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Symptoms of clinical depression in the elderly, tinnitus causes symptoms treatment - Reviews

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The other major mood disorder is bipolar disorder, formerly called manic-depressive illness, which is characterized by periods of depression alternating with episodes of excessive energy and activity. In major, or acute, depression, at least five of the symptoms listed below must occur for a period of at least 2 weeks, and they must represent a change from previous behavior or mood. The symptoms listed above do not follow or accompany manic episodes (such as in bipolar disorder or other disorders). Dysthymia, or chronic depression, afflicts 3 - 6% of the general population and is characterized by many of the same symptoms that occur in major depression. Seasonal affective disorder (SAD) is characterized by annual episodes of depression during fall or winter that improve in the spring or summer.
Seasonal changes affect many people's moods, regardless of gender and whether or not they have SAD. Other neurotransmitters possibly involved in depression include acetylcholine and catecholamines, a group of neurotransmitters that consists of dopamine, norepinephrine, and epinephrine (also called adrenaline).
Endocrine glands release hormones into the bloodstream that are transported to various organs and tissues throughout the body.
The degree to which these chemical messengers are disturbed may be affected by other factors such as genetic susceptibility.
Women, regardless of nationality, race, ethnicity, or socioeconomic level, have twice the rate of depression than men.
While many women experience mood changes around the time of menstruation, a small percentage of women suffer from a condition called premenstrual dysphoric disorder (PMDD). Depression is less reported in the male population, but this may be caused by male tendency to mask emotional disorders with behavior such as alcohol abuse. Adolescents who have depression are at significantly higher risk for substance abuse, recurring depression, and other emotional and mental health problems in adulthood. Studies suggest that 3 - 5% of children and adolescents suffer from clinical depression, and 10 - 15% have some depressive symptoms. Any chronic or serious illness, such as diabetes, that is life-threatening or out of a person's control can lead to depression. Hypothyroidism (a condition caused when the thyroid gland does not produce enough hormone) can cause depression. Studies have reported a strong association between depression and headaches, including chronic tension-type and migraine. There is a significant association between cigarette smoking and a susceptibility to depression. However, antidepressants can also raise the risk for suicidality (suicidal thoughts and behavior) in some young people, particularly those ages 18 - 24. Children, adolescents, and young adults who are prescribed antidepressant medication should be carefully monitored by both their parents and doctor, especially during the first few months of treatment, for any worsening of depression symptoms or changes in behavior. Risk factors for suicide include a history of neglect or abuse, history of deliberate self-harm, a family member who committed suicide, access to firearms, and living in communities where there have been recent outbreaks of suicide among young people.
Parents should not hesitate to seek professional help for their children if they suspect they are thinking about killing themselves. Major depression in the elderly or in people with serious illness may reduce survival rates, even independently of any accompanying illness. Data suggest that depression itself may be a risk factor for heart disease as well as its increased severity.
While the evidence is less conclusive, studies also indicate that depression in healthy people may increase the risk for developing heart disease. Studies are now showing that depression may contribute to poor outcomes for patients with heart disease. Depression does not increase the risk for cancer, but cancer can physically trigger depression by affecting chemicals in the brain. Many people with major depression also have an alcohol use disorder or drug abuse problems. Depression is a well-known risk factor for smoking, and many people with major depression are nicotine dependent. Individuals who have certain factors might ask their doctor if they should be screened for depression. Mental health professionals may administer a screening test such as the Beck Depression Inventory or the Hamilton Rating Scale, both of which consist of about 20 questions that assess the individual for depression.
Symptoms of depression can vary depending on a person’s cultural and ethnic background, For example, people from non-Western countries are more apt to report physical symptoms (such as headache, constipation, weakness, or back pain) related to the depression, rather than mood-related symptoms. Unfortunately, many Americans with major depression receive either inadequate treatment or no treatment at all. Numerous studies support a combination of cognitive behavioral therapy (CBT) plus antidepressants, typically a selective serotonin reuptake inhibitor (SSRI) or serotonin norepinephrine reuptake inhibitor (SNRI). Brain stimulation techniques, such as electroconvulsive therapy (ECT), are options for treatment-resistant depression. Patients with minor depression (fewer than five symptoms that persist for fewer than 2 years) may respond well to watchful waiting to see if antidepressants are necessary.
