My parents do a beautiful job with decorating for Christmas - they always have. Every year they get a real live tree. They have a couple of hundred of beautiful ornaments, as well as garlands and other assorted decorations. The tree is always put up at least two weeks before Christmas. Granted, they're retired, but it was always like this even when they both were working.
In contrast, my husband and I broke down a couple of years ago and got a fake tree (I love the smell of evergreens, but it's not enough to counter the expense of a live tree and the cleanup). I feel virtuous if we get the tree up a week before Christmas, and it's been done on Christmas Eve on more than one occasion. It took me a long time to let go of my parents' standards and to stop feeling guilty if I didn't live up to them.
Read on
Posted: Dec 21, 2009
tags: depression,
holidays
Let's face it - even in an un-depressed state, the holidays can be stressful and often disappointing. We run ourselves ragged buying gifts, cooking, decorating and entertaining. Tempers flare as we're thrown together with relatives whom we see infrequently, and don't necessarily enjoy spending time with. Expectations are high that this season will be magical and perfect as we try to recapture the wonderment we felt as children waiting for Santa, or wait for a rush of emotion as we ponder the religious significance of Christmas and Chanukah. When those feelings don't automatically well up, we're disappointed.
I broke down in tears twice while trying to juggle visits to my ex-husband's family and my own. I wasn't even depressed - both those times I was on antidepressants and doing great. The sheer stress of the holidays was just too much for me. One year I even said to my ex-husband, "Do we really have to decorate this year?". Of course the answer was yes, and I'm glad we did. But this illustrates to me how sometimes the ideals of the holidays and the reality can be far apart.
Being Depressed During the Holidays - I'm in Hell, Right?
So that's my view of how holidays can be when you're not depressed. When you are depressed, it's like Dante created your own private circle of hell. The idea of doing all this holiday stuff while you're depressed is beyond overwhelming. Shop for Christmas or Chanukah presents? You're having trouble getting out to shop for food! Decorate the house? You don't even know if you'll get laundry done so you'll have clean underwear tomorrow. Send out Christmas cards to 50 of your closest relatives and friends? What would you say in them - "Doing awful. My new pastime is staring at the ceiling. I hate myself. My clothes are falling off me because I don't eat anymore. I can't wait till the holidays are over. Don't bother to call. By the way, Happy Holidays!".
It's miserable to be depressed during the holidays. One reason is that you know that you really should be enjoying all the wonderful things that come along with them. As down as I sound on the season, I really do enjoy a lot of Christmas-sy things - decorating the tree and the house, giving and receiving presents, watching Rudolph and the Grinch and even sending out Christmas cards. But when I'm depressed, the fact that I can't enjoy these things makes me twice as miserable, and I berate myself for not partaking fully in the joys of the season.
The second thing that makes it so hard to be depressed during the holidays is that doing the holidays right requires planning and organization. If you're depressed, you're so far from having those capabilities that it's pathetic. You can't even plan past the next five minutes, let alone a whole holiday season. And organization? Please! You probably are about to have your electricity cut off because you haven't been able to organize yourself enough to pay your bills.
Have a Holly Jolly Christmas? I Don't Think So
Another horrendous aspect of being depressed during the holidays is spending time with people. Parties, dinners, get-togethers, etc. You're having so much trouble smiling that you're sure you have an absolutely ghastly expression pinned to your face. You feel like bursting into tears when someone asks you to join in singing a Christmas carol. Worst of all, you're overly sensitive in general - to noise, to anything sad, like the other reindeer teasing Rudolph, to really garish decorations that make you really depressed for some unknown reason. So you have to try to act normal while all this turmoil and pain is going on inside you, instead of being able to cry and scream or stare at the ceiling like you can do when you're alone.
I've saved the worst for last - the thing that makes the holidays least bearable in a depressed state. It's that everyone you know (and even strangers and TV commercials) is telling you how much you should be enjoying this time of year. Even if they're at the end of their rope trying to get everything done, they will be telling you what a downer you're being. You know you should be happy and having fun. No one has to tell you. But they do anyway, and you just want to slug them and burst out crying at the same time. Yes, they "mean well." But they're not making things any easier for you.
Ways to Get Through It
Well, that's the bad news. Here's the good news: it doesn't have to be that way. I have some suggestions for the depressive's holiday, drawn from my experience and what I did wrong during my miserable depressed holiday seasons. By the way, these are also good for the non-depressive who's totally stressed out and at the end of his/her rope.
The number one most important rule is: Give yourself permission. Permission to drastically cut back on holiday preparations, permission to feel emotions other than unqualified joy and happiness and permission to gently but firmly tell other people off. Remember that you are ill. Depression is an illness that is affecting your body, mind and personality. You are as fragile as any invalid. Keep this rule in mind during the season, and you should make it through okay. Remember - you are not a loser for scaling back. Other people would probably love to do it too, but there's major peer pressure to "enjoy" holidays to their fullest.
That's the rule; here are the suggestions:
- Instead of making yourself go through the ordeal of sending out paper Christmas cards, send electronic ones instead. Hallmark and Amazon have a good selection of free holiday e-cards.
- When it comes to giving gifts, think gift certificates. They're the perfect present. Most mail-order catalogues offer them now, and if you're like me, you receive enough catalogues to cover everyone on your list. This also keeps you out of the stores at a time when you're very vulnerable to excess buying. Yes, everyone will know what you spent - who cares? If you have the energy and the inclination, do an extra-special job of wrapping. If you don't, don't worry about it. Also, consider shopping online, which also keeps you out of the mall. Maybe I'm the only one, but malls at Christmas freak me out when I'm depressed, and I'm ultra-sensitive to the noise and crowds.
- Do not, under any circumstances, have Christmas or Chanukah at your house. No way. If it's your turn, switch with someone else and tell them you'll make it up to them. They'll just have to understand. If you're going to someone else's place and you're expected to bring food, buy it, don't make it. If they want home-made, too bad. Let them make it, then. Just say, "I'm sorry - I'm just not up to it." End of story.
- You'll need excuses. To people who know you're suffering from depression, tell them that you're just not up to doing all the Christmas stuff, or going all the Christmas places, or expressing all the Christmas cheer. To people who don't, perhaps co-workers, tell them, "I'm just so busy, I can't fit it in." Or, "It's just so hard to get into the holiday spirit sometimes, what with all the work that comes with it." If someone calls you a Grinch say, "Well, what would Christmas be without at least one?" and spit in their eggnog when they're not looking.
- If you must send out cards, just sign them instead of racking your brain trying to come up with something cheerful.
- If the usual Christmas music is really grating on your nerves, try different music, like classical or choral renditions of carols.
- Scale back on your decorating. Don't wrap the house and bushes in lights. Put the wreath on the door, and you've taken care of the decorating for the outside of the house. Decorating a Christmas tree is a monumental task, especially if you get a live tree. Consider scrapping it for this year, or just having a mini tree.
- Don't beat yourself up over feeling empty instead of full of the joy of the season. You're feeling empty because that's a part of the illness. It's not your fault, and you're not a bad person or a loser because of it. Even people who are not depressed are often having trouble getting in touch with the real meaning of the season.
- Try to stay away from the alcohol that's flowing freely this time of year. Very simply, alcohol is a depressant. It's the last thing you need. It may relieve the pain for a little while, but you'll probably end up feeling sad and maudlin.
- If you can afford to, arrange to take a vacation during Christmas. Go somewhere tropical or where Christmas isn't celebrated, and just avoid the whole thing. You can use the excuse of getting ready for your vacation as a way to avoid social commitments.
Web Pages/Articles Online
Here are some links which focus less on the commercial aspects of Christmas, and more on the traditions and simple pleasures of the season.
Shopping Online
Reading
- Robinson, Jo and Staeheli, Jean Coppock, Unplug the Christmas Machine: A Complete Guide to Putting Love and Joy Back into the Season. William Morrow, 1991.
Music Guaranteed to be Non-Irritating (Yes, it's a short list)
- Breath of Heaven (Mary's Song) - Amy Grant, Home for Christmas
- Gabriel's Message - Sting, A Very Special Christmas
- Grown-Up Christmas List - Amy Grant, Home for Christmas
- Have Yourself a Merry Little Christmas - Pretenders, A Very Special Christmas
Do not listen to:
- It's the Most Wonderful Time of the Year
- Winter Wonderland
Posted: Dec 16, 2009
tags: depression,
holidays,
living with depression
Right before I got diagnosed with depression, I suffered through the most horrible Christmas ever. On the surface, everything was fine. I spent Christmas Day with my family as usual and a couple of days later my best friend got married in a lovely ceremony and reception. But the moment I was out of sight on my way home from my parents' house, I burst out crying and cried for hours. And I was only able to endure an hour of the wedding reception before escaping. Thankfully, by the next holiday season my depression was controlled by antidepressants and I truly enjoyed it.
The holidays put a lot of demands on everyone, but are exponentially more difficult for someone with depression.
Read on
Posted: Dec 09, 2009
tags: depression,
holidays
If you're going to be alone during the holidays and you have clinical depression, you're looking at a double whammy that could do a number on you before the end of the year. By Christmas Eve, your depression voice might be telling you that you're a sad loser - unless you come up with some countermeasures. Keep these suggestions in mind:
- If you're alone because someone close to you has died, or because your marriage or relationship has ended, realize that it's normal to feel sadness and grief. It's OK to take time to cry or express your feelings. You can't force yourself to be happy just because it's the holiday season.
Read on
Posted: Dec 09, 2009
tags: depression,
holidays
Check out two good articles on Online Psychology Degrees: 10 Common Myths about Clinical Depression and Six Biggest Myths about Psychology that Everyone Believes. Even though I've been writing about mental health for fourteen years, I learned a few things.
Posted: Nov 10, 2009
tags: depression,
psychology
Last November I started getting sick with a sinus headache and fever. At the end of a week, I was so sick that I ended up throwing up in a bathroom stall at work. The doctor diagnosed a sinus infection. Not unusual for someone with allergies, but I hadn't had one in years. I got a prescription for antibiotics, and thought that was the end of it.
Nope. For a few days after I started the antibiotic, my fever abated and I felt better. But even before I finished the last dose, I was feeling crummy again. I went back to the doctor. She diagnosed a viral infection and prescribed a week in bed. I spent the whole week of Thanksgiving in bed. Nothing changed except that I got a lot of knitting done.
Read on
Posted: Nov 06, 2009
tags: depression,
depression and illness
I'm perusing the shelves of the bookstore, in the psychology section, looking for new books about depression and depression treatment. I know that I really shouldn't be doing this, because it inevitably raises by blood pressure and puts me in danger of choking on my decaf mocha. The problem is, this activity exposes me to all the ways in which someone is trying to sell us a book that will cure/heal/or treat your depression - without doctors or drugs! Let's see, there's:
The Depression Cure: The 6-Step Program to Beat Depression without Drugs
Happiness is a Choice
Dealing with Depression Naturally
Healing Depression the Mind-Body Way
The Mindful Way through Depression
Let me just mention first that Happiness is a Choice has always made me froth at the mouth. I mean, seriously, maybe there are some people like beat poets and goths who think being depressed is preferable to being happy, but the rest of us disagree. We're not choosing to be depressed, which is what the book implies, any more than someone chooses to be diabetic. I mean, come on, I was seven when I started suffering from depression. Can the author seriously think that a child of that age just was choosing to be depressed?
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Posted: Nov 02, 2009
tags: depression,
depression treatment
Before my own depression was diagnosed, I dated a man who suffered from clinical depression and alcoholism. Of course, I wasn't aware of this when I started dating him, or I never would have started. I don't have a burning need to "fix" people. A couple of months after I started treatment for my depression, we split up. Although I think it was more or less mutual, I would not have stayed around for long in any case. I had gotten tired of trying to talk him into getting help for his depression. He had kept the alcoholism at bay by quitting drinking cold turkey, but the underlying problem, the depression, was still there. For some reason, he was dead set against any kind of treatment for his depression. He had had therapy when he was in his teens, and apparently it had done more harm than good.
Read on
Posted: Sep 28, 2009
tags: depression,
depression treatment
Genetics researchers have yet to pinpoint a specific gene or genes for depression. But researchers do know that people with depression in their family are more vulnerable to the condition. This is most likely due to both genetic factors — and the struggle of having a depressed family member. As scientists work to figure out the genetics of the illness, families and therapists are figuring out ways to cope.
Untreated depression can be "a family calamity," says Dr. William Beardslee, a professor of psychiatry at Harvard Medical School and longstanding researcher of the effects of severe parental mental illness on children. Nearly 16 million children under the age of 18 are living with an adult who had a bout of major depression in the last year, according to a recent report from the National Academy of Sciences.
Read on
Posted: Aug 31, 2009
tags: depression,
depression and family
(HealthDay News) -- The epidemic of home foreclosures is having a serious impact on Americans' health, suggests a study that looked at 250 Philadelphia homeowners facing foreclosure.
More than half of them reported being depressed, and 37 percent of them had major depression. In addition, almost 60 percent reported skipping meals because they couldn't afford food and 48 percent said they couldn't afford prescription drugs.
The study also found that for 9 percent of participants, a medical condition in their family was the primary reason for the home foreclosure, and more than 25 percent said they had significant unpaid medical bills.
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Posted: Aug 20, 2009
tags: depression
(HealthDay News) -- A new study shows that gloomy days are linked with memory and other cognitive problems in people suffering from depression.
