Introduction

From high to low. From mania to depression. From recklessness to listlessness. These are the extremes associated with bipolar disorder, a mental illness characterized by mood instability that can be serious and disabling. Bipolar disorder is also known as manic-depression or manic-depressive illness — manic behavior is one extreme of this disorder, and depression is the other.

The deep mood swings of bipolar disorder may last for weeks or months, causing great disturbances in the lives of those affected, and those of family and friends, too. Today, a growing volume of research suggests that bipolar disorder occurs across a spectrum of symptoms, and that many people aren’t correctly diagnosed. Left untreated, bipolar disorder generally worsens, and the suicide rate is high among those with bipolar disorder. But with effective treatment, you can live an enjoyable and productive life despite bipolar disorder.

Signs and symptoms

Bipolar disorder symptoms are characterized by an alternating pattern of emotional highs (mania) and lows (depression). The intensity of signs and symptoms can vary from mild to severe. There may even be periods when your life doesn’t seem affected at all.

Manic phase of bipolar disorder
Signs and symptoms of the manic phase of bipolar disorder may include:

• Euphoria
• Extreme optimism
• Inflated self-esteem
• Poor judgment
• Rapid speech
• Racing thoughts
• Aggressive behavior
• Agitation
• Increased physical activity
• Risky behavior
• Spending sprees
• Increased drive to perform or achieve goals
• Increased sexual drive
• Decreased need for sleep
• Tendency to be easily distracted
• Inability to concentrate
• Drug abuse

Depressive phase of bipolar disorder
Signs and symptoms of the depressive phase of bipolar disorder may include:

• Sadness
• Hopelessness
• Suicidal thoughts or behavior
• Anxiety
• Guilt
• Sleep problems
• Appetite problems
• Fatigue
• Loss of interest in daily activities
• Problems concentrating
• Irritability
• Chronic pain without a known cause

Types of bipolar disorder
Bipolar disorder is divided into two main subtypes:

• Bipolar I disorder. You’ve had at least one manic episode, with or without previous episodes of depression.
• Bipolar II disorder. You’ve had at least one episode of depression and at least one hypomanic episode. A hypomanic episode is similar to a manic episode but much briefer, lasting only a few days, and not as severe. With hypomania, you may have an elevated mood, irritability and some changes in your functioning, but generally you can carry on with your normal daily routine and functioning, and you don’t require hospitalization. In bipolar II disorder, the periods of depression are typically much longer than the periods of hypomania.
• Cyclothymia. Cyclothymia is a mild form of bipolar disorder. Cyclothymia includes mood swings but the highs and lows are not as severe as those of full-blown bipolar disorder.

Other bipolar disorder symptoms
In addition, some people with bipolar disorder have rapid cycling bipolar disorder. This is the occurrence of four or more mood swings within 12 months. These moods shifts can occur rapidly, sometimes within just hours. In mixed state bipolar disorder, symptoms of both mania and depression occur at the same time.

Severe episodes of either mania or depression may result in psychosis, or a detachment from reality. Symptoms of psychosis may include hearing or seeing things that aren’t there (hallucinations) and false but strongly held beliefs (delusions).

Causes

It’s not known what causes bipolar disorder. But a variety of biochemical, genetic and environmental factors seem to be involved in causing and triggering bipolar episodes:

• Biochemical. Some evidence from high-tech imaging studies indicates that people with bipolar disorder have physical changes in their brains. The significance of these changes is still uncertain but may eventually help pinpoint causes. The naturally occurring brain chemicals called neurotransmitters, which are tied to mood, also may play a role. Hormonal imbalances also are thought to be a culprit.
• Genes. Some studies show that bipolar disorder is more common in people whose biological family members also have the condition. Researchers are trying to find genes that may be involved in causing bipolar disorder. Some studies also show links between bipolar disorder and schizophrenia, pointing to a shared genetic cause.
• Environment. Environment also is thought to play a causal role in some way. Some studies of identical twins show that one twin has the condition while the other doesn’t — which means genes alone aren’t responsible for bipolar disorder. Environmental causes may include problems with self-esteem, significant loss or high stress.

Risk factors

It’s estimated that about 1 percent of the population has bipolar disorder. However, some researchers suggest that bipolar disorder occurs on a continuum, and that many more people may have other forms of the disorder, pushing its prevalence as high as 6 percent of the population. In addition, some people may go undiagnosed because they don’t seek treatment, because their condition is mistaken for depression or because their symptoms don’t meet current diagnostic criteria.

Bipolar I disorder affects about the same number of men and women, but bipolar II, the rapid cycling form, is more common in women. In either case, bipolar disorder usually starts between ages 15 and 30.

Factors that may increase the risk of developing bipolar disorder include:

• Having other biological family members with bipolar disorder
• Periods of high stress
• Drug abuse
• Major life changes, such as the death of a loved one

When to seek medical advice

If you have any symptoms of bipolar disorder, seek medical help as soon as possible. Bipolar disorder doesn’t get better on its own. Yet many people with the disorder don’t get treatment or are reluctant to get treatment. Despite the mood extremes, people with bipolar disorder often don’t recognize how greatly it affects their lives — and the lives of their loved ones. And if you’re like some people with bipolar disorder, you may enjoy the feelings of euphoria and cycles of being more productive — but they’re bound to be followed by emotional crashes that can leave you depressed, worn out, and perhaps in financial or legal trouble.

Getting treatment from a mental health provider with experience in bipolar disorder can help you learn ways to manage your symptoms. If you’re reluctant to seek treatment, try to work up the courage to confide in someone, whether it’s a friend or loved one, a health care professional, a faith leader or someone else you trust. They can help you take the first steps to successful treatment.

When you have suicidal thoughts
Suicidal thoughts and behavior are common among people with bipolar disorder. Tragically, the suicide rate is higher in bipolar disorder than most other mental illnesses. If you’re considering suicide right now and have the means available, talk to someone now. The best choice is to call 911 or your local emergency services number. If you simply don’t want to do that, for whatever reason, you have other choices for reaching out to someone:

• Contact a family member or friend
• Contact a doctor, mental health provider or other health care professional
• Contact a minister, spiritual leader or someone in your faith community
• Go to your local hospital emergency room
• Call a crisis center or hot line

Helping a loved one with bipolar disorder symptoms
If you have a loved one you think may have symptoms of bipolar disorder, have an open and honest discussion about your concerns. You may not be able to force someone to seek professional help, but you can offer encouragement and support and help your loved one find a qualified doctor or mental health provider. If you have a loved one who has harmed himself or herself, or is seriously considering doing so, take them to the hospital or call for emergency help.

Screening and diagnosis

When doctors suspect someone has bipolar disorder, they typically run a battery of medical and psychological tests and exams. These can help rule out other problems, pinpoint a diagnosis and also check for any related complications.

