| IntroductionDepression is a serious medical condition. In | | | | oxidase inhibitors (MAOIs). Although both generations |
| contrast to the normal emotional experiences of | | | | of medications are effective in relieving depression, |
| sadness, loss, or passing mood states, clinical | | | | some people will respond to one type of drug, but not |
| depression is persistent and can interfere significantly | | | | another. Other types of antidepressants are now in |
| with an individual's ability to function. There are three | | | | development.Certain types of psychotherapy, |
| main types of depressive disorders: major depressive | | | | specifically cognitive-behavioral therapy (CBT) and |
| disorder, dysthymic disorder, and bipolar disorder | | | | interpersonal therapy (IPT), have been found helpful for |
| (manic-depressive illness).Symptoms and Types of | | | | depression. Research indicates that mild to moderate |
| DepressionSymptoms of depression include sad mood, | | | | depression often can be treated successfully with |
| loss of interest or pleasure in activities that were once | | | | either therapy alone; however, severe depression |
| enjoyed, change in appetite or weight, difficulty sleeping | | | | appears more likely to respond to a combination of |
| or oversleeping, physical slowing or agitation, energy | | | | psychotherapy and medication. 7 More than 80 |
| loss, feelings of worthlessness or inappropriate guilt, | | | | percent of people with depressive disorders improve |
| difficulty thinking or concentrating, and recurrent | | | | when they receive appropriate treatment.In situations |
| thoughts of death or suicide. A diagnosis of major | | | | where medication, psychotherapy, and the combination |
| depressive disorder is made if a person has 5 or more | | | | of these interventions prove ineffective, or work too |
| of these symptoms and impairment in usual functioning | | | | slowly to relieve severe symptoms such as psychosis |
| nearly every day during the same two-week period. | | | | (e.g., hallucinations, delusional thinking) or suicidality, |
| Major depression often begins between ages 15 to 30 | | | | electroconvulsive therapy (ECT) may be considered. |
| but also can appear in children. 1 Episodes typically | | | | ECT is a highly effective treatment for severe |
| recur.Some people have a chronic but less severe | | | | depressive episodes.The possibility of long-lasting |
| form of depression, called dysthymic disorder, which is | | | | memory problems, although a concern in the past, has |
| diagnosed when depressed mood persists for at least | | | | been significantly reduced with modern ECT |
| 2 years (1 year in children) and is accompanied by at | | | | techniques. However, the potential benefits and risks of |
| least 2 other symptoms of depression. Many people | | | | ECT, and of available alternative interventions, should |
| with dysthymia develop major depressive | | | | be carefully reviewed and discussed with individuals |
| episodes.Episodes of depression also occur in people | | | | considering this treatment and, where appropriate, with |
| with bipolar disorder. In this disorder, depression | | | | family or friends.One herbal supplement, hypericum or |
| alternates with mania, which is characterized by | | | | St. John's wort, has been promoted as having |
| abnormally and persistently elevated mood or irritability | | | | antidepressant properties. Results from the first |
| and symptoms including overly-inflated self-esteem, | | | | large-scale, controlled study of St. John's wort for |
| decreased need for sleep, increased talkativeness, | | | | major depression, which was funded in part by NIMH, |
| racing thoughts, distractibility, physical agitation, and | | | | are expected in 2001. Note: There is evidence that St. |
| excessive risk taking. Because bipolar disorder requires | | | | John's wort can reduce the effectiveness of certain |
| different treatment than major depressive disorder or | | | | medications. Use of any herbal or natural supplements |
| dysthymia, obtaining an accurate diagnosis is | | | | should always be discussed with your doctor before |
| extremely important.Facts About DepressionMajor | | | | they are tried.Research FindingsBrain imaging research |
| depression is the leading cause of disability in the U.S. | | | | is revealing that in depression, neural circuits responsible |
| and worldwide. 2 Depressive disorders affect an | | | | for moods, thinking, sleep, appetite, and behavior fail to |
| estimated 9.5 percent of adult Americans ages 18 and | | | | function properly, and that the regulation of critical |
| over in a given year, 3 or about 18.8 million people in | | | | neurotransmitters is impaired. Genetics research, |
| 1998. Nearly twice as many women (12 percent) as | | | | including studies of twins, indicates that genes play a |
| men (7 percent) are affected by a depressive | | | | role in depression. Vulnerability to depression appears |
| disorder each year.Depression can be devastating to | | | | to result from the influence of multiple genes acting |
| family relationships, friendships, and the ability to work | | | | together with environmental factors.Other research |
| or go to school. Many people still believe that the | | | | has shown that stressful life events, particularly in the |
| emotional symptoms caused by depression are "not | | | | form of loss such as the death of a close family |
| real," and that a person should be able to shake off | | | | member, may trigger major depression in susceptible |
| the symptoms. Because of these inaccurate beliefs, | | | | individuals. The hypothalamic-pituitary-adrenal (HPA) |
| people with depression either may not recognize that | | | | axis, the hormonal system that regulates the body's |
| they have a treatable disorder or may be discouraged | | | | response to stress, is overactive in many people with |
| from seeking or staying on treatment due to feelings | | | | depression. Research findings suggest that persistent |
| of shame and stigma. Too often, untreated or | | | | overactivation of this system may lay the groundwork |
| inadequately treated depression is associated with | | | | for depression.Studies of brain chemistry, mechanisms |
| suicide.TreatmentsAntidepressant medications are | | | | of action of antidepressant medications, and the |
| widely used, effective treatments for depression. | | | | cognitive distortions and disturbed interpersonal |
| Existing antidepressants influence the functioning of | | | | relationships commonly associated with depression, |
| certain chemicals in the brain called neurotransmitters. | | | | continue to inform the development of new and better |
| The newer medications, such as the selective | | | | treatments.New Clinical TrialsNIMH is funding two new, |
| serotonin reuptake inhibitors (SSRIs), tend to have | | | | large-scale, multi-site clinical trials on treatments for |
| fewer side effects than the older drugs, which include | | | | major depression in adults and adolescents. |
| tricyclic antidepressants (TCAs) and monoamine | | | | |