Nevertheless, attempts are major risk factors for a later suicide. Any expression of suicidal intent should be treated very seriously. Children, adolescents, and young adults who are prescribed antidepressant medication should be carefully monitored by both their parents and doctor, especially during the first few months of treatment, for any worsening of depression symptoms or changes in behavior.
The following are danger signs in young people: Withdrawal from friends Sudden decrease in school performance Loss of interest in activities that were previously pleasurable Unusual irritability Unusual changes in sleep or eating habits Risk factors for suicide include a history of neglect or abuse, history of deliberate self-harm, a family member who committed suicide, access to firearms, and living in communities where there have been recent outbreaks of suicide among young people.
A romantic break-up is often the trigger for a suicidal attempt in teenagers. Feeling connected with parents and family can help protect young people with depression from suicide.
Parents should not hesitate to seek professional help for their children if they suspect they are thinking about killing themselves. This is a medical emergency and requires immediate treatment. Effect on Physical Health Major depression in the elderly or in people with serious illness may reduce survival rates, even independently of any accompanying illness. Decreased physical activity and social involvement certainly play a role in the association between depression and illness severity.
Heart Disease and Heart Attacks. Data suggest that depression itself may be a risk factor for heart disease as well as its increased severity. Patients with heart disease who are depressed tend to have more severe cardiac symptoms than those who are not depressed, and a poorer quality of life.
Depression can worsen the prognosis of heart disease and increase the risk of death. While the evidence is less conclusive, studies also indicate that depression in healthy people may increase the risk for developing heart disease. The more severe the depression, the greater the risk. Studies are now showing that depression may contribute to poor outcomes for patients with heart disease. People, especially adolescents, who are depressed have a high risk for obesity. The conditions may have common risk factors such as low physical activity may also be a common factor.
Depression in the elderly is associated with a decline in mental functioning, regardless of the presence of dementia. Depression does not increase the risk for cancer, but cancer can physically trigger depression by affecting chemicals in the brain. Sometimes depressive symptoms can manifest even before the cancer is diagnosed. Depression in parents may increase the risk for childhood depression. People who suffer from psychiatric disorders tend to have higher divorce rates than healthy people.
Spouses of partners with depression are themselves at higher risk for depression. Depression can adversely affect a person's work life. It significantly increases the risk for unemployment and lower income.
Substance Abuse Alcohol and Drug Abuse. Many people with major depression also have an alcohol use disorder or drug abuse problems. Studies on the connections between alcohol dependence and depression have still not resolved whether one causes the other or if they both share some common biologic factor.
Depression is a well-known risk factor for smoking, and many people with major depression are nicotine dependent. Nicotine may stimulate receptors in the brain that improve mood in some people with depression. Diagnosis A diagnosis of depression is based on symptoms meeting specific criteria.
Many people who are depressed first seek help from their family doctors. Guidelines now recommend that family doctors screen for depression adults and adolescents ages 12 - 18 , as long as these doctors have appropriate systems in place to ensure accurate diagnosis, treatment, and follow-up of their patients.
To check if you have depression, a doctor may ask you questions such as: Over the past month, have you felt down, depressed or hopeless? Over the past month, have you felt little interest or pleasure in doing things?
Individuals who have certain factors might ask their doctor if they should be screened for depression. People with a family or personal history of depression Patients with multiple medical problems Patients with physical symptoms that have no clear medical cause Patients with chronic pain Individuals who visit their doctor more frequently than expected Screening Tests Mental health professionals may administer a screening test such as the Beck Depression Inventory or the Hamilton Rating Scale, both of which consist of about 20 questions that assess the individual for depression.
However, most mental health professionals generally diagnose depression based on symptoms and other criteria. Ruling Out Other Conditions Depression can sometimes be confused with other medical illnesses. Weight loss and fatigue, for example, accompany many conditions, some serious, but they can also occur with depression.
Treatment Depression is a treatable illness, with many therapeutic options available including psychotherapy, antidepressants, or both. In general, the treatment choice depends on the degree and type of depression and other accompanying conditions. It also may depend on age, pregnancy status, or other individual factors. Unfortunately, many Americans with major depression receive either inadequate treatment or no treatment at all. Reasons may include treatment by providers who may not have sufficient information or training on dosages or specific drugs that would be best suited for individual cases, lack of recognition of depression symptoms by providers, poor access to health care services, lack of health insurance, and poor compliance with medications.
Patients with Major Depression. Numerous studies support a combination of cognitive behavioral therapy CBT plus antidepressants, typically a selective serotonin reuptake inhibitor SSRI or serotonin norepinephrine reuptake inhibitor SNRI.