Depression can worsen many medical conditions and may even increase mortality rates from some disorders, such as heart attack and stroke. Treating depression in patients who abuse alcohol or drugs is important and can sometimes help patients quit. Most people with depression can be treated in an office setting by a psychiatrist, psychologist, or other therapist. Although other mental health professionals cannot prescribe drugs, most therapists have arrangements with a psychiatrist for providing medications to their patients.
A clinical social worker has a master's degree and 2 years of supervised experience in mental health and human services. Advanced-practice psychiatric nurses have a master's degree and can provide therapeutic services.
Patients can locate a mental health professional in their area by asking their doctor for a referral or by contacting a mental health organization. The patient should describe problems briefly but specifically over the phone to any prospective therapist to get a sense of whether he or she will suit the patient's needs.
Patients should not be shy about considering a change in their therapist if they lack confidence in their current one.
Between 14 - 23% of women experience depressive symptoms during pregnancy, and some women develop full-blown postpartum depression following delivery.
The American College of Obstetricians and Gynecologists (ACOG) recommends that pregnant women with depression receive care from a multidisciplinary team that includes the patient’s obstetrician, primary care physician, and mental health clinician. The use of antidepressants during pregnancy is controversial, especially for women with major depression who regularly take antidepressant medication. ACOG and the American Psychiatric Association (APA) recommend that women who are pregnant or thinking about becoming pregnant should not stop taking antidepressants without first talking to their doctors. Studies have been inconsistent as to whether serotonin reuptake inhibitors (SSRIs) drugs increase the risk for birth defects.
In terms of non-drug treatment of postpartum depression, doctors recommend that women with signs of postpartum depression receive intensive and individualized psychotherapy within a month after giving birth. Tricyclics are as effective as, and less expensive than, SSRIs, but they have more side effects. Studies suggest that when children or adolescents are treated for depression, a large majority recover. It is important to recognize that childhood depression differs from adult depression and that children may respond differently than adults to antidepressant medication. The pediatrician may want to monitor a child with mild depression for 6 - 8 weeks before deciding whether to prescribe psychotherapy, antidepressant medication, or a referral to a mental health professional.
The American Academy of Child and Adolescent Psychiatry recommends an SSRI antidepressant for children and adolescents with very severe depression that does not respond to psychotherapy. Many SSRIs appear to be safe and effective, but at this time fluoxetine (Prozac) and escitalopram (Lexapro) are the only ones approved for adolescents (ages 12 - 17), and fluoxetine is the only antidepressant approved for children age 8 and older. Due to potential suicide risks, children and adolescents should be monitored regularly during the initial months of antidepressant treatment.
These drugs are effective but can have severe adverse effects, particularly in older people.
All of these drugs appear to work equally well, although they may vary in terms of side effects.
If no improvement occurs within 6- 8 weeks of starting drug treatment, the doctor may either increase the dosage or switch to an alternative drug.
In general, patients are asked to continue taking antidepressants for at least 4 - 9 months after symptom relief to help prevent relapse.
Patients with at least two episodes of major depression or major depression that lasts for 2 years or longer before initial treatment. Patients who continue to have low-level depression for 7 months after starting antidepressant treatments. There is no risk for addiction with current antidepressants, and many of the common antidepressants, including most standard SSRIs, have been proven safe when taken for a number of years. No matter how well a drug treats depression, the ability of patients to tolerate its side effects strongly influences their compliance with therapy. Sexual dysfunction is a common side effect of many of the standard antidepressants and some of the newer drugs. Nearly all antidepressants are metabolized in the liver, so anyone with liver abnormalities should use them with caution.
In recent years, there has been concern that SSRI antidepressants can increase the risk for suicidal behavior. The FDA recommends that caregivers monitor children, adolescents, and young adults being treated with antidepressants for sudden behavioral changes, and immediately notify their doctor if such changes occur. The FDA’s guidelines for medication usage also recommend that all patients see their doctors regularly after initiating drug treatment.
Selective serotonin-reuptake inhibitors (SSRIs) are now the first-line treatment for major depression. At this time, fluoxetine and escitalopram are the only antidepressants approved for treatment of major depressive disorder in adolescents (ages 12 - 17).