These exams and tests generally include:

• Physical exam. This may include measuring height and weight; checking vital signs, such as heart rate, blood pressure and temperature; listening to the heart and lungs; and examining the abdomen.
• Laboratory tests. These may include a complete blood count (CBC) as well as thyroid tests and other blood tests. You may also have a urinalysis.
• Psychological evaluation. A doctor or mental health provider will talk to you about your thoughts, feelings and behavior patterns. You may also fill out psychological self-assessments and questionnaires. You may be asked about substance or alcohol abuse. And with your permission, family members or close friends may be asked to provide information about your symptoms and possible episodes of mania or depression.

Diagnostic criteria for bipolar disorder
To be diagnosed with bipolar disorder, you must meet the criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.

Diagnostic criteria for bipolar disorder are based on the specific type of bipolar disorder as well as the history and types of episodes, such as manic, hypomanic or depressed. Talk to your doctor about which type of bipolar disorder you have so that you can learn more about your specific situation and its treatments.

Some researchers believe the current diagnostic criteria are too strict, though. Indeed, a growing volume of evidence indicates that bipolar disorder can be thought of more as a spectrum of disorders, with varying degrees of symptoms. Some researchers believe that many people go undiagnosed or misdiagnosed — and thus don’t get appropriate treatment — because the criteria don’t account for less severe but still serious symptoms.

Complications

Left untreated, bipolar disorder can result in severe emotional and even legal and financial problems that affect every area of your life.

Complications that bipolar disorder may cause or be associated with include:

• Suicide
• Substance and alcohol abuse
• Legal problems
• Financial problems
• Relationship troubles
• Isolation
• Poor work or school performance

Treatment

Bipolar disorder is a long-term condition that requires lifelong treatment, even during periods when you feel better. Bipolar disorder treatment is usually guided by a psychiatrist skilled in treating the condition. But you may have others on your treatment team as well, including psychologists, social workers and psychiatric nurses, because the condition can affect so many areas of your life.

Effective and appropriate treatment is vital for reducing the frequency and severity of manic and depressive episodes and allowing you to live a more balanced and enjoyable life. Maintenance treatment — continued treatment during periods of remission — also is important. People who skip maintenance treatment are at high risk of a relapse of their symptoms or having minor episodes turn into full-blown mania or depression. If you have problems with alcohol or substance abuse, you must get treatment for those, too, since they can worsen bipolar symptoms.

Here are the core treatments for bipolar disorder:

Medications
Medications are a vital part of bipolar treatment. Because medications for bipolar disorder can cause serious but rare side effects, you may be reluctant to take medications. But you can work with your psychiatrist and other health care professionals to find a medication regimen that works for you.

Medication options include:

• Mood stabilizers. Mood stabilizers are most the commonly prescribed medications for bipolar disorder. These medications help regulate and stabilize mood so that you don’t swing between depression and mania. Lithium (Eskalith, Lithobid) has been widely used as a mood stabilizer and is generally the first line of treatment for manic episodes. Your doctor may recommend that you take mood stabilizers for the rest of your life to prevent and treat manic episodes.
• Anti-seizure medications. The medications are used to prevent mood swings, especially in people with rapid cycling bipolar disorder. These medications, such as valproic acid (Depakene), divalproex (Depakote) and lamotrigine (Lamictal), also are widely used as mood regulators. These medications are also known as anticonvulsants.
• Antidepressants. Use of antidepressants in bipolar disorder, although once common, is now controversial. Antidepressants may not be advised at all, depending on your situation. There’s limited data indicating that antidepressants are effective for bipolar disorder, and in some cases they can trigger manic episodes. Before taking antidepressants, carefully weigh the pros and cons with your doctor.
• Other medications. Certain atypical antipsychotic medications, such as olanzapine (Zyprexa) and risperidone (Risperdal), may help people who don’t gain benefits from anti-seizure medications. And anti-anxiety medications, such as benzodiazepines, may help improve sleep. In addition, one medication, quetiapine (Seroquel), has been approved by the Food and Drug Administration to treat both the manic and depressive episodes of bipolar disorder.Numerous medications are available to treat bipolar disorder. If one doesn’t work well for you, there are many others to explore. Your doctor may advise combining certain medications for maximum effect. It can take several weeks after first starting a medication to notice an improvement in your symptoms.Be aware that all medications have side effects and possible health risks. Certain antipsychotic medications, for instance, may increase the risk of diabetes, obesity and high blood pressure. If you take these medications, talk to your doctor about being monitored for health problems. Also, mood-stabilizing medications may harm a developing fetus or nursing infant. So women with bipolar disorder who want to become pregnant or do become pregnant must fully explore with their health care providers their options and the benefits and risks of medications.

Psychotherapy
Psychotherapy is another vital part of bipolar disorder treatment. Several types of therapy may be helpful.

• Cognitive behavioral therapy. This is a common form of individual therapy for bipolar disorder. The focus of cognitive behavioral therapy is identifying unhealthy, negative beliefs and behaviors and replacing them with healthy, positive ones. In addition, you can learn about bipolar disorder and its treatment and what may trigger your bipolar episodes. You also learn effective strategies to manage stress and to cope with upsetting situations.
• Family therapy. Family therapy involves you and your family members. Family therapy can help identify and reduce stressors within your family. It can help your family improve its communication style and problem-solving skills and resolve conflicts.
• Group therapy. Group therapy provides a forum to communicate with and learn from others in a similar situation. It may also help build better relationship skills.

Electroconvulsive therapy(ECT)
Electroconvulsive therapy is geared mainly for people who have episodes of severe depression with suicidal tendencies or for people who haven’t seen improvements in their symptoms despite other treatment. Electroconvulsive therapy is a procedure in which electrical currents are passed through your brain to trigger a seizure. Researchers don’t fully understand just how ECT works. But it’s thought that the seizure causes changes in brain chemistry that may lead to improvements in your mood.

Hospitalization
In some cases, people with bipolar disorder may benefit from inpatient hospitalization. Hospitalization for psychiatric treatment can help stabilize your mood, whether you’re in a full-blown manic episode or a deep depression. Partial hospitalization or day treatment programs also are options to consider.

Prevention

There’s no sure way to prevent bipolar disorder. However, treatment at the earliest sign of a mental health disorder can help prevent bipolar disorder from worsening. Long-term preventive treatment also can help prevent minor episodes from becoming full-blown episodes of mania or depression.