Previous research has shown that many people feel their moods shift with shifting skies, with more depression linked with less sunlight, but this is the first time that light exposure and cognition have been paired, stated the authors of a study appearing in the July 28 online issue of Environmental Health.
Light therapy, such as that prescribed for people with seasonal affective disorder (SAD), might also help people with cognitive impairments, the authors added.
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Posted: Jul 28, 2009
tags: depression,
depression and environment
(Reuters Health) – Although people with diabetes have a higher risk of being diagnosed with depression than other people, a large new study has found that much of that increase can be accounted for by their more frequent contacts with the medical system, rather than the diabetes itself.
"Our results are consistent with the hypothesis that having a diagnosed chronic condition increases the frequency of a depression diagnosis," write Dr. Patrick J. O'Connor of HealthPartners Research Foundation in Bloomington, Minnesota, and his colleagues. "Our data suggest, however, that patients with diabetes are no more affected by this susceptibility than patients with other chronic conditions who have frequent outpatient visits."
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Posted: Jul 19, 2009
tags: depression,
depression and diabetes,
diabetes
(HealthDay News) -- Don't automatically blame mom: A crying, colicky baby can be just as much the result of dad's state of mind, Dutch researchers report.
Other studies have found that depression among mothers can be related to excessive crying or colic, a common problem with newborns, but the researchers said that little was known about whether fathers' emotions and behavior also have an effect.
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Posted: Jul 01, 2009
tags: depressed parents,
depression,
depression and parenting
Are some people hardwired to get the blues? Scientists have long believed that a tendency toward melancholy runs in families, much like dimpled chins and blue eyes. But the tricky part has been figuring out which genes are involved and how strongly they are correlated with a risk for developing depression.
A new study published on June 16 in the Journal of the American Medical Association (JAMA) now threatens to send researchers back to the drawing board.
Read on
Posted: Jun 22, 2009
tags: depression
(Reuters Health) – Adults with type 1 diabetes report more symptoms of depression and more often use anti-depressant medication than adults without type 1 diabetes, according to data released here at the 69th Scientific Sessions of the American Diabetes Association (ADA).
Different from type 2 diabetes, type 1 diabetes is diagnosed in children or in young adults and has a completely different mode of action. Type 1 diabetes, also referred to as insulin-dependent diabetes or juvenile diabetes, occurs when the pancreas does not produce enough insulin to control blood sugar levels. Eventually, the insulin-producing beta cells of the pancreas are completely destroyed and the body longer produces any insulin.
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Posted: Jun 09, 2009
tags: depression,
depression and illness,
diabetes
(Reuters Health) – Reducing on-the-job stress and strain may lower the risk of depression, new research shows.
Over a 10-year period, workers who initially reported having high-strain jobs but then later reported perceiving their jobs as being less stressful were at the same risk of major depression as their peers who worked at low-strain jobs for the entire time, Dr. JianLi Wang of the University of Calgary in Alberta and colleagues found.
"These results indicated that interventions targeted to reducing job strain may significantly reduce the risk of depression," they noted in a report in the American Journal of Epidemiology.
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Posted: Apr 27, 2009
tags: depression,
depression and workplace,
depression at work,
stress
(HealthDay News) -- Two factors that predict depression in people after they've been hospitalized in an intensive care unit have been identified by Johns Hopkins researchers.
Their study involved 160 people who'd been hospitalized with acute lung injury, a respiratory distress syndrome that typically requires invasive interventions, including the use of ventilators. The death rate of people with acute lung injury is about 40 percent.
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Posted: Apr 21, 2009
tags: depression,
depression and illness
(HealthDay News) -- A stressful work environment brought on by lack of team spirit increases worker depression and the odds that employees will turn to antidepressants for relief, a new study finds.
Given the current recession, the workplace has become even more stressful with people afraid of losing their jobs and uncertain about their economic future, one expert says.
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Posted: Apr 09, 2009
tags: depression,
stress
(Reuters) – People who have a high family risk of developing depression had less brain matter on the right side of their brains on par with losses seen in Alzheimer's disease, U.S. researchers said on Monday.
Brain scans showed a 28-percent thinning in the right cortex -- the outer layer of the brain -- in people who had a family history of depression compared with people who did not.
"The difference was so great that at first we almost didn't believe it. But we checked and re-checked all of our data, and we looked for all possible alternative explanations, and still the difference was there," said Dr. Bradley Peterson of Columbia University Medical Center and the New York State Psychiatric Institute.
Read on
Posted: Mar 24, 2009
tags: depression
(HealthDay News) -- Alcohol abuse may increase the risk of depression, instead of the other way around, a New Zealand study suggests.
Previous research has identified a link between alcohol abuse or dependence and major depression. But it hasn't been determined whether one disorder causes the other, or whether a common genetic or environmental factor increases the risk for both conditions.
Read on
Posted: Mar 09, 2009
tags: alcoholism,
depression
What Is Depression?
Everyone occasionally feels blue or sad, but these feelings are usually fleeting and pass within a couple of days. When a person has a depressive disorder, it interferes with daily life, normal functioning, and causes pain for both the person with the disorder and those who care about him or her. Depression is a common but serious illness, and most who experience it need treatment to get better.
Many people with a depressive illness never seek treatment. But the vast majority, even those with the most severe depression, can get better with treatment. Intensive research into the illness has resulted in the development of medications, psychotherapies, and other methods to treat people with this disabling disorder.
What are the different forms of depression?
There are several forms of depressive disorders. The most common are major depressive disorder and dysthymic disorder.
Major depressive disorder, also called major depression, is characterized by a combination of symptoms that interfere with a person's ability to work, sleep, study, eat, and enjoy once–pleasurable activities. Major depression is disabling and prevents a person from functioning normally. An episode of major depression may occur only once in a person's lifetime, but more often, it recurs throughout a person's life.
Dysthymic disorder, also called dysthymia, is characterized by long–term (two years or longer) but less severe symptoms that may not disable a person but can prevent one from functioning normally or feeling well. People with dysthymia may also experience one or more episodes of major depression during their lifetimes.
Some forms of depressive disorder exhibit slightly different characteristics than those described above, or they may develop under unique circumstances. However, not all scientists agree on how to characterize and define these forms of depression. They include:
Psychotic depression, which occurs when a severe depressive illness is accompanied by some form of psychosis, such as a break with reality, hallucinations, and delusions.
Postpartum depression, which is diagnosed if a new mother develops a major depressive episode within one month after delivery. It is estimated that 10 to 15 percent of women experience postpartum depression after giving birth.1
Seasonal affective disorder (SAD), which is characterized by the onset of a depressive illness during the winter months, when there is less natural sunlight. The depression generally lifts during spring and summer. SAD may be effectively treated with light therapy, but nearly half of those with SAD do not respond to light therapy alone. Antidepressant medication and psychotherapy can reduce SAD symptoms, either alone or in combination with light therapy.2
Bipolar disorder, also called manic-depressive illness, is not as common as major depression or dysthymia. Bipolar disorder is characterized by cycling mood changes-from extreme highs (e.g., mania) to extreme lows (e.g., depression). Visit the NIMH website for more information about bipolar disorder.
What are the signs and symptoms of depression?
People with depressive illnesses do not all experience the same symptoms. The severity, frequency and duration of symptoms will vary depending on the individual and his or her particular illness.
Symptoms include:
- Persistent sad, anxious or "empty" feelings
- Feelings of hopelessness and/or pessimism
- Feelings of guilt, worthlessness and/or helplessness
- Irritability, restlessness
- Loss of interest in activities or hobbies once pleasurable, including sex
- Fatigue and decreased energy
- Difficulty concentrating, remembering details and making decisions
- Insomnia, early–morning wakefulness, or excessive sleeping
- Overeating, or appetite loss
- Thoughts of suicide, suicide attempts
- Persistent aches or pains, headaches, cramps or digestive problems that do not ease even with treatment
What illnesses often co-exist with depression?
Depression often co–exists with other illnesses. Such illnesses may precede the depression, cause it, and/or be a consequence of it. It is likely that the mechanics behind the intersection of depression and other illnesses differ for every person and situation. Regardless, these other co–occurring illnesses need to be diagnosed and treated.
Anxiety disorders, such as post–traumatic stress disorder (PTSD), obsessive–compulsive disorder, panic disorder, social phobia and generalized anxiety disorder, often accompany depression.3,4 People experiencing PTSD are especially prone to having co-occurring depression. PTSD is a debilitating condition that can result after a person experiences a terrifying event or ordeal, such as a violent assault, a natural disaster, an accident, terrorism or military combat.
People with PTSD often re–live the traumatic event in flashbacks, memories or nightmares. Other symptoms include irritability, anger outbursts, intense guilt, and avoidance of thinking or talking about the traumatic ordeal. In a National Institute of Mental Health (NIMH)–funded study, researchers found that more than 40 percent of people with PTSD also had depression at one-month and four-month intervals after the traumatic event.5
Alcohol and other substance abuse or dependence may also co–occur with depression. In fact, research has indicated that the co–existence of mood disorders and substance abuse is pervasive among the U.S. population. 6
Depression also often co–exists with other serious medical illnesses such as heart disease, stroke, cancer, hiv/aids, diabetes, and Parkinson's disease. Studies have shown that people who have depression in addition to another serious medical illness tend to have more severe symptoms of both depression and the medical illness, more difficulty adapting to their medical condition, and more medical costs than those who do not have co–existing depression.7 Research has yielded increasing evidence that treating the depression can also help improve the outcome of treating the co–occurring illness.8
What causes depression?
There is no single known cause of depression. Rather, it likely results from a combination of genetic, biochemical, environmental, and psychological factors.
Research indicates that depressive illnesses are disorders of the brain. Brain-imaging technologies, such as magnetic resonance imaging (MRI), have shown that the brains of people who have depression look different than those of people without depression. The parts of the brain responsible for regulating mood, thinking, sleep, appetite and behavior appear to function abnormally. In addition, important neurotransmitters–chemicals that brain cells use to communicate–appear to be out of balance. But these images do not reveal why the depression has occurred.
Some types of depression tend to run in families, suggesting a genetic link. However, depression can occur in people without family histories of depression as well.9 Genetics research indicates that risk for depression results from the influence of multiple genes acting together with environmental or other factors.10
In addition, trauma, loss of a loved one, a difficult relationship, or any stressful situation may trigger a depressive episode. Subsequent depressive episodes may occur with or without an obvious trigger.
How do women experience depression?
Depression is more common among women than among men. Biological, life cycle, hormonal and psychosocial factors unique to women may be linked to women's higher depression rate. Researchers have shown that hormones directly affect brain chemistry that controls emotions and mood. For example, women are particularly vulnerable to depression after giving birth, when hormonal and physical changes, along with the new responsibility of caring for a newborn, can be overwhelming. Many new mothers experience a brief episode of the "baby blues," but some will develop postpartum depression, a much more serious condition that requires active treatment and emotional support for the new mother. Some studies suggest that women who experience postpartum depression often have had prior depressive episodes.
Some women may also be susceptible to a severe form of premenstrual syndrome (PMS), sometimes called premenstrual dysphoric disorder (PMDD), a condition resulting from the hormonal changes that typically occur around ovulation and before menstruation begins. During the transition into menopause, some women experience an increased risk for depression. Scientists are exploring how the cyclical rise and fall of estrogen and other hormones may affect the brain chemistry that is associated with depressive illness.11
Finally, many women face the additional stresses of work and home responsibilities, caring for children and aging parents, abuse, poverty, and relationship strains. It remains unclear why some women faced with enormous challenges develop depression, while others with similar challenges do not.
How do men experience depression?
Men often experience depression differently than women and may have different ways of coping with the symptoms. Men are more likely to acknowledge having fatigue, irritability, loss of interest in once–pleasurable activities, and sleep disturbances, whereas women are more likely to admit to feelings of sadness, worthlessness and/or excessive guilt.12,13
Men are more likely than women to turn to alcohol or drugs when they are depressed, or become frustrated, discouraged, irritable, angry and sometimes abusive. Some men throw themselves into their work to avoid talking about their depression with family or friends, or engage in reckless, risky behavior. And even though more women attempt suicide, many more men die by suicide in the United States.14
How do older adults experience depression?
Depression is not a normal part of aging, and studies show that most seniors feel satisfied with their lives, despite increased physical ailments. However, when older adults do have depression, it may be overlooked because seniors may show different, less obvious symptoms, and may be less inclined to experience or acknowledge feelings of sadness or grief.15
In addition, older adults may have more medical conditions such as heart disease, stroke or cancer, which may cause depressive symptoms, or they may be taking medications with side effects that contribute to depression. Some older adults may experience what some doctors call vascular depression, also called arteriosclerotic depression or subcortical ischemic depression. Vascular depression may result when blood vessels become less flexible and harden over time, becoming constricted. Such hardening of vessels prevents normal blood flow to the body's organs, including the brain. Those with vascular depression may have, or be at risk for, a co–existing cardiovascular illness or stroke.16
Although many people assume that the highest rates of suicide are among the young, older white males age 85 and older actually have the highest suicide rate. Many have a depressive illness that their doctors may not detect, despite the fact that these suicide victims often visit their doctors within one month of their deaths.17
The majority of older adults with depression improve when they receive treatment with an antidepressant, psychotherapy, or a combination of both.18 Research has shown that medication alone and combination treatment are both effective in reducing the rate of depressive recurrences in older adults.19 Psychotherapy alone also can be effective in prolonging periods free of depression, especially for older adults with minor depression, and it is particularly useful for those who are unable or unwilling to take antidepressant medication.20, 21
How do children and adolescents experience depression?
