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on: Friday, 20 November 2009 20:12
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Depression & Mental Health FAQs
US Centers for Disease Control and Prevention (CDC) estimated 40 million Americans living today will suffer from major depressive illness during their lives. Seasonal affective disorder is major depression that appears in the fall or winter and goes away in spring, thought to be caused by lack of sunlight.
Postpartum depression occurs within four weeks of a women giving childbirth. Most new mothers suffer from some form of the �baby blues.� Postpartum depression, by contrast, is major depression, thought to be triggered by changes in hormonal flows associated with childbirth. Catatonic depression is a rare form of major depression characterized by (at least two): Stupor, excessive motor activity, extreme negativism, peculiarities in voluntary movement, and repetition of other people's words or actions. - mcmanweb.com
Psychotic depression is a rare form of depression characterized by delusions or hallucinations, such as believing you are someone you are not and hearing voices.
According to the National Institute of Mental Health, approximately 18.8 million American adults, or about 9.5 percent of the US population age 18 and older in a given year, have a depressive disorder. Depression is a chronic illness that exacts a significant toll on
America's health and productivity. It affects more than 21 million
American children and adults annually and is the leading cause of
disability in the United States for individuals ages 15 to 44.
Lost productive time among U.S. workers due to depression is estimated
to be in excess of $31 billion per year. Depression frequently
co-occurs with a variety of medical illnesses such as heart disease,
cancer, and chronic pain and is associated with poorer health status
and prognosis. It is also the principal cause of the 30,000 suicides
in the U.S. each year. In 2004, suicide was the 11 th leading cause of death in the United States, third among individuals 15-24.
According to the World Health Organization, depression is presently on track to becoming the world's second-most disabling disease (after heart disease) by the year 2020. Depression is responsible for some $87 billion a year in lost productivity in the US (a conservative estimate), and according to Bank One, is responsible for most lost work days in its employees after pregnancy and childbirth. Additionally, one million people worldwide die by their own hand, most as a result of a mood disorder. Finally, the linkage between depression and a host of physical illnesses makes it arguably the world's greatest killer.
Research presented at the 56th Annual Conference of the Canadian
Psychiatric Association shows a marked link between bipolar disorder
and migraines. The odds of migraine in persons with bipolar disorder were 40% higher than the general population. Data
obtained from 36,984 people aged 15 and over, who screened positive for
manic or depressive episodes with migraine, were compared against those
who screened positive for mania but who didn�t suffer from migraines. Amongst
males, 14.9% of those with manic episodes were also diagnosed with
migraines compared with 5.8% of the general population. Amongst
females, 34.7% had both migraines and bipolar disorder compared with
14.7% who only had migraines.unquote.gif While the research was
skewed towards persons who were already diagnosed with bipolar
disorders, what does it mean for people who suffer from migraines but
who may have an undiagnosed bipolar disorder?
Migraines and headaches aren�t fully understood but the manifestations are very real and debilitating for their sufferers: Throbbing pain Nausea Heightened sensitivity to light or sound Seeing dots, wavy lines, flashing lights, or blind spots Difficulty with speech, sensation, or movement
An estimated 2.1 million
American adolescents have experienced major depression within the last
year, according to a new comprehensive government study. Researchers
surveyed more than 67,000 young people ages 12 to 17 and found that one
in 12 had suffered from serious depression in the previous year.Nearly
13 percent of girls had struggled with depression, compared to less
than 5 percent of boys. Odds of depression increased with age -- just 4
percent of 12-year-olds experienced depression but that climbed to 11
percent for older teens.
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Seasonal Affective Disorder (SAD)
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Seasonal affective disorder (SAD)
Seasonal affective disorder (also called SAD) is a type of depression that occurs at the same time every year. If you're like most people with seasonal affective disorder, your symptoms start in the fall and may continue into the winter months, sapping your energy and making you feel moody. Less often, seasonal affective disorder causes depression in the spring or early summer.
Don't brush off that yearly feeling as simply a case of the "winter blues" or a seasonal funk that you have to tough out on your own — you may have seasonal affective disorder. Treatment for seasonal affective disorder includes light therapy (phototherapy), psychotherapy and medications. Addressing the problem can help you keep your mood and motivation steady throughout the year.