Paroxetine (Paxil) may cause birth defects if taken during the first 3 months of pregnancy. Cognitive problems, sleep disturbances, increase in depressive symptoms, and electric shock-like symptoms have been known to occur with sudden discontinuation of SSRIs. These antidepressants target other neurotransmitters, such as norepinephrine or dopamine, alone or in addition to serotonin. They may be better tolerated than the older tricyclic compounds and even some SSRIs, although long-term side effects are not fully known in this group. Some of these drugs may be helpful for additional problems -- such as insomnia, fibromyalgia and similar chronic pain syndromes, or smoking -- that affect some people with depression. These drugs do share some side effects with other antidepressants, including dizziness and dry mouth. Bupropion (Wellbutrin, generic) affects the reuptake of serotonin, norepinephrine, and dopamine -- a third important neurotransmitter. In 2009, the FDA warned that bupropion products may cause symptoms such as changes in behavior, hostility, agitation, depressed mood, suicidal thoughts and behavior, and attempted suicide.
They tend to cause disturbances in heart rhythm, which can pose a danger for some patients with certain heart diseases. Also of concern are reports that tricyclics, particularly imipramine as well as mianserin and dothiepin, may increase the risk for a lung disease called idiopathic pulmonary fibrosis (IPF), which can cause lung inflammation and scarring. Monoamine oxidase inhibitors (MAOIs) block monoamine oxidase, an enzyme which has negative effects on many of the neurotransmitters that are important for well-being. Newer MAOIs, such as selegiline (Eldepryl, Movergan), target only one form of the MAOI enzyme. Because these drugs can have very severe side effects, they are usually prescribed only for severe depression or when other types of antidepressants do not help (treatment-resistant depression). The most serious side effect is severe hypertension (high blood pressure), which can be brought on by eating certain foods having high tyramine content. In a major analysis, cognitive behavioral therapy (CBT) worked as well as antidepressants in treating severe depression for many patients. Children of parents with the depression -- in this case, therapy should involve the whole family. First, the patient must learn to recognize depressive reactions and thoughts as they occur, usually by keeping a journal of feelings about, and reactions to, daily events. The patient is often given "homework" that tests old negative assumptions against reality and demands different responses. Then, the patient and therapist examine and challenge these entrenched and automatic reactions and thoughts. As the patient begins to understand the underlying falseness of the assumptions that cause depression, they can begin substituting new ways of coping.
Based in part on psychodynamic theory, interpersonal therapy acknowledges the childhood roots of depression, but focuses on symptoms and current issues that may be causing problems. The intent of supportive psychotherapy or attention intervention is to provide the patient with a nonjudgmental environment by offering advice, attention, and sympathy. A small amount of electric current is sent to the brain, causing a generalized seizure that lasts for about 40 seconds.
Repetitive transcranial magnetic stimulation (rTMS) uses high frequency magnetic pulses that target affected areas of the brain.
VNS involves implanting a battery-powered device under the skin in the upper left of the chest. Studies report response rates of 35 - 46% in appropriate candidates with treatment-resistant depression.
The vagus nerves branch off the brain on either side of the head and travel down the neck, along the esophagus to the intestinal tract.
Side effects include headache, eye strain, and irritability, although these symptoms tend to disappear within a week.
A surgical technique called cingulotomy interrupts the cingulate gyrus, a bundle of nerve fibers in the front of the brain, by applying heat or cold. Generally, manufacturers of herbal remedies and dietary supplements do not need FDA approval to sell their products. Some people report relief from depression by eating foods or diet supplements that boost levels of tryptophan, an amino acid involved in the production of serotonin. Some studies have suggested that an imbalance in the ratio of specific fatty acids (omega-6 to omega-3) may increase the risk for depression.


The bottom line may be to increase intake of omega-3 rich foods, such as fish, nuts, and canola oil, and reduce consumption of foods containing omega-6 fatty acids, such as corn and sunflower oils. Omega-3 fatty acids, found in oily fish and flaxseed and canola oils, may be beneficial to people with depression. Vitamin B-3 (niacin) is important in the production of tryptophan and is produced from processing vitamin B3 (niacin).
Vitamin B-12 and calcium supplements may help reduce depression that occurs before menstruation. Either brief periods of intense training or prolonged aerobic workouts can raise chemicals in the brain, such as endorphins, adrenaline, serotonin, and dopamine that produce the so-called runner's high.
A strong network of social support is important for both prevention and recovery from depression.
