Depression And Antidepressants

It's normal to feel depressed following the loss of a loved one or during other sad and stressful situations but this type of despondency tends to gradually diminish and fade away. However, in patients who are clinically depressed, there is usually no obvious precipitating factor. A family history of depression increases risk but how much is genetic as opposed to a behavior learned from contact with depressed relatives may be difficult to determine. Some researchers believe there is a specific depression gene but it seems more likely that multiple genes may be involved in different patients.

We all have our ups and downs so how can you tell if you suffer from clinical depression? The current standards mandate the presence of at least FIVE of the following symptoms and at least ONE of the first two for at least 2 WEEKS:

1. Sad, depressed mood most of the day, nearly every day
2. Anhedonia -a loss of interest and pleasure in activities that are usually enjoyable
3. Difficulties in sleeping or in some patients a desire to sleep a great deal of the time
4. A shift in activity level, becoming either lethargic or agitated
5. Poor appetite and weight loss or increased appetite and weight gain
6. Loss of energy, great fatigue, negative self-concept, feelings of worthlessness and guilt
7. Complaints or evidence of difficulty in concentrating such as slowed thinking and indecisiveness
8. Recurrent thoughts of death and suicide.

To add to the confusion, many of these symptoms may be intermittent or associated with feelings of marked anxiety. Some patients also have mood swings that alternate between deep depression and severe hyperactive behavior, or Manic Depressive Psychosis, now called Bipolar Disorder. People with Seasonal Affective Disorder, appropriately called SAD Syndrome, become depressed during the winter months because of diminished exposure to daylight. Depression is not uncommon after childbirth (post partum depression) or following menopause in what used to be called involutional melancholia. Depression can also be seen in thyroid and certain endocrine disorders, in patients suffering from stroke, Parkinson's and other neurological diseases, inflammatory disorders like lupus and rheumatoid arthritis, various vitamin deficiencies, as a side effect of numerous medications as well as following a heart attack.

Since depression can have so many causes, there are various types of therapies, including: different types of drugs (monoamine oxidase inhibitors, tricyclic and tetracyclic antidepressants, SSRIs (selective serotonin reuptake inhibitors), lithium, light therapy, estrogen, melatonin, amphetamines), supplements (St. Johns wort, Ginkgo biloba, panax Ginseng, SAM-E, fish oils, calcium, folic acid and other B vitamins); psychiatric interventions; psychoanalysis, cognitive restructuring and group therapy; exercise and other stress reduction measures; sleep deprivation; exercise; ultraviolet light; acupuncture; surgery (stereotactic cingulotomy, brain stimulator or vagal stimulation with an implanted device); electroconvulsive therapy (ECT); and new bioelectromagnetic approaches such as cranioelectrical stimulation and repetitive transcranial magnetic stimulation (rTMS).

It's hard to think of any disease for which so many very different treatments are available. This is due to the fact that unless you know what is causing the depression, which is most often the case, we have no clue as to which will prove best for any given patient. As noted, the most popular treatments are SSRI antidepressants like, Prozac, Paxil, Effexor and Zoloft. However, these have recently come under severe criticism because of evidence that placebos are almost or more effective in clinical trials, that serious side effects such as suicide and violent behavior have been concealed and that patients are also not warned of severe reactions when attempts are made to discontinue these drugs. This is especially true in children and teenagers. SSRI's are banned in the UK for those under the age of 18 and similar restrictions or "black box" warnings have been urged in the US. On the other hand, these drugs seem to be superior in the elderly compared to other treatments such as psychotherapy.

You can find out much more about depression and antidepressants at Current and Past Stress Scoops, Current and Past Newsletters, and elsewhere on www.stress.org.