signals to the signal-receiving neuron. They act by
attaching to special molecules ("receptors") on the surface of the
signal-receiving cells. Each neurotransmitter has its own special
receptors.
After a neurotransmitter is released from a neuron, the neuron reabsorbs
the neurotransmitter ("reuptake"). When reuptake is blocked, the amount
of neurotransmitter is increased in the synapse. It is believed chat
when the supply of either norepinephrine or serotonin (two important
neurotransmitters) is too low, symptoms of depression can result.
Antidepressant medications that block the reabsorption of
neurotransmitters by the signal-sending neuron can effectively increase
the amount of serotonin or norepinephrine, or both, available in the
synapse.
In general, antidepressant medications work by increasing the amount of
serotonin or norepinephrine, or both, available at the synapses. Each of
the four classes of antidepressant medications does this job slightly
differently.
Tricyclic antidepressants (TCAs)
Antidepressants in this class increase the amount of norepinephrine and
serotonin to varying degrees at the synaptic gap by slowing the rate at
which they are reabsorbed by neurons. At the same time, however, they
also block several other neurotransmitter receptors that play no part in
depression, and it is for this reason that the TCAs produce a relatively
high rate of side effects. Examples of TCAs include imipramine
(Tofranil), amitriptyline (Elavil), desipramine (Norpramin), and
nortriptyline (Pamelor).