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on: Friday, 08 August 2008 15:06
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QUOTE (Dr_Bunsen_Honeydew @ Jul 6 2008, 12:56 PM) *
Hello. I'm a new member to this site but have been 'researching' here for quite awhile. I just want to say I'm happy i found this website. Like everyone else here I'm looking for answers. I decided to join because maybe some of my experiences can help other people in the same way i was helped by so many posters. Just think it's a great community and really look forward to being a part of it! Thanks
(Dr_Bunsen_Honeydew)
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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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All Depressed Brains Are Not the Same
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From Nancy Schimelpfening
All Depressed Brains Are Not the Same
Very often I am asked to recommend a good antidepressant. My answer, other than the obvious, "Please see your doctor for medical advice", is this: "the one that works for you"!
Each class of antidepressant works on your brain chemistry in a different way. Dr. Abbott Lee Granoff, a noted expert in the field of panic disorder and depression, says the following: "There are currently 23 antidepressants on the market (Guide Note: this figure is for the US only. There are some antidepressants available in other countries which are not approved for use in the US). Each increases certain neurotransmitters in the brain and each can do this in slightly different parts of the brain."1 So, while one person may get relief from having their serotonin boosted, another may need a drug that affects both serotonin and norepinephrine. Still another person may need an entirely different sort of medication, such an anticonvulsant or a mood stabilizer like lithium. Further, a person who does well on a medication such as Zoloft may not do as well on Prozac, even though both belong to the same class.2 Each person will be very different in their medication needs.
Just like the wide variety of brains, there are a wide variety of antidepressants. Broadly speaking, these fall into the following classes: monoamine oxidase inhibitors (MAOIs), tricyclics (TCAs) and selective serotonin reuptake inhibitors (SSRIs). There are also several newer medications that are unique in their mechanism of action.
Monoamine Oxidase Inhibitors
The monoamine oxidase inhibitors (MAOIs) were some of the first antidepressant medications developed. The neurotransmitters responsible for mood, primarily norepinephrine and serotonin, are also known as monoamines. Monoamine oxidase is an enzyme which breaks these substances down. Monoamine oxidase inhibitors, as the name implies, inhibits this enzyme, thus allowing a greater supply of these chemicals to remain available.
MAOIs have fallen out of favor as first-line antidepressants because they offer several disadvantages to patients compared to newer medications. Potentially fatal drug-drug interactions can occur with MAOIs when combined with a variety of drugs which are serotonin agonists (the "serotonin syndrome") or norepinephrine agonists.3 People on these medications must also follow strict dietary restrictions of foods rich in tyramine4 to avoid potential hypertensive (high blood pressure) crisis. A major adverse effect that occurs on MAOIs alone is hypotension (low blood pressure), which can present as fatigue and may mimic worsening of the underlying depressive syndrome. For this reason, the blood pressure should always be monitored when using these antidepressants.5
Tricyclics
Tricyclics, also known as heterocyclics, came into broad use in the 1950's. These drugs inhibit the nerve cell's ability to reuptake serotonin and norepinephrine, thus allowing a greater amount of these two substances to be available for use by nerve cells.
In addition to acting on norepinephrine and serotonin, tricyclics exhibit similar effects on histamine and acetylcholine. This is responsible for the troublesome side-effects we usually associate with these medications, such as dry mouth, blurry vision, weight gain and sedation.6
With tricyclics, a patient's medical history must be closely considered. These medications may cause orthostatic hypotension (dizziness upon standing); rapid heartbeat, sometimes with palpitations; and may aggravate preexisting heart conditions. Patients with a history of seizures or head injury must also be cautious as these drugs may cause seizure.7
Selective Serotonin Reuptake Inhibitors
Claims of decreased side-effects and increased safety relative to the older medications have made this class of antidepressant very popular in recent years. Five drugs currently belong to this class: fluoxetine (Prozac), citalopram (Celexa), fluvoxamine (Luvox), sertraline (Zoloft), and paroxetine (Paxil).
SSRI stands for Selective Serotonin Reuptake Inhibitor. These medications work, as the name implies, by blocking the presynaptic serotonin transporter receptor.8 This drug differs from the tricyclics in that it's action is specific to serotonin only. It's effect on norepinephrine is indirect, through the fact that falling serotonin "permits" norepinephrine to fall so preserving serotonin preserves norepinephrine.9
SSRIs, through their specificity, have the advantage of not affecting histamine and acetylcholine. The implication is that although they are not without side-effects, they do not create the same bothersome side-effects as the tricyclics.
Newer Mechanisms
Five newer medications which do not fit into the above categories are: buproprion (Wellbutrin), nefazodone (Serzone), trazodone (Desyrel), venlafaxine (Effexor), and mirtazapine (Remeron).
The mechanism of bupropion's antidepressant activity is poorly understood, but is thought to be mediated through noradrenergic or dopaminergic pathways or both.10 This medication lacks the sexual side-effects so common to the SSRIs and is popular for patients who exhibit a lack of energy, psychomotor slowness and excessive sleep.
Nefazodone and it's precursor trazodone both inhibit neuronal reuptake of serotonin and, to a lesser extent, norepinepherine. They also blocks postsynaptic 5-HT2 receptors. Nefazodone has weak affinity for cholinergic and a1- adrenergic receptors and, therefore, is associated with less sedation and orthostasis than trazodone.11
Venlafaxine is a compound that is structurally unrelated to other antidepressants.12 Like the TCAs, venlafaxine inhibits the neuronal uptake of both serotonin and norepinepherine. Venlafaxine has dose-dependent, sequential effects on the uptake pumps for serotonin and then norepinephrine.. At 75 mg/day, venlafaxine is predominantly a serotonin reuptake inhibitor (SRI) like the SSRIs. At 375 mg/day, it produces comparable norepinephrine uptake inhibition to an NSRI such as desipramine.13
Mirtazapine is the most recently released of these four and is the first a2-antagonist marketed as an antidepressant.14 Mirtazapine's unique mechanism of action does not involve enzyme inhibition or blockade of neurotransmitter reuptake. Mirtazapine increases the release of norepinepherine from central noradrenergic neurons by blocking the presynaptic inhibitory alpha-2 autoreceptors. It spares the alpha-1 postsynaptic receptor and therefore results in net increase noradrenergic transmission. As a second presynaptic receptor blocking function, mirtazapine blocks the inhibitory alpha-2 heteroreceptors located on serotonergic neurons, resulting in increase release of serotonin. Postsynaptically, mirtazapine has low affinity for the 5-HT1A receptor, thus allowing serotonin released into the synapse to bind to and stimulate this receptor. However, it blocks postsynaptic 5-HT2 and 5-HT3 receptors. Stimulation of the 5-HT2 receptor is thought to be responsible for the serotonergic side effects of insomnia, agitation, and sexual dysfunction seen with the SSRI's and 5-HT3 receptor stimulation is thought to mediate nausea seen with these agents.15, 16, 17 Therefore, mirtazapine's receptor blocking profile prevents the side-effects seen with nonselective activation of serotonin receptors which occurs with pure reuptake blockers.
Source: About.com
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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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