Understanding Depression

Sometimes physical problems can cause depression. But other times, symptoms of depression are part of a more complex psychiatric problem. There are several different types of depression, including:
* Major depressive disorder
* Dysthymia
* Seasonal affective disorder
* Psychotic depression
* Bipolar depression

Major Depression
An individual with major depression, or major depressive disorder, feels a profound and constant sense of hopelessness and despair.
Major depression is marked by a combination of symptoms that interfere with the person's ability to work, study, sleep, eat, and enjoy once pleasurable activities. Major depression may occur only once but more commonly occurs several times in a lifetime.

What are the symptoms of major depression?
Symptoms of depression include:
* Sadness
* Anxiety
* Irritability
* Loss of interest in activities once enjoyed
* Withdrawal from social activities
* Inability to concentrate
Psychotic Depression:
Roughly 25% of people who are admitted to the hospital for depression suffer from what is called psychotic depression. In addition to the symptoms of depression, psychotic depression includes some features of psychosis, such as hallucinations (seeing or hearing things that aren't really there) or delusions (irrational thoughts and fears).

How is psychotic depression different than other mental disorders?
While people with other mental disorders, like schizophrenia, also experience these symptoms, those with psychotic depression are usually aware that these thoughts aren't true. They may be ashamed or embarrassed and try to hide them, which can make diagnosing this condition difficult.

What are the symptoms of psychotic depression?
* Anxiety (fear and nervousness)
* Agitation
* Paranoia
* Insomnia (difficulty falling and staying asleep)
* Physical immobility
* Constipation (difficulty having a bowel movement)
* Intellectual impairment
* Psychosis

Dysthymia
Dysthymia, sometimes referred to as chronic depression, is a less severe form of depression but the depression symptoms linger for a long period of time, perhaps years. Those who suffer from dysthymia are usually able to function normally, but seem consistently unhappy.
It is common for a person with dysthymia to also experience major depression at the same time - swinging into a major depressive episode and then back to a more mild state of dysthymia. This is called double depression.

Symptoms of dysthymia include:
* Difficulty sleeping
* Loss of interest or the ability to enjoy oneself
* Excessive feelings of guilt or worthlessness
* Loss of energy or fatigue
* Difficulty concentrating, thinking or making decisions
* Changes in appetite
* Observable mental and physical sluggishness
* Thoughts of death or suicide

Seasonal Affective Disorder
Seasonal depression, called seasonal affective disorder (SAD), is a depression that occurs each year at the same time, usually starting in fall or winter and ending in spring or early summer. It is more than just "the winter blues" or "cabin fever." A rare form of SAD known as "summer depression," begins in late spring or early summer and ends in fall.

What are the symptoms of seasonal affective disorder?
People who suffer from SAD have many of the common signs of depression: Sadness, anxiety, irritability, loss of interest in their usual activities, withdrawal from social activities, and inability to concentrate. But symptoms of winter SAD differ from symptoms of summer SAD.
Symptoms of winter SAD include the seasonal occurrence of:
* Fatigue
* Increased need for sleep
* Decreased levels of energy
* Weight gain
* Increase in appetite
* Difficulty concentrating
* Increased desire to be alone
Symptoms of summer SAD include the seasonal occurrence of:
* Weight loss
* Trouble sleeping
* Decreased appetite

What causes depression?
There is not just one cause of depression. It is a complex disease that can occur as a result of a multitude of different factors, including biology, emotional and environmental influences. For some, depression occurs due to a loss of a loved one, a change in one's life, or after being diagnosed with a serious medical disease. For others, depression just happened, possibly due to a family history of the disorder.
There is absolute proof that people suffering from depression have changes in their brains compared to people who do not suffer from depression. The hippocampus, a small part of the brain that is vital to the storage of memories, is 9%-13% smaller in women with a history of depression than in those who've never been depressed. A smaller hippocampus has fewer serotonin receptors. Serotonin is a neurotransmitter -- a chemical messenger that allows communication between nerves in the brain and the body.
What scientists don't yet know is why the hippocampus is smaller. Investigators have found that cortisol (a stress hormone that is important to the normal function of the hippocampus) is produced in excess in depressed people. They believe that cortisol has a toxic or poisonous effect on the hippocampus. It's also possible that depressed people are simply born with a smaller hippocampus and are therefore inclined to suffer from depression.

How is depression diagnosed?
The diagnosis of depression begins with a physical exam by a doctor. Although there are no laboratory tests to specifically diagnose depression, the doctor may use various tests to look for physical illness as the cause of the symptoms. If a physical cause for the depression is ruled out, your doctor will likely refer you to a psychiatrist or psychologist for evaluation.
The doctor bases his or her diagnosis of depression on the patient's report of the intensity and duration of symptoms -- including any problems with functioning caused by the symptoms. The doctor then determines if the patient's symptoms and degree of dysfunction point to depression.

How is depression treated?
The most common treatment for depression includes the combination of antidepressant medicine, including selective-serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants, and psychotherapy (called "therapy" for short, or "counseling"). Electroconvulsive therapy, also called ECT, may be used as a last resort when severe depression is unresponsive to other forms of therapy.
In October 2004, The FDA has determined that antidepressant medications increase the risk of suicidal thinking and behavior in children and adolescents with depression and other psychiatric disorders. If you have questions or concerns, discuss them with your health care provider.

What is the outlook for people with depression?
The outlook for depressed people who seek treatment is very promising. By working with a qualified and experienced mental health care professional, you can regain control of your life.

Source: http://www.medscape.com/viewarticle/465005