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Clinical Depression


Feeling down or depressed once in awhile is a normal for most people. However, if these feelings become very intense and persist for a very long period of time, hampering normal daily activities, clinical depression has set in, an abnormality that must be treated. Depression is not a temporary setback in emotions or a result of emotional weakness, but it is a real mental illness that cannot be overcome by sheer will. It brings many difficulties occupationally, socially, and physically. Unlike sadness or sorrow, depression does not resolve with a change in circumstance (good news, for instance), and unlike the gradual recovery from mourning a loved one's death, it does not get better. If depression is not treated, it can persist for several years, hampering relationships, reducing productivity at work, undermining confidence and self-esteem, and, ultimately, even leading to suicide. A depression sufferer is not able to solve his/her problem on his/her own. It is a mental illness that requires professional treatment. With proper treatment, depression is relatively easily treated and has a success rate as high as 80%.


Depression is a common disorder occurring in 15% of the men and 25% of the women during their lifetimes. Presumably, women have a higher tendency to suffer depression than men because of the extra societal pressures put upon them and the hormonal roller coaster they go through during pregnancy and delivery. Generally, the first episode of depression happens in the mid-twenties, and then again during menopause for women, and after retirement in men. Although depression is a relatively easily treated disease, without prompt and proper care, it can become chronic or recurrent.


Depression, just like other diseases, can appear in many different forms. It is divided into three major groupings: major depression, dysthymia, and manic-depressive. The most serious of the three types, major depression, affects the body physical, emotions, thought, and all aspects of behavior. Thus, work performance suffers and even daily activities such as sleep and eating can be affected. Dysthymia is a relatively mild form of depression in which unhappiness lingers on for a long period of time bringing sub-par performance in daily activities. Sometimes, patients with dysthymia also exhibit symptoms of major depression. Manic-depressive depression does not occur as frequently as the others, however, it is important nonetheless. Here, the patient is seen to alternate from a state of depression and mania, forming a periodic cycle. Mania can be described as a condition of being restless, occupied in thought, and unnecessarily busy in behavior. In contrast, depression is a submergence of feeling, a settling of thought and behavior, which together with its antithesis, mania, comprise manic-depressive. The depressive cycle of manic-depressive depression often appears in the form of major depression, as discussed above. In all three types of depression, the number, severity, and duration of the symptoms will vary depending on the individual.


There are many different causes of depression. First, physiologically, neurotransmitters, the substance that links nerves to nerve may be the source of the problem. It is believed that the brain's activity, namely our thoughts and emotions, arise out of the change in the properties of these neurotransmitters. In the case of depression, it is believed that a decline in the activities of the neurotransmitters, norepinephrine and serotonin, are involved in the disorder. Secondly, heredity can play a factor in depression. If a close relative (parents, brothers and sisters, or children) suffers from depression, the chances of falling into major depression are 2-3 times greater. Although heredity is an influential factor in causing depressions, it does not necessitate it. Thirdly, there are environmental, psychological, and societal factors that can also drive a person into depression. A person with low self-esteem, a strong superego, weak social interaction, and a very dependent personality will be more susceptible to these external pressures, whether it may be due to divorce, failure, or family discord.


The most notable symptoms of depression are gloominess, loss of interest and pleasures, fatigue, and loss of vigor. In addition, there are other symptoms such as loss of concentration and attentiveness, loss of self-respect and self-confidence, guilt, lack of self-worth, hopelessness, thoughts of suicide, insomnia, and a loss of appetite. Sometimes, these symptoms may occur due to the accumulation of unexpressed anger, emotions, or personal preferences bottled up by peer-pressure, societal rules and customs, resulting in a redirected expression of these emotions in the form of various psychosomatic symptoms such as loss of appetite and sexual desire, insomnia, etc. For teenagers, anger or other misgivings may be expressed with truancy, by smoking, drinking, getting into fights, or leaving home. Menopausal women may exhibit symptoms of 'being on pins and needles' and become anxious and irritable.


The treatment of depression can be divided as follows: medication, psychotherapy, and electroconvulsive therapy. Some people are cured by psychotherapy or taking medications. Most people, however, choose to take advantage of both, benefiting from the fast acting power of medications and the know-how of coping with daily problems acquired from psychotherapy. The important point here is that most people can be treated for depression with proper attention. In rare cases, electroconvulsive therapy is used to treat extreme depression.
1. Antidepressants
# Traditionally, depression has been treated through the use of three types of antidepressants, namely tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAO inhibitors), and selective serotonin reuptake inhibitors (SSRIs). However, TCAs are encumbered by side effects such as dry mouth, constipation, drowsiness, and a decrease in sexual performance, and MAO inhibitors have the inconvenience of having to avoid certain foods such as cheese and wine. Recent additions to the antidepressant lineup do not have such side effects. These include the new class of antidepressants called SSRIs. Since antidepressants take 2 to 6 weeks to take effect, it is important that drug use be maintained for a reasonable amount of time before deciding to quit. If any difficulties arise, consult the prescribing doctor immediately. Alcohol and other medications can interfere with the potency of antidepressants and must be avoided.
2. Psychotherapy
# Psychotherapy aids the patient by identifying and resolving her problems through consultations with the psychiatrist, and helps the patient get a better understanding of her mental illness. Behavioral therapy involves directing the individual to gain satisfaction and initiative by her own actions, and helping her to understand ways to avoid behaviors that may lead to depression. It also teaches her to adjust to her environment, becoming a master of her environment rather than a slave to it. Personal relations therapy and human-behavioral therapy are also helpful. Personal relations therapy rectifies the wrongs of personal behavior that contribute to depression, and human-behavioral therapy eliminates the patient's negative behavior and frame of mind that is associated with depression. Retrogressive psychotherapy focuses on the psychological problems of childhood as the center stage for resolving conflicts in the patient's current mental state.
3. Electroconvulsive therapy
# Electroconvulsive therapy is useful in treating very severe depression accompanied by suicidal tendencies, as well as those patients incapable of taking antidepressants. Also it is very effective in treating patients who have not completely recovered after using antidepressants.



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