Self-care

Bipolar disorder isn’t an illness that you can treat on your own. But you can do some things for yourself that will build on your treatment plan:

• Take your medications as directed. Even if you’re feeling well, resist any temptation to skip your medications. If you stop, bipolar signs and symptoms are likely to come back.
• Pay attention to warning signs. You and your caregivers may have identified a pattern to your bipolar episodes and what triggers them. Call your doctor if you feel you’re facing an episode. Involve family members or friends in watching for warning signs. Addressing symptoms early on can prevent episodes from becoming full blown.
• Avoid drugs and alcohol. Illicit drugs and alcohol may be part of what triggers episodes of bipolar disorder.
• Check first before taking other medications. Call the doctor who’s treating you for bipolar disorder before you take medications prescribed by another doctor. Sometimes other medications trigger episodes of bipolar disorder or may interfere with medications you’re taking to treat bipolar disorder.

Coping skills

Coping with bipolar disorder can be difficult. Medications can have unwanted side effects, and you may feel angry or resentful about having a serious condition that requires lifelong treatment. During periods when you feel better, you may be tempted to stop treatment. Here are some ways to cope with bipolar disorder:

• Learn about bipolar disorder. Education about your condition can empower you and motivate you to stick to your treatment plan.
• Join a support group. Support groups for people with bipolar disorder can help you reach out to others facing similar challenges.
• Stay focused on your goals. Recovery from bipolar disorder can take time. Stay motivated by keeping your recovery goals in mind and reminding yourself that you can work to repair damaged relationships and financial and legal problems.
• Find healthy outlets. Explore healthy ways to channel your energy, such as hobbies, exercise and recreational activities.
• Learn relaxation and stress management. Try such stress reduction techniques as meditation, yoga or tai chi.

Complementary and alternative medicine

Some people with bipolar disorder turn to complementary and alternative medicine treatments to help manage symptoms, improve mood and reduce stress. These treatments may include prayer or spiritual healing, meditation, and vitamin and herbal supplements.

Although some complementary treatments can be a good addition to your regular treatment, take some precautions first:

• Don’t stop taking your prescribed bipolar medications or skip therapy sessions. Complementary medicine is not a substitute for regular medical care.
• Be honest with your doctors and mental health providers. Tell them exactly which complementary treatments you practice or would like to explore.
• Be aware that some complementary treatments can interfere with your regular treatment. Even over-the-counter or so-called natural supplements can interfere with your prescribed medications.

Bipolar disorder is a post from: by the pines

Introduction

Depression is a disorder that affects your thoughts, moods, feelings, behavior and even your physical health. People used to think it was “all in your head” and that if you really tried, you could “snap out of it” or just “get over it.” But doctors now know that depression is not a weakness, and it’s not something you can treat on your own. Depression is a medical disorder with a biological and chemical basis.

Sometimes a stressful life event triggers depression. Other times depression seems to occur spontaneously with no identifiable specific cause. Depression is much more than grieving or a bout of the blues.

Depression may occur only once in a person’s life. Often, however, it occurs as repeated episodes over a lifetime, with periods free of depression in between. Or it may be a chronic condition, requiring ongoing treatment over a lifetime.

People of all ages and races suffer from depression. Medications are available that are generally safe and effective, even for the most severe depression. With proper treatment, most people with serious depression improve, often within weeks, and can return to normal daily activities.

Signs and symptoms

Two hallmarks of depression — symptoms key to establishing a diagnosis — are:

• Loss of interest in normal daily activities. You lose interest in or pleasure from activities that you used to enjoy.
• Depressed mood. You feel sad, helpless or hopeless, and may have crying spells.

In addition, for a doctor or other health professional to diagnose depression, most of the following signs and symptoms also must be present for at least two weeks.

• Sleep disturbances. Sleeping too much or having problems sleeping can be a sign you’re depressed. Waking in the middle of the night or early in the morning and not being able to get back to sleep are typical.
• Impaired thinking or concentration. You may have trouble concentrating or making decisions and have problems with memory.
• Changes in weight. An increased or reduced appetite and unexplained weight gain or loss may indicate depression.
• Agitation. You may seem restless, agitated, irritable and easily annoyed.
• Fatigue or slowing of body movements. You feel weariness and lack of energy nearly every day. You may feel as tired in the morning as you did when you went to bed the night before. You may feel like you’re doing everything in slow motion, or you may speak in a slow, monotonous tone.
• Low self-esteem. You feel worthless and have excessive guilt.
• Less interest in sex. If you were sexually active before developing depression, you may notice a dramatic decrease in your level of interest in having sexual relations.
• Thoughts of death. You have a persistent negative view of yourself, your situation and the future. You may have thoughts of death, dying or suicide.

Depression can also cause a wide variety of physical complaints, such as gastrointestinal problems (indigestion, constipation or diarrhea), headache and backache. Many people with depression also have symptoms of anxiety.

Children, teens and older adults may react differently to depression. In these groups, symptoms may take different forms or may be masked by other conditions. Kids may pretend to be sick, worry that a parent is going to die, perform poorly in school, refuse to go to school, or exhibit behavioral problems. Older people may be more willing to discuss the physical manifestations of depression, instead of their emotional difficulties.

Types of depression
The main types of depression include:

• Major depression. This type of mood disturbance lasts more than two weeks. Symptoms may include overwhelming feelings of sadness and grief, loss of interest or pleasure in activities you usually enjoy, and feelings of worthlessness or guilt. This type of depression may result in poor sleep, a change in appetite, severe fatigue and difficulty concentrating. Severe depression may increase the risk of suicide.
• Dysthymia. Dysthymia (dis-THI-me-uh) is a less severe but more chronic form of depression. Signs and symptoms usually aren’t disabling, and periods of dysthymia can alternate with short periods of feeling normal. Having dysthymia places you at an increased risk of major depression.
• Adjustment disorders. If a loved one dies, you lose your job or you receive a diagnosis of cancer, it’s perfectly normal to feel tense, sad, overwhelmed or angry. Eventually, most people come to terms with the lasting consequences of life stresses, but some don’t. This is what’s known as an adjustment disorder — when your response to a stressful event or situation causes signs and symptoms of depression. Some people develop an adjustment disorder in response to a single event. In others, it stems from a combination of stressors. Adjustment disorders can be acute (lasting less than six months) or chronic (lasting longer). Doctors classify adjustment disorders based on the primary signs and symptoms of depression or anxiety.
• Bipolar disorder. Having recurrent episodes of depression and elation (mania) is characteristic of bipolar disorder. Because this condition involves emotions at both extremes (poles), it’s called bipolar disorder or manic-depressive disorder. Mania affects your judgment, causing you to make unwise decisions. Some people have bursts of increased creativity and productivity during the manic phase. The number of episodes at either extreme may not be equal. Some people may have several episodes of depression before having another manic phase, or vice versa.
• Seasonal affective disorder. Seasonal affective disorder (SAD) is a pattern of depression related to changes in seasons and a lack of exposure to sunlight. It may cause headaches, irritability and a low energy level.