Scientists and doctors have begun to take seriously the risk of depression in children. Research has shown that childhood depression often persists, recurs and continues into adulthood, especially if it goes untreated. The presence of childhood depression also tends to be a predictor of more severe illnesses in adulthood.22
A child with depression may pretend to be sick, refuse to go to school, cling to a parent, or worry that a parent may die. Older children may sulk, get into trouble at school, be negative and irritable, and feel misunderstood. Because these signs may be viewed as normal mood swings typical of children as they move through developmental stages, it may be difficult to accurately diagnose a young person with depression.
Before puberty, boys and girls are equally likely to develop depressive disorders. By age 15, however, girls are twice as likely as boys to have experienced a major depressive episode.23
Depression in adolescence comes at a time of great personal change–when boys and girls are forming an identity distinct from their parents, grappling with gender issues and emerging sexuality, and making decisions for the first time in their lives. Depression in adolescence frequently co–occurs with other disorders such as anxiety, disruptive behavior, eating disorders or substance abuse. It can also lead to increased risk for suicide. 22, 24
An NIMH–funded clinical trial of 439 adolescents with major depression found that a combination of medication and psychotherapy was the most effective treatment option.25 Other NIMH–funded researchers are developing and testing ways to prevent suicide in children and adolescents, including early diagnosis and treatment, and a better understanding of suicidal thinking.
How is depression detected and treated?
Depression, even the most severe cases, is a highly treatable disorder. As with many illnesses, the earlier that treatment can begin, the more effective it is and the greater the likelihood that recurrence can be prevented.
The first step to getting appropriate treatment is to visit a doctor. Certain medications, and some medical conditions such as viruses or a thyroid disorder, can cause the same symptoms as depression. A doctor can rule out these possibilities by conducting a physical examination, interview and lab tests. If the doctor can eliminate a medical condition as a cause, he or she should conduct a psychological evaluation or refer the patient to a mental health professional.
The doctor or mental health professional will conduct a complete diagnostic evaluation. He or she should discuss any family history of depression, and get a complete history of symptoms, e.g., when they started, how long they have lasted, their severity, and whether they have occurred before and if so, how they were treated. He or she should also ask if the patient is using alcohol or drugs, and whether the patient is thinking about death or suicide.
Once diagnosed, a person with depression can be treated with a number of methods. The most common treatments are medication and psychotherapy.
Medication
Antidepressants work to normalize naturally occurring brain chemicals called neurotransmitters, notably serotonin and norepinephrine. Other antidepressants work on the neurotransmitter dopamine. Scientists studying depression have found that these particular chemicals are involved in regulating mood, but they are unsure of the exact ways in which they work.
The newest and most popular types of antidepressant medications are called selective serotonin reuptake inhibitors (SSRIs). SSRIs include fluoxetine (Prozac), citalopram (Celexa), sertraline (Zoloft) and several others. Serotonin and norepinephrine reuptake inhibitors (SNRIs) are similar to SSRIs and include venlafaxine (Effexor) and duloxetine (Cymbalta). SSRIs and SNRIs are more popular than the older classes of antidepressants, such as tricyclics–named for their chemical structure–and monoamine oxidase inhibitors (MAOIs) because they tend to have fewer side effects. However, medications affect everyone differently–no one–size–fits–all approach to medication exists. Therefore, for some people, tricyclics or MAOIs may be the best choice.
People taking MAOIs must adhere to significant food and medicinal restrictions to avoid potentially serious interactions. They must avoid certain foods that contain high levels of the chemical tyramine, which is found in many cheeses, wines and pickles, and some medications including decongestants. MAOIs interact with tyramine in such a way that may cause a sharp increase in blood pressure, which could lead to a stroke. A doctor should give a patient taking an MAOI a complete list of prohibited foods, medicines and substances.
For all classes of antidepressants, patients must take regular doses for at least three to four weeks before they are likely to experience a full therapeutic effect. They should continue taking the medication for the time specified by their doctor, even if they are feeling better, in order to prevent a relapse of the depression. Medication should be stopped only under a doctor's supervision. Some medications need to be gradually stopped to give the body time to adjust. Although antidepressants are not habit–forming or addictive, abruptly ending an antidepressant can cause withdrawal symptoms or lead to a relapse. Some individuals, such as those with chronic or recurrent depression, may need to stay on the medication indefinitely.
In addition, if one medication does not work, patients should be open to trying another. NIMH–funded research has shown that patients who did not get well after taking a first medication increased their chances of becoming symptom–free after they switched to a different medication or added another medication to their existing one. 26,27
Sometimes stimulants, anti–anxiety medications, or other medications are used in conjunction with an antidepressant, especially if the patient has a co–existing mental or physical disorder. However, neither anti–anxiety medications nor stimulants are effective against depression when taken alone, and both should be taken only under a doctor's close supervision.
What are the side effects of antidepressants?
Antidepressants may cause mild and often temporary side effects in some people, but they are usually not long–term. However, any unusual reactions or side effects that interfere with normal functioning should be reported to a doctor immediately.
The most common side effects associated with SSRIs and SNRIs include:
- Headache–usually temporary and will subside.
- Nausea–temporary and usually short–lived.
- Insomnia and nervousness (trouble falling asleep or waking often during the night)–may occur during the first few weeks but often subside over time or if the dose is reduced.
- Agitation (feeling jittery).
- Sexual problems–both men and women can experience sexual problems including reduced sex drive, erectile dysfunction, delayed ejaculation, or inability to have an orgasm.
Tricyclic antidepressants also can cause side effects including:
- Dry mouth-it is helpful to drink plenty of water, chew gum, and clean teeth daily.
- Constipation-it is helpful to eat more bran cereals, prunes, fruits, and vegetables.
- Bladder problems–emptying the bladder may be difficult, and the urine stream may not be as strong as usual. Older men with enlarged prostate conditions may be more affected. The doctor should be notified if it is painful to urinate.
- Sexual problems–sexual functioning may change, and side effects are similar to those from SSRIs.
- Blurred vision–often passes soon and usually will not require a new corrective lenses prescription.
- Drowsiness during the day–usually passes soon, but driving or operating heavy machinery should be avoided while drowsiness occurs. The more sedating antidepressants are generally taken at bedtime to help sleep and minimize daytime drowsiness.
FDA Warning on Antidepressants
Despite the relative safety and popularity of SSRIs and other antidepressants, some studies have suggested that they may have unintentional effects on some people, especially adolescents and young adults. In 2004, the Food and Drug Administration (FDA) conducted a thorough review of published and unpublished controlled clinical trials of antidepressants that involved nearly 4,400 children and adolescents. The review revealed that 4% of those taking antidepressants thought about or attempted suicide (although no suicides occurred), compared to 2% of those receiving placebos.
This information prompted the FDA, in 2005, to adopt a "black box" warning label on all antidepressant medications to alert the public about the potential increased risk of suicidal thinking or attempts in children and adolescents taking antidepressants. In 2007, the FDA proposed that makers of all antidepressant medications extend the warning to include young adults up through age 24. A "black box" warning is the most serious type of warning on prescription drug labeling.
The warning emphasizes that patients of all ages taking antidepressants should be closely monitored, especially during the initial weeks of treatment. Possible side effects to look for are worsening depression, suicidal thinking or behavior, or any unusual changes in behavior such as sleeplessness, agitation, or withdrawal from normal social situations. The warning adds that families and caregivers should also be told of the need for close monitoring and report any changes to the physician. The latest information from the FDA can be found on their Web site at www.fda.gov.
Results of a comprehensive review of pediatric trials conducted between 1988 and 2006 suggested that the benefits of antidepressant medications likely outweigh their risks to children and adolescents with major depression and anxiety disorders.28 The study was funded in part by the National Institute of Mental Health.
Also, the FDA issued a warning that combining an SSRI or SNRI antidepressant with one of the commonly-used "triptan" medications for migraine headache could cause a life-threatening "serotonin syndrome," marked by agitation, hallucinations, elevated body temperature, and rapid changes in blood pressure. Although most dramatic in the case of the MAOIs, newer antidepressants may also be associated with potentially dangerous interactions with other medications.
What about St. John's wort?
The extract from St. John's wort (Hypericum perforatum), a bushy, wild-growing plant with yellow flowers, has been used for centuries in many folk and herbal remedies. Today in Europe, it is used extensively to treat mild to moderate depression. In the United States, it is one of the top-selling botanical products.
To address increasing American interests in St. John's wort, the National Institutes of Health conducted a clinical trial to determine the effectiveness of the herb in treating adults who have major depression. Involving 340 patients diagnosed with major depression, the eight-week trial randomly assigned one-third of them to a uniform dose of St. John's wort, one-third to a commonly prescribed SSRI, and one-third to a placebo. The trial found that St. John's wort was no more effective than the placebo in treating major depression.29 Another study is looking at the effectiveness of St. John's wort for treating mild or minor depression.
Other research has shown that St. John's wort can interact unfavorably with other medications, including those used to control HIV infection. On February 10, 2000, the FDA issued a Public Health Advisory letter stating that the herb appears to interfere with certain medications used to treat heart disease, depression, seizures, certain cancers, and organ transplant rejection. The herb also may interfere with the effectiveness of oral contraceptives. Because of these potential interactions, patients should always consult with their doctors before taking any herbal supplement.
Psychotherapy
Several types of psychotherapy–or "talk therapy"–can help people with depression.
Some regimens are short–term (10 to 20 weeks) and other regimens are longer–term, depending on the needs of the individual. Two main types of psychotherapies–cognitive–behavioral therapy (CBT) and interpersonal therapy (IPT)-have been shown to be effective in treating depression. By teaching new ways of thinking and behaving, CBT helps people change negative styles of thinking and behaving that may contribute to their depression. IPT helps people understand and work through troubled personal relationships that may cause their depression or make it worse.
For mild to moderate depression, psychotherapy may be the best treatment option. However, for major depression or for certain people, psychotherapy may not be enough. Studies have indicated that for adolescents, a combination of medication and psychotherapy may be the most effective approach to treating major depression and reducing the likelihood for recurrence.25 Similarly, a study examining depression treatment among older adults found that patients who responded to initial treatment of medication and IPT were less likely to have recurring depression if they continued their combination treatment for at least two years.21
Electroconvulsive Therapy
For cases in which medication and/or psychotherapy does not help alleviate a person's treatment–resistant depression, electroconvulsive therapy (ECT) may be useful. ECT, formerly known as "shock therapy," once had a bad reputation. But in recent years, it has greatly improved and can provide relief for people with severe depression who have not been able to feel better with other treatments.
Before ECT is administered, a patient takes a muscle relaxant and is put under brief anesthesia. He or she does not consciously feel the electrical impulse administered in ECT. A patient typically will undergo ECT several times a week, and often will need to take an antidepressant or mood stabilizing medication to supplement the ECT treatments and prevent relapse. Although some patients will need only a few courses of ECT, others may need maintenance ECT, usually once a week at first, then gradually decreasing to monthly treatments for up to one year.
ECT may cause some short-term side effects, including confusion, disorientation and memory loss. But these side effects typically clear soon after treatment. Research has indicated that after one year of ECT treatments, patients showed no adverse cognitive effects.30
What efforts are underway to improve treatment?
Researchers are looking for ways to better understand, diagnose and treat depression among all groups of people. New potential treatments are being tested that give hope to those who live with depression that is particularly difficult to treat, and researchers are studying the risk factors for depression and how it affects the brain. NIMH continues to fund cutting–edge research into this debilitating disorder.
For more information on NIMH-funded research on depression, visit the NIMH website.
How can I help a friend or relative who is depressed?
If you know someone who is depressed, it affects you too. The first and most important thing you can do to help a friend or relative who has depression is to help him or her get an appropriate diagnosis and treatment. You may need to make an appointment on behalf of your friend or relative and go with him or her to see the doctor. Encourage him or her to stay in treatment, or to seek different treatment if no improvement occurs after six to eight weeks.
To help a friend or relative:
- Offer emotional support, understanding, patience and encouragement.
- Engage your friend or relative in conversation, and listen carefully.
- Never disparage feelings your friend or relative expresses, but point out realities and offer hope.
- Never ignore comments about suicide, and report them to your friend's or relative's therapist or doctor.
- Invite your friend or relative out for walks, outings and other activities. Keep trying if he or she declines, but don't push him or her to take on too much too soon. Although diversions and company are needed, too many demands may increase feelings of failure.
- Remind your friend or relative that with time and treatment, the depression will lift.
How can I help myself if I am depressed?
If you have depression, you may feel exhausted, helpless and hopeless. It may be extremely difficult to take any action to help yourself. But it is important to realize that these feelings are part of the depression and do not accurately reflect actual circumstances. As you begin to recognize your depression and begin treatment, negative thinking will fade.
To help yourself:
- Engage in mild activity or exercise. Go to a movie, a ballgame, or another event or activity that you once enjoyed. Participate in religious, social or other activities.
- Set realistic goals for yourself.
- Break up large tasks into small ones, set some priorities and do what you can as you can.
- Try to spend time with other people and confide in a trusted friend or relative. Try not to isolate yourself, and let others help you.
- Expect your mood to improve gradually, not immediately. Do not expect to suddenly "snap out of" your depression. Often during treatment for depression, sleep and appetite will begin to improve before your depressed mood lifts.
- Postpone important decisions, such as getting married or divorced or changing jobs, until you feel better. Discuss decisions with others who know you well and have a more objective view of your situation.
