DEPRESSION: SYMPTOMS AND TREATMENTS

By Helen Borel, R.N.,Ph.D.

Beyond the Blues: Sadness or Depression?
Depression, a worldwide challenge to psychiatrists, afflicts 15 to 19 million Americans. Untreated 
or undertreated, it accounts for the daily disability and suffering of these millions, but suicide is 
its major danger.

Common Sadness and Ordinary Grief are Not Depression 
Never confuse depression with common but fleeting down-moods like sadness due to loss of a 
job. Or like that "bad mood" caused by insomnia or hunger. And not even the pain of grief over 
a death. These latter are typically time-limited. Moreover, although the duration of grief varies in 
different people, in contrast to depression grief generally follows a four-stage course. These 4 
stages proceed, respectively, as Shock, Bargaining ("If I do so-and-so, the person will return to 
me"), Anger, and Letting Go. Depression does not include this very specific experiential quartet.

Actual Depression is Unbearable and Seems Never-Ending 
True depression is tenacious and prolonged; its symptoms, to the depressed person's life, 
devastating. So emotionally painful that the depressed person may feel that the only way out of 
the blackness is suicide. It is this danger, in addition to the joy-robbing symptoms, that makes 
the rapid diagnosis and immediate treatment of depression so essential.

Kinds of Depression 
Occurring on a continuum,depressive mood states can be relatively moderate,others prolonged 
and severe such as Major Depressive Disorder(MDD) and the depressive phases of Manic 
Depression (also known as Bipolar Disorder). It's important to note that Bipolar Disorder tends 
to run in families.

All too often, depression goes unrecognized since it can seem to be a physiologic illness, 
such as pain of unknown etiology (cause), or progressively deteriorating hygiene, or as a 
forced, painted-on smile in spite of marked internal suffering. These confounding symptoms 
and  family-upsetting behaviors are too often not viewed as typical depression.  Unfortunately, 
in such cases, essential therapies are delayed due to absence of a swift and accurate 
diagnosis of depression.

Swift Depression Diagnosis and Treatments 
Improve Mood and Can Prevent Suicide 
Biochemically, emotionally and psychosocially,depression is a serious disorder. To recover 
from it, or at least sustain a full remission, it requires long-term treatment - and sometimes a 
lifetime of treatments. The earlier a depression diagnosis is made, the better in order to lift the 
depressive's mood state and prevent suicide. Then, ideally, a prescription drug and/or 
psychotherapy begins immediately; upon prompt diagnosis, the optimal regimen for each 
particular patient is prescribed. This means that one or another antidepressant drug and/or 
psychotherapy will begin right away.

Behaviors and Feelings Pointing to Depression 
At its worst, depression is a shutting down of feelings and a retardation of physical motion. 
In the depressed state, a patient's activity is markedly slowed, eventually to a halt. So much 
so that the patient's appetite can vanish resulting in refusal of food and liquids, with dehydration 
an added risk. So too, such patients in such severe depression may remain in bed all day. But 
not only is over-sleeping common. In some cases, inability to sleep enough is paradoxically 
present and can result in irritability and agitation.

Look for the Following Indicators When You Suspect Depression: 
1) Feelings of Lethargy, Hollowness inside and Worthlessness
2) Feeling and exhibiting Irritability, Anxiety and Agitation 
3) Insomnia or Hypersomnia (Oversleeping)   4) Anorexia or Overeating 
5) Indecisiveness and Poor Concentration 
6) Anhedonia (unable to feel pleasure) or have interest in a sexual or social life 
7) Copelessness (can't cope due to lack of hope)  8) Unrelenting Sadness 
9) Physical Complaints unrelieved by medical interventions 
and finally A paramount risk in depression is 
10) Suicide. Suicide itself can proceed from thoughts of suicide to 
attempts to kill oneself, to completion of one's suicide.

Varied Therapies Decrease Depressive Suffering, Often Preventing Suicides 
PSYCHOTHERAPY is the first-line intervention for intransigent dark mood states and 
moderate levels of depression. Cognitive-Behavioral Therapy (CBT) is one approach that 
helps redirect a depressed person's negative beliefs toward positive thoughts and attainable 
goals. Thus, CBT teaches and helps the patient maintain personal behaviors and interactions 
that restore normal moods and awaken enthusiasm for life.

PSYCHOANALYTIC APPROACHES are useful, too, because these techniques help 
depressed individuals face and handle their critical problems arising from childhood events. 
Particularly those that are dysregulating current relationships and that can complicate 
recovery from depression.

ANTIDEPRESSANT DRUGS may be needed along with psychotherapy in some moderately 
affected patients. However, all severely depressed patients require antidepressant medication. 
Such prescription drugs include the chemical class known as the tricyclics, of which 
Elavil (R) (amitriptyline) is an example.

Or the depressed patient may be given one of the "newer generation" antidepressants called 
SSRIs (serotonin selective reuptake inhibitors). Examples of this chemical class include 
Prozac(R) (fluoxetine), Zoloft(R) (sertraline), and Paxil(R) (paroxetine). Somewhat more 
side-effect-free than the tricyclics of yesteryear, the SSRIs intervene in serotonin brain 
chemistry, thereby delivering their antidepressant effects.

Other prescription agents, particularly Lithium carbonate and anti-epileptic medications are 
also used to treat the episodic mania-depression cycles of bipolar disorder.

ELECTROCONVULSIVE THERAPY (ECT) is sometimes unavoidable to quickly reverse 
severe depression that is, too often, medication-resistant. ECT is necessary in such dire 
circumstances because this only minutes-long procedure - performed with the patient 
under anesthesia - is a safe and rapid way to resolve depressive symptoms unresponsive 
to antidepressant drugs.

ECT's one inconvenience of temporary memory loss 
is a small price to pay to get better and not end one's life.

To sum up, ECT is administered in unrelenting, drug-resistant depression because it is 
the surest method for quickly combatting depressive pain and obviating suicidal actions. 
It thus saves many lives.

A key fact is that ECT can more rapidly accomplish what drugs 
and psychotherapy take measurably longer to bring about
Basically, ECT shakes up the patient's neurotransmitters (brain chemical messengers), 
shifting them toward homeostasis and elevating mood states toward more optimistic 
frames of mind by effectively "balancing the brain."

Getting Help for Depression 
If you suspect you are (or a loved one is) depressed, get psychiatric help immediately. 
Remember that the earlier your diagnosis, the swifter your treatment regimen can begin. 
You don't have to suffer any longer now that you know depression is substantially 
treatable. You can feel better. You'll be able to get back your pleasure in life. 

Don't wait. Reach out for help right now!

(c) Copyright 2008-2015 Dr. Helen Borel. All rights reserved.

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