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  1. Symptoms, Causes and Diagnosis Symptoms Depression can be difficult to detect from the outside looking in, but for those who experience major depression, it is disruptive in a multitude of ways. The symptoms of clinical depression usually represent a significant change in how a person functions. Sometimes individuals become so discouraged and hopeless that death seems preferable to life. These feelings can lead to suicidal ideation, attempts and death by suicide. The following are key areas where depression causes major changes in people. Changes in sleep. Many people experience difficulty in falling asleep, waking throughout the night and/or awakening an hour to several hours earlier than desired in the morning. Other people experiencing depression will sleep excessively–for much longer than they used to.Changes in appetite. Many people in the midst of depression experience a decrease in appetite, and sometimes, noticeable weight loss. Some people eat more, sometimes resulting in weight gain.Poor concentration. The inability to concentrate and/or make decisions is a scary aspect of depression. During a severe depression, many people cannot follow the thread of a simple newspaper article or the plot of a 30-minute TV show. Major decision-making is often impossible. This leads depressed individuals to feel as though they are literally losing their minds.Loss of energy. The loss of energy and profound fatigue often affects people living with depression. Mental speed and activity are usually reduced, as is the ability to perform normal daily routines. If you are living with depression, you will likely find that you response to your environment much more slowly.Lack of interest. During depression, people feel sad and lose interest in usual activities. You might even lose the capacity to experience pleasure. For instance, eating and sex are often no longer appealing. Formerly enjoyable activities seem boring or unrewarding during depression and the ability to feel and offer love may be diminished or lost.Low self-esteem. During periods of depression, people dwell on memories of losses or failures and feel excessive guilt and helplessness. “I am a loser” or “the world is a terrible place” may take over and increase the risk of suicide.Hopelessness or guilt. The symptoms of depression often come together to produce a strong feeling of hopelessness, or a belief that nothing will ever improve. These feelings can lead to thoughts of suicide.Movement changes. People who are depressed may literally look “slowed down” and physically depleted or, alternatively, activated and agitated. For example, a depressed person may awaken very early in the morning and pace the floor for hours.Causes The general scientific understanding is that depression does not have a single cause; it arises from multiple factors that may need to occur simultaneously. A person’s life experience, genetic inheritance, age, sex, brain chemistry imbalance, hormone changes, substance abuse and other illnesses all play significant roles in the development of a depression. It also may be that there is no observable trigger leading to the illness; depression may occur spontaneously and be unassociated with any life crisis, physical illness or other currently known risks. Our current understanding is that major depression can have many causes and develop from a variety of genetic pathways. The occurrence of mood disorders and suicides tend to run in families. However, your genetic inheritance is only one factor. Identical twins share 100 percent of the same genes, but both identical twins develop depression only about 30 percent of the time. Some proposed genetic pathways in the development of depression include changes observed in the regional brain functioning. For instance, imaging studies have shown consistently that the left, front portion of the brain becomes less active during depression. Also, brain patterns during sleep change in a characteristic way during depression. Depression is also associated with changes in how the pituitary gland and hypothalamus respond to hormone stimulation. Additional factors that have been linked to depression include a history of sleep disturbances, medical illness, chronic pain, anxiety, attention-deficit hyperactivity disorder, and alcoholism or drug abuse. We know that a biologically inherited tendency to develop depression is associated with a younger age of depression onset, and that new onset depression occurring after age 60 is less likely due to genetic predisposition. Life factors and events seem to influence whether an inherited, genetic tendency to develop depression will ever lead to an episode of major depression. Certain aspects of life, such as marital status, financial standing and where a person lives, do have some bearing on whether someone develops depression, but it can be a case of “the chicken or the egg.” For instance, though depression is more common in people who are homeless, it may be that the depression strongly influences why any given person becomes homeless. We also know that long-lasting stressors like unemployment or a difficult marriage play a more significant role in developing depression than sudden stressors like an argument or receiving bad news. Traumatic experiences may not only contribute to one’s general state of stress, but also seem to alter how the brain functions for years to come. Early-life traumatic experiences have been shown to cause long-term changes in how the brain responds to future fears and stresses. This may be what accounts for the greater lifetime incidence of major depression in people who have a history of significant childhood trauma. Other proposed genetic pathways in the development of depression include changes observed in the regional brain functioning. For instance, imaging studies have shown consistently that the left, front portion of the brain becomes less active during depression. Also, brain patters during sleep change in a characteristic way. Depression is also associated with changes in how the pituitary gland and hypothalamus respond to hormone stimulation. Other factors that have been linked to depression include a history of sleep disturbances, medical illness, chronic pain, anxiety, attention-deficit hyperactivity disorder, alcoholism or drug abuse. Our current understanding is that major depression can have many causes and develop from a variety of genetic pathways. Diagnosis The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) is the current reference used by health care professionals to diagnose mental illnesses such as depression. This manual was first published in 1952 and has since gone through several revisions. The current edition was published in 1994 and lists over 200 mental health conditions and the criteria required for each one in making an appropriate diagnosis. In the DSM-IV, depression is classified as a mood disorder. The DSM-IV's criteria for a major depressive episode (which needs to last longer than two weeks) include: Major Depressive Episode Depressed mood (such as feelings of sadness or emptiness). Reduced interest in activities that used to be enjoyed. Change in appetite or weight increase/decrease. Sleep disturbances (either not being able to sleep well or sleeping too much). Feeling agitated or slowed down. Fatigue or loss of energy. Feeling worthless or excessive guilt. Difficulty thinking, concentrating or troubles making decisions. Suicidal thoughts or intentions.There is a strong possibility that a depressive episode can be a part of bipolar disorder. Having a physician make the right distinction between unipolar and bipolar disorder is critical because treatments for these two depressive disorders differ. The use of antidepressants, the cornerstone of treatment of major depression can sometimes activate manic symptoms or even worsen depressive symptoms, including suicidal thinking, in people with bipolar depression. At the same time, antidepressants do not appear to be particularly effective for treating bipolar depression. In major depression associated with bipolar disorder, mood stabilizers and psychosocial treatments-not antidepressants-have a strong evidence base and can often be effective. Speaking with a mental health care provider can help guide this process.