- Remember that positive thinking will replace negative thoughts as your depression responds to treatment.
Where can I go for help?
If you are unsure where to go for help, ask your family doctor. Others who can help are listed below.
Mental Health Resources:
- Mental health specialists, such as psychiatrists, psychologists, social workers, or mental health counselors
- Health maintenance organizations
- Community mental health centers
- Hospital psychiatry departments and outpatient clinics
- Mental health programs at universities or medical schools
- State hospital outpatient clinics
- Family services, social agencies or clergy
- Peer support groups
- Private clinics and facilities
- Employee assistance programs
- Local medical and/or psychiatric societies
- You can also check the phone book under "mental health," "health," "social services," "hotlines," or "physicians" for phone numbers and addresses. An emergency room doctor also can provide temporary help and can tell you where and how to get further help.
What if I or someone I know is in crisis?
If you are thinking about harming yourself, or know someone who is, tell someone who can help immediately.
- Call your doctor.
- Call 911 or go to a hospital emergency room to get immediate help or ask a friend or family member to help you do these things.
- Call the toll-free, 24-hour hotline of the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255); TTY: 1-800-799-4TTY (4889) to talk to a trained counselor.
- Make sure you or the suicidal person is not left alone.
For More Information
Information from NIMH is available in multiple formats. You can browse online, download documents in PDF, and order paper brochures through the mail. If you would like to have NIMH publications, you can order them online at www.nimh.nih.gov. If you do not have Internet access and wish to have information that supplements this publication, please contact the NIMH Information Center at the numbers listed below.
Please check the NIMH Web site for the most up-to-date information on this topic.
National Institute of Mental Health
Science Writing, Press & Dissemination Branch
6001 Executive Boulevard
Room 8184, MSC 9663
Bethesda, MD 20892-9663
Phone: 301-443-4513 or
1-866-615-NIMH (6464) toll-free
TTY: 301-443-8431
TTY: 866-415-8051
FAX: 301-443-4279
E-mail: nimhinfo@nih.gov
Web site: http://www.nimh.nih.gov
If you want to copy this booklet…
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Citations
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2. Rohan KJ, Lindsey KT, Roecklein KA, Lacy TJ. Cognitive-behavioral therapy, light therapy and their combination in treating seasonal affective disorder. Journal of Affective Disorders, 2004; 80: 273-283.
3. Regier DA, Rae DS, Narrow WE, Kaebler CT, Schatzberg AF. Prevalence of anxiety disorders and their comorbidity with mood and addictive disorders. British Journal of Psychiatry, 1998; 173 (Suppl. 34): 24-28.
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5. Shalev AY, Freedman S, Perry T, Brandes D, Sahar T, Orr SP, Pitman RK. Prospective study of posttraumatic stress disorder and depression following trauma. American Journal of Psychiatry, 1998; 155(5): 630-637.
6. Conway KP, ComptonW, Stinson FS, Grant BF. Lifetime comorbidity of DSM-IV mood and anxiety disorders and specific drug use disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry, 2006 Feb; 67(2): 247-257.
7. Cassano P, Fava M. Depression and public health, an overview. Journal of Psychosomatic Research, 2002; 53: 849-857.
8. Katon W, Ciechanowski P. Impact of major depression on chronic medical illness. Journal of Psychosomatic Research, 2002; 53: 859-863.
9. Tsuang MT, Faraone SV. The genetics of mood disorders. Baltimore, MD: Johns Hopkins University Press, 1990.
10. Tsuang MT, Bar JL, Stone WS, Faraone SV. Gene-environment interactions in mental disorders. World Psychiatry, 2004 June; 3(2): 73-83.
11. Rubinow DR, Schmidt PJ, Roca CA. Estrogen-serotonin interactions: implications for affective regulation. Biological Psychiatry, 1998; 44(9): 839-850.
12. Pollack W. Mourning, melancholia and masculinity: recognizing and treating depression in men. In: Pollack W, Levant R, eds. New Psychotherapy for Men. New York: Wiley, 1998; 147-166.
13. Cochran SV, Rabinowitz FE. Men and Depression: clinical and empirical perspectives. San Diego: Academic Press, 2000.
14. Kochanek KD, Murphy SL, Anderson RN, Scott C. Deaths: final data for 2002. National Vital Statistics Reports; 53(5). Hyattsville, MD: National Center for Health Statistics, 2004.
15. Gallo JJ, Rabins PV. Depression without sadness: alternative presentations of depression in late life. American Family Physician, 1999; 60(3): 820-826.
16. Krishnan KRR, Taylor WD, et al. Clinical characteristics of magnetic resonance imaging-defined subcortical ischemic depression. Biological Psychiatry, 2004; 55: 390-397.
17. Conwell Y. Suicide in later life: a review and recommendations for prevention. Suicide and Life Threatening Behavior, 2001; 31(Suppl.): 32-47.
18. Little JT, Reynolds CF III, Dew MA, Frank E, Begley AE, Miller MD, Cornes C, Mazumdar S, Perel JM, Kupfer DJ. How common is resistance to treatment in recurrent, nonpsychotic geriatric depression? American Journal of Psychiatry, 1998; 155(8): 1035-1038.
19. Reynolds CF III, Frank E, Perel JM, Imber SD, Cornes C, Miller MD, Mazumdar S, Houck PR, Dew MA, Stack JA, Pollock BG, Kupfer DJ. Nortriptyline and interpersonal psychotherapy as maintenance therapies for recurrent major depression: a randomized controlled trial in patients older than 59 years. Journal of the American Medical Association, 1999; 281(1): 39-45.
20. Lebowitz BD, Pearson JL, Schneider LS, Reynolds CF, Alexopoulos GS, Bruce MI, Conwell Y, Katz IR, Meyers BS, Morrison MF, Mossey J, Niederehe G, Parmelee P. Diagnosis and treatment of depression in late life: consensus statement update. Journal of the American Medical Association, 1997; 278(14): 1186-1190.
21. Reynolds CF III, Dew MA, Pollock BG, Mulsant BH, Frank E, Miller MD, Houck PR, Mazumdar S, Butters MA, Stack JA, Schlernitzauer MA, Whyte EM, Gildengers A, Karp J, Lenze E, Szanto K, Bensasi S, Kupfer DJ. Maintenance treatment of major depression in old age. New England Journal of Medicine, 2006 Mar 16; 354(11): 1130-1138.
22. Weissman MM, Wolk S, Goldstein RB, Moreau D, Adams P, Greenwald S, Klier CM, Ryan ND, Dahl RE, Wichramaratne P. Depressed adolescents grown up. Journal of the American Medical Association, 1999; 281(18): 1701-1713.
23. Cyranowski JM, Frank E, Young E, Shear MK. Adolescent onset of the gender difference in lifetime rates of major depression. Archives of General Psychiatry, 2000; 57: 21-27.
24. Shaffer D, Gould MS, Fisher P, Trautman P, Moreau D, Kleinman M, Flory M. Psychiatric diagnosis in child and adolescent suicide. Archives of General Psychiatry, 1996; 53(4): 339-348.
25. March J, Silva S, Petrycki S, Curry J, Wells K, Fairbank J, Burns B, Domino M, McNulty S, Vitiello B, Severe J. Treatment for Adolescents with Depression Study (TADS) team. Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for Adolescents with Depression Study (TADS) randomized controlled trial. Journal of the American Medical Association, 2004; 292(7): 807-820.
26. Rush JA, Trivedi MH, Wisniewski SR, Stewart JW, Nierenberg AA, Thase ME, Ritz L, Biggs MM, Warden D, Luther JF, Shores-Wilson K, Niederehe G, Fava M. Bupropion-SR, Sertraline, or Venlafaxine-XR after failure of SSRIs for depression. New England Journal of Medicine, 2006 Mar 23; 354(12): 1231-1242.
27. Trivedi MH, Fava M, Wisniewski SR, Thase ME, Quitkin F, Warden D, Ritz L, Nierenberg AA, Lebowitz BD, Biggs MM, Luther JF, Shores-Wilson K, Rush JA. Medication augmentation after the failure of SSRIs for depression. New England Journal of Medicine, 2006 Mar 23; 354(12): 1243-1252.
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Posted: Mar 04, 2009
tags: depression,
depression diagnosis,
depression symptoms
Part 2 of 5
===========
**Causes** (cont.)
- What initiates the alteration in brain chemistry?
- Is a tendency to depression inherited?
**Treatment**
- What sorts of psychotherapy are effective for depression?
**Medication**
- Do certain drugs work best with certain depressive illnesses? What are the guidelines for choosing a drug?
- How do you tell when a treatment is not working? How do you know when to switch treatments?
- How do antidepressants relieve depression?
- Are Antidepressants just "happy pills?"
- What percentage of depressed people will respond to antidepressants?
- What does it feel like to respond to an antidepressant? Will I feel euphoric if my depression responds to an antidepressant?
- What are the major categories of anti-depressants?
- What are the side-effects of some of the commonly used antidepressants?
- What are some techniques that can be used by people taking antidepressants to make side effects more tolerable?
- Many antidepressants seem to have sexual side effects. Can anything be done about those side-effects?
- What should I do if my antidepressant does not work?
Causes (cont.)
--------------
Q. What initiates the alteration in brain chemistry?
It can be either a psychological or a physical event. On the physical side, a hormonal change may provide the initial trigger: some women dip into depression briefly each month during their premenstrual phase; some find that the hormone balance created by oral contraceptives disposes them to depression; pregnancy, the end of pregnancy, and menopause have also been cited. Men's hormone levels fluctuate as deeply but less obviously.
It is well known that certain chronic illnesses have depression as a frequent consequence: some forms of heart disease, for example, and Parkinsonism. This seems to be the result of a chemical effect rather than a purely psychological one, since other, equally traumatic and serious illnesses don't show the same high risk of depression.
Q. Is a tendency to depression inherited?
It seems there are some people whose brain chemistry is predisposed to the depressive response, and others who are at much lower risk of depression even if exposed to the same physical or psychological triggers. The genetic relations of manic-depressives are at a higher risk for unipolar depression than the population at large or their adopted/by marriage relations. There seems to be a link between high creativity and the gene for manic-depression: artists and writers often are not manic-depressive themselves, but have a family member who is. Studies of families in which members of each generation develop manic-depressive illness found that those with the illness have a somewhat different genetic make-up than those who do not get ill. However, the reverse is not true: not everybody with the genetic make-up that causes vulnerability to manic-depressive illness has the disorder. Apparently additional factors, possibly a stressful environment, are involved in its onset.
Major depression also seems to occur, generation after generation, in some families. However, depression can occur in people with no family history of any form of mental illness. And I would be reluctant to suggest that there is any human who is entirely immune to depression under all possible conditions.
Psychological triggers: many, if not most, people with depression can point to some incident or condition which they believe is responsible for their unhappiness. Of course, people with severe depression are prone to astonishingly virulent and inappropriate guilt and self-hatred.
The (genuine) life events that most often appear in connection with depression are various, but there is one distinguishing feature that appears in many cases, over and over: loss of self-determination, of empowerment, of self-confidence. More profoundly: a loss of self, of the abilities or activities that a person identifies with herself. Stereotypically: a man loses the job that had defined him to himself and others, whether that definition was "executive" or "breadwinner"; a woman who had spent her whole life preparing for and living the role of wife, supporter, caretaker, is suddenly left alone by divorce or death. In general, any life change, often caused by events beyond one's control, which damages the structure that gave life meaning.
The ability of a person to respond to such an event will depend on many factors, including genetic predisposition, support from friends, physical health, even the weather. It can also depend on internal psychological factors which may best be explored in talk therapy: why is the person's self-esteem so bound up in the position or state that has been lost? Can she find a new source of self-esteem? Therapy can be immensely helpful here.
Obviously, not everyone to whom this sort of event happens becomes depressed, and not every person who becomes depressed has had this sort of catastrophe befall them. In fact, if a person suffers a loss and then becomes depressed, it may well be that they weathered the loss in fine style and then succumbed to a much less obvious trigger, psychological or physical.
Some depressions may well be caused by a spontaneous aberration in brain chemistry, with no trigger that we can currently identify, just as a seizure or migraine may have an obvious trigger or be apparently spontaneous.
However, once the depressive state has set in, both physical and psychological problems will be generated in abundance. What faster way to lose a job or a spouse than to be too depressed to work or to communicate? What worse psychological state for coping with a blow to identity can there be than a chemically promoted, pathological self-hatred? And what can be worse for self-esteem than watching one's appearance and household disintegrate as one loses the motivation to shower, straighten up, wash dishes or laundry, or choose attractive clothes? Health deteriorates as well: some depressed people can't sleep or eat, others sleep constantly (a real help on the job!) and eat incessantly, sometimes in order to stay awake, sometimes because it's the only thing that gives a little pleasure or comfort. (Carbohydrates induce production of serotonin, so there may be an element of self-medication here); almost no one has the impulse to exercise or get fresh air and sunshine. Most if not all of these effects form feedback loops, increasing in magnitude and becoming triggers for further depression.
The question, "Is depression mostly physical or psychological," is rather beside the point. Depression may be triggered by either physical or psychological events. Most commonly, both seem to be involved, though it is often difficult to separate the two when one is talking about psychology and neurochemistry. But however it begins, depression quickly develops into a set of physical and psychological problems which feed on each other and grow. This is why a combination of physical and psychological intervention has been shown to give the best results for most patients, regardless of any classifications that doctors may have tried to impose on their depression and its cause.