Causes

There’s no single known cause for depression. The illness often runs in families. Experts believe a genetic vulnerability combined with environmental factors, such as stress or physical illness, may trigger an imbalance in brain chemicals called neurotransmitters, resulting in depression. Imbalances in three neurotransmitters — serotonin, norepinephrine and dopamine — seem to be linked to depression.

Scientists don’t fully understand how imbalances in neurotransmitters cause signs and symptoms of depression. It’s not certain whether changes in neurotransmitters are a cause or a result of depression.

Factors that contribute to depression include:

• Heredity. Researchers have identified several genes that may be involved in bipolar disorder, and they’re looking for genes linked to other types of depression. But not everyone with a family history of depression develops the disorder, and conversely, people with no family history of the disorder can become depressed.
• 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 high blood pressure, sleeping pills or, occasionally, 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 you at higher risk of developing depression. Having an underactive thyroid (hypothyroidism), even mildly, also can cause 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 you more vulnerable to depression.
• Postpartum depression. It’s common for mothers to feel a mild form of distress that usually occurs a few days to weeks after giving birth. During this time you 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.
• Hormones. Women experience depression about twice as much as men, which leads researchers to believe hormonal factors may play a role in the development of depression.
• Alcohol, nicotine and drug abuse. Experts once thought that people with depression used alcohol, nicotine and mood-altering drugs as a way to ease depression. But using these substances may actually contribute to depression and anxiety disorders.

Risk factors

Depression affects all ages and all races. Twice as many women experience depression as men. While men are less likely to become depressed than women are, depression does affect men as well. Gender differences in depression may be due in part to biological causes, such as hormones and different levels of neurotransmitters.

Other factors that may put you at an increased risk of depression include a family history of the disorder, pregnancy or stressful life events, such as the loss of a loved one or a job.

When to seek medical advice

If you show little interest in once-enjoyable activities, if you feel sad, helpless, tired or worthless, and if your eating and sleeping habits have changed greatly, see your doctor to determine if you have depression. If you know someone who exhibits the characteristics of depression, encourage him or her to seek professional help.

Screening and diagnosis

To diagnose depression, your doctor may perform a physical examination, including tests to rule out conditions that can cause symptoms that mimic depression.

If your doctor sees signs of severe depression or suspects the possibility of suicide, he or she may refer you to a medical doctor who specializes in mental illness (psychiatrist) or even recommend immediate hospitalization.

Your doctor or psychiatrist diagnoses depression based on the hallmark signs and symptoms of the disease, plus the presence of other signs and symptoms that typically accompany depression.

Complications

Depression is a serious illness that can take a terrible toll on individuals and families. Untreated, depression can lead to a downward spiral of disability, dependency and suicide. Women attempt suicide more often than men do, but men are much more likely to succeed in killing themselves. The rate of suicide is four times greater for men. Men over 70 are the most likely to commit suicide.

Certain warning signs may indicate serious depression and the possibility of suicide. Take any threat of suicide seriously, even if the person is already being treated for depression. If you see any of the following danger signs, call a doctor, mental health clinic or suicide hot line immediately:

• Pacing, agitated behavior, frequent mood changes and sleeplessness for several nights
• Actions or threats of assault, physical harm or violence
• Threats or talk of death or suicide, such as “I don’t care anymore,” or “You won’t need to worry about me much longer”
• Withdrawal from activities and relationships
• Putting affairs in order, such as saying goodbye to friends, giving away prized possessions or writing a will
• A sudden brightening of mood after a period of being depressed
• Unusually risky behavior, such as buying or handling a gun or driving recklessly

Treatment

The development of newer antidepressant medications and mood-stabilizing drugs has improved the treatment of depression. Medications can relieve symptoms of depression and have become the first line of treatment for most types of the disorder.

Treatment may also include psychotherapy, which may help you cope with ongoing problems that may trigger or contribute to depression. A combination of medications and a brief course of psychotherapy usually is effective if you have mild to moderate depression. If you’re severely depressed, initial treatment usually is with medications or electroconvulsive therapy. Once you improve, psychotherapy can be more effective.

Doctors usually treat depression in two stages. Acute treatment with medications helps relieve symptoms until you feel well. Once your symptoms ease, maintenance treatment typically continues for four to nine months to prevent a relapse. It’s important to keep taking your medication even though you feel fine and are back to your usual activities. Episodes of depression recur in the majority of people who have one episode, but continuing treatment greatly reduces your risk of a rapid relapse. If you’ve had two or more previous episodes of depression, your doctor may suggest long-term treatment with antidepressants.

Medications

• Selective serotonin reuptake inhibitors (SSRIs). Doctors often consider selective serotonin reuptake inhibitors, such as fluoxetine (Prozac, Sarafem), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa) and escitalopram (Lexapro), as the first-line treatment for depression because they have fewer serious side effects. They seem to work by increasing the availability of the neurotransmitter serotonin in your brain. Drugs similar to SSRIs include serotonin and norepinephrine reuptake inhibitors (SNRIs), such as trazodone (Desyrel, Trialodine) and venlafaxine (Effexor), and dopamine reuptake inhibitors, such as bupropion (Wellbutrin).
• Tricyclic and tetracyclic antidepressants. These medications also affect neurotransmitters, but by a different mechanism than that of SSRIs. They may be used for any type of depression, be it mild or severe. Among tricyclic antidepressants are amitriptyline, desipramine (Norpramin), nortriptyline (Aventyl, Pamelor), protriptyline (Vivactil), trimipramine (Surmontil), and a combination of perphenazine and amitriptyline. Tetracyclics include maprotiline and mirtazapine (Remeron).
• Monoamine oxidase inhibitors (MAOIs). These drugs, which include phenelzine (Nardil) and tranylcypromine (Parnate), prevent the breakdown of neurotransmitters. The drugs have potentially serious side effects if combined with certain other medications or food products. Doctors rarely use them unless other options have failed. Your doctor may prescribe them if you have chronic depression and eat or sleep excessively.
• Stimulants. Your doctor may initially prescribe a stimulant such as methylphenidate (Ritalin, Concerta), dextroamphetamine (Dexedrine, Dextrostat) or modafinil (Provigil) if you can’t take antidepressants because they’re contraindicated due to another medical condition. These medications are also sometimes given in conjunction with antidepressants.
• Lithium and mood-stabilizing medications. Doctors prescribe lithium (Eskalith, Lithobid), valproic acid (Depakene), divalproex (Depakote) and carbamazepine (Tegretol, Carbatrol) to treat bipolar depression. Medications called atypical antipsychotics such as olanzapine (Zyprexa), risperidone (Risperdal) and quetiapine (Seroquel) were initially developed for treatment of psychotic disorders. Doctors sometimes also use them to treat bipolar disorder.