  2. Today in JAMA Pediatrics, researchers from The Children's Hospital of Philadelphia's (CHOP) PolicyLab published the largest study to date documenting the significant risks to children's health associated with prescription antipsychotics, a powerful a class of medications used to treat mental and behavioral health disorders. The results suggest that initiating antipsychotics may elevate a child's risk not only for significant weight gain, but also for type II diabetes by nearly 50 percent; moreover, among children who are also receiving antidepressants, the risk may double. Previous PolicyLab research showed that one in three youth receiving antidepressants in the Medicaid program were receiving an antipsychotic at the same time. Traditionally, antipsychotics have been narrowly prescribed to children with a diagnosis of schizophrenia or bipolar disorder, or to those with significant developmental delays who were displaying aggressive behaviors that were potentially injurious to themselves or others. However, in recent years, these medications are increasingly being prescribed in the absence of strong supporting safety and efficacy data to treat healthier children and adolescents with disruptive behaviors, such as those who are diagnosed with attention deficit hyperactivity disorder (ADHD). The new study, which used national Medicaid data on more than 1.3 million youth ages 10 to 18 with a mental health diagnosis from the Centers for Medicare and Medicaid Services, must be interpreted in the context of emerging evidence that Medicaid-enrolled children are far more likely than privately insured children to be prescribed antipsychotic medications. Overall, over 25 percent of Medicaid-enrolled children receiving prescription medications for behavioral problems were prescribed antipsychotics by 2008, largely for less severe disorders. "With such vast numbers of children being exposed to these medications, the implications for potential long-lasting harm can be jarring," said David Rubin, MD, MSCE, the study's lead author and co-director of PolicyLab at CHOP. Nevertheless, Rubin and his co-authors remain cautious in over-reacting to these findings. The baseline risk for diabetes among youth who were not exposed to antipsychotics in the study was only 1 in 400, rising to 1 in 260 among those initiating antipsychotics, and at most to 1 in 200 among those who initiated antipsychotics while they were simultaneously receiving antidepressants. "Although these findings should certainly give us pause," Dr. Rubin added, "we should not reflexively over-react to them. Rather, we need to incorporate these new revelations about the risk for diabetes into a more thoughtful consideration of the true risks and benefits of prescribing an antipsychotic to a child. Yes, we should try, by all means possible, to minimize the numbers of children and adolescents exposed to these powerful medications. But for some children in immediate crisis, we must also concede that the benefit of the antipsychotic for acute management may still outweigh the risk." The study's authors recommend that clinicians and families who are making medication decisions periodically revisit the treatment strategy to address challenging behaviors. For example, when planning to prescribe antipsychotics to a child, professional organizations recommend beginning cautiously with the lowest dose possible, while strictly monitoring for early evidence of weight gain or abnormal lab tests that often predict later onset of diabetes. Dr. Rubin, who is also an attending pediatrician at CHOP, notes, "Once a child is on the antipsychotic drug, a plan should be agreed upon and periodically revisited to see whether or not an evidence-based counseling service, such as trauma-focused cognitive therapy, could address underlying emotional trauma, which is often the root cause for the behavior. That same periodic review would also seek to transition the child off the antipsychotic as soon as possible, once these problems are more suitably addressed. " Ultimately, say Rubin and his co-authors, the prescription of antipsychotics to children and adolescents is likely to continue, reflecting a growing demand to address very challenging behaviors in children "At the end of the day, the approach to the individual child who is in crisis is still a case-by-case decision between a family and the treating provider," said Dr. Rubin. "We can only hope that those decisions are made in full recognition of our findings, and that for some children, alternatives to these powerful medications--such as counseling or other supportive services, will be considered first." Source:Children's Hospital of Philadelphia
  3. Hello there, After reading some posts here I was wondering about peoples experience with weight gain on mirtazapine. Did you find it was because you were eating more of was it because of a metabolic change? It makes me very anxious to think that I could gain weight on this pill, which really doesn't help at all. Did anyone find they were snacking more, craving more foods, eating more at certain times? I know it may seem superficial to think about weight gain, but it is something that concerns me. I just started on Mirtazapine two days ago and it is making me very drowsy, and is helping my appitite a bit but not to excess. Thanks for the replies!
