Depression

Unlike normal emotional experiences of sadness, loss or passing mood states, depressive disorders are persistent and can significantly interfere with your thoughts, behavior, mood, activity and physical health. It is not the same as being unhappy or in a blue mood. Nor is it a sign of personal weakness or a condition that can be willed or wished away. People with a depressive illness cannot merely "pull themselves together" and get better.

More than half of those who experience a single episode of depression will continue to have episodes that occur as frequently as once or even twice a year. Without treatment, the frequency of depressive illness as well as the severity of symptoms tends to increase over time.

Among all medical illnesses, major depression is the leading cause of disability in the United States. Appropriate treatment, however, can help most people who suffer from depression.

Though the cause of depression is unknown, studies suggest that an imbalance in three types of brain chemicals called neurotransmitters may be one possible cause. These three neurotransmitters are serotonin, norepinephrine and dopamine.

Some risk factors for depression include:

• Heredity – Depression can run in families. However, not everyone with a family history of depression develops the disorder, and conversely people with no family history of the disorder can become depressed.
• Gender – Depression occurs twice as frequently in women as in men, for reasons that are not fully understood. Many hormonal factors may contribute to the increased rate of depression in women.
• Stress – Stressful life events, particularly a loss or threatened loss of a loved one or a job, can trigger depression.
• Medications – Long-term use of certain medications, such as some drugs used to control hypertension (high blood pressure), sleeping pills or birth control pills, may cause symptoms of depression in some people.
• Illnesses – Having a chronic illness, such as heart disease, stroke, diabetes, cancer or Alzheimer's disease, puts an individual at a higher risk for developing depression. Having an underactive thyroid (hypothyroidism), even mildly, also can cause depression. Physical trauma (damage) to the brain also can trigger depression.
• Personality – Certain personality traits, such as having low self-esteem and being overly dependent, self-critical, pessimistic and easily overwhelmed by stress, can make an individual more vulnerable to depression.
• Childbirth – It is common for mothers to feel a mild form of distress that usually occurs a few days to weeks after giving birth. During this time the woman may have feelings of sadness, anger, anxiety, irritability and incompetence. A more severe form of the baby blues, called postpartum depression, also can affect new mothers.
• Alcohol, smoking and drug abuse – Abuse of alcohol, cigarettes and recreational drugs such as cocaine, methamphetamine (crystal meth), ecstasy and marijuana can lead to depression.

Signs of depression

The following are the most common major depression symptoms. However, each individual may experience symptoms differently. Symptoms may include:

• Persistent sad, anxious or empty mood
• Loss of interest in activities once previously enjoyed
• Excessive crying
• Increased restlessness and irritability
• Decreased ability to concentrate and make decisions
• Decreased energy
• Thoughts of death or suicide, or suicide attempts
• Increased feelings of guilt, helplessness and/or hopelessness
• Weight and/or appetite changes due to over- or under-eating
• Changes in sleep patterns
• Social withdrawal
• Physical symptoms unrealized by standard treatment (i.e., chronic pain, headaches)

For a diagnosis of major depression to be made, an individual must exhibit five or more of these symptoms during the same two-week period. 

Older adults may react differently to depression. The elderly may be more willing to discuss the physical symptoms of depression instead of their emotional difficulties, and may complain constantly about aches and pains.

Diagnosis of depression

A depression diagnosis often is made after a careful psychiatric examination and medical history performed by a psychiatrist or other mental health professional.

Typically, the diagnosis begins with a medical history, including questions about the duration, severity and characteristics of symptoms. Your physician may ask about diet, stress, any medications currently being taken and changes in sleep patterns. Questionnaires may also be used to determine the level of your depression.

Diagnosis also involves ruling out all other disease possibilities and other mental health conditions that may produce symptoms similar to depression. These may include other mood disorders, such as bipolar disorder, schizophrenia, attention-deficit/hyperactivity disorder (ADHD) and borderline personality disorder.

Because depression has shown to often coexist with other medical conditions, such as heart disease, cancer or diabetes, and other psychiatric disorders, such as substance abuse or anxiety disorders, seeking early diagnosis and treatment is crucial to recovery.