Qaseem A, Snow V, Denberg TD, Forciea MA, Owens DK; Clinical Efficacy Assessment Subcommittee of American College of Physicians. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Exercise Doesn’t Just Alleviate Depression Symptoms, It May Help Prevent ThemHuffington PostResearchers surveyed nearly 3,000 women between ages 42 to 52 to assess their fitness levels as well as their depression symptoms. The library is an integral part of a project being developed by FAPESP - Fundacao de Amparo a Pesquisa do Estado de Sao Paulo, in partnership with BIREME - the Latin American and Caribbean Center on Health Sciences Information.
The Project envisages the development of a common methodology for the preparation, storage, dissemination and evaluation of scientific literature in electronic format. The objective of the site is to implement an electronic virtual library, providing full access to a collection of serial titles, a collection of issues from individual serial titles, as well as to the full text of articles. The interface also provides access to the full text of articles via author index or subject index, or by a search form on article elements such as author names, words from title, subject, words from the full text and publication year. BackgroundEveryone experiences some unhappiness, often as a result of a change, either in the form of a setback or a loss, or simply, as Freud said, "everyday misery." The painful feelings that accompany these events are usually appropriate and temporary, and can even present an opportunity for personal growth and improvement. The primary subtypes are major depression, dysthymia (longstanding but milder depression), and atypical depression.
Atypical depression refers to a subtype of depression characterized by mood reactivity, which is the ability to temporarily respond to positive experiences.
Other SAD symptoms include fatigue and a tendency to overeat (particularly carbohydrates) and oversleep in winter.
The basic biologic causes of depression are strongly linked to abnormalities in the delivery of certain key neurotransmitters (chemical messengers in the brain). Corticotropin-releasing factor (CRF), a stress hormone and neurotransmitter, may be involved in depression and anxiety disorders. For instance, the pancreas secretes insulin, which allows the body to regulate levels of sugar in the blood. For example, researchers have identified a defect in the gene known as SERT, which regulates serotonin and has been linked to depression.
Risk FactorsAccording to major surveys, major depressive disorder affects nearly 15 million Americans (nearly 7% of the adult population) in a given year. While both boys and girls have similar rates of depression before puberty, girls have twice the risk for depression once they reach puberty. PMDD is a specific psychiatric syndrome that includes severe depression, irritability, and tension before menstruation. Hormonal fluctuations that occur during and after pregnancy, especially when combined with relationship stresses and anxiety, can contribute to depression. Risk factors for depression in young people include having parents with depression, particularly if it is the mother who is depressed. Fibromyalgia, arthritis, and other chronic pain syndromes are also associated with depression.
Also, neurological conditions that impair movement or thinking are associated with depression. Patients with heart failure or patients who have suffered a heart attack may also be at increased risk for depression. Sleep abnormalities are a hallmark of depressive disorders, with many depressed patients experiencing insomnia. People who are prone to depression face a 25% chance of becoming depressed when they quit smoking, and this increased risk persists for at least 6 months.
There has been a decline in adolescent suicides over the past decade, which some researchers attribute to the increased use of antidepressants in this population.
Suicide is the third most common cause of death among adolescents, and is one of the most devastating events than can happen to a family. Decreased physical activity and social involvement certainly play a role in the association between depression and illness severity. Patients with heart disease who are depressed tend to have more severe cardiac symptoms than those who are not depressed, and a poorer quality of life. Conversely, obese people are about 25% more likely than non-obese people to develop depression or other mood disorders.
Depression in the elderly is associated with a decline in mental functioning, regardless of the presence of dementia. Studies on the connections between alcohol dependence and depression have still not resolved whether one causes the other or if they both share some common biologic factor. Nicotine may stimulate receptors in the brain that improve mood in some people with depression. Guidelines now recommend that family doctors screen for depression adults and adolescents (ages 12 - 18), as long as these doctors have appropriate systems in place to ensure accurate diagnosis, treatment, and follow-up of their patients. However, most mental health professionals generally diagnose depression based on symptoms and other criteria. Reasons may include treatment by providers who may not have sufficient information or training on dosages or specific drugs that would be best suited for individual cases, lack of recognition of depression symptoms by providers, poor access to health care services, lack of health insurance, and poor compliance with medications.