Symptoms
Seasonal affective disorder is a cyclic, seasonal condition. This means that signs and symptoms come back and go away at the same time every year. Usually, seasonal affective disorder symptoms appear during late fall or early winter and go away during the sunnier days of spring and summer. Some people have the opposite pattern and become depressed with the onset of spring or summer. In either case, problems may start out mild and become more severe as the season progresses.
Fall and winter seasonal affective disorder (winter depression)
Winter-onset seasonal affective disorder symptoms include:
* Depression
* Hopelessness
* Anxiety
* Loss of energy
* Social withdrawal
* Oversleeping
* Loss of interest in activities you once enjoyed
* Appetite changes, especially a craving for foods high in carbohydrates
* Weight gain
* Difficulty concentrating and processing information
Spring and summer seasonal affective disorder (summer depression)
Summer-onset seasonal affective disorder symptoms include:
* Anxiety
* Trouble sleeping (insomnia)
* Irritability
* Agitation
* Weight loss
* Poor appetite
* Increased sex drive
Reverse seasonal affective disorder
In some people, spring and summer can bring on symptoms of mania or a less intense form of mania (hypomania). These can include elevated mood, agitation, and rapid thoughts and speech. Reverse seasonal affective disorder is a form of bipolar disorder.
Signs and symptoms of reverse seasonal affective disorder include:
* Persistently elevated mood
* Increased social activity
* Hyperactivity
* Unbridled enthusiasm out of proportion to the situation
When to see a doctor
It's normal to have some days when you feel down. But if you feel down for days at a time and you can't seem to get motivated to do activities you normally enjoy, see your doctor. This is particularly important if you notice that your sleep patterns and appetite have changed or if you feel hopeless, think about suicide, or find yourself turning to alcohol for comfort or relaxation.
Causes
The specific cause of seasonal affective disorder remains unknown. It's likely, as with many mental health conditions, that genetics, age and, perhaps most importantly, your body's natural chemical makeup all play a role in developing the condition. A few specific factors that may come into play include:
* Your biological clock (circadian rhythm). The reduced level of sunlight in fall and winter may disrupt your body's internal clock, which lets you know when you should sleep or be awake. This disruption of your circadian rhythm may lead to feelings of depression.
* Melatonin levels. The change in season can disrupt the balance of the natural hormone melatonin, which plays a role in sleep patterns and mood. Talk to your doctor to see whether taking melatonin supplements is a good option.
* Serotonin levels. A drop in serotonin, a brain chemical (neurotransmitter) that affects mood, might play a role in seasonal affective disorder. Reduced sunlight can cause a drop in serotonin, perhaps leading to depression.
Factors that may increase your risk of seasonal affective disorder include:
* Being female. Some studies show that seasonal affective disorder is diagnosed more often in women than in men, but that men may have more-severe symptoms.
* Living far from the equator. Seasonal affective disorder appears to be more common among people who live far north or south of the equator. This may be due to decreased sunlight during the winter, and the longer days of summer.
* Family history. As with other types of depression, some studies have shown that people with seasonal affective disorder are more likely to have blood relatives with the condition.
Complications
Take signs and symptoms of seasonal affective disorder seriously. As with other types of depression, seasonal affective disorder can worsen and lead to problems if it's not treated. These can include:
* Suicidal thoughts or behavior
* Social withdrawal
* School or work problems
* Substance abuse
Treatment can help prevent complications, especially if seasonal affective disorder is diagnosed and treated before symptoms get bad.
Preparing for your appointment
You're likely to start by first seeing your family doctor or a general practitioner. Or, you may start by seeing a mental health provider such as a psychiatrist or psychologist.
Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.
What you can do:
* Record your symptoms so that you can tell your doctor or mental health provider exactly what they are (feeling down or lack of energy, for example).
* Write information about your depression patterns, such as when your depression starts and what seems to make it better or worse.
* Make a note of any other mental or physical health problems you have, as both can affect mood.
* Write down any major stressors or life changes you've had recently.
* Make a list of all medications, as well as any vitamins or supplements, that you're taking.
* Write down questions to ask your doctor.
Your time with your doctor is limited, so preparing a list of questions ahead of time will help you make the most of your time together. List your questions from most important to least important in case time runs out. For seasonal affective disorder, some basic questions to ask your doctor include:
* Are my symptoms most likely caused by seasonal affective disorder?
* What else could be causing or worsening my symptoms of depression?
* What are the best treatment options?
* Are there any restrictions that I need to follow or steps I should take to help improve my mood?