  4. Hey all, I am back after a few months of absence. Been doing a lot of soul searching, and after the Effexor XR kicked in properly again (been on it again for about a year, now on 300mg dose for many months) I have been back to work part time and getting out and about. After spending a year trying out 7 different medications to help with my anxiety and having horrid side effects, Effexor is once again the only one that works for me. However, like the last time I was on it for 3 years before it pooped out.. I'm am gaining weight absurdly. When I went off it and was trying all the other meds, I was so sick all the time, I dropped the 40lbs I had gained before and an additional 20lbs from exercise and watching my diet closely. I still continue to exercise and watch what I eat, but I have gained 30lbs in a few months!! Like, it's completely ridiculous, and that amazing self-image I had? Gone. So, (and I know what I'm about to ask might be controversial to some), has anyone been able to lose weight that was gained by Effexor, and how did you do it? Anyone tried any supplements and notice a difference without crazy side effects? I know there are a lot of "herbal no-no's" when it comes to interracting with Effexor, and I'm careful not to take anything that might give me problems or risk my health. I HAVE to stay on the Effexor XR, it's the only thing that works for my anxiety (sad as that is) but I also HAVE to lose this weight. I know I should be happy that my anxiety is down to a dull roar from being completely agoraphobic for 6 months, but I'm not because how I view myself has been so distorted (in thighs and stomach). Any advice or options?
  5. Hey ladies and gentleman, I know this is a thread thats focused on Wellbutrin. However, my doctor prescribed me Topamax (100mg) to help control my binge eating behavior which i've been suffering from for many many years now. It works great for me with none of the side effects that I read on the internet at all. I also have a love/hate relationship with wellbutrin. It has done wonders for my mood but I fear causes weight gain around my mid section and I don't think i'm delusional! Of course that would defeat the whole purpose of being medicated to begin with. The topamax was working great to help my urges to binge. I'm curious if any of you are knowledgeable enough on these medicines to know that 1) i know for sure topamax helps with weight loss/urges to binge at a high enough dosage. if I continue with it, will it override wellbutrins weight gain? 2) Or would the wellbutrin override the topamaxs weight loss effect. Does anyone have any experience with this? Thanks for trying.
  6. Hi All, I have questions that hopefully someone can give me advice on. My daughter is on Lovan (prozac) for depression and SAD (Social anxiety)and has been for about 18 months. SHe is also on the pill for painful periods. She is 17. She is also well into her last year at High school and has major exams at the end of the year. She is a perfectionist( but that is being dealt with through therapy) and incredibly bright. There has also been bullying issues that have been dealt with, but she stills see the bully daily and has listen to the "crap"that she espouses. Being a "normal"teenager she can't fit as much exercise into her routine as I'd like. She does seem to be tired a lot, but school, work, depression , boyfriend and the occasional outing with friends may account for that. My question is about her weight. SHe is roughly 5 ft 7 tall and I would guess about 68 kgs. SHe wouldn't tell me if I asked, so don't go there. In the last couple of months she has put on 4 or 5 kgs. My husband thinks I am over-reacting and that I should just let her be. A huge part of me agrees, as she isn't in a depressed state, isn't self harming, . self medicating etc. I think she likes herself at the moment, and that is a big step for her. I'm just wanting more information, so I can be informed I just don't want her to turn around one day and be depressed necause she has put on weight and I didn't do anything about it. We model a reasonably healthy lifestyle. Do you think it is the antidepressants putting on the weight by increasing her appetitie, carb craving... or is she a normal teenager just not doing enough?. I have read that the longer you are on some antidepressants that they can incur weight gain. I really don't want to say anything and I wonder if I too, am swayed by the super skinny images we see on TV. One of her friends is a similar build (slightly lighter), while most of them look like 10 yr old gilrls. I Pity the men who like curves and boobs. Would really love to hear what other people think, especially teen girls or their parents. Thanks for reading my ramblings Leebux Trying hard to be understanding
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