Although some people may feel better after taking antidepressants for a few weeks, most people need to take medication for at least 4 - 9 months to ensure a full response and to prevent depression from recurring. For patients with severe depression who are not helped by SSRIs or SNRIs, other types of antidepressants are available.
If patients also suffer from anxiety, treating the depression first often relieves both problems. However, absence from substance abuse is considered essential for adequate treatment of depression. Infrequently, the level of dysfunction may be serious enough to warrant hospitalization to provide protection from further deterioration or self-harm.
The patient's belief in their health care provider may be the most important component in recovery.
Although a mother's depression during and after pregnancy can have serious effects on her child, researchers are still trying to determine the best methods for preventing and treating pregnancy-related depression. Any woman who has suicidal or psychotic symptoms during depression should immediately seek treatment from a psychiatrist. Women who have mild or no depressive symptoms for at least 6 months before becoming pregnant may be able to taper off or discontinue antidepressant medication, under supervision of their doctor. Specifically, they pose a higher risk for adverse effects on the heart and possibly the lungs. However, SSRIs may not pose any lower risk for falls than the older tricyclic antidepressants. Still, up to a half of these young people have a recurrence of depression within 2 years of their first episode of depression. These variances are due to childhood brain development processes as well as age-related differences in drug metabolism. Once medication has been started, the doctor will decide if the dosage needs to be increased after another 6 - 8 weeks.
Tricyclic antidepressants do not tend to help adolescents and children and these drugs have many side effects. The FDA strongly advises against the use of some specific SSRIs, such as paroxetine (Paxil), due to concerns about an increased risk for suicidal behavior as well as the lack of any evidence supporting the drug's efficacy in pediatric patients. These drugs target neurotransmitters other than or in addition to serotonin, such as norepinephrine.
MAOIs are the most effective antidepressants for atypical depression, but have some severe side effects and require restrictive dietary rules and care to avoid drug interactions. Patients who have had at least 2 episodes of depression may need to continue drug treatment for longer than 9 months. About a third of patients will relapse after a first episode within a year of ending treatment, and more than half will experience a recurring bout of depression at some point during their lives. Doctors disagree, however, on the optimal length or the appropriate dosage of maintenance therapy. Patients can increase salivation by chewing gum, using saliva substitutes, and rinsing the mouth frequently.
Patients should inform the doctor of any drugs they are taking, including over-the-counter medications and herbal remedies. Of particular concern is a greater risk for suicide in young people taking these medications. The FDA’s data do not show an increased risk for suicidality in adults older than age 24.
A repackaged form of fluoxetine (Sarafem) is the first SSRI specifically FDA-approved for PMDD. These symptoms may be particularly problematic in patients who also suffer from anxiety, sleeplessness, or both.
The symptoms are more likely to occur with antidepressants with shorter half-lives as compared with fluoxetine, which has a long half-life. In addition to depression, bupropion is also approved for treating seasonal affectiveness disorder (SAD) and, under the tradename Zyban, for smoking cessation.
Secondary amines may have fewer side effects, including drowsiness, than tertiary amines, but they are as toxic in high amounts.
They may offer benefits for many people with dysthymia, who generally do not respond to SSRIs. In an analysis of studies, more tricyclic users discontinued their drugs due to side effects than did SSRI or MAOI users. Care should be taken when these medications are prescribed to the elderly and to those at risk of overdose. Ketamine, an anesthetic drug, may be helpful for patients with severe treatment-resistant depression. PsychotherapyAmong the various psychotherapeutic "talk therapies," cognitive-behavioral therapy appears to be the most effective approach. CBT focuses on identification of distorted perceptions that patients may have of the world and themselves, on changing these perceptions, and on discovering new patterns of actions and behavior. IPT is not as specific as cognitive or behavioral therapy, and all work is done during the sessions.
The neurologist programs the device to deliver mild electrical stimulation to the vagus nerve. VNS is approved by the FDA for long-term treatment of chronic depression in adults who have not responded to typical treatments for their major depressive episode. Patients taking light-sensitive drugs (such as those used for psoriasis), certain antibiotics, or antipsychotic drugs should not use light therapy. A variation of this procedure using MRI scans to guide the surgeon has been shown to produce long-term improvement in patients with severe intractable depression. Just like a drug, herbs and supplements can affect the body's chemistry, and therefore have the potential to produce side effects that may be harmful. Although its efficacy has not been clearly shown, it may help some patients with mild-to-moderate depression. John's wort is believed to be helpful in relieving mild-to-moderate depression, but should only be taken under a doctor's supervision. Researchers are studying whether folate supplements may help enhance the effectiveness of SSRIs and other antidepressants.