Precautions for children, teens and young adults
In some cases, antidepressants have been linked to an increase in suicidal thoughts and behavior. The Food and Drug Administration requires that all antidepressants have black box warnings — the strongest health warnings possible on prescription medications — about their link to suicide in children, adolescents and young adults ages 18 to 24. These warnings don’t mean that people in these age groups should avoid antidepressants entirely. However, anyone in these age groups who takes antidepressants must be closely monitored by their loved ones, caregivers and health care providers.

The increased risk of suicidal thoughts and behavior doesn’t appear to apply to adults older than age 24. In fact, for adults age 65 and older, antidepressants can actually decrease the risk of suicidal thoughts and behavior.

Side effects of antidepressants
As with any medication, antidepressants often cause side effects. You may notice side effects before you can feel the drug begin to ease your depression. Most of the side effects from antidepressants are temporary and will disappear as your body gets used to the medication. Let your doctor know about any side effects that interfere with daily functioning, or if they’re especially bothersome.

• SSRIs. Side effects that may occur with SSRIs and other new antidepressants include headache, nausea, insomnia, agitation or a jittery feeling, and sexual difficulties.
• Tricyclic antidepressants. Older medications, such as tricyclics, may cause dry mouth, constipation, sexual difficulties, blurred vision, dizziness, bladder problems and daytime drowsiness.
• MAOIs. These drugs can cause a significant increase in blood pressure if you eat foods high in tyramine, such as wine, cheese or pickles, or if you take certain drugs, such as decongestants, while taking an MAOI. Ask your doctor or pharmacist for a list of foods and drugs to avoid.

According to the American Diabetes Association (ADA), certain antipsychotic medications may increase the risk of diabetes, obesity and high blood pressure. The ADA recommends that anyone taking Risperdal, Seroquel and Zyprexa be screened and monitored.

Alcohol can interfere with the way your body absorbs antidepressants. Talk with your doctor before drinking alcohol while you’re taking an antidepressant.

Not everyone responds the same way
Most antidepressants have a similar level of effectiveness. But a medication that works for someone else might not work for you. Doctors choose antidepressants based on your family history and the match between your symptoms and the medication’s side effects. For example, if you have insomnia, a sedating antidepressant may help you. But if you’re lethargic, then a more energizing antidepressant may be more helpful.

It can take up to eight to 12 weeks before you feel the full effects of an antidepressant, though you may feel some changes earlier. If your response to medication hasn’t resulted in satisfactory progress after that time, your doctor may suggest either adding another antidepressant or replacing the first medication with another drug from a different chemical family.

Other treatments
In addition to medications, depression treatment may include:

• Psychotherapy. There are several types of psychotherapy. Each type involves a short-term, goal-oriented approach aimed at helping you deal with a specific issue. Prolonged psychotherapy is seldom necessary to treat depression. If an underlying factor contributing to your depression is an inability to get along with others or difficulty finding your place in life, then prolonged psychotherapy could help you.The success of therapy depends on finding a doctor, psychiatrist or psychologist you’re comfortable with. Both medications and psychotherapy can take weeks to have an effect. Specialized and supervised group therapy, such as bereavement groups, stress management classes, marital counseling and family therapy, also may help.
• Electroconvulsive therapy. Despite the images that many people conjure up, electroconvulsive therapy is generally safe and effective. Experts aren’t sure how this therapy relieves the signs and symptoms of depression. The procedure may affect levels of neurotransmitters in your brain. The most common side effect is confusion that lasts a few minutes to several hours. Some people experience some transient memory loss. This therapy is usually used for people who don’t respond to medications and for those at high risk of suicide. It may be the only treatment available for severely depressed older adults who can’t take medications because of heart disease.
• Light therapy. This therapy may help if you have seasonal affective disorder. This disorder involves periods of depression that recur at the same time each year, usually when days are shorter in the fall and winter. Scientists believe fewer hours of sunlight may increase levels of melatonin, a brain hormone thought to induce sleep and depress mood. Treatment in the morning with a specialized type of bright light, which suppresses production of melatonin, may help if you have this disorder.

Self-care

Once treatment for depression begins, you still have to manage on a day-to-day basis. Here are some guidelines:

• See your doctor regularly. Your doctor can monitor your progress, provide support and encouragement, and adjust your medication if necessary.
• Take your medications. Finding the best medication for you may take several tries. It may take several weeks for you to start seeing results. Once you feel better, continue to take your medication as prescribed.
• Don’t become isolated. Try to participate in normal activities.
• Take care of yourself. Eat a healthy diet and get the right amount of sleep and exercise. Exercise can help treat some forms of depression, ease stress and help you relax.
• Avoid alcohol and recreational drugs. Abuse of alcohol and drugs will slow or prevent your recovery.

Coping skills

Self-help organizations have become potent allies for people who are coping with mental illness or who care about someone with such an illness. For depression or other mental illnesses, self-help groups include:

• National Mental Health Association (NMHA): (800) 969-6642; or, in a crisis: (800) SUICIDE (784-2433)
• National Alliance for the Mentally Ill (NAMI): (800) 950-6264
• Depression and Bipolar Support Alliance: (800) 826-3632

Complementary and alternative medicine

Herbal and dietary supplements sold in stores have become increasingly popular. People take them to help prevent or treat a number of health conditions. Some of these alternative therapies are being studied to determine their effectiveness in helping depression. With additional studies, researchers may know more about these products, how effective they are and if they can cause other health problems or interfere with medications.

In the meantime, talk with your doctor before taking any herbal or dietary supplement. A problem with herbal and dietary products is that they aren’t regulated. The FDA doesn’t test them for safety, purity or effectiveness. That means you can’t always be sure of what you’re getting or if it’s safe. Also, if you’re already taking medications, herbal or dietary supplements may interfere with the way they work, or could cause dangerous interactions.

Some popular supplements marketed or taken for treatment of depression include:

• St. John’s wort. St. John’s wort is an herbal preparation from the Hypericum perforatum plant. It has long been used in folk medicine, and today it’s widely prescribed in Europe to treat anxiety and depression. In the United States, it’s sold in health food stores and pharmacies in the form of tablets or tea.European studies suggest that St. John’s wort may work as well as antidepressants in mild depression and with fewer side effects. However, some studies have found that St. John’s wort isn’t effective in treating major depression. Adverse reactions include dry mouth, dizziness, digestive problems, fatigue, headache and sexual problems. In most cases, signs and symptoms are mild. Of concern is that St. John’s wort can interfere with the effectiveness of prescription medications, including antidepressants, drugs to treat human immunodeficiency virus (HIV) infections and AIDS, and drugs to prevent organ rejection in people who’ve had transplants.
• SAM-e. Pronounced “sammy,” short for S-adenosyl-methionine, this chemical substance is available in Europe as a prescription drug to treat depression. In the United States it’s sold as an over-the-counter dietary supplement.SAM-e is a chemical substance found in all human cells and plays a role in many body functions. It’s thought to increase levels of serotonin and dopamine. Some studies have found SAM-e to be more effective than a placebo, but no more effective than treatment with antidepressant medications. The pills are expensive, especially considering their effectiveness is unproved. SAM-e can cause nausea and constipation.
• 5-HTP. One of the raw materials that your body needs to make serotonin is a chemical called 5-HTP, which is short for 5-hydroxytryptophan. In theory, if you boost your body’s level of 5-HTP, you should also elevate your levels of serotonin. But there’s not enough evidence to determine if 5-HTP is effective and safe. Larger studies than have been conducted to date are needed.
• Omega-3 fatty acids. Omega-3 fatty acids are found in fish oil and certain plants. They’re being studied as a possible mood stabilizer for people with bipolar depression and other psychiatric disorders.Fish oil capsules containing omega-3 fatty acids are sold in stores. The capsules are high in fat and calories and may produce gastrointestinal problems. Another way to get more omega-3 fatty acids is simply to eat more fish, tofu, soybeans, walnuts, or canola or flaxseed oil.

