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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.
Our DF Members
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Chronic Pain and Depression: A Chicken or the Egg Story
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By Rosalyn Carson-DeWitt, MD
Do patients who are depressed perceive pain more acutely than people who aren’t depressed? Or does chronic pain have a debilitating effect on not just the body, but also the psyche, resulting in depression?
Researchers still don’t know whether there is a cause-and-effect relationship between chronic pain and depression, and if there is, which condition causes the other. Some research suggests that insufficiently treated, ongoing pain may cause changes in the chemical environment of the brain, thereby increasing the likelihood of depression. Similarly, other research suggests that insufficiently treated, ongoing depression causes changes in the chemical environment of the brain such that it increases an individual’s perception of painful sensations.
Who’s at Risk?
Some patients are at increased risk for both chronic pain and depression. For example, women and elderly patients are more likely to report both symptoms of chronic pain and symptoms of major depression. (Older adults, however, tend to report somatic or physical symptoms of depression rather than typical symptoms.) Researchers don’t fully understand why this is true.
Patients whose pain interferes with their independence, their mobility, or their ability to actively participate in their usual social activities are at a particularly high risk for depression.
Symptoms of Chronic Pain and Depression
Certain areas of the body are more likely to cause painful symptoms in patients with both chronic pain and depression. The types of chronic pain most commonly reported by depressed patients include:
* Headache
* Neck and back pain
* Pain in the musculoskeletal system (muscles, bones)
* Stomach pain
* Chest pain
The symptoms that lead to a diagnosis of depression include:
* Low or sad mood
* Inability to enjoy usual activities
* Irritability
* Under- or over-eating
* Difficulty sleeping or sleeping too much
* Difficulty concentrating
* Low energy
* Sense of guilt
* Negative thought patterns
Complications of Chronic Pain and Depression
Both chronic pain and depression interfere with daily functioning at school, at work, and within relationships.
The most serious complication of depression is suicide. Patients who have both chronic pain and depression have a much higher risk of feeling suicidal, acting on those suicidal feelings, and successfully committing suicide. Treatments that both improve depression and relieve chronic pain may decrease the risk of suicide in patients.
Diagnosis of Chronic Pain and Depression
Unfortunately, depression can be a slippery diagnosis. When someone is already suffering from chronic pain, it may seem obvious that some degree of depression is likely. Depression may even worsen the physical symptoms of chronic pain. Similarly, untreated chronic pain may cause a cycle of distress and depression. Diagnosing the presence of both chronic pain and depression may be the first step toward breaking this cycle and improving both pain and depression.
And yet, depression is not an inevitable result of every chronic pain condition. Nor is chronic pain an inevitable result of depression. However, until researchers unravel the complex interactions between depression and chronic pain, it is important that both healthcare providers and patients be aware that these two conditions frequently co-exist. Diagnosing and treating only one of them could result in serious complications, debilitation, or decreased functioning.
A thorough evaluation by your healthcare provider should always include an inquiry into the presence of any chronic pain, as well as screening questions designed to uncover the presence of a mood disorder. A questionnaire called the SF-36 Health Status Survey is particularly helpful at uncovering the dimensions of chronic pain and the presence of depressive symptoms.
Treatment of Chronic Pain and Depression
The good news is that there are medications available that treat both depression and chronic pain. Certain medications traditionally used for depression also have a significant effect on decreasing chronic pain. This association has been tested in individuals who suffer from chronic pain without depression; when these patients are asked to fill out rating scales that describe the intensity of their chronic pain, those patients who are given antidepressants rate their pain as significantly decreased. But these medications are prescribed by your doctor and can have side effects. Consult with your doctor about what would be best for you.
The antidepressant medications that have been successfully used to decrease chronic pain include:
* Tricyclic antidepressants
o Amitryptiline (Elavil)
o Desiprimaine (Norpramin)
o Imipramine (Tofranil)
o Doxepin (Sinequan)
o Nortiptyline (Pamelor)
* Selective serotonin reuptake inhibitors
o Fluoxetine (Prozac)
o Sertraline(Zoloft)
o Paroxetine (Paxil)
o Fluvoxamine (Luvox)
o Citalopram (Celexa)
***Please Note: On March 22, 2004, the Food and Drug Administration (FDA) issued a Public Health Advisory that cautions physicians, patients, families and caregivers of patients with depression to closely monitor both adults and children receiving certain antidepressant medications. The FDA is concerned about the possibility of worsening depression and/or the emergence of suicidal thoughts, especially among children and adolescents at the beginning of treatment, or when there is an increase or decrease in the dose. The medications of concern - mostly SSRIs (Selective Serotonin Re-uptake Inhibitors) - are: Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine), Luvox (fluvoxamine), Celexa (citalopram); Lexapro (escitalopram), Wellbutrin (bupropion), Effexor (venlafaxine), Serzone (nefazodone), and Remeron (mirtazapine). Of these, only Prozac (fluoxetine) is approved for use in children and adolescents for the treatment of major depressive disorder. Prozac (fluoxetine), Zoloft (sertraline), and Luvox (fluvoxamine) are approved for use in children and adolescents for the treatment of obsessive compulsive disorder. For more information, please visit http://www.fda.gov/cder/drug/antidepressants.
* Atypical antidepressants
o Venlafaxine (Effexor)
o Nafazodone (Serzone)
o Trazodone (Desyrel)
o Bupropion (Wellbutrin)
o Mirtazepine (Remeron)
What Else Can I Do?
Psychotherapy, referred to commonly as therapy, in which a person with depression talks to a licensed and trained mental healthcare professional, can also be helpful for patients who are struggling with both chronic pain and depression.
In addition, a variety of other treatments are available that may improve pain and lessen depression, such as:
* Behavioral therapy
* Biofeedback
* Massage
* Occupational therapy
* Yoga
* Stretching
* Relaxation techniques
* Hypnosis
Finally, keeping a pain diary might also help you recognize which interventions help and which situations exacerbate your pain and/or depression. Or, you can try getting involved with a support group, which can put you into contact with other people who are meeting similar challenges. It may also give you an opportunity to learn from the experiences of others, and to share your own coping strategies with people who could use your support.
RESOURCES:
American Academy of Pain Management
http://www.aapainmanage.org
American Pain Foundation
http://www.painfoundation.org
American Pain Society
http://www.ampainsoc.org
References:
Clark, M. Chronic pain, depression and antidepressants: Issues and relationships.
Available at: http://www.hopkins-arthritis.som.jhmi.edu/mngmnt/depression.html
Accessed June 3, 2003.
Gallagher, R. The pain-depression conundrum: Bridging the body and mind. Medscape CME program. Available at: http://www.medscape.com/viewprogram/2030
Accessed June 3, 2003.
Ohayon, MM, Schatzberg, AF. Using chronic pain to predict depressive morbidity in the general population. Arch Gen Psychiatry. 2003;60:39-47.
Accessed June 3, 2003.
Rosack, J. New antidepressants target aches and pains, too. Psychiatric News. 2003:38(8):39.
Accessed June 3, 2003.
Sylvester, B. AAPM: widely used questionnaire spots depression in chronic pain patients.
Available at: http://www.pslgroup.com/dg/22cba6.htm
Accessed June 3, 2003.
Last reviewed January 2006 by Steven Bratman, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
© 2006EBSCO Publishing. All rights reserved.
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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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