ACOG Practice Bulletin: Clinical management guidelines for obstetrician-gynecologists number 92. Clinical response and risk for reported suicidal ideation and suicide attempts in pediatric antidepressant treatment: a meta-analysis of randomized controlled trials. Comparative benefits and harms of second-generation antidepressants: background paper for the American College of Physicians.
Transcranial magnetic stimulation in the treatment of major depressive disorder: a comprehensive summary of safety experience from acute exposure, extended exposure, and during reintroduction treatment.
Continuation electroconvulsive therapy vs pharmacotherapy for relapse prevention in major depression: a multisite study from the Consortium for Research in Electroconvulsive Therapy (CORE).
Canadian Network for Mood and Anxiety Treatments (CANMAT) Clinical guidelines for the management of major depressive disorder in adults. Atypical antipsychotic augmentation in major depressive disorder: a meta-analysis of placebo-controlled randomized trials. Screening for depression in adult patients in primary care settings: a systematic evidence review. Using second-generation antidepressants to treat depressive disorders: a clinical practice guideline from the American College of Physicians. Dietary restrictions and drug interactions with monoamine oxidase inhibitors: the state of the art.
Risk of suicidality in clinical trials of antidepressants in adults: analysis of proprietary data submitted to US Food and Drug Administration.
Screening and treatment for major depressive disorder in children and adolescents: US Preventive Services Task Force Recommendation Statement.
Screening for child and adolescent depression in primary care settings: a systematic evidence review for the US Preventive Services Task Force. The management of depression during pregnancy: a report from the American Psychiatric Association and the American College of Obstetricians and Gynecologists. In some casesFrequentlyFrom time to time badinsufficient dietnourishment could intensify depression. Since 2002, the Project is also supported by CNPq - Conselho Nacional de Desenvolvimento Cientifico e Tecnologico. However, when sadness persists and impairs daily life, it may be an indication of a depressive disorder. Other depressive disorders include premenstrual dysphoric disorder (PDD or PMDD) and seasonal affective disorder (SAD).


The symptoms of dysthymia have been described as a "veil of sadness" that covers most activities. It is accompanied by two or more associated symptoms such as sensitivity to rejection, hypersomnia (oversleeping), overeating (usually related to carbohydrate craving), and leaden paralysis (feelings of heaviness in the arms and legs). Living in a northern country with long winter nights does not guarantee a higher risk for depression.
Studies have found that close relatives of patients with depression are two to six times more likely to develop the problem than individuals without a family history. Imbalances in the brain’s serotonin levels can trigger depression and other mood disorders.
The thyroid gets instructions from the pituitary gland to secrete hormones that determine the pace of chemical activity in the body.
These medications include certain types of drugs used for acne, high blood pressure, contraception, Parkinson’s disease, inflammation, gastrointestinal relief, and other conditions. While depression is an illness that can afflict anyone at any time in their life, the average age of onset is 32 (although adults age 49 - 54 years are the age group with the highest rates of depression.). In addition to hormonal factors, sociocultural factors may also affect the development of depression in girls in this age group. Post-partum depression is a severe depression (sometimes accompanied by psychosis) that occurs within the first year after giving birth.
Early negative experiences and exposure to stress, neglect, or abuse also pose a risk for depression.
Depression also occurs in some elderly people who require home healthcare or hospitalization.
Likewise, insomnia or other changes in waking and sleeping patterns can have significant effects on a person's mood, and perhaps worsen or draw out an underlying depression. About a third of patients with a single episode of major depression will have another episode within 1 year after discontinuing treatment, and more than half will have a recurrence at some point in their lives. Suicide is most commonly associated with depression in young people but it is also linked with anxiety, psychosis, substance abuse, or impulsivity. Feeling connected with parents and family can help protect young people with depression from suicide.
The conditions may have common risk factors such as low physical activity may also be a common factor.