Depression is a post from: by the pines

Introduction

Depression is a disorder that affects your thoughts, moods, feelings, behavior and even your physical health. People used to think it was “all in your head” and that if you really tried, you could “snap out of it” or just “get over it.” But doctors now know that depression is not a weakness, and it’s not something you can treat on your own. Depression is a medical disorder with a biological and chemical basis.

Sometimes a stressful life event triggers depression. Other times depression seems to occur spontaneously with no identifiable specific cause. Depression is much more than grieving or a bout of the blues.

Depression may occur only once in a person’s life. Often, however, it occurs as repeated episodes over a lifetime, with periods free of depression in between. Or it may be a chronic condition, requiring ongoing treatment over a lifetime.

People of all ages and races suffer from depression. Medications are available that are generally safe and effective, even for the most severe depression. With proper treatment, most people with serious depression improve, often within weeks, and can return to normal daily activities.

Signs and symptoms

Two hallmarks of depression — symptoms key to establishing a diagnosis — are:

• Loss of interest in normal daily activities. You lose interest in or pleasure from activities that you used to enjoy.
• Depressed mood. You feel sad, helpless or hopeless, and may have crying spells.

In addition, for a doctor or other health professional to diagnose depression, most of the following signs and symptoms also must be present for at least two weeks.

• Sleep disturbances. Sleeping too much or having problems sleeping can be a sign you’re depressed. Waking in the middle of the night or early in the morning and not being able to get back to sleep are typical.
• Impaired thinking or concentration. You may have trouble concentrating or making decisions and have problems with memory.
• Changes in weight. An increased or reduced appetite and unexplained weight gain or loss may indicate depression.
• Agitation. You may seem restless, agitated, irritable and easily annoyed.
• Fatigue or slowing of body movements. You feel weariness and lack of energy nearly every day. You may feel as tired in the morning as you did when you went to bed the night before. You may feel like you’re doing everything in slow motion, or you may speak in a slow, monotonous tone.
• Low self-esteem. You feel worthless and have excessive guilt.
• Less interest in sex. If you were sexually active before developing depression, you may notice a dramatic decrease in your level of interest in having sexual relations.
• Thoughts of death. You have a persistent negative view of yourself, your situation and the future. You may have thoughts of death, dying or suicide.

Depression can also cause a wide variety of physical complaints, such as gastrointestinal problems (indigestion, constipation or diarrhea), headache and backache. Many people with depression also have symptoms of anxiety.

Children, teens and older adults may react differently to depression. In these groups, symptoms may take different forms or may be masked by other conditions. Kids may pretend to be sick, worry that a parent is going to die, perform poorly in school, refuse to go to school, or exhibit behavioral problems. Older people may be more willing to discuss the physical manifestations of depression, instead of their emotional difficulties.

Types of depression
The main types of depression include:

• Major depression. This type of mood disturbance lasts more than two weeks. Symptoms may include overwhelming feelings of sadness and grief, loss of interest or pleasure in activities you usually enjoy, and feelings of worthlessness or guilt. This type of depression may result in poor sleep, a change in appetite, severe fatigue and difficulty concentrating. Severe depression may increase the risk of suicide.
• Dysthymia. Dysthymia (dis-THI-me-uh) is a less severe but more chronic form of depression. Signs and symptoms usually aren’t disabling, and periods of dysthymia can alternate with short periods of feeling normal. Having dysthymia places you at an increased risk of major depression.
• Adjustment disorders. If a loved one dies, you lose your job or you receive a diagnosis of cancer, it’s perfectly normal to feel tense, sad, overwhelmed or angry. Eventually, most people come to terms with the lasting consequences of life stresses, but some don’t. This is what’s known as an adjustment disorder — when your response to a stressful event or situation causes signs and symptoms of depression. Some people develop an adjustment disorder in response to a single event. In others, it stems from a combination of stressors. Adjustment disorders can be acute (lasting less than six months) or chronic (lasting longer). Doctors classify adjustment disorders based on the primary signs and symptoms of depression or anxiety.
• Bipolar disorder. Having recurrent episodes of depression and elation (mania) is characteristic of bipolar disorder. Because this condition involves emotions at both extremes (poles), it’s called bipolar disorder or manic-depressive disorder. Mania affects your judgment, causing you to make unwise decisions. Some people have bursts of increased creativity and productivity during the manic phase. The number of episodes at either extreme may not be equal. Some people may have several episodes of depression before having another manic phase, or vice versa.
• Seasonal affective disorder. Seasonal affective disorder (SAD) is a pattern of depression related to changes in seasons and a lack of exposure to sunlight. It may cause headaches, irritability and a low energy level.

Causes

There’s no single known cause for depression. The illness often runs in families. Experts believe a genetic vulnerability combined with environmental factors, such as stress or physical illness, may trigger an imbalance in brain chemicals called neurotransmitters, resulting in depression. Imbalances in three neurotransmitters — serotonin, norepinephrine and dopamine — seem to be linked to depression.

Scientists don’t fully understand how imbalances in neurotransmitters cause signs and symptoms of depression. It’s not certain whether changes in neurotransmitters are a cause or a result of depression.

Factors that contribute to depression include:

• Heredity. Researchers have identified several genes that may be involved in bipolar disorder, and they’re looking for genes linked to other types of depression. But not everyone with a family history of depression develops the disorder, and conversely, people with no family history of the disorder can become depressed.
• 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 high blood pressure, sleeping pills or, occasionally, 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 you at higher risk of developing depression. Having an underactive thyroid (hypothyroidism), even mildly, also can cause 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 you more vulnerable to depression.
• Postpartum depression. It’s common for mothers to feel a mild form of distress that usually occurs a few days to weeks after giving birth. During this time you 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.
• Hormones. Women experience depression about twice as much as men, which leads researchers to believe hormonal factors may play a role in the development of depression.
• Alcohol, nicotine and drug abuse. Experts once thought that people with depression used alcohol, nicotine and mood-altering drugs as a way to ease depression. But using these substances may actually contribute to depression and anxiety disorders.

