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Depression

Definition

Depression is a medical condition that leads to intense feelings of sadness or despair. These feelings do not go away by themselves. They are not necessarily related to a particular life event.

What is going on in the body?

Depression is a disorder of the brain. Researchers believe that chemicals called neurotransmitters are involved in depression. Nerve impulses cause the release of neurotransmitters from one nerve cell to the next. This release allows cells to communicate with one another. Too little or too much of these important neurotransmitters may be released and cause or contribute to depression. Some of the neurotransmitters believed to be linked to depression are serotonin, norepinephrine, and dopamine.
Some of the common types of depression are:
  • Bipolar disorder: Also called manic depression, bipolar disorder is a type of depression that has either subtle or extreme "high" periods alternating with "low" periods of depression for years.
  • Dysthymia: This type of chronic depression is characterized by ongoing symptoms of depression.
  • Major depressive disorder: This type of clinical depression is characterized by a severe lack of interest in the things that were once enjoyed or nonstop feelings of sadness.
  • Seasonal affective disorder: This type of depression occurs seasonally and is caused by lack of sunlight.
  • Adjustment affective disorder. This type of depression usually occurs after a major loss or negative change in a person's life.

Risks

What are the causes and risks of the condition?

There are many theories about what causes depression. Depression may be caused by any of these things:
  • certain illnesses
  • certain medicines, including antibiotics and medicines used to treat acne
  • changes in brain chemicals
  • heredity
  • hormonal changes
  • lack of sunlight
  • major stresses
  • negative thinking patterns
Risk factors for depression include:
  • alcohol abuse
  • drug abuse and addiction
  • job strain
  • personal history of a suicide attempt
  • personal or family history of depression
  • stress
Risk factors for depression can also be specific to an age group, such as children, adolescents, and seniors. Women who have just given birth may be at risk for postpartum depression.

Prevention

What can be done to prevent the condition?

Depression may not be preventable. However, some of these steps may be helpful in preventing it:
  • avoiding alcohol and illegal drugs
  • avoiding cigarette smoking
  • getting prompt treatment for other psychiatric disorders
  • seeking effective treatment for chronic diseases
  • talking with a counselor after experiencing a major trauma
Depression can lead to suicide. The lifetime risk of suicide for a person with depression is about 15 percent. It is important to recognize and treat the condition early. Individuals should be encouraged to seek help from a physician, licensed counselor or psychologist if they are concerned about depression. Conversations with clergy members, trusted friends, and family members are important and very helpful, but do not substitute for the clinical care needed to treat depression.

Diagnosed

How is the condition diagnosed?

Screening tests for depression include:
  • the Beck Depression Inventory (BDI)
  • the Center for Epidemiologic Studies Depression (CES-D) Scale
  • the Children's Depression Inventory (CDI)
  • the Zung Depression Scale
  • the Hamilton Depression Scale
A person who screens positively on one of these tests should have a comprehensive evaluation for depression. The evaluation may include a medical history, physical examination, and laboratory tests.

Long Term Effects

What are the long-term effects of the condition?

With adequate treatment, many people recover from depression. Some people experience it only once in their lives. Others have periodic bouts of depression.
If depression is not effectively treated, a person can experience serious difficulties in every area of life. Depression often hurts relationships. It also impairs work or academic performance. In some cases, it leads to suicide.
People with depression are at higher risk for many chronic diseases and conditions, including:
  • coronary artery disease
  • heart attack
  • personality disorders
  • stroke

Other Risks

What are the risks to others?

Depression is not contagious. Depression tends to run in families.

Treatments

What are the treatments for the condition?

The two most common ways of treating depression are with antidepressant medicines and psychotherapy. Often a combination is used. Occasionally, a person must be hospitalized for intense treatment or for his or her own safety.
Antidepressant medicines are effective in:
  • increasing the person's ability to function in daily life
  • lowering the risk of suicide
  • making the person feel better
The following types of medicines are used to treat depression:
  • selective serotonin reuptake inhibitors (SSRIs), including paroxetine HCl (i.e., Paxil, Pexeva) and fluoxetine HCl (i.e., Prozac, Serafem)
  • monoamine oxidase inhibitors (MAOIs), such as phenelzine sulfate (i.e., Nardil) and tranylcypromine sulfate (i.e., Parnate)
  • other antidepressants, such as nefazodone (i.e., Serzone) and venlafaxine (i.e., Effexor)
  • tetracyclic antidepressants, such as maprotiline HCl and mirtazapine (i.e., Remeron)
  • tricyclic antidepressants (TCAs), including amitriptyline, nortriptyline HCl (i.e., Aventyl, Pamelor) and desipramine HCl (i.e., Norpramin).
Psychotherapy can help people:
  • cope better with having depression
  • feel less alone
  • improve relations with family, friends, and coworkers
  • learn about depression and how it affects them
  • learn to recognize and avoid situations that can bring on a depressive episode
  • learn to view the world and others more positively and more realistically
  • positively address problems that they may be facing
  • stop episodes of depression early by recognizing warning signs and symptoms

Side Effects

What are the side effects of the treatments?

Antidepressants may cause mild and usually temporary side effects in some people. The most common side effects are:
  • agitation
  • constipation
  • dizziness
  • drowsiness
  • insomnia
  • dry mouth
  • nausea

After Treatment

What happens after treatment for the condition?

An individual can help prevent relapses by living a healthy lifestyle. Some important parts of the healthy lifestyle include:
  • avoiding alcohol, illegal drugs, and smoking
  • doing regular exercise
  • eating a balanced diet, following the food guide pyramid
  • finding a support system for dealing with depression
  • finding ways to manage stress
  • getting enough rest

Monitor

How is the condition monitored?

Once a person has an episode of depression, he or she is at higher risk for further episodes. Any new or worsening symptoms should be reported to the healthcare provider. The provider may recommend regular visits to monitor symptoms. The provider may also order blood tests to monitor the levels of medicines.

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