TreatmentDepression is a treatable illness, with many therapeutic options available including psychotherapy, antidepressants, or both. Research indicates that patients respond better to medications when drug therapy is combined with CBT. Sometimes an atypical antipsychotic drug may be given in combination with an antidepressant for patients with severe major depressive disorder. But, women with depression who stop taking antidepressants during pregnancy may be likely to have a relapse of depression, which can have negative consequences for prenatal care and subsequent mother-child bonding. Stopping medication may be more difficult for women with a history of severe recurrent depression. There is evidence that paroxetine (Paxil) may cause major birth defects -- including heart abnormalities -- if taken during the first trimester of pregnancy.
Medication may need to be continued for 1 year after the symptoms have resolved, and the doctor should continue to monitor the child on a monthly basis for 6 months after full remission of depression. Some recent research indicates that the overall benefits of antidepressants for children and adolescents may outweigh the risks for suicidal behavior. While depression is itself the major risk factor for suicide, and antidepressant medication may revitalize suicidal attempts in patients who were too despondent before treatment to make the effort, evidence suggests that in some cases the medication itself can cause suicidal thoughts and behavior (suicidality).
Because they act specifically on serotonin, SSRIs have fewer side effects than older antidepressants, which have more widespread effects in the body.
They should be aware that some of the weight-loss medications, notably sibutramine (Meridia), can have serious interactions with SSRIs.
Taking a supervised drug "holiday" on the weekend may improve sexual function during that time. The most common heart abnormalities are ventricular septal defects, which are holes in the muscular wall that separate the main pumping chambers of the heart. In particular, desipramine (Norpramin) has been associated with dangerous heart rhythm abnormalities in patients who have a family history of these problems. A skin patch form of selegiline (Emsam) is also available for treatment of major depressive disorder in adults. Serotonin syndrome is a potentially fatal condition that is caused by the interaction of serotonergic drugs. Two atypical antipsychotics, aripiprazole (Abilify) and quetiapine (Seroquel), are currently approved in combination with antidepressant therapy for treatment of adults with major depressive disorder. In a small preliminary study, a single intravenous dose of ketamine helped patients quickly recover from depression within 2 hours, and some patients sustained benefits for up to a week. If psychotherapy is used alone without medications, benefits should be evident within 8 weeks and symptoms should be fully resolved by 12 weeks.
Many studies suggest that combining cognitive therapy with antidepressants offer the greatest benefits.
These perceptions, known as schemas, are negative assumptions developed in childhood that can precipitate and prolong depression. The therapist seeks to redirect the patient's attention, which has been distorted by depression, toward the daily details of social and family interaction. Since its introduction in the 1930s, ECT has been significantly refined, and is now considered an effective and safe treatment for severe depression in the appropriate situation.
Patients, (especially those who are elderly), who have high blood pressure, atrial fibrillation, asthma, or other heart or lung problems may be at increased risk for heart-related side effects.
The device uses four electrodes that are surgically implanted into the brain and connected to a small generator that is implanted near the abdomen or collar bone. Patients who use VNS may continue to show improvement in both their depression symptoms and quality of life. Long-term studies on patients with epilepsy have reported no serious adverse side effects, although the treatment may cause lung function deterioration in some people with existing lung disease. The patient sits a few feet away from a box-like device that emits very bright fluorescent light (10,000 lux) for about 30 minutes every day. If no improvement is experienced after that, depressive symptoms will be unlikely to respond to phototherapy. There have been a number of reported cases of serious and even lethal side effects from herbal products. This herb may also interact with other types of medications and increase or decrease their potency. Researchers are studying whether eating fish or taking fish oil supplements can reduce depression. By proceeding and also being right here in today you might damage withoutlacking of the manacles of depression. Severity, duration, and the presence of other symptoms are the factors that distinguish normal sadness from clinical depression. Possibly because of the duration of the symptoms, patients who suffer from chronic minor depression do not exhibit marked changes in mood or in daily functioning, although they have low energy, a general negativity, and a sense of dissatisfaction and hopelessness. The more thyroid hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the metabolism.
Other major risk factors for depression include being female, being African-American, and living in poverty. The rapid decline of reproductive hormones that accompany childbirth may play the major role in postpartum depression in susceptible women, particularly first-time mothers. In addition, older people often have to contend with significant stressful life changes such as the loss of a spouse. Smokers with a history of depression are not encouraged to continue smoking, but rather to keep a close watch on recurrence of depressive symptoms if they do stop smoking. Depression is more likely to recur if the first episode was severe or prolonged, or if there have been prior recurrences. More girls attempt suicide but more boys succeed, most often because they choose guns or violent methods while girls tend to overdose, which is more treatable.