Treatment
---------
Q. What sorts of psychotherapy are effective for depression?
Two effective methods of psychotherapy for people with depressions are cognitive therapy and interpersonal therapy. Both psychoanalysis, and insight oriented psychotherapy have not been shown to be effective treatments for people with a depressive disorder. Cognitive (and cognitive-behavioral) therapists can be found in most major cities.
For a referral to a properly trained cognitive therapist practicing close to your location, contact:
Aaron T. Beck, MD.
The Center for Cognitive Therapy
3600 Market Street
Philadelphia, PA 19101
(215) 898-4100.
While many therapists call themselves cognitive therapists and interpersonal therapists, only a few have had proper training. To find an interpersonal therapist with the best training, contact:
Myrna Weissman, Ph.D.
New Your State Psychiatric Institute
722 West 168th Street
New York, NY 10032
(212) 996-6390
Medication
----------
Q. Do certain drugs work best with certain depressive illnesses? What are the guidelines for choosing a drug?
There are very few kinds of depression for which there are specific antidepressant treatments. When it comes to people with Bipolar Disorder who are depressed there are some major problems. Most importantly, with any antidepressant, there is a possibility that the antidepressant treatment will cause depressed bipolar people not just to come out of their depressions, but to develop manic episodes. The possibility of an antidepressant causing mania is least when the antidepressant is bupropion (Wellbutrin). The possibility of mania is greatly reduced if depressed bipolar folks are on a mood stabilizer such as lithium, Tegretol or Depakote when they are started on an antidepressant.
Q. How do you tell when a treatment is not working? How do you know when to switch treatments?
Antidepressant treatment is clearly not working when the individual receiving the treatment remains depressed or becomes depressed again. When a recently started antidepressant fails to cause improvement, the depressed individual often asks that the medication be stopped, and a new one started. It generally does not make sense to change antidepressants until 8-weeks at the maximum tolerated dose have elapsed. With some tricyclic antidepressants, it is important to check the blood level of the antidepressant before it is stopped. The blood test can tell if the amount in the blood has been adequate. Only after an adequate trial of one antidepressant should another be tried. To have been on four antidepressants in an 8-week period means that one has not had an adequate trial on any of them.
Q. How do antidepressants relieve depression?
There are several classes of antidepressants, all of which seem to work by increasing levels of certain neurotransmitters (most commonly serotonin, norepinephrine, and dopamine) in the brain. It is not entirely clear why increasing neurotransmitter levels should reduce the severity of a depression. One theory holds that the increased concentration of neurotransmitters causes changes in the brain's concentration of molecules, receptors, to which these transmitters bind. In some unknown way it is the changes in the receptors that are thought responsible for improvement.
Q. Are Antidepressants just "happy pills?"
No matter what their exact mode of action may be, it is clear that antidepressants are not "happy pills." There is no street-market in antidepressants, for unlike "speed" which will improve the mood of almost everybody, antidepressants only improve the mood of depressed people. Also unlike the almost instant effects of speed, the mood-improving effects of antidepressants develop slowly over a number of weeks. "Speed" induces a highly artificial state, antidepressants cause the brain to slowly increase its production of naturally occurring neurotransmitters.
Q. What percentage of depressed people will respond to antidepressants?
Generally, about 2/3 of depressed people will respond to any given antidepressant. People who do not respond to the first antidepressant they have taken, have an excellent chance of responding to another.
Q. What does it feel like to respond to an antidepressant? Will I feel euphoric if my depression responds to an antidepressant?
The most common description of the effects of antidepressants is that of feeling the depression gradually lift, and for the person to feel normal again. People who have responded to antidepressants are not euphoric. They are not unfeeling automatons. The are still able to feel sad when bad things happen, and they are able to feel very happy in response to happy events. The sadness they feel with disappointments is not depression, but is the sadness anyone feels when disappointed or when having experienced a loss. Antidepressants do not bring about happiness, they just relieve depression. Happiness is not something that can be had from a pill.
Q. What are the major categories of anti-depressants?
There are many classes of antidepressants. Two kinds of antidepressants have been around for over 30 years. These are the tricyclic antidepressants and the monoamine oxidase inhibitors. While there are newer antidepressants, many with fewer side-effects, none of the newer antidepressants has been shown to be more effective than these two classes of drugs. In fact, many people who have not responded to newer antidepressants have been successfully treated with one of these classes of drugs.
The tricyclic antidepressants (TCAs) include such drugs as imipramine (Tofranil, amitriptyline (Elavil), desipramine (Norpramin), nortriptyline (Aventyl and Pamelor).
The monoamine oxidase inhibitors (MAOIs) include tranylcypromine (Parnate), phenelzine (Nardil), and isocarboxazid (Marplan) which has recently been taken off the market in the U.S.A. for marketing rather than safety or efficacy reasons.
One of the popular new classes of antidepressants are the selective serotonin reuptake inhibitors (SSRIs). The first of these drugs to be marketed in the USA was fluoxetine (Prozac). Sertraline (Zoloft), and paroxetine (Paxil) soon followed, and fluvoxamine (Luvox) is scheduled to be marketed in late 1994, or early 1995.
Bupropion (Wellbutrin) is the only drug in its class, as is trazodone (Desyrel). The most recently marketed antidepressant (4/94) is venlafaxine (Effexor), the first drug in yet another class of drugs.
Q. What are the side-effects of some of the commonly used antidepressants?
Below is a list of some of the more frequently prescribed antidepressants, and their most common side effects. The figure following each side effect is the percentage of people taking the medication who experience that side effect.
Aventyl (nortriptyline): Dry mouth (15); Constipation (15);
Weakness-fatigue (10); Tremor (10).
Effexor (venlafaxine) Nausea (35); Headache (25); Sleepiness (25);
Dry mouth (20); Insomnia (20); Constipation (15).
Elavil (amitriptyline): Dry mouth (40); Drowsiness (30); Weight gain
(30); Constipation (25); Sweating (20).
Nardil (phenelzine): dry mouth (30); insomnia (25); Increased heart
rate (25); Lowered blood pressure (20); Sedation (15); Over
stimulation (10);
Norpramin (desipramine): dry mouth (15); increased pulse (15);
constipation (10); reduced blood pressure (10).
Pamelor - see Aventyl
Parnate (tranylcypromine) Dry mouth (20); Insomnia (20); Increased
pulse rate (20); Lowered blood pressure (15); Over stimulation (15);
Sedation (15).
Paxil (paroxetine): Decreased sexual interest and/or problems
achieving orgasm (30); Nausea (25); Sedation (25); Dizziness (15)
Insomnia (15)
Prozac (fluoxetine): Decreased sexual interest and/or problems
achieving orgasm (30); Nausea (20); Headache (20); Nervousness (15);
Insomnia (15); Diarrhea (15).
Sinequan (doxepin): Dry mouth (40); Sedation (40); Weight gain (30);
Lowered blood pressure (25); Constipation (25); Sweating (20).
Tofranil (imipramine): Dry mouth (30), Reduced blood pressure (30),
Constipation (20), Difficulty with urination (15).
Wellbutrin (bupropion): Agitation (30); Weight loss (25), Dizziness
(20); Decreased appetite (20);
Zoloft (sertraline): Decreased sexual interest and/or problems
achieving orgasm (30);Nausea (25); Headache (20); Diarrhea (20);
Insomnia 15); Dry mouth (15); Sedation (15).
Q. What are some techniques that can be used by people taking antidepressants to make side effects more tolerable?
Listed below are some frequent side effects of antidepressants, and some techniques to reduce their severity:
Dry mouth: Drink lots of water, chew sugarless gum, clean teeth daily, ask the dentist to suggest a fluoride rinse to prevent cavities, visit the dentist more often than usual for tooth and gum hygiene
Constipation: Drink at least six 8-ounce glasses of water every day, eat bran cereals, eat salads twice a day, exercise daily (walk for at least 30 minutes a day), ask your doctor about taking a bulk producing agent such as Metamucil, also ask about taking a stool softener such as Colace, be sure to avoid laxatives such as Ex-Lax.
Bladder problems: The effects of some antidepressants, especially the tricyclic medications may make it difficult for you to start the stream of urine. There may be some hesitation between the time you try to urinate and the time your urine starts to flow. If it takes you over 5-minutes to start the stream, call your doctor.
Blurred vision: The tricyclic antidepressants may make it difficult for you to read. Distant vision is usually unaffected. If reading is important to you the effects of the antidepressant can be compensated for by a change in glasses. As you may compensate for the change in your vision, try to postpone getting new glasses as long as possible.
Dizziness: Dizziness when getting out of bed or when standing up from a chair, or when climbing stairs may be a problem when taking tricyclic antidepressants and monoamine oxidase inhibitors. Changing posture slowly may help prevent this kind of dizziness. Drinking adequate amounts of liquid and eating enough salt each day is important. Be sure to speak to your doctor if this side-effect is severe.
Drowsiness: This side effect often passes as you get used to taking the antidepressant that has been prescribed for you. Ask your doctor if it is safe for you to increase your intake of caffeine, and if so, by how much. If you are drowsy be sure not to drive or operate dangerous machinery.
Q. Many antidepressants seem to have sexual side effects. Can anything be done about those side-effects?
Both lowered sexual desire and difficulties having an orgasm, in both men and women, are particularly a problem with the selective serotonin re-uptake inhibitors (Prozac, Zoloft, Paxil and Luvox), and the monoamine oxidase inhibitors (Nardil and Parnate). There is no treatment for decreased sexual interest except lowering the dose or switching to a drug that does not have sexual side effects such as bupropion (Wellbutrin). Difficulty having orgasms may be treated by a number of medications. Among those medications are: Periactin, Urecholine, and Symmetrel. None of these are over-the-counter drugs and they must be prescribed by a physician. Unfortunately, many psychiatrists are not familiar with using these medications to treat the sexual side-effects of antidepressants.
Q. What should I do if my antidepressant does not work?
Many people decide that their antidepressant is not working prematurely. When one starts an antidepressant the hope is for rapid relief from depression. What must be remembered is that for an antidepressant to work, you must be on an adequate dose of the drug for an adequate length of time. A fair trial of any antidepressant is at least two months. Prior to a two month trial the only reason to abandon an antidepressant trial is if the medication is causing severe side effects. With many antidepressants the dose has to be increased at intervals far above the starting dose. Unfortunately, the two-month period mentioned above, refers to two months following the most recent increase in the dose, not the time from starting the particular antidepressant.
Posted: Mar 02, 2009
tags: antidepressant medication,
antidepressants,
depression,
depression treatment,
faq
Part 3 of 5
===========
**Medication** (cont.)
- If an antidepressant has produced a partial response, but has not fully eliminated depression, what can be done about it?
**Electroconvulsive Therapy**
- What is electroconvulsive therapy (ECT) and when is it used?
- Exactly what happens when someone gets ECT?
- How do individuals who have had ECT feel about having had the treatments?
- How long do the beneficial effects of ECT last?
- Is it true that ECT causes brain damage?
- Why is there so much controversy about ECT?
**Substance Abuse**
- May I drink alcohol while taking antidepressants?
- If I plan to drink alcohol while on medication, what precautions should I take?
- What's the relationship between depression and recovery from substance abuse?
- What does the term "dual-diagnosis" mean?
- Is it safe for a person recovering from substance abuse to take drugs?
- How do you know when depression is severe enough that help should be sought?
**Getting Help**
-Where should a person go for help?
-Where can I find help in the United Kingdom?
-Where can I find out about support groups for depression?
-How can family and friends help the depressed person?
**Choosing A Doctor**
-What should you look for in a doctor? How can you tell if he/she really understands depression?
**Self-care**
- How may I measure the effects my treatment is having on my depression?
Medication (cont.)
------------------
Q. If an antidepressant has produced a partial response, but has not fully eliminated depression, what can be done about it?
There are many techniques to help an antidepressant work more completely. The simplest is to increase the dose until relief is experienced or side- effects are severe. If the dose can not be increased, lithium can be added to any antidepressant to augment its effect. With all antidepressants it is possible to add small doses of stimulants such as pemoline (Cylert), methylphenidate (Ritalin), or dextroamphetamine (Dexedrine) to augment the antidepressant effect.Selective serotonin re-uptake inhibitors often work better when small doses of desipramine (Norpramin) or nortriptyline (Aventyl and Pamelor) are co-administered. Thyroid hormones (Synthroid or Cytomel) may be used to augment any antidepressant. At times combinations of these techniques may be utilized.
Electroconvulsive Therapy
-------------------------
Q. What is electroconvulsive therapy (ECT) and when is it used?;
ECT is an effective form of treatment for people with depressions and other mood disorders. ECT may be used when a severely depressed patient has not responded to antidepressants, is unable to tolerate the side effects of antidepressants, or must improve rapidly. Some depressed people simply do not respond to antidepressants or mood controlling drugs, and ECT is a way for such people to be effectively treated. ECT is utilized in the treatment of both mania and depression. There are some people who because of severe physical illness are unable to tolerate the side-effects of the medications used to treat mood disorders. Many of these people can be successfully be treated with ECT. Pregnant women and people who have recently had heart attacks can be safely treated with ECT. Because of time pressure regarding occupational, social, or family events, some people do not have the time to wait for antidepressants or mood regulating medications to become effective. As ECT quite regularly brings about improvement within two or three weeks, people who are under such time pressure are also excellent candidates for ECT.