* Should I see a psychiatrist, psychologist or other mental health provider? What will that cost, and will my insurance cover seeing a specialist?
* Is there a generic alternative to the medicine you're prescribing me?
* Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend visiting?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:
* What are your symptoms?
* When did you first begin having symptoms?
* Have your symptoms been continuous or occasional?
* How severe are your symptoms?
* What, if anything, seems to improve your symptoms?
* What, if anything, appears to worsen your symptoms?
* Do you have any other physical or mental health conditions?
* Are you taking any herbal remedies or medications?
* Do you use alcohol or drugs?
* Do any of your blood relatives have seasonal affective disorder or another mental health condition?
Tests and diagnosis
To help diagnose seasonal affective disorder, your doctor or mental health provider will do a thorough evaluation, which generally includes:
* Detailed questions. Your doctor or mental health provider may ask about your mood, seasonal changes in your thoughts and behavior, your lifestyle and social situation, and sleeping and eating patterns, for example. You may also fill out psychological questionnaires.
* Physical exam. Your doctor or mental health provider may do a physical examination to check for any underlying physical issues that could be linked to your depression.
* Medical tests. There's no medical test for seasonal affective disorder, but if your doctor suspects a physical condition may be causing or worsening your depression, you may need blood tests or other tests to rule out an underlying problem.
Seasonal affective disorder is considered a subtype of depression or bipolar disorder. Even with a thorough evaluation, it can sometimes be difficult for your doctor or mental health provider to diagnose seasonal affective disorder because other types of depression or mental health conditions may mimic seasonal affective disorder.
To be diagnosed with seasonal affective disorder, you must meet criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health professionals to diagnose mental conditions and by insurance companies to reimburse for treatment.
The following criteria must be met for a diagnosis of seasonal affective disorder:
* You've experienced depression and other symptoms for at least two consecutive years, during the same season every year.
* The periods of depression have been followed by periods without depression.
* There are no other explanations for the changes in your mood or behavior.
Expand Arrow DownTreatments and drugs
Treatment for seasonal affective disorder may include light therapy, medications and psychotherapy.
Light therapy
In light therapy, also called phototherapy, you sit a few feet from a specialized light therapy box so that you're exposed to bright light. Light therapy mimics outdoor light and appears to cause a change in brain chemicals linked to mood. This treatment is easy to use and seems to have few side effects.
Although light therapy is widely used and appears to be helpful, it isn't clear how light therapy works and how effective it is in treating seasonal affective disorder. Before you purchase a light therapy box or consider light therapy, talk to your doctor or mental health provider to make sure it's a good idea and to make sure you're getting a high-quality light therapy box.
Medications
Some people with seasonal affective disorder benefit from treatment with antidepressants, especially if symptoms are severe. Medications commonly used to treat seasonal affective disorder include:
* Bupropion. An extended-release version of the antidepressant bupropion (Wellbutrin XL) may help prevent depressive episodes in people with a history of seasonal affective disorder.
* Other antidepressants. Antidepressants commonly used to treat seasonal affective disorder include paroxetine (Paxil), sertraline (Zoloft), fluoxetine (Prozac, Sarafem) and venlafaxine (Effexor).
Your doctor may recommend starting treatment with an antidepressant before your symptoms typically begin each year. He or she may also recommend that you continue to take antidepressant medication beyond the time your symptoms normally go away.
Keep in mind that it may take several weeks to notice full benefits from an antidepressant. In addition, you may have to try several different medications before you find one that works well for you and has the fewest side effects.
Psychotherapy
Psychotherapy is another option to treat seasonal affective disorder. Although seasonal affective disorder is thought to be related to biochemical processes, your mood and behavior also can add to symptoms. Psychotherapy can help you identify and change negative thoughts and behaviors that may be making you feel worse. You can also learn healthy ways to cope with seasonal affective disorder and manage stress.
Lifestyle and home remedies
Especially if your seasonal depression symptoms are severe, you may need medications, light therapy or other treatments to manage seasonal affective disorder. However, there are some measures you can do on your own that may help, such as:
* Make your environment sunnier and brighter. Open blinds, add skylights and trim tree branches that block sunlight. Sit closer to bright windows while at home or in the office.
* Get outside. Take a long walk, eat lunch at a nearby park, or simply sit on a bench and soak up the sun. Even on cold or cloudy days, outdoor light can help — especially if you spend some time outside within two hours of getting up in the morning.
