Chủ Nhật, 12 tháng 1, 2014

Major Depression

Major Depression Major depression is a serious mental disorder that affects the quality of life impairing the way you feel and think and behave. There will be loss of interest and a feeling of sadness persistently which will eventually cause various physical as well as emotional problems. You may have trouble carrying out routine activities and many times you may feel that life is worthless. Depression is not an acute problem but is type of chronic illness that requires treatment for many more years.


Even the worst type of depression can be overcome by effective treatments like medications and psychological counseling. For some people depression can develop only for certain period and for others it can be life-long.


Symptoms :


Feeling “low” or sad most of the time is the main feature of major depression. Some of the common signs of depression are given below:-


• Feeling worthless every day or feeling guilt for no apparent reason


• Feeling unhappy or sad


• Lack of concentration and impairment in taking decision


• Loss of energy and extreme tiredness daily


• Loss of interest in normal activities that the person enjoyed before


• Insomnia (difficulty in sleeping) or hypersomnia (excessive sleeping patterns)


• Feeling restless or slowed down


• Having repeated thoughts of suicide and death


• Marked weight gain or weight loss within short span of time


• Reduced sex drive


• Getting irritated easily and engaging in frequent angry outbursts


• Crying frequently for no reason


Symptoms may vary from one person to another. Most of them often feel miserable and sad without knowing the reason. Depression will not affect each person in the same way since it differs widely with age, cultural background and gender. In children symptoms of major depression will be avoiding social interaction and getting anger/frustrated very often.


Changes in sleeping pattern, cognitive thinking and difficulty in concentrating are some of the other symptoms. It will cause various behavior problems like aggression, attention deficit disorder and anxiety. In the result they may not be able to complete their schoolwork.


In Adults and Old People :


Most of the time, adults and older people feel that their life is worthless. It can cause loss of appetite, loss of interest in pleasurable activities and can become the root cause for much physical illness. Many people feel reluctant to seek help and hence the disorder goes undiagnosed. They feel helpless and bored in life.


They feel isolated having no friends and never engage in social activities. They do not care for their hygiene and looks. Older men are at the highest risk of committing suicide due to major depression. As many people believe depression symptoms may not get better over time.


Causes :


Exact cause of major depression is not known. It is believed to run in families and can be inherited through genes. Various factors like hereditary, environmental and medical factors are involved I causing depression. It is believed that a person with depression will have tremendous physical changes in his brain. What exactly causes these changes is not known. Neurotransmitters in the brain are responsible for mood behavior and causes major role in depression.


Imbalance in hormone level can trigger thoughts of depression. Women in menopause stage and teenagers in adolescent stage can experience depression symptoms. An inherited trait is also a reason for depression. A person is likely to develop depression if his family members or relative has similar problems. Uncertain events like loss of job, sudden death of loved ones, childhood abuse and heightened stress can trigger depression.


Who are at risk?


Depression occurs in teenage or adolescence largely but it can occur at any age. Women are more prone to develop major depression than men. A person with traumatic childhood experiences, a person with family members having depression, a person facing sudden death of loved ones or stressful events in life, a person who seldom makes friends and stays away from society and a person having serious medical illness (AIDS, cancer, diabetes etc.) is likely to develop depression.


Certain personality traits that cause low self esteem in people can also trigger depression. Certain medications given for managing blood pressure and drugs take for sleeping problems can cause depression. Untreated depression can cause complications in your workplace or school, relationship issues, anxiety, alcohol/substance abuse, social isolation.


Tests :


Many times major depression goes undiagnosed since it is very common. Your doctor may ask you many questions regarding your mood and behavior and he may ask you to complete the questionnaire for detecting the signs of depression. He will collect complete history of the patient from his relatives and friends. He will physically examine the patient for checking his weight, height and other basic functions. He may order for blood culture to eliminate thyroid problems.