Risk factors

Depression affects all ages and all races. Twice as many women experience depression as men. While men are less likely to become depressed than women are, depression does affect men as well. Gender differences in depression may be due in part to biological causes, such as hormones and different levels of neurotransmitters.

Other factors that may put you at an increased risk of depression include a family history of the disorder, pregnancy or stressful life events, such as the loss of a loved one or a job.

When to seek medical advice

If you show little interest in once-enjoyable activities, if you feel sad, helpless, tired or worthless, and if your eating and sleeping habits have changed greatly, see your doctor to determine if you have depression. If you know someone who exhibits the characteristics of depression, encourage him or her to seek professional help.

Screening and diagnosis

To diagnose depression, your doctor may perform a physical examination, including tests to rule out conditions that can cause symptoms that mimic depression.

If your doctor sees signs of severe depression or suspects the possibility of suicide, he or she may refer you to a medical doctor who specializes in mental illness (psychiatrist) or even recommend immediate hospitalization.

Your doctor or psychiatrist diagnoses depression based on the hallmark signs and symptoms of the disease, plus the presence of other signs and symptoms that typically accompany depression.

Complications

Depression is a serious illness that can take a terrible toll on individuals and families. Untreated, depression can lead to a downward spiral of disability, dependency and suicide. Women attempt suicide more often than men do, but men are much more likely to succeed in killing themselves. The rate of suicide is four times greater for men. Men over 70 are the most likely to commit suicide.

Certain warning signs may indicate serious depression and the possibility of suicide. Take any threat of suicide seriously, even if the person is already being treated for depression. If you see any of the following danger signs, call a doctor, mental health clinic or suicide hot line immediately:

• Pacing, agitated behavior, frequent mood changes and sleeplessness for several nights
• Actions or threats of assault, physical harm or violence
• Threats or talk of death or suicide, such as “I don’t care anymore,” or “You won’t need to worry about me much longer”
• Withdrawal from activities and relationships
• Putting affairs in order, such as saying goodbye to friends, giving away prized possessions or writing a will
• A sudden brightening of mood after a period of being depressed
• Unusually risky behavior, such as buying or handling a gun or driving recklessly

Treatment

The development of newer antidepressant medications and mood-stabilizing drugs has improved the treatment of depression. Medications can relieve symptoms of depression and have become the first line of treatment for most types of the disorder.

Treatment may also include psychotherapy, which may help you cope with ongoing problems that may trigger or contribute to depression. A combination of medications and a brief course of psychotherapy usually is effective if you have mild to moderate depression. If you’re severely depressed, initial treatment usually is with medications or electroconvulsive therapy. Once you improve, psychotherapy can be more effective.

Doctors usually treat depression in two stages. Acute treatment with medications helps relieve symptoms until you feel well. Once your symptoms ease, maintenance treatment typically continues for four to nine months to prevent a relapse. It’s important to keep taking your medication even though you feel fine and are back to your usual activities. Episodes of depression recur in the majority of people who have one episode, but continuing treatment greatly reduces your risk of a rapid relapse. If you’ve had two or more previous episodes of depression, your doctor may suggest long-term treatment with antidepressants.

Medications

• Selective serotonin reuptake inhibitors (SSRIs). Doctors often consider selective serotonin reuptake inhibitors, such as fluoxetine (Prozac, Sarafem), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa) and escitalopram (Lexapro), as the first-line treatment for depression because they have fewer serious side effects. They seem to work by increasing the availability of the neurotransmitter serotonin in your brain. Drugs similar to SSRIs include serotonin and norepinephrine reuptake inhibitors (SNRIs), such as trazodone (Desyrel, Trialodine) and venlafaxine (Effexor), and dopamine reuptake inhibitors, such as bupropion (Wellbutrin).
• Tricyclic and tetracyclic antidepressants. These medications also affect neurotransmitters, but by a different mechanism than that of SSRIs. They may be used for any type of depression, be it mild or severe. Among tricyclic antidepressants are amitriptyline, desipramine (Norpramin), nortriptyline (Aventyl, Pamelor), protriptyline (Vivactil), trimipramine (Surmontil), and a combination of perphenazine and amitriptyline. Tetracyclics include maprotiline and mirtazapine (Remeron).
• Monoamine oxidase inhibitors (MAOIs). These drugs, which include phenelzine (Nardil) and tranylcypromine (Parnate), prevent the breakdown of neurotransmitters. The drugs have potentially serious side effects if combined with certain other medications or food products. Doctors rarely use them unless other options have failed. Your doctor may prescribe them if you have chronic depression and eat or sleep excessively.
• Stimulants. Your doctor may initially prescribe a stimulant such as methylphenidate (Ritalin, Concerta), dextroamphetamine (Dexedrine, Dextrostat) or modafinil (Provigil) if you can’t take antidepressants because they’re contraindicated due to another medical condition. These medications are also sometimes given in conjunction with antidepressants.
• Lithium and mood-stabilizing medications. Doctors prescribe lithium (Eskalith, Lithobid), valproic acid (Depakene), divalproex (Depakote) and carbamazepine (Tegretol, Carbatrol) to treat bipolar depression. Medications called atypical antipsychotics such as olanzapine (Zyprexa), risperidone (Risperdal) and quetiapine (Seroquel) were initially developed for treatment of psychotic disorders. Doctors sometimes also use them to treat bipolar disorder.

Precautions for children, teens and young adults
In some cases, antidepressants have been linked to an increase in suicidal thoughts and behavior. The Food and Drug Administration requires that all antidepressants have black box warnings — the strongest health warnings possible on prescription medications — about their link to suicide in children, adolescents and young adults ages 18 to 24. These warnings don’t mean that people in these age groups should avoid antidepressants entirely. However, anyone in these age groups who takes antidepressants must be closely monitored by their loved ones, caregivers and health care providers.

The increased risk of suicidal thoughts and behavior doesn’t appear to apply to adults older than age 24. In fact, for adults age 65 and older, antidepressants can actually decrease the risk of suicidal thoughts and behavior.

Side effects of antidepressants
As with any medication, antidepressants often cause side effects. You may notice side effects before you can feel the drug begin to ease your depression. Most of the side effects from antidepressants are temporary and will disappear as your body gets used to the medication. Let your doctor know about any side effects that interfere with daily functioning, or if they’re especially bothersome.