Q. Exactly what happens when someone gets ECT?
The physician must fully explain the benefits and dangers of ECT, and the patient give consent, before ECT can be administered. The patient should be encouraged to ask questions about the procedure and should be told that consent for treatments can be withdrawn at any time, and in the event that this happens, the treatments will be stopped. After giving consent, the patient undergoes a complete physical examination, including a chest x-ray, electrocardiogram, and blood and urine tests. A series of ECTs usually consists of six to twelve treatments. Treatments can be administered to either in-patients or out-patients. Nothing should be taken by mouth for 8-hours prior to a treatment. An intravenous drip is started and through it medications to induce sleep, relax the muscles of the body, and reduce saliva are given. Once these medications are fully effective, an electrical stimulus is administered through electrodes to the head. The electrical stimulus produces brain wave (EEG) changes that are characteristic of a grand mal seizure. It is believed that this seizure activity leads to the clinical improvement seen after a series of ECT. About 30-minutes after the treatment the patient awakens from sleep. While confused at first, the patient is soon oriented enough to eat breakfast, and return home if the treatments are being done in an outpatient setting.
Q. How do individuals who have had ECT feel about having had the
treatments?
In studies of people treated with ECT it has been found that 80% of such people report that they were helped by the treatments. About 75% say that ECT is no more frightening than going to the dentist.
Q. How long do the beneficial effects of ECT last?;
While ECT is a highly successful way of helping people come out of
depressions, it has to be followed by antidepressant therapy. If antidepressants are not administered after a series of ECTs, there is a 50% relapse rate within 6-months.
Q. Is it true that ECT causes brain damage?;
There is no scientific evidence that ECT causes brain damage. A woman who had over 1,000 ECT died of natural causes, and her brain was examined for evidence of ECT-induced brain damage. None was found. ECT does cause memory problems. These memory problems may take a number of months to clear. A small number of people who have received ECT complain of longer lasting memory problems. Such problems do not show up on psychological tests, it is not clear what causes them.
Q. Why is there so much controversy about ECT?
There is little controversy about ECT among psychiatrists. Much of the opposition to ECT seems political in nature and originates in the anti-psychiatry groups that oppose the use of Ritalin for the treatment of children with attention deficit disorder, and who oppose the use of Prozac for the treatment of depressed people.
Substance Abuse
---------------
Q. May I drink alcohol while taking antidepressants?
There are a number of problems with the mixture of alcohol and antidepressants. First, antidepressants may make you especially susceptible to the intoxicating effects of alcohol. Second, if you drink more than three or four drinks a week, the effects of alcohol may prevent the antidepressants from working. Many people who seem not to benefit from antidepressants, do so, if they reduce or eliminate their intake of alcohol. Third, you may be taking along with the antidepressant a drug such as clonazepan (Klonopin) with which one should not drink at all.
Q. If I plan to drink alcohol while on medication, what precautions should I take?
There is much misinformation about drinking while on anti-depressants. Alcohol can prevent antidepressants from being effective. This is not so much because it interferes with the absorption of antidepressants, it is because of the effects of alcohol upon brain chemistry. Antidepressants can also increase one's susceptibility to the intoxicating effects of alcohol. Also, both alcohol and some anti-depressants (especially Wellbutrin) increase the possibility of seizures.
If you are determined to drink despite taking antidepressants you
should discuss the matter with your psychiatrist. If you get
permission you might want to determine the extent to which the
medication has made you more sensitive to the alcohol. You might
start by seeing what are the effects of half a glass of wine. You
might then experiment with a full glass. Remember, a 4 oz glass of
wine, a 12 oz bottle of beer, and 1 oz of "hard stuff" all contain
the same amount of alcohol.
Q. What's the relationship between depression and recovery from
substance abuse?
It is not unusual for people who have recently been withdrawn from
alcohol, or other abusable drugs to become depressed. These
depressions are often self-limited, and clear in about 8-weeks. If
depression has not cleared by the end of that period, anti-depressant
therapy should be started.
Q. What does the term "dual-diagnosis" mean?
Dual-diagnosis is a phrase used to indicate the combination of
substance abuse and a psychiatric disorder. A path to alcohol or
other substance abuse is an attempt to self- medicate uncomfortable
symptoms such as depression, anxiety, agitation or feelings of
emptiness. The psychiatric disorders that cause such symptoms are
often diagnosed in substance abusers.
Q. Is it safe for a person recovering from substance abuse to take
drugs?
People recovering from substance abuse can safely take many kinds of
psychiatric drugs. Most psychiatric drugs are unable to be abused.
The best evidence for this is that there are not street markets for
such drugs. On the other hand, The benzodiazepines (diazepam
[Valium], lorazepam [Ativan], alprazolam [Xanax], etc.) and the
psycho-stimulants (dextroamphetamine [Dexedrine], methamphetamine
[Desoxyn], and Ritalin [methylphenidate]) are quite abusable.
For people active in AA please read the pamphlet "The AA
Member--Medications & Other Drugs." This outlines AA's official
attitude toward medication--that it is necessary for certain
illnesses including depression. Too many depressed people who have
been talked out of taking antidepressants by members of their AA
groups have killed themselves as a result.
Q. How do you know when depression is severe enough that help should be
sought?
Professional help is needed when symptoms of depression arise without
a clear precipitating cause, when emotional reactions are out of
proportion to life events, and especially when symptoms interfere
with day-to-day functioning.. Professional help should definitely be
sought if a person is experiencing suicidal thoughts.
Getting Help
------------
Q. Where should a person go for help?
If you think you might need help, see your internist or general
practitioner and explain your situation. Sometimes an actual physical
illness can cause depression-like symptoms so that is why it is best
to see your regular physician first to be checked out. Your doctor
should be able to refer you to a psychiatrist if the severity of your
depression warrants it.
Other sources of help include the members of the clergy, local
suicide hotline, local hospital emergency room, local mental health
center.
Q. Where can I find help in the United Kingdom?
The following are places one might find help in Great Britain:
Depressives Associated
PO Box 1022
London SE1 7QB
Depressives Anonymous
36 Chestnut Avenue
Beverley
Humberside
HU17 9QU
MIND (National association for mental health)
22 Harley Street
London W1N 2ED
To find a psychiatrist/ psychologist near you, call or write:
Royal College of Psychiatrists
17 Belgrave Square
London SW1X 8PG
Q. Where can I find out about support groups for depression?
The following is a list of national organizations dealing with the
issues of depression. Please note: Model groups are not national
organizations and should be contacted primarily by persons wishing to
start a similar group in their area. Also, please enclose a
self-addressed stamped envelope when requesting information from any
group. When calling a contact number, remember that many of them are
home numbers, so be considerate of the time you call. Keep in mind
the different time zones.
[Reprinted from The Self-Help Sourcebook, 4th Edition, 1992. American
Self-Help Clearinghouse, St.Clares' Riverside Medical Center,
Denville, New Jersey 07834]
**Depressed Anonymous** Int'l. 8 affiliated groups. Founded 1985.
12-step program to help depressed persons believe & hope they can
feel better. Newsletter, phone support, information & referrals, pen
pals, workshops, conference & seminars. Information packet ($5),
group starting manual ($10.95).Newsletter. Write: 1013 Wagner Ave.,
Louisville, KY 40217. Call Hugh S. 502-969-3359.
**Depression After Deliver** National. 85 chapters. Founded 1985.
Support & Information for women who have suffered from post-partum
depression. Telephone support in most states, newsletter, group
development guidelines, pen pals, conferences. Write: PO. Box 1281,
Morrisville, PA 19067. Call 215-295-3994 or 800-944-4773 (to leave name & address for information to be sent).
**Emotions Anonymous** National. 1200 chapters. Founded 1971. Fellowship sharing experiences, hopes & strengths with each other, using the 12-step program to gain better emotional health. Correspondence program for those who cannot attend meetings. Chapter development guidelines. Write: PO. Box 4245, St. Paul, MN 55104. Call
612-647-9712.
**National Depressive & Manic-Depressive Association** National. 250 chapters. Founded 1986. Mutual support & information for manic-depressives, depressives & their families. Public education on the biochemical nature of depressive illnesses. Annual conferences, chapter development guidelines. Newsletter. Write: NDMDA, 730 Franklin, 501, Chicago, IL 60610. Call 800-82-NDMDA or 312-642-0049.
**National Foundation for Depressive Illness**. An informational service, which provides a recorded message of the clear warning signs of depression and manic-depression, and instructs how to get help and further information. Call 1-800-239-1295. For a bibliography and referral list of physicians and support groups in your area, send $5 (if you can afford it) and a self-addressed, stamped business-size envelope with 98 cents postage to, NAAFDI, PO. Box 2257, New York, NY
100116.
NOSAD (**National Organization for Seasonal Affective Disorder**) National. groups. Founded 1988. Provides information & education re: the causes, nature & treatment of Seasonal Affective Disorder. Encourages development of services to patients & families, research into causes & treatment. Newsletter. Write: PO. Box 451, Vienna, VA 22180. Call 301-762-0768.
(Model) **Helping Hands** Founded 1985. A comfortable & homey atmosphere for people with manic-depression, schizophrenia or clinical depression who seek an environment that makes them more aware of themselves & eliminates a negative attitude. Group development guidelines. Write: c/o Rita Martone, 86 Poor St, Andover, MA 01810.
Call 508-475-3388.
(Model) MDSG-NY (**Mood Disorders Support Group, Inc.**) Founded 1981. Support & education for people with manic-depression or depression & their families & friends. Guest lectures, newsletter, rap groups, assistance in starting groups. Write: PO. Box 1747, Madison Square Station, New York, NY 10159. Call 212-533-MDSG.
Q. How can family and friends help the depressed person?
The most important things anyone can do for depressed people is to help them get appropriate diagnosis and treatment. This may involve encouraging a depressed individual to stay with treatment until symptoms begin to abate (several weeks) or to seek different treatment if no improvement occurs. On occasion, it may require making an appointment and accompanying the depressed person to the doctor. It may also mean monitoring whether the depressed person is taking medication.
The second most important thing is to offer emotional support. This involves understanding, patience, affection, and encouragement. Engage the depressed person in conversation and listen carefully. Do not disparage feelings expressed, but point out realities and offer hope. Do not ignore remarks about suicide. Always report them to the doctor. Invite the depressed person for walks, outings, to the movies, and other activities. Be gently insistent if your invitation is refused. Encourage participation in some activities that once gave pleasure, such as hobbies, sports, religious or cultural activities, but do not push the depressed person to undertake too much too soon.
The depressed person needs diversion and company. but too many demands can increase feelings of failure. Do not accuse the depressed person of faking illness or laziness or expect him or her to "snap out of it." Eventually, with treatment, most depressed people do yet better. Keep that in mind, and keep reassuring the depressed person that with time and help, he or she will feel better.
Choosing A Doctor
-----------------
Q. What should you look for in a doctor? How can you tell if he/she really understands depression?
If you are looking for a psychopharmacologist to prescribe medications to help control your depression there are a number of things to check. If you are in psychotherapy, it is important to ask prospective doctors about their opinions on the psychotherapeutic treatment of depression. Psychopharmacologists who are hostile to psychotherapy are difficult to deal with while you are in therapy.
It is always legitimate to ask any professionals you are thinking about seeing regularly about their understanding of depression, their beliefs about the causes of depression and their philosophy of treatment. You might ask about how often the prospective doctor has worked with people who have had your particular variety of depression. If you have a rapidly cycling Bipolar depression, for example, you should seek a doctor who has much experience dealing with people who have this problem. Prior to the first visit it is important to clarify with the doctor or the secretary the fee of the initial and subsequent visits, the doctor's policy regarding missed and changed appointments, whether the doctor will accept assignment from insurance companies. If you have Medicare or Medicaid it is important to make sure that the doctor sees people with these forms of medical coverage.
Another aspect of the style of doctors is the extent to which they include their patients in the decision-making process. You might ask "How do you go about deciding which treatment is right for me?" See if you are comfortable with the method the doctor describes. Much can also be learned from how doctors respond to questions such as these. There is much difference between a doctor who welcomes such questions and answers them fully and one who is annoyed by them and answers them superficially.
Self-care
---------
Q. How may I measure the effects my treatment is having on my depression?
If one completes the following scale each week, and keeps track of the scores, one would have a detailed record of one's progress.
Name _________________________ Date _________
The items below refer to how you have felt and behaved **during the past
week.** For each item, indicate the extent to which it is true, by
circling one of the numbers that follows it. Use the following scale:
0 = Not at all
1 = Just a little
2 = Somewhat
3 = Moderately
4 = Quite a lot
5 = Very much
_______________________
1. I do things slowly............................0 1 2 3 4 5
2. My future seems hopeless......................0 1 2 3 4 5
3. It is hard for me to concentrate on reading...0 1 2 3 4 5
4. The pleasure and joy has gone out of my life..0 1 2 3 4 5
5. I have difficulty making decisions............0 1 2 3 4 5
6. I have lost interest in aspects of life that
used to be important to me...................0 1 2 3 4 5
7. I feel sad, blue, and unhappy.................0 1 2 3 4 5
8. I am agitated and keep moving around..........0 1 2 3 4 5
9. I feel fatigued...............................0 1 2 3 4 5
10. It takes great effort for me to do simple
things.......................................0 1 2 3 4 5
11. I feel that I am a guilty person who
deserves to be punished......................0 1 2 3 4 5
12. I feel like a failure.........................0 1 2 3 4 5
13. I feel lifeless--more dead than alive.........0 1 2 3 4 5
14. My sleep has been disturbed:
too little, too much, or broken sleep........0 1 2 3 4 5
15. I spend time thinking about HOW I might kill myself..................................0 1 2 3 4 5
16. I feel trapped or caught......................0 1 2 3 4 5
17. I feel depressed even when good things happen to me.................................0 1 2 3 4 5
18. Without trying to diet, I have lost, or gained, weight............................0 1 2 3 4 5
Note: This scale is designed to measure changes in the severity of depression and it has been shown to be sensitive to the changes that result from psychotherapeutic or psychopharmacologic treatment. These scales are not designed to diagnose the presence or absence of either depression or mania.