In general, the treatment choice depends on the degree and type of depression and other accompanying conditions. In general, the more treatment strategies that patients need, the less likely they are to recover completely from depression. The risks for negative outcomes are highest when depression occurs during the late second or early third trimester. Psychotherapy (preferably cognitive behavioral therapy or interpersonal therapy) may be helpful in addition to, or in replacement of, antidepressant medication. For psychotherapy, cognitive therapy may be the best approach for children and adolescents with depression. In general, the fewer drug treatment strategies required, the better a patient's chances of recovering completely from depression. Paroxetine (Paxil) appears to have the strongest association with increased suicidal risk, particularly in younger adults.
There do not appear to be significant differences among SSRI brands in effectiveness for treating major depressive disorder, although individual drugs may have different side effects or benefits for specific patients.
Some of the newer SSRIs or other antidepressants may cause less severe impairment of sexual function.
Still, recent research suggests that most types of SSRI-associated birth defects are rare and the overall risks are low.
People who take SSRIs may drink alcohol in moderation, although the combination may compound any drowsiness experienced with SSRIs, and some SSRIs increase the effects of alcohol. The drug can increase blood pressure and heart rate and should be used with caution in patients with high blood pressure or heart disease.
If these conditions are not met, then the patient should strongly consider antidepressant drugs. Studies also indicate that the benefits of cognitive therapy persist after treatment has ended.
CBT works on the principle that these schemas can be recognized and altered, thereby changing the response and eliminating the depression. The goals of this treatment method are improved communication skills and increased self-esteem within a short period (3 - 4 months of weekly appointments) of time.
It is especially effective for patients with severe depression who experience delusions and hallucinations.
The generator delivers precisely controlled electrical pulses to target specific areas of the brain.
They run along each side of the neck, then down the esophagus to the gastrointestinal tract. In many seizures disorders, electrical stimulation of the vagus nerves may help relieve symptoms. Small preliminary studies suggest that these dietary approaches may be helpful for some patients. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Attempt to dining at the identicalexact same occasions of day to ensure thatto make sure thatto make certain that your organic designs will certainly maintain sync.
Studies suggest that women who are more sensitive to hormone fluctuations are at greater risk for postpartum depression if they have a personal or family history of depression. To date, even newer antidepressants have failed to achieve permanent remission in many patients with major depression, although the standard medications are very effective in treating and preventing acute episodes. In addition, antidepressant medications may increase the risk for suicidal behavior in some children and adolescents. Depression during pregnancy may also increase the risk of developing postpartum depression.
Electroconvulsive therapy (ECT) may be an option for pregnant women with severe depression.
Some studies have indicated that sertraline (Zoloft) and citalopram (Celexa) may also increase the risk of heart defects. Other types of psychotherapy, such as family therapy and supportive therapy, may also be effective. Patients who become symptom-free have the best chance for complete recovery compared to patients whose symptoms merely improve. Studies indicate that the standard SSRIs are generally safe to be taken long term, although it is still unclear which patients most benefit from on-going medication. Pregnant women who are being treated for major depression should not stop taking antidepressants without first talking to their doctors. Cognitive behavioral therapy has been shown to help prevent future suicide attempts in patients with a history of suicidal behavior.
Among the forms of depression best served by IPT are those caused by distorted or delayed mourning, unexpressed conflicts with people in close relationships, major life changes, and isolation. The vagus nerve travels to areas of the brain that control functions such as sleep and mood. Recent research has also indicated that the Mediterranean Diet, which is high in omega-3 rich foods as well as vegetables and fruit and low in saturated fats from meat, may help reduce the risk of developing depression.
Men account for the majority of these suicides, with divorced or widowed men at highest risk.
SSRIs, and most tricyclic antidepressants, are considered safe to use during breastfeeding but more research is needed to clarify the effects of SSRI on infant and child development. Venlafaxine should not be taken during the last trimester of pregnancy as it can cause complications in newborn infants. Scientists are also investigating which type of fish oil compound -- eicosapentaenoic acid (EPA) or docosahexaenoic acid (DHA) -- provides the greatest benefit. Any duplication or distribution of the information contained herein is strictly prohibited. It is important that patients discuss with their doctors any other medications they are taking.



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