• SSRIs. Side effects that may occur with SSRIs and other new antidepressants include headache, nausea, insomnia, agitation or a jittery feeling, and sexual difficulties.
• Tricyclic antidepressants. Older medications, such as tricyclics, may cause dry mouth, constipation, sexual difficulties, blurred vision, dizziness, bladder problems and daytime drowsiness.
• MAOIs. These drugs can cause a significant increase in blood pressure if you eat foods high in tyramine, such as wine, cheese or pickles, or if you take certain drugs, such as decongestants, while taking an MAOI. Ask your doctor or pharmacist for a list of foods and drugs to avoid.

According to the American Diabetes Association (ADA), certain antipsychotic medications may increase the risk of diabetes, obesity and high blood pressure. The ADA recommends that anyone taking Risperdal, Seroquel and Zyprexa be screened and monitored.

Alcohol can interfere with the way your body absorbs antidepressants. Talk with your doctor before drinking alcohol while you’re taking an antidepressant.

Not everyone responds the same way
Most antidepressants have a similar level of effectiveness. But a medication that works for someone else might not work for you. Doctors choose antidepressants based on your family history and the match between your symptoms and the medication’s side effects. For example, if you have insomnia, a sedating antidepressant may help you. But if you’re lethargic, then a more energizing antidepressant may be more helpful.

It can take up to eight to 12 weeks before you feel the full effects of an antidepressant, though you may feel some changes earlier. If your response to medication hasn’t resulted in satisfactory progress after that time, your doctor may suggest either adding another antidepressant or replacing the first medication with another drug from a different chemical family.

Other treatments
In addition to medications, depression treatment may include:

• Psychotherapy. There are several types of psychotherapy. Each type involves a short-term, goal-oriented approach aimed at helping you deal with a specific issue. Prolonged psychotherapy is seldom necessary to treat depression. If an underlying factor contributing to your depression is an inability to get along with others or difficulty finding your place in life, then prolonged psychotherapy could help you.The success of therapy depends on finding a doctor, psychiatrist or psychologist you’re comfortable with. Both medications and psychotherapy can take weeks to have an effect. Specialized and supervised group therapy, such as bereavement groups, stress management classes, marital counseling and family therapy, also may help.
• Electroconvulsive therapy. Despite the images that many people conjure up, electroconvulsive therapy is generally safe and effective. Experts aren’t sure how this therapy relieves the signs and symptoms of depression. The procedure may affect levels of neurotransmitters in your brain. The most common side effect is confusion that lasts a few minutes to several hours. Some people experience some transient memory loss. This therapy is usually used for people who don’t respond to medications and for those at high risk of suicide. It may be the only treatment available for severely depressed older adults who can’t take medications because of heart disease.
• Light therapy. This therapy may help if you have seasonal affective disorder. This disorder involves periods of depression that recur at the same time each year, usually when days are shorter in the fall and winter. Scientists believe fewer hours of sunlight may increase levels of melatonin, a brain hormone thought to induce sleep and depress mood. Treatment in the morning with a specialized type of bright light, which suppresses production of melatonin, may help if you have this disorder.

Self-care

Once treatment for depression begins, you still have to manage on a day-to-day basis. Here are some guidelines:

• See your doctor regularly. Your doctor can monitor your progress, provide support and encouragement, and adjust your medication if necessary.
• Take your medications. Finding the best medication for you may take several tries. It may take several weeks for you to start seeing results. Once you feel better, continue to take your medication as prescribed.
• Don’t become isolated. Try to participate in normal activities.
• Take care of yourself. Eat a healthy diet and get the right amount of sleep and exercise. Exercise can help treat some forms of depression, ease stress and help you relax.
• Avoid alcohol and recreational drugs. Abuse of alcohol and drugs will slow or prevent your recovery.

Coping skills

Self-help organizations have become potent allies for people who are coping with mental illness or who care about someone with such an illness. For depression or other mental illnesses, self-help groups include:

• National Mental Health Association (NMHA): (800) 969-6642; or, in a crisis: (800) SUICIDE (784-2433)
• National Alliance for the Mentally Ill (NAMI): (800) 950-6264
• Depression and Bipolar Support Alliance: (800) 826-3632

Complementary and alternative medicine

Herbal and dietary supplements sold in stores have become increasingly popular. People take them to help prevent or treat a number of health conditions. Some of these alternative therapies are being studied to determine their effectiveness in helping depression. With additional studies, researchers may know more about these products, how effective they are and if they can cause other health problems or interfere with medications.

In the meantime, talk with your doctor before taking any herbal or dietary supplement. A problem with herbal and dietary products is that they aren’t regulated. The FDA doesn’t test them for safety, purity or effectiveness. That means you can’t always be sure of what you’re getting or if it’s safe. Also, if you’re already taking medications, herbal or dietary supplements may interfere with the way they work, or could cause dangerous interactions.

Some popular supplements marketed or taken for treatment of depression include:

• St. John’s wort. St. John’s wort is an herbal preparation from the Hypericum perforatum plant. It has long been used in folk medicine, and today it’s widely prescribed in Europe to treat anxiety and depression. In the United States, it’s sold in health food stores and pharmacies in the form of tablets or tea.European studies suggest that St. John’s wort may work as well as antidepressants in mild depression and with fewer side effects. However, some studies have found that St. John’s wort isn’t effective in treating major depression. Adverse reactions include dry mouth, dizziness, digestive problems, fatigue, headache and sexual problems. In most cases, signs and symptoms are mild. Of concern is that St. John’s wort can interfere with the effectiveness of prescription medications, including antidepressants, drugs to treat human immunodeficiency virus (HIV) infections and AIDS, and drugs to prevent organ rejection in people who’ve had transplants.
• SAM-e. Pronounced “sammy,” short for S-adenosyl-methionine, this chemical substance is available in Europe as a prescription drug to treat depression. In the United States it’s sold as an over-the-counter dietary supplement.SAM-e is a chemical substance found in all human cells and plays a role in many body functions. It’s thought to increase levels of serotonin and dopamine. Some studies have found SAM-e to be more effective than a placebo, but no more effective than treatment with antidepressant medications. The pills are expensive, especially considering their effectiveness is unproved. SAM-e can cause nausea and constipation.
• 5-HTP. One of the raw materials that your body needs to make serotonin is a chemical called 5-HTP, which is short for 5-hydroxytryptophan. In theory, if you boost your body’s level of 5-HTP, you should also elevate your levels of serotonin. But there’s not enough evidence to determine if 5-HTP is effective and safe. Larger studies than have been conducted to date are needed.
• Omega-3 fatty acids. Omega-3 fatty acids are found in fish oil and certain plants. They’re being studied as a possible mood stabilizer for people with bipolar depression and other psychiatric disorders.Fish oil capsules containing omega-3 fatty acids are sold in stores. The capsules are high in fat and calories and may produce gastrointestinal problems. Another way to get more omega-3 fatty acids is simply to eat more fish, tofu, soybeans, walnuts, or canola or flaxseed oil.

Depression is a post from: by the pines