Copyright (c) 1993 Ivan Goldberg
Posted: Mar 02, 2009
tags: antidepressant medication,
antidepressants,
depression,
depression treatment,
faq
Part 4 of 5
===========
**Self-care** (cont.)
- How can I help myself get through depression on a day-to-day basis?
**Books**
- What are some books about depression?
Self-care (cont.)
-----------------
Q. How can I help myself get through depression on a day-to-day basis?
On a day-to-day basis, separate from, or concurrently with therapy or
medication, we all have our own methods for getting through the worst
times as best we can. The following comments and ideas on what to do
during depression were solicited from people in the
alt.support.depression newsgroup. Sometimes these things work,
sometimes they don't. Just keep trying them until you find some
techniques that work for you.
* Write. Keep a journal. Somehow writing everything down helps keep
the misery from running around in circles.
* Listen to your favorite "help" songs (a bunch of songs that have
strong positive meaning for you)
* Read (anything and everything) Go to the library and check out
fiction you've wanted to read for a long time; books about
depression, spirituality, morality; biographies about people who
suffered from depression but still did well with their lives
(Winston Churchill and Martin Luther, to name two;).
* Sleep for a while
* Even when busy, remember to sleep. Notice if what you do before
sleeping changes how you sleep.
* If you might be a danger to yourself, don't be alone. Find people.
If that is not practical, call them up on the phone. If there is no
one you feel you can call, suicide hotlines can be helpful, even if
you're not quite that badly off yet.
* Hug someone or have someone hug you.
* Remember to eat. Notice if eating certain things (e.g. sugar or
coffee) changes how you feel.
* Make yourself a fancy dinner, maybe invite someone over.
* Take a bath or a perfumed bubble bath.
* Mess around on the computer.
* Rent comedy videos.
* Go for a long walk
* Dancing. Alone in my house or out with a friend.
* Eat well. Try to alternate foods you like ( Maybe junk foods) with
the stuff you know you should be eating.
* Spend some time playing with a child
* Buy yourself a gift
* Phone a friend
* Read the newspaper comics page
* Do something unexpectedly nice for someone
* Do something unexpectedly nice for yourself.
* Go outside and look at the sky.
* Get some exercise while you're out, but don't take it too seriously.
* Pulling weeds is nice, and so is digging in the dirt.
* Sing. If you are worried about responses from critical neighbors,
go for a drive and sing as loud as you want in the car. There's
something about the physical act of singing old favorites that's
very soothing. Maybe the rhythmic breathing that singing enforces
does something for you too. Lullabies are especially good.
* Pick a small easy task, like sweeping the floor, and do it.
* If you can meditate, it's really helpful. But when you're really
down you may not be able to meditate. Your ability to meditate will
return when the depression lifts. If you are unable to meditate,
find some comforting reading and read it out loud.
* Feed yourself nourishing food.
* Bring in some flowers and look at them.
* Exercise, Sports. It is amazing how well some people can play
sports even when feeling very miserable.
* Pick some action that is so small and specific you know you can do
it in the present. This helps you feel better because you actually
accomplish something, instead of getting caught up in abstract
worries and huge ideas for change. For example say "hi" to someone
new if you are trying to be more sociable. Or, clean up one side of
a room if you are trying to regain control over your home.
* If you're anxious about something you're avoiding, try to get some
support to face it.
* Getting Up. Many depressions are characterized by guilt, and lots
of it. Many of the things that depressed people want to do because
of their depressions (staying in bed, not going out) wind up making
the depression worse because they end up causing depressed people
to feel like they are screwing things up more and more. So if
you've had six or seven hours of sleep, try to make yourself get
out of bed the moment you wake up...you may not always succeed,
but when you do, it's nice to have gotten a head start on the day.
* Cleaning the house. This worked for some people me in a big way.
When depressions are at their worst, you may find yourself unable
to do brain work, but you probably can do body things. One
depressed person wrote, "So I spent two weeks cleaning my house,
and I mean CLEANING: cupboards scrubbed, walls washed, stuff given
away... throughout the two weeks, I kept on thinking "I'm not
cleaning it right, this looks terrible, I don't even know how to
clean properly", but at the end, I had this sparkling beautiful
house!"
* Volunteer work. Doing volunteer work on a regular basis seems to
keep the demons at bay, somewhat... it can help take the focus off
of yourself and put it on people who may have larger problems (even
though it doesn't always feel that way).
* In general, It is extremely important to try to understand if
something you can't seem to accomplish is something you simply CAN'T
do because you're depressed (write a computer program, be charming
on a date), or whether its something you CAN do, but it's going to
be hell (cleaning the house, going for a walk with a friend, getting
out of bed). If it turns out to be something you can do, but don't
want to, try to do it anyway. You will not always succeed, but try.
And when you succeed, it will always amaze you to look back on it
afterwards and say "I felt like such shit, but look how well I
managed to...!" This last technique, by the way, usually works for
body stuff only (cleaning, cooking, etc.). The brain stuff often
winds up getting put off until after the depression lifts.
* Do not set yourself difficult goals or take on a great deal of
responsibility.
* Break large tasks into many smaller ones, set some priorities, and
do what you can, as you can.
* Do not expect too much from yourself. Unrealistic expectations will
only increase feelings of failure, as they are impossible to meet.
Perfectionism leads to increased depression.
* Try to be with other people, it is usually better than being alone.
* Participate in activities that may make you feel better. You might
try mild exercise, going to a movie, a ball game, or participating
in religious or social activities. Don't overdo it or get upset if
your mood does not greatly improve right away. Feeling better takes
time.
* Do not make any major life decisions, such as quitting your job or
getting married or separated while depressed. The negative thinking
that accompanies depression may lead to horribly wrong decisions.
If pressured to make such a decision, explain that you will make the
decision as soon as possible after the depression lifts. Remember
you are not seeing yourself, the world, or the future in an objective
way when you are depressed.
* While people may tell you to "snap out" of your depression, that is
not possible. The recovery from depression usually requires
antidepressant therapy and/or psychotherapy. You cannot simple make
yourself "snap out" of the depression. Asking you to "snap out" of a
depression makes as much sense as asking someone to "snap out" of
diabetes or an under-active thyroid gland.
* Remember: Depression makes you have negative thoughts about
yourself, about the world, the people in your life, and about the
future. Remember that your negative thoughts are not a rational way
to think of things. It is as if you are seeing yourself, the world,
and the future through a fog of negativity. Do not accept your
negative thinking as being true. It is part of the depression and
will disappear as your depression responds to treatment. If your
negative (hopeless) view of the future leads you to seriously
consider suicide, be sure to tell your doctor about this and ask for
help. Suicide would be an irreversible act based on your
unrealistically hopeless thoughts.
* Remember that the feeling that nothing can make depression better
is part of the illness of depression. Things are probably not
nearly as hopeless as you think they are.
* If you are on medication:
a. Take the medication as directed. Keep taking it as directed
for as long as directed.
b. Discuss with the doctor ahead of time what happens in case of
unacceptable side-effects.
c. Don't stop taking medication or change dosage without discussing
it with your doctor, unless you discussed it ahead of time.
d. Remember to check about mixing other things with medication. Ask
the prescribing doctor, and/or the pharmacist and/or look it up
in the Physician's Desk Reference. Redundancy is good.
e. Except in emergencies, it is a good idea to check what your
insurance covers before receiving treatment.
* Do not rely on your doctor or therapist to know everything. Do some
reading yourself. Some of what is available to read yourself may be
wrong, but much of it will shed light on your disorder.
* Talk to your doctor if you think your medication is giving
undesirable side-effects.
* Do ask them if you think an alternative treatment might be more
appropriate for you.
* Do tell them anything you think it is important to know.
* Do feel free to seek out a second opinion from a different
qualified medical professional if you feel that you cannot get what you
need from the one you have.
* Skipping appointments, because you are "too sick to go to the
doctor" is generally a bad idea..
* If you procrastinate, don't try to get everything done. Start by
getting one thing done. Then get the next thing done. Handle one
crisis at a time.
* If you are trying to remember too many things to do, it is okay to
write them down. If you make lists of tasks, work on only one task
at a time. Trying to do too many things can be too much. It can be
helpful to have a short list of things to do "now" and a longer
list of things you have decided not to worry about just yet. When you
finish writing the long list, try to forget about it for a while.
* If you have a list of things to do, also keep a list of what you
have accomplished too, and congratulate yourself each time you get
something done. Don't take completed tasks off your to-do list. If
you do, you will only have a list of uncompleted tasks. It's useful
to have the crossed-off items visible so you can see what you have
accomplished
* In general, drinking alcohol makes depression worse. Many cold
remedies contain alcohol. Read the label. Being on medication may
change how alcohol affects you.
* Books on the topic of "What to do during Depression": "A Reason to
Live," Melody Beattie, Tyndale House Publishers, Wheaton, IL. 167
pages. This book focuses on reasons to choose life over suicide,
but is still useful even if suicide isn't on your mind. In fact, it
reads a lot like this portion of the FAQ. An excerpt:
* Do two things each day. In times of severe crisis, when you don't
want to do anything, do two things each day. Depending on your physical
and emotional condition, the two things could be taking a shower and
making a phone call, or writing a letter and painting a room.
* Get a cat. Cats are clean and quiet, they are often permitted by
landlords who won't allow dogs, they are warm and furry.
Books
-----
Q. What are some books about depression?
This is an shorter version from a list of books compiled from the
personal recommendations of the members/readers/participants of the
Walkers-in-Darkness mailing list, the alt.support.depression
newsgroup, and the Mood Disorders Support Network on AOL.
The full list is available at the Walkers ftp site (see Internet
Resources) and at the MIT *.answers site, rtfm.mit.edu;
pub/usenet/alt-support-depression/books
If you have any additions, updates, corrections, etc. for this list,
please send email to "danash@aol.com" (Dan Ash).
~A Brilliant Madness: Living with Manic Depressive Illness.~ Patty
"Anna" Duke and Gloria Hochman. Bantam Books 1992 Comments: Patty
Duke's very personal account of her account of her struggle with
manic-depression.
~The Broken Brain: The Biological Revolution in Psychiatry.~ Nancy
Andreasen, MD, Ph.D.. Harper. Perennial. 1984
~Care of the Soul.~ Thomas Moore. Harper. Perennial. 1992
~The Consumers Guide to Psychotherapy.~ Jack Engler, Ph.D. and Daniel
Goleman, Ph.D. Fireside-Simon & Schuster. 1992
~Cognitive Therapy & The Emotional Disorders.~ Aaron T. Beck, MD
Penguin. Meridian. 1976
~Darkness Visible: A Memoir of Madness.~ William Styron. Vintage. 1990.
~The Depression Handbook.~ Workbook. Mary Ellen Copeland
~Depression and it's Treatment.~ John H. Greist, MD.. and James W.
Jefferson, MD.. Warner Books. 1992
~The Essential Guide to Psychiatric Drugs.~ Jack Gorman. St. Martin's
Press. 1992
~Everything You Wanted to Know About Prozac.~ Jeffrey M. Jonas, MD and
Ron Schaumburg. Bantam. 1991
~Feeling Good: The New Mood Therapy.~ David Burns, MD. Signet. 1980
Self-help cognitive therapy techniques for depression, anxiety, etc.
~The Feeling Good Handbook.~ David D. Burns, MD. Plume. 1989
~Good Mood: The New Psychology of Overcoming Depression.~ Julian L.
Simon. Open Court Press. 1993.
~The Good News About Depression.~ Mark S. Gold. Bantam. 1986
~Listening To Prozac.~ Peter D. Kramer, M.D. Viking. 1993 A
psychiatrist explores some of the implications of anti- depressants,
and especially of Prozac's unusual effects on the personality. Kramer
also discusses the recent research on depression, as well as several
other issues which seem linked to depression.
~How to Heal Depression.~ Harold H. Bloomfield, MD and Peter
McWilliams. Prelude Press. 1994
~Manic-Depressive Illness.~ Fredrick K. Goodwin, MD, & Kay Redfield
Jamison, Ph.D.. Oxford. 1990
~Munchausen's Pigtail.~ Psychotherapy and 'Reality': Essays & Lectures.
Paul Walzlawick, Ph.D.. Norton
~On The Edge Of Darkness.~ Kathy Cronkite. Doubleday. 1994
~Overcoming Depression.~ Demitri F. and Janice Papolos. Harper.
Perennial. 1992. Good basic text on the various aspects of depression
and manic depression. Considered by some to be a "classic" in the
field.
~A Primer of Drug Action: A Concise, Non technical Guide to the"
"Actions,Uses and Side Effects of Psychoactive Drugs.~ Robert M.
Julien. W.H. Freeman. 1992. 6 ed.
~Prozac: Questions and Answers for Patients, Families and Physicians.~
Dr. Robert Fieve, MD... Avon. 1993
~Questions and Answers about Depression and its Treatment.~ Dr. Ivan
Goldberg. The Charles Press in Philadelphia. 1993. A 112-page FAQ on
depression that has appeared in book form. Dr. Goldberg has also
contributed to the FAQ for a.s.d. and frequently posts to
Walkers-in-darkness.
~A Reason to Live.~ Melody Beattie (General Editor).. Tyndale House
Publishers, Inc.. 1992. This is a book that explores reasons to live
and reasons not to commit suicide. It also contains suggestions for
life-affirming actions people can take to help themselves get through
those times when they're struggling to find a reason to live.
~From Sad to Glad.~ Nathan S. Kline, MD. Ballantine Books.. 1991 20th
printing. Out of date pharmacologically "but excellent otherwise."
Kline says: "Psychiatry has labored too long under the delusion that
every emotional malfunction requires an endless talking out of
everything the patient ever experienced."
~Season of the Mind.~ Norman Rosenthal, MD.. This book explores
Seasonal Affective Disorder.
~Talking Back to Prozac.~ Peter Breggin. St. Martins Press. 1994
~Touched with Fire: Manic-depressive Illness and the Artistic~
~Temperament.~ Kay Jamison. A look at a number of 19th century poets,
writers, and composers who were Bipolar. This book in quoted
liberally in this FAQ under "Who are some famous people with
depression?"
~Toxic Psychiatry: Why Therapy, Empathy, and Love Must Replace Drugs,~
~Electroshock, and the Biochemical Theories of the 'New Psychiatry'.~
Peter Breggin. St. Martin's Press. 1991
~We Heard the Angels of Madness: One Family's Struggle with Manic~
~Depression.~ Diane and Lisa Berger This book was written by a mother
who had a son stricken by manic-depression at 19 and documents the
rough road they walked to get him the help he needed. Very heartfelt
and well written.
~Understanding Depression.~ Donald Klein, MD, and Paul Wender, MD
(founders of the National Assn. for Depressive Illness). Oxford,
1993 Melvin Sabshin, MD, Medical Director, American Psychiatric Assn.
writes: "A very good source of information that will be
extraordinarily useful to patients and their families."
~The Way Up From Down.~ Priscilla Slagle, M.D. This book stresses a
nutritional approach heavy on the amino acid tyrosine, and a complete
vitamin supplement program.
~What You Need to Know About Psychiatric Drugs.~ Stuart C. Yudofsky,
MD; Robert E. Hales, MD; and Tom Ferguson, MD. Ballantine. 1991
~When am I Going to Be Happy?~ Penelope Russianoff, Ph.D.. Bantam.
1989
~When the Blues Won't Go Away.~ Robert Hirschfeld, MD... 1991 Concerns
new approaches to Dysthymic Disorder and other forms of chronic
low-grade depression.
~Winter Blues: Seasonal Affective Disorder and How to Overcome It.~
Norman Rosenthal, MD... The Guilfold Press. 1993
~You Are Not Alone.~ Julia Thorne with Larry Rothstein. Harper Collins.
1993 Comments: The writings of depressives, for both depressives and
those who need to understand them. Shervert Frazier, MD, former
director of the National Institutes of Mental Health says: "A
ground breaking book that...reveals the impact of depression on the
lives of everyday people. This little book is must reading for
sufferers, those associated with depression, and mental health
professionals"
~You Mean I Don't Have To Feel This Way?~ Collette Dowling. Bantam.
1993 Comments: Jeffrey M. Jonas, MD writes: "An important book that
is filled with information helpful to sufferers of mood and eating
disorders and other illnesses. It should be read not only by lay
people but also by professionals who deal with these illnesses."
Posted: Mar 02, 2009
tags: coping with depression,
depression,
faq,
living with depression
Part 5 of 5
===========
**Famous People**
- Who are some famous people who suffer from depression and bipolar
disorder?
**Internet Resources**
- What are some electronic resources on the internet related to
depression?
**Anonymous Posting**
- How can I post anonymously to alt.support.depression?
**Sources**
- Sources
**Contributors**
- Contributors
Famous People
-------------
Q. Who are some famous people who suffer from depression and bipolar
disorder?
This list represents a few of the famous people included in a list posted to a.s.d. on a periodic basis. Much of it is taken from the book by Kay Redfield Jamison, "Touched With Fire; Manic-Depressive Illness and the Artistic Temperament." The Free Press (Macmillan), New York, 1993. Used without permission, but with intent to educate, and not for profit. Please send updates (or additions) to jikelman@ngdc.noaa.gov
"This is meant to be an illustrative rather than a comprehensive list... Most of the writers, composers, and artists are American, British, European, Irish, or Russian; all are deceased... Many if not most of these writers, artists, and composers had other major problems as well, such as medical illnesses, alcoholism or drug addiction, or exceptionally difficult life circumstances. They are listed here as having suffered from a mood disorder because their mood symptoms predated their other conditions, because the nature and course of their mood and behavior symptoms were consistent with a diagnosis of an independently existing affective illness, and/or because their family histories of depression, manic-depressive illness, and suicide--coupled with their own symptoms--were sufficiently strong to warrant their inclusion." (from Touched With Fire...)
KEY:
H = Asylum or psychiatric hospital
S = Suicide
SA = Suicide Attempt
**WRITERS:** Hans Christian Andersen, Honore de Balzac, James Barrie, William Faulkner (H), F. Scott Fitzgerald (H), Ernest Hemingway (H, S), Hermann Hesse (H, SA), Henrik Ibsen, Henry James, William James, Samuel Clemens (Mark Twain), Joseph Conrad (SA), Charles Dickens, Isak Dinesen (SA), Ralph Waldo Emerson, Herman Melville, Eugene O'Neill (H, SA), Mary Shelley, Robert Louis Stevenson, Leo Tolstoy, Tennessee Williams (H), Mary Wollstonecraft (SA), Virginia Woolf (H, S)
**COMPOSERS:** Hector Berlioz (SA), Anton Bruckner (H), George Frederic Handel, Gustav Holst, Charles Ives, Gustav Mahler, Modest Mussorgsky, Sergey Rachmaninoff, Giocchino Rossini, Robert Schumann (H, SA), Alexander Scriabin, Peter Tchaikovsky
**NONCLASSICAL COMPOSERS AND MUSICIANS:** Irving Berlin (H), Noel Coward, Stephen Foster, Charles Mingus (H), Charles Parker (H, SA), Cole Porter (H)
**POETS:** William Blake, Robert Burns, George Gordon, Lord Byron, Samuel Taylor Coleridge, Hart Crane (S) , Emily Dickinson, T.S. Eliot (H), Oliver Goldsmith, Gerard Manley Hopkins, Victor Hugo, Samuel Johnson, John Keats, Vachel Lindsay (S), James Russell Lowell, Robert Lowell (H), Edna St. Vincent Millay (H), Boris Pasternak (H), Sylvia Plath (H, S), Edgar Allan Poe (SA), Ezra Pound (H), Anne Sexton (H, S), Percy Bysshe Shelley (SA), Alfred, Lord Tennyson, Dylan Thomas, Walt Whitman
**ARTISTS:** Richard Dadd (H), Thomas Eakins, Paul Gauguin (SA), Vincent van Gogh (H, S), Ernst Ludwig Kirchner (H, S), Edward Lear, Michelangelo, Edvard Meunch (H), Georgia O'Keeffe (H), George Romney, Dante Gabriel Rossetti (SA)
**Confirmed Bipolars (still living):** Idi Amin, former dictator; Patty Duke (Anna Pearce), actor, writer; Connie Francis, actor, musician; Peter Gabriel, musician; Charles Haley, athlete (Dallas Cowboys); Kristy McNichols, actor; Spike Mulligan, comic actor; Abigail Padgett, mystery writer; Murray Pezim, financier (Canada); Charley Pride, musician; Axl Rose, musician; Ted Turner, entrepreneur, media giant (U.S.); Robin Williams, actor, comedian
**Confirmed Unipolars (still living):** Roseanne Arnold, actor, writer, comedienne (also has Multiple personality disorder and obsessive compulsive disorder); Dick Cavett, writer, media personality; Tony Dow, actor, director; Kitty Dukakis, Massachusetts first lady; William Styron, writer; James Taylor, musician; Mike Wallace, news anchor.
Internet Resources
------------------
Q. What are some electronic resources on the internet related to depression?
This list is a shortened version of one compiled and maintained by Sylvia Caras. It is posted periodically to ThisIsCrazy-L (see below for subscription information) If you would like to suggest additions for this list, contact <sylviac@netcom.com> To suggest additions to this list for the Alt.support.depression FAQ, send them to cf12@cornell.edu.
* News groups:
alt.support.depression
alt.support.phobias
sci.psychology
sci.med
sci.med.psychobiology
* Internet Health Resources is an extensive listing of medical resources available over the internet.
ftp2.cc.ukans.edu
cd pub/hmatrix
get file medlst03.txt or medlst03.zip.
* An FTP site at Temple University containing articles related to depression
ftp 129.32.32.98
cd/pub/psych
* ThisIsCrazy is an electronic action and information letter for people who experience moods swings, fright, voices, and visions (People Who). To subscribe, send a message to majordomo@netcom.com with this command in the body of the message:
subscribe ThisIsCrazy-L
* Pendulum is a mailing list for people diagnosed with bipolar mood disorder (manic depression) and related disorders and their supporters, and some professionals. To subscribe to pendulum, send a message to majordomo@ncar.ucar.edu containing the line subscribe pendulum
* Walkers-in-Darkness is a list for people diagnosed with various depressive disorders (unipolar, atypical, and bipolar depression, S.A.D., related disorders). The list also includes sufferers of panic attacks and Borderline Personality Disorder. Please, no researchers trying to study us, etc. (Postings are copyrighted by individual posters.)
To subscribe to walkers or walkers-digest, send a message to majordomo@world.std.com containing the line "subscribe walkers" or,
for the digest, "subscribe walkers-digest". There is an anonymous FTP site at ftp.std.com in ~/pub/walkers, that includes a technical FAQ.
* To subscribe to the Mailbase list psychiatry send the command SUBSCRIBE psychiatry <your name> to mailbase@uk.ac.mailbase
Q. How can I post anonymously to alt.support.depression?
For more information, consult the Privacy & Anonymity on the Internet FAQ, posted regularly to sci.crypt, comp.society.privacy, and alt.privacy.
Sources
-------
Pamphlet: Depression: What you need to know, National Institute of Mental Heath. By Marilyn Sargent. Office of Scientific Information National Institute of Mental Health
Diagnostic and Statistical Manual of Mental Disorders. The DSM stands for the Diagnostic and Statistical Manual of Mental Disorders. It is published by the American Psychiatric Association. The latest version is the DSM-III-R (1987). For reference, the DSM-III was published in 1980. The first edition of this manual was published in 1952, and the second edition in 1968. The fourth edition (DSM-IV) is currently in press and should be available this summer. It is used by the vast majority of psychologists and mental health professionals in the United States of America as a diagnostic tool. Psychiatrists and professionals outside of the U.S. will often use a diagnostic system called ICD-9, which differs in many respects from the DSM.
Contributors
------------
Becky <becky@panix.com> Elmont,NY
Brian Gerred <gerredb@cae.wisc.edu>
Dawn Sharon Friedman <friedman@husc.harvard.edu>
Dana Quinn <dana@lassi.ece.uiuc.edu>
John M. Grohol (grohol@alpha.acast.nova.edu), Nova S.E. University
Joy Ikelman <jikelman@ngdc.noaa.gov> Boulder, CO
kxr@netcom.com (Keith Rich)
Mary-Anne Wolf <mgw@world.std.com>
Rachel Findley
Robert Orenstein (rlo@netcom.com)
Silja Muller <smuller@unix1.tcd.ie>
Stephan Klaus Heilmayr <heilmayr@math.berkeley.edu> Oakland, CA
Sue W. <SUE235@delphi.com>
Sylvia Caras <sylviac@netcom.com> Owner, ThisIsCrazy-L
Todd Daniel Woodward <danash@aol.com> Mountain View, CA
Wes Melander <melander@hplvec.lvld.hp.com>
Editor: Cynthia Frazier (cf12@CORNELL.edu) Lansing, NY
Special thanks to Ivan Goldberg, MD, NY Psychopharmacologic Inst,.<ikg@mindvox.phantom.com>, who has provided many of the questions and answers as well as made corrections throughout the FAQ.
Posted: Mar 02, 2009
tags: depression,
faq
For much of my childhood and young adulthood, I suffered from depression. Although I did have some periods of major depression, the bulk of the time my depression was a type called dysthymia.
Dysthymia is a low-grade form of depression that lasts at least two years, with symptom free periods lasting no longer than two months.
Read on
Posted: Feb 14, 2009
tags: depression,
dysthymia
Most people know the risk factors for illnesses such as heart disease or high blood pressure, but not many people realize that clinical depression has risk factors associated with it also. Having these risk factors doesn't mean you will suffer from depression, only that you may be predisposed to it. Below, in no particular order, are listed some of these risk factors.
- There is a history of mental illness in your family.
- You are a woman. One in four women suffers from depression at some point in her life.
- You were sexually abused as a child.
- Someone close to you is depressed (depression can be "contagious").
- You have a chronic illness or are in chronic pain.
- You lost a parent at an early age, either through death or abandonment.
- You have heart disease. One in five heart patients has severe depression.
- Someone close to you has recently died, or you are experiencing another stressful life event such as divorce or financial problems.
- You are taking a medication that can cause depression as a side-effect.
Related Links
Posted: Feb 05, 2009
tags: depression,
diagnosis