Psychological evaluation is done based on the symptoms of depression. According to the Diagnostic and Statistical Manual DSM of mental disorders the patient should have at least some of the symptoms of major depression for over two weeks or more, to be classified under the category of depression. For major depression your doctor will check for symptoms of mania and depression, bipolar disorder, severe changes in routine life, and disturbed relationship with loved ones.


Treatment :


Combined approach of medications and psychotherapy is effective for treating major depression.


Medications :


Antidepressant drugs are prescribed for reducing the symptoms of depression. Some of the commonly available antidepressants are SSRI (Selective Serotonin Reuptake Inhibitor), Serotonin and Nor-epinephrine Reuptake Inhibitors, NDRI, and atypical antidepressants. Medications like Prozac, Paxil, Zoloft and Citalopram falls under SSRI category. Drugs like Cymbalta, Effexor Xr, and Pristiq are some of the commonly used SNRI drugs. Antidepressants like Trazodone, mirtazapine are also given for getting quality sleep. Most of the depression medications have side effects like vomiting, nausea and constipation.


For severe cases Monoamine Oxidase inhibitors like Parnate and Nardil are prescribed if other treatments are not effective. Finding the right drugs is certainly difficult and the doctor will depend on trial and error method for selecting the right set of drugs. For finding the right set of drugs your doctor may order for genetic testing of cytochrome P450 testing to know how well the body can metabolize the given medication.


Antidepressant can cause withdrawal symptoms and hence you need to gradually taper the dose before stopping it. Taking antidepressant drugs during pregnancy can affect child’s health. Certain type of antidepressant drugs can provoke suicidal thoughts initially. Hence it is necessary to monitor the health condition of the patient closely for any change in behavior.


Psychotherapy :


This can be done by a psychologist and the affected person can freely talk with the counselor about his/her feelings. Through repeated sessions, one can understand and explore relationships and find better ways to solve problems. Cognitive behavior therapy CBT is widely used form of psychotherapy. This would help you to get rid of negative beliefs and feelings and replace them with positive ones. You will be able to understand that it is your thought and not other’s action that can cause changes in you.


ECT (Electroconvulsive therapy) is given for treating patients with major depression. This process will affect and make changes in the neurotransmitters of your brain. But it can cause serious side effects like memory loss and confusion of thoughts. ECT is the last option for treating depression if other medications cannot make the desired changes in behavior. In severe cases, the patient is closely monitored by hospitalized setup so that he/she does not endanger his life or harm others.


Lifestyle Changes :


It is possible to overcome major depression since it is not an illness. You need to take regular medications and follow psychotherapy. Stick on to the plan of treatment without skipping any sessions. You can educate yourself about depression to identify what exactly triggers the depressive thoughts in you. Pay attention to certain warning signals.


Practice exercise regimen daily and join a gym or swimming class to keep you active. Avoid smoking and taking alcohol since it can worsen the symptoms. Go to bed in time and take sincere effort to get good sleep. Some people prefer to go for mind body techniques like acupuncture, yoga and meditation therapies for curing depression.


Coping and Support :


It is really challenging to cope with major depression. Discuss openly with your doctor/counselor about developing coping skills. You can simplify your lifestyle and cut down any obligations. Take a break whenever you feel down. Take part in active social groups on internet to share your feelings. Write a journal to express your pain or anger. Become a member with lot of websites that provide you opportunity to read plenty of self help books.


Find support groups in your area and actively get involved with them. Arrange for get together with friends or family. Join a yoga class or gym to boost your self confidence and reduce stress. Take part in sports activities to keep you active and healthy.


Prevention :


You cannot prevent depression if you are inheriting it. However you can take steps to manage stressful events and develop confidence and self esteem. You need to have lot of friends and supporting groups so that you will not break during the time of crisis. It is highly recommended that you should identify the initial symptoms of depression so that you can control it to prevent any major episodes of depression. Make sure that you are taking treatment for long term so that depression does not relapse in your life.


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