Although some people may feel better after taking antidepressants for a few weeks, most people need to take medication for at least 4 - 9 months to ensure a full response and to prevent depression from recurring.
Research indicates that patients respond better to medications when drug therapy is combined with CBT. Exercise may also help relieve depressive symptoms. Patients with Treatment-Resistant Depression. Sometimes an atypical antipsychotic drug may be given in combination with an antidepressant for patients with severe major depressive disorder.
Brain stimulation techniques, such as electroconvulsive therapy ECT , are options for treatment-resistant depression. Experimental procedures, such as repetitive transcranial magnetic stimulation and implantable deep brain stimulation devices, are being studied and may be helpful.
Researchers are also investigating new types of drugs such as ketamine , which may provide rapid, if temporary, improvement.
In general, the more treatment strategies that patients need, the less likely they are to recover completely from depression.
Patients with Minor Depression. Patients with minor depression fewer than five symptoms that persist for fewer than 2 years may respond well to watchful waiting to see if antidepressants are necessary. Counseling or cognitive behavioral therapy may be helpful, as is regular exercise. Patients with Depression and Other Psychiatric Problems.
Other psychiatric problems often coexist with depression. If patients also suffer from anxiety, treating the depression first often relieves both problems. More severe psychiatric problems, such as bipolar disorder or schizophrenia, require specialized treatments. Patients with Depression and Medical Conditions. Depression can worsen many medical conditions and may even increase mortality rates from some disorders, such as heart attack and stroke.
Depression, then, should be aggressively treated in anyone with a serious medical problem. Patients with Depression and Substance Abuse Problems. Treating depression in patients who abuse alcohol or drugs is important and can sometimes help patients quit. Additionally, with reduced sunlight serotonin, one of our natural brain neurotransmitters is reduced.
This, too, can lead to senior depression. These last for a shorter time and are not associated with the hopeless, low feelings that are associated with Seasonal Affective Disorder. The American Psychiatric Association's guidelines on major depressive disorders recommend the entire range of depressive treatments for Seasonal Affective Disorder.
Exercise Counseling Antidepressant therapies Light therapy Note: Patients suffering from seasonal affective disorder may benefit from light or drug, but the overall quality of evidence, especially for drug therapy is low.
Bupropion is the most effective drug treatment. Westrin A, Lam RW. Issues Ment Health Nurs. Gelenberg AJ, et al. Anderson I, et al. Depression in adults update: Helping patients to cope with seasonal affective disorder. Modell JG, et al. Seasonal affective disorder and its prevention by anticipatory treatment with bupropion XL.
Long-term and preventative treatment for seasonal affective disorder. Second-generation antidepressants for seasonal affective disorder.
Cochrane Database Syst Rev. Cheung A, et al. Direct health care costs of treating seasonal affective disorder: Epub Oct Lam RW, et al. There is also a genetic component in that you are more likely to have SAD if a close relative is affected.
How does light affect mood and behaviour? Circadian rhythms are innate physiological, mental and behavioural changes which follow a roughly to hour cycle. Biological clocks are groups of interacting molecules in cells throughout the body. A master biological clock is located in the supra-chiasmic nucleus SCN which sits within the hypothalamus.
This co-ordinates all the body clocks so that they are synchronised. The master clock in the SCN is affected by light and darkness via the retino-hypothalamic tract.
The retino-hypothalamic tract is a neurological pathway connecting the retinal ganglion cells RGCs of the retinae to the SCN in the hypothalamus. This connects with the pineal gland via the superior cervical ganglion SCG. Melanopsin 'signals' daytime to the SCN which in turn induces the pineal gland to suppress melatonin production.
Melatonin is produced by the pineal gland. Its primary function is to signal day length to the SCN, acting as a cue for innate night-time behaviour.
Counseling or cognitive behavioral disorder may be helpful, as is regular exercise. Individuals who have certain factors might ask their doctor if they should be screened for depression. No sexual side effects escitalopram it worked great for about 6 months then I started noticing that I would get very irritable after taking it. Hormonal fluctuations that occur during and seasonal pregnancy, escitalopram in seasonal affective disorder, especially when combined with relationship stresses and anxiety, can contribute to depression. Possibly because of the duration of the symptoms, patients who suffer from chronic minor depression do not exhibit marked changes in mood or in daily functioning, although they have low energy, a general negativity, and a sense of dissatisfaction and hopelessness. They can offer support, a shoulder to cry on or shared laughter to give you a little boost. The degree to which these chemical messengers are disturbed may be affected by other factors such as genetic susceptibility. While the evidence is less conclusive, studies also indicate that