Treatment for depression

At Lehigh Valley Health Network, we are dedicated to helping you find ways to overcome your day-to-day challenges in a safe and comfortable environment. In an atmosphere of trust, security and privacy, you’ll benefit from our expertise and be comforted by our compassion. We’ll provide treatment that blends the latest science with genuine concern and kindness.

We don't hesitate to seek help for our body's aches and pains. Yet when our emotions hurt, we're often reluctant to see a doctor. Patients sometimes don't want to admit that's why they've come in. When you're in emotional pain, consulting a medical professional can help you feel better.

Most people seeking help for a psychological problem start with their primary care provider. There's a built-in comfort level in this doctor-patient relationship. Your doctor knows your medical history, life situation and family dynamics, and that makes it easier to plan a course of treatment. As your health care "gatekeeper," he or she can choose from a range of options – from relaxation therapies such as yoga and massage, to medications, to a referral to a trusted mental health professional – to help bring your symptoms under control.

Doctors typically prescribe antidepressant medications and/or some form of talk therapy. The specific combination varies with the individual. Treatment may include:

Psychotherapy

Psychotherapy involves talking to a health care professional about one's problems and life situation. There are several types of psychotherapy that have been shown to be effective for depression, including cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT). Research has shown that mild to moderate depression often can be treated successfully with either of these therapies used alone. However, severe depression appears more likely to respond to a combination of psychotherapy and medication.

• Cognitive-behavioral therapy (CBT) – CBT helps to change the negative thinking and unsatisfying behavior associated with depression, while teaching individuals how to unlearn the behavioral patterns that contribute to their depression.
• Interpersonal therapy (IPT) – IPT focuses on improving troubled personal relationships and on adapting to new life roles that may have been associated with a person's depression.

Medications

Drugs used for depression often take two to four weeks to start having an effect, and six to 12 weeks to have their full effect. The first antidepressant medications were introduced in the 1950s. Research has reported that imbalances in neurotransmitters including serotonin, dopamine and norepinephrine can be improved with antidepressant use.

Suicidal tendencies can develop after the start of drug treatment in some people, especially children and teenagers. Careful observation of behavior and open communication about suicidal thoughts are the keys to observing for these changes in anyone taking antidepressant medication.

Medications for depression may include:

• Selective serotonin reuptake inhibitors (SSRI)
• Serotonin and norepinephrine reuptake inhibitors (SNRI)
• Norepinephrine-dopamine reuptake inhibitors (NDRI)
• Tricyclic antidepressants (TCA)
• Monoamine oxidase inhibitors (MAOI)
• Mirtazapine (Remeron®)
• Atypical antipsychotics (AAP)
• Stimulants

Electroconvulsive therapy (ECT)

Electroconvulsive therapy (ECT) is considered one of the safest and most effective procedures for treating severe depressive symptoms. ECT uses electrical currents to stimulate various parts of the brain and cause a brief seizure. This is done while the patient is under general anesthesia. ECT has been shown to positively affect brain chemistry and reduce symptoms of depression and bipolar disorder. Patients typically see improvement in their condition within 6-12 sessions, but this may vary depending on symptoms, diagnosis and other factors.

Spravato®

Spravato® is a nasal spray used in combination with oral antidepressants to relieve severe symptoms of depression (including suicidal thoughts and actions). It is the first Food and Drug Administration-approved nasal spray for adults ages 18 and older who have treatment-resistant depression (depression that has not responded to two or more prescribed antidepressant medications).

Transcranial Magnetic Stimulation (TMS)

TMS is a noninvasive procedure that uses magnetic fields to stimulate nerve cells in the areas of your brain that control your mood and depression.

If you have tried antidepressant medications and therapy but continue to have depression symptoms that interfere with your everyday life, you may be a candidate for TMS. It is also an alternative treatment option if you have experienced side effects from depression medications or are worried about potential side effects of them. A full treatment course of TMS is 36 sessions, and daily treatments can vary between 3-to-18-minute treatments (depending on your individualized treatment plan).