Depression Treatment

 

Are you suffering with fear, sadness, sleeplessness, tiredness, weakness, loss of interest, decreased concentration, thoughts of dying, or low sex drive? It may be depression.  In many cases, you can start improving the first day with medication targeting anxiety and/or insomnia, although antidepressant medications can take several weeks to start helping with mood. The disorder can be very different in different people or in the same person over time. It is a common but serious illness. When a person is depressed, it interferes with his or her daily life and routine, such as going to work or school, taking care of children, and relationships with family and friends. The illness causes pain for the person who has it and for those who care about him or her.  Loss of a loved one, divorce, bereavement, social isolation, stress and hormonal changes, or traumatic events may trigger depression at any age.

 

Depression also may occur with other serious medical illnesses such as heart disease, stroke, cancer, HIV/AIDS, diabetes, and Parkinson's disease. People who have depression along with another medical illness tend to have more severe symptoms of both mood and the medical illness, more difficulty adapting to their medical condition, and more medical costs than those who do not have co-existing depression. Treating the depression can also help improve the outcome of treating the co-occurring illness.

Women are twice as likely to be diagnosed with Major Depressive Disorder as men.  It occurs most often between the ages of 25 and 44.  At any given time, up to 9 percent of women and 4 percent of men may have the disorder.  

Symptoms of a Major Depressive Episode

1.  Depressed mood nearly every day for most of the day
2. Marked reduction or loss of interest or pleasure in all, or nearly all, activities for most of the day, nearly every day
3. Significant non-dieting weight loss or weight gain (more than 5% change in body weight)
4. Insomnia or hypersomnia nearly every day
5. Psychomotor agitation or slowing (should be observable by others)
6. Fatigue/loss of energy nearly every day
7. Feelings of worthlessness or excessive/inappropriate guilt (possibly delusional) nearly every day
8. Diminished cognitive function (reduced ability to think or concentrate, or indecisiveness) nearly every day
9. Recurrent thoughts of death and/or suicide, suicide planning, or a suicide attempt

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Types of Depression

 Major depressive disorder is a combination of symptoms that interfere with a person's ability to work, sleep, study, eat, and enjoy once-pleasurable activities. Major depression is disabling and prevents a person from functioning normally. An episode of major depression may occur only once in a person's lifetime, but more often, it recurs throughout a person's life.

Dysthymic disorder, also called dysthymia, is characterized by long-term (two years or longer), but less severe, symptoms that may not disable a person but can prevent one from functioning normally or feeling well. People with dysthymia may also experience one or more episodes of major depression during their lifetimes.  In fact, up to 25 percent of people who develop unipolar depression have been previously diagnosed with dysthymic disorder.  Both dysthymic disorder and major depressive disorder can exist at the same time.  

Postpartum depression, which is diagnosed if a new mother develops a major depressive episode within one month after delivery. It is estimated that 10 to 15 percent of women experience postpartum depression after giving birth.

Seasonal affective disorder (SAD), which is characterized by the onset of a depressive illness during the winter months, when there is less natural sunlight. The depression generally lifts during spring and summer. SAD may be effectively treated with light therapy, but nearly half of those with SAD do not respond to light therapy alone. Antidepressant medication and psychotherapy can reduce SAD symptoms, either alone or in combination with light therapy.

​Bipolar disorder, also called manic-depressive illness, is not as common as major depression or dysthymia. Bipolar disorder is characterized by cycling mood changes-from extreme highs (e.g., mania) to extreme lows (e.g., depression).
Other illnesses may start before depression, cause it, or be a consequence of it. But depression and other illnesses interact differently in different people. Anxiety disorders, such as post-traumatic stress disorder (PTSD), obsessive-compulsive disorder, panic disorder, social phobia, and generalized anxiety disorder, often accompany depression. 

 

Medications

Anti-depressants: Lexapro, Celexa, Luvox, Paxil, Zoloft, Prozac, Wellbutrin, Effexor, Cymbalta, mirtazapine.
Anti-anxiety (Immediate action but can be abused): Xanax, Klonopin, Ativan, Valium
Anti-anxiety (Delayed action): Lexapro, Celexa, Luvox, Paxil, Zoloft, Prozac, Effexor, Cymbalta, mirtazapine.
Insomnia aids: mirtazapine, trazodone, gabapentin, Ambien, Lunesta, Rozerem,Keppra.
Anti-depressant augmentors: Lithium, Abilify, Seroquel

 

Does substance use impact my symptoms of depression? Drinking as little as two drinks per day may reduce or cancel an anti-depressant’s benefits. Stimulant abuse with cocaine, crack, methamphetamine, or diet pills use may cause depressive symptoms or mood swings. Using pain medications and abusing narcotics commonly cause some depression, and withdrawal from them causes even more depression. There are medications to help reduce, stop, and/or withdraw from, alcohol, narcotics, and sedatives.

 

St. John's Wort

St. John’s Wort is an herbal treatment that is used widely in Europe. A large number of trials that compare St. John’s Wort with standard antidepressants and placebo have been published; however, a lack of a consensus on efficacy for depression still exists.   A number of double-blind studies have demonstrated superiority over placebo, although others have not.  Of the larger, more rigorous placebo-controlled trials, two that required participants to have Hamilton Rating Scale for Depression (HAM-D) scores of 20 or above at entry did not demonstrate a difference between St. John’s Wort and placebo on primary outcome measures (Shelton et al., 2001; Hypericum Study Group, 2002).  Also, it is important to consider that at least half of random-controlled trials of synthetic antidepressants may fail to yield significant differences between the antidepressant under study and placebo. It is therefore not surprising that we see a fairly broad range of results with the studies in question. There is greater consensus and support from studies in mild to moderate MDD, and less for more severe MDD. St. John’s Wort may be a reasonable treatment for mild to moderate symptoms for some individuals, although not all recent studies for the treatment of depression in the U.S. demonstrated efficacy over placebo. Drug interactions limit use and are important safety considerations. 

St John’s Wort has significant drug-drug interactions. It induces the metabolism of concomitantly administered medications through the induction of the cytochrome P450 3A4 system, with a possible reduction in therapeutic effects of medications including antiretrovirals, immunosuppressants, antineoplastic agents, anticoagulants, digoxin, oral contraceptives and hormone replacement therapy.   Unintended pregnancies have been reported with concomitant St. John’s Wort and oral contraceptive use.