* Exercise regularly. Physical exercise helps relieve stress and anxiety, both of which can increase seasonal affective disorder symptoms. Being more fit can make you feel better about yourself, too, which can lift your mood.
Alternative medicine
Several herbal remedies, supplements and mind-body techniques are commonly used to relieve depression symptoms. It's not clear how effective these treatments are for seasonal affective disorder, but there are several that may help. Keep in mind, alternative treatments alone may not be enough to relieve your symptoms. Some alternative treatments may not be safe if you have other health conditions or take certain medications.
Nutritional and dietary supplements used to treat depression include:
* St. John's wort. This herb has traditionally been used to treat a variety of problems, including depression. It may be helpful if you have mild or moderate depression.
* SAMe. This is a synthetic form of a chemical that occurs naturally in the body. SAMe hasn't been approved by the Food and Drug Administration to treat depression in the United States. However, it's used in Europe as a prescription drug to treat depression.
* Melatonin. This natural hormone helps regulate mood. A change in the season may change the level of melatonin in your body. Some people try taking melatonin supplements, but discuss this with your health care provider first before doing so.
* Omega-3 fatty acids. Omega-3 fatty acid supplements have been shown to relieve depression symptoms in some studies. Sources of omega-3s include fatty, cold-water fish, such as salmon, mackerel and herring. Flaxseed, flax oil and walnuts also contain omega-3 fatty acids, and small amounts are found in soybean and canola oils.
SAMe and St. John's wort can interact with medications for other conditions, especially antidepressants. Talk to your doctor before trying either of these remedies to make sure they're safe for you.
Mind-body therapies that may help relieve depression symptoms include:
* Acupuncture
* Yoga
* Meditation
* Guided imagery
* Massage therapy
Coping and support
You can take action to cope with seasonal affective disorder. Here are tips to help you manage the condition:
* Stick to your treatment plan. Take medications as directed and attend therapy appointments as scheduled.
* Take care of yourself. Get enough rest. Eat regular, healthy meals. Take time to relax. Don't turn to alcohol or unprescribed drugs for relief.
* Practice stress management. Learn how to manage your stress better. Unmanaged stress can lead to depression, overeating, or other unhealthy thoughts and behaviors.
* Socialize. When you're feeling down, it can be hard to be social. Make an effort to connect with people you enjoy being around. They can offer support, a shoulder to cry on or a joke to give you a little boost.
* Take a trip. If possible, take winter vacations in sunny, warm locations if you have winter seasonal affective disorder or to cooler locations if you have summer seasonal affective disorder.
Prevention
There's no known way to prevent the development of seasonal affective disorder. However, if you take steps early on to manage symptoms, you may be able to prevent them from getting worse over time. Some people find it helpful to begin treatment before symptoms would normally start in the fall or winter, and then continue treatment past the time symptoms would normally go away. If you can get control of your symptoms before they get worse, you may be able to head off serious changes in mood, appetite and energy levels.
©1998-2009 Mayo Foundation for Medical Education and Research (MFMER).
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Depression & Mental Health FAQs 2
What is Clinical Depression? Clinical
depression can affect your body, mood, thoughts, and behavior. It can
change your eating habits, how you feel and think about things, your
ability to work and study, and how you interact with people. Clinical
depression is not a passing mood, a sign of personal weakness or a
condition that can be willed away. Clinically depressed people cannot
"pull themselves together" and get better. Depression can be
successfully treated by a mental health professional or certain health
care providers. With the right treatment, 80 percent of those who seek
help get better. And many people begin to feel better in just a few
weeks.
Depression a Big Factor in Poor Health World Health Organization Finds Depression Often Goes Untreated By Salynn Boyles WebMD Medical News Reviewed by Louise Chang, MD Sept.
6, 2007 -- Depression has a greater impact on overall health than
arthritis, diabetes, angina, and asthma, but it all too often goes
unrecognized and untreated, a report from the World Health Organization
(WHO) suggests. more... Depression a Big Factor in Poor Health
For Additional Information About Depression Write To: The National Institute of Mental Health (NIMH)6001 Executive Boulevard, Room 8184, MSC 9663 Bethesda, MD 20892-9663
For free brochures on depression and its treatment call: 1-800-421-4211. or visit: http://www.nimh.nih.gov
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