What is Depression?

Most people have felt sad or depressed at times. Feeling depressed can be a normal reaction to loss, life's struggles, or an injured self-esteem. But when feelings of intense sadness -- including feeling helpless, hopeless, and worthless -- last for days to weeks and keep you from functioning normally, your depression may be something more than sadness. It may very well be clinical depression -- a treatable medical condition.

According to the DSM-IV, a manual used to diagnose mental disorders, depression occurs when you have at least five of the following nine symptoms at the same time:

• a depressed mood during most of the day, particularly in the morning
• fatigue or loss of energy almost every day
• feelings of worthlessness or guilt almost every day
• impaired concentration, indecisiveness
• insomnia or hypersomnia (excessive sleeping) almost every day
• markedly diminished interest or pleasure in almost all activities nearly every day
• recurring thoughts of death or suicide (not just fearing death)
• a sense of restlessness -- known as psychomotor agitation -- or being slowed down -- retardation
• significant weight loss or gain (a change of more than 5% of body weight in a month)

What are some common feelings associated with depression?

According to the National Institute of Mental Health, people with depressive illnesses do not all experience the same symptoms. How severe they are, how frequent, and how long they last will vary. It depends on the individual and his or her particular illness. Here are common symptoms people with depression experience:

• difficulty concentrating, remembering details, and making decisions
• fatigue and decreased energy
• feelings of guilt, worthlessness, and/or helplessness
• feelings of hopelessness and/or pessimism
• insomnia, early morning wakefulness, or excessive sleeping
• irritability, restlessness
• loss of interest in activities or hobbies once pleasurable, including sex
• no pleasure left in life any more
• overeating or appetite loss
• persistent aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment
• persistent sad, anxious, or "empty" feelings
• thoughts of suicide, suicide attempts

While these are common symptoms of depression, they may also occur in patterns. For example, a person may experience depression with mania or hypomania -- a condition sometimes called manic depression. Or the symptoms may be seasonal as in the case of seasonal affective disorder.
There are several types of manic depression. People with bipolar II disorder have at least one episode of major depression and at least one hypomanic -- mild elation or high -- episode. People with bipolar I disorder have a history of at least one manic -- extreme elation or high -- episode, with or without past major depressive episodes. A patient with unipolar depression has major depression only but does not have hypomania or mania.

What are depression medicines?

Depression medicines include many types of antidepressants and other mood stabilizers. They can help lift your mood and ease the sadness and hopelessness you feel. You’ll need to work with your doctor to find the depression medicine that is most effective with the fewest side effects.

How do antidepressants work to end depression?

It’s thought that three chemical messengers are involved with depression. The three are norepinephrine, serotonin, and dopamine, which are neurotransmitters. Neurotransmitters transmit electrical signals between brain cells.
Researchers agree that if there is a chemical imbalance in these brain chemicals, then clinical states of depression result. Antidepressant medications work by increasing the availability of neurotransmitters or by changing the sensitivity of the receptors for these chemical messengers. It is believed that modifying these brain chemicals can help improve emotions.

What types of antidepressants help treat depression?

There are several types of antidepressants. These depression medications are also used to treat conditions that have depression as a component of the disease. For example, they might be used to treat bipolar disorder.
These drugs improve symptoms of depression. The major types of antidepressants include:

• Tricyclic antidepressants (TCAs). TCAs primarily affect the levels of two chemical messengers in the brain, norepinephrine and serotonin. Although these drugs are effective in treating depression, they can have more side effects than other drugs. So they typically aren't the first drugs used.
• Monoamine oxidase inhibitors (MAOIs). MAOIs are most effective in people with depression who do not respond to other treatments. They are also effective for treating other mental illnesses. Substances in certain foods like cheese, beverages like wine, and medications can interact with an MAOI. So people taking this medication must adhere to strict dietary restrictions. For this reason these antidepressants also aren't usually the first drugs used.
• Selective serotonin reuptake inhibitors (SSRIs). SSRIs are a newer form of antidepressant. These drugs work by altering the amount of a chemical in the brain called serotonin.
• Serotonin and norepinephrine reuptake inhibitors (SNRIs). SNRIs are another newer form of antidepressant medicine. They treat depression by increasing availability of the brain chemicals serotonin and norepinephrine

Electroconvulsive and Other Depression Therapies

When medication fails to ease the symptoms of clinical depression, there are other options to try. For example, electroconvulsive therapy (ECT) as well as vagus nerve stimulation (VNS) can be used to treat severe depression and major depression that has proven resistant to treatment. With ECT, an electric current is briefly applied through the scalp to the brain, inducing a seizure. VNS uses a device known as a vagus nerve stimulator to alleviate depression. In addition, alternative therapies such as yoga and hypnosis sometimes work for mild depression.

What is electroconvulsive therapy (ECT)?

ECT is safe and among the most effective treatments available for depression. With ECT, electrodes are put on the patient's scalp and a finely controlled electric current is applied. The current causes a brief seizure in the brain. ECT is one of the fastest ways to relieve symptoms in severely depressed or suicidal patients. It's also very effective for patients who suffer from mania or other mental illnesses.
ECT is generally used when severe depression is unresponsive to other forms of therapy. Or it might be used when patients pose a severe threat to themselves or others and it is dangerous to wait until medications take effect.
Although ECT has been used since the 1940s and 1950s, it remains misunderstood by the general public. Many of the procedure's risks and side effects are related to the misuse of equipment, incorrect administration, or improperly trained staff. It is also a misconception that ECT is used as a "quick fix" in place of long-term therapy or hospitalization. Nor is it correct to believe that the patient is painfully "shocked" out of the depression. Unfavorable news reports and media coverage have contributed to the controversy surrounding this treatment.

How is ECT done?

Prior to ECT treatment, a patient is given a muscle relaxant and is put to sleep with a general anesthesia. Electrodes are placed on the patient's scalp and a finely controlled electric current is applied. This current causes a brief seizure in the brain.
Because the muscles are relaxed, the visible effects of the seizure will usually be limited to slight movement of the hands and feet. Patients are carefully monitored during the treatment. The patient awakens minutes later, does not remember the treatment or events surrounding it, and is often confused. The confusion typically lasts for only a short period of time.
When used, ECT is usually given up to three times a week for a total of two to four weeks.

Who might benefit from ECT?

According to the American Psychiatric Association, ECT can be beneficial in the following situations:

• when a need exists for rapid treatment response, such as in pregnancy
• when a patient refuses food and that leads to nutritional compromise
• when a patient's depression is resistant to antidepressant therapy
• when other medical ailments prevent the use of antidepressant medication
• when the patient is in a catatonic stupor
• when the depression is accompanied by psychotic features
• when treating bipolar disorder
• when treating mania
• when treating patients who have a severe risk of suicide
• when treating patients who have had a previous response to ECT
• when treating patients with atypical psychosis
• when treating patients with major depression
• when treating schizophrenia

Suicidal gestures and attempts
Sometimes, a person will make actions resembling suicide attempts while not being fully committed. This is called a suicidal gesture. Prototypical methods might be a non-lethal method of self-harm that leaves obvious signs of the attempt, or simply a lethal action at a time when the person considers it likely that he/she will be rescued or prevented from fully carrying it out.
On the other hand, a person who genuinely wishes to die may survive, due to lack of knowledge, unwillingness to try methods that may end in permanent damage to her- or himself (in the event of an attempt which does not result in death), unwillingness to try methods which may harm others, an unanticipated rescue, among other reasons. There may be conflict, whereby a genuinely suicidal person can be desperate enough to want to kill themselves but at the same time, too afraid to go through with the extreme measures that are needed to guarantee death. It may be incorrect to state that a person who survived an overdose was issuing a 'cry for help' when in reality it was a suicide attempt that simply did not result in death. This highlights a basic fact that it is not easy to kill oneself in a way that is not traumatic or painful, hence the phenomenon of assisted suicides. This is referred to as a suicide attempt.
Distinguishing between a suicide attempt and a suicidal gesture may be difficult. Intent and motivation are not always fully discernible since so many people in a suicidal state are genuinely conflicted over whether they wish to end their lives. One approach, assuming that a sufficiently strong suicide intent will ensure death, considers all near-suicides to be suicidal gestures. This, however, does not explain why so many people whose suicide attempts do not result in death end up with severe injuries, often permanent, which are most likely undesirable to those who are making a suicidal gesture. Another possibility is those wishing merely to make a suicidal gesture may end up accidentally killing themselves, perhaps by underestimating the lethality of the method chosen or by overestimating the possibility of external intervention by others. Suicide-like acts should generally be treated as seriously as possible, because if there is an insufficiently strong reaction from loved ones from a suicidal gesture, this may motivate future and ultimately more committed attempts.
In the technical literature the use of the terms parasuicide, or deliberate self-harm (DSH) are preferred – both of these terms avoid the question of the intent of the actions.
Nearly half of all suicides are preceded by an attempt at suicide that does not end in death. Those with a history of such attempts are 23 times more likely to eventually end their own lives than those without. Those who attempt to harm themselves are, as a group, quite different from those who actually die from suicide; females attempt suicide much more frequently than males, however males are four times more likely to die from suicide

The following facts about suicide were obtained from the media and press kit created for National Suicide Prevention week by The American Association of Suicidology

• In the United States, one person completes suicide every 16 minutes.
  
• It is estimated that 5 million people in the United States are survivors of suicide (those who have lost a loved one to suicide).
  
• 51% of people who die by suicide use a firearm, and guns stored in the house are used for suicide 40 times more often than for self-protection.
  
• In the United States, more people die by suicide (50% more!) each year than by homicide.
  
• Over 90 percent of suicide victims have a significant psychiatric illness at the time of their death. These are often undiagnosed, untreated, or both. Mood disorders and substance abuse are the two most common.
  
• There is a relationship between alcoholism and suicide; the risk of suicide in alcoholics is 50 to 70 percent higher than the general population.
  
• Whereas the overall suicide rate in our country has only slightly declined from record highs in recent years, the suicide rate for those 15-24 years old has more than doubled since the mid-1950s; and the suicide rate remains highest for adults 75 years of age and older.