Health Concerns - Depression
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What is Depression?

Depression is a common problem that affects over 18 million Americans per year. Women are two to three times more likely than men to suffer depression and it affects up to one in five women at some point in their life. A complex combination of biological, social, environmental, cultural, hormonal, and psychological factors may explain why women experience depression at a higher rate than men. And problems with depression frequently occur during the perimenopause and menopause transition. Although it is a complex medical condition, a significant number of people can be helped with proper diagnosis and treatment.

Depression is classified as a mood disorder. Dysthymia is a mild, but chronic mood disorder. Some types of depression are related to situations, such as depression after childbirth (postpartum depression), depression related to the change of seasons (seasonal affective disorder), and mood changes associated with PMS (premenstrual dysphoric disorder).

See also: Irritability/Anxiety

What are the Symptoms of Depression?
Feelings of sadness are a normal response to some of life’s disappointments and losses. However, if these feelings persist or impair with your normal activities, you may have a depressive disorder. Among other symptoms, the length of time and the degree to which you are affected are determinants in diagnosing depression.

Common symptoms of depression include: Feelings of despair, hopelessness, loss of interest in favorite activities, change in appetite, change in sleep pattern, sexual difficulties, excessive guilt, difficulty concentrating, preoccupation with death or suicide.

What Causes Depression?
Although the exact cause of depression is unknown, the most current thinking about the cause of depression revolves around an imbalance of certain chemicals related to brain function. These chemicals are known as neurotransmitters, and are responsible for many functions of the brain, including mood. Many factors are probably necessary to trigger a depressive episode. For some individuals with a predisposition to depression, these neurotransmitters can malfunction without specific reason. For others, a trigger (such as prolonged stress or certain medications) can alter these chemicals and cause depression. Most cases of major depression last approximately six months.

Many medications have been implicated in triggering an episode of depression. Examples of medications that can be linked to depression include: Certain blood pressure medications, cholesterol lowering medications, certain arthritis medications, hormonal medications, and some antibiotics. It is prudent to discuss medications with your doctor if you have a history of depression.

How is Depression Treated?
Fortunately, depression is a treatable illness. While many people do not think that depression is a real medical problem, and sadly, do not seek treatment at a result, depression it is quite clearly a clinical disorder. With proper treatment, many people are able to regain control of their lives and return to their previous level of function.

The diagnosis of depression can be made by your primary care physician or mental health professional after reviewing your history and asking a series of questions. Examples of questions that are helpful to determine whether depression may be present include: Have you been sad a lot lately? Have you had crying spells? Is there a change in your productivity or your ability to concentrate? How does your future look? Do you have difficulty making decisions? Have you lost interest in aspects of life that used to be important to you? Are you tired? Do you feel guilty or like a failure? Do you think about killing yourself? Do you think about how you might kill yourself? Have you thought about killing someone else?

Unfortunately, depression can be a debilitating illness. It can be linked to worsening other chronic illnesses or making other conditions more difficult to treat. Left untreated, depression can be result in suicide in approximately 12-15% of people.

The good news is that with proper diagnosis and treatment, many people can significantly improve their quality of life. Over 75% of people will improve with appropriate treatment.

Treatment for depression centers on the severity of the episode. Mild cases may respond to medication and/or counseling, while severe cases may require a comprehensive approach using many skilled practitioners.

Psychological counseling can be beneficial in over 50% of cases and is often used in conjunction with medications. This counseling may be performed by professionals trained in different approaches to psychotherapy, such as psychiatrists, psychologists, and social worker counselors.

Medications used to treat depression have improved dramatically within the past ten years. Over 90% of patients will improve with these medications. They generally impact the level of neurotransmitters (specifically serotonin) and can improve mood within 2 to 4 weeks during an episode of depression.

Examples of commonly used anti-depressants include:

  • Celexa
  • Paxil
  • Prozac
  • Zoloft
  • Effexor
  • Wellbutrin

The herb known as St. Johns Wort has been advocated as a treatment for mild depression. In Europe, St. John's wort is widely prescribed for depression. In the United States, St. John's wort is not a prescription medication, but there is considerable public interest in it. St. John's wort remains among the top-selling herbal products in the United States.

Numerous studies have had conflicting results with this popular herbal treatment. In Europe, results from a number of scientific studies have supported the effectiveness of certain St. John's wort extracts for depression. An overview of 23 clinical studies, published in the British Medical Journal in 1996, found that the herb might be useful in cases of mild to moderate depression. The studies, which included 1,757 outpatients, reported that St. John's wort was more effective than a placebo (a"dummy" pill designed to have no effect) and appeared to produce fewer side effects than some standard antidepressants.

Other studies conducted recently have found no benefit from the use of St. John's wort for certain types of depression. For example, the results of a study funded by Pfizer Inc., a pharmaceutical company, found that St. John's wort, when compared with placebo, was not effective for treating major depression (Shelton, et al. JAMA, 2001).

In addition, several components of the National Institutes of Health--NCCAM, the Office of Dietary Supplements, and the National Institute of Mental Health--funded a large, carefully designed research study to find out whether St. John's wort extract benefits people with major depression of moderate severity. This trial found that St. John's wort was no more effective for treating major depression of moderate severity than placebo (Hypericum Depression Trial Study Group. JAMA, 2002)

A U.S Food and Drug Administration (FDA) public health advisory, issued in February 2000, stated that St. John's Wort appears to affect an important metabolic pathway that is used by many drugs prescribed to treat conditions such as heart disease, depression, seizures, certain cancers and rejection of transplants. The advisory urged health care professionals to alert their patients about these potential drug interactions.

The National Institute of Mental Health (NIMH) also issued a public alert in February 2001 stating that adverse interactions have been reported between St John's Wort and two drugs: indinavir, a protease inhibitor used to treat HIV and cyclosporine, a drug used to reduce the risk of organ transplant rejection. Potentially dangerous changes in drug effects can occur when medications such as cyclosporine (Neoral, Sandimmune), digoxin (Lanoxin, Lanoxicaps) and warfarin (Coumadin) are taken with St. John’s Wort extracts. The extracts can decrease the blood levels of antiretroviral medications that are used in the treatment of HIV infection, thus making these drugs less effective. Recent data showed that the plasma levels of the protease inhibitor indinavir (Crixivan) were reduced by more than 50 percent by hypericum (St. John’s Wort) products, according to the NIMH.

The information provided by MenopauseRx, Inc. is not intended to replace the medical advice of your doctor or health-care provider. Please consult your health-care provider for advice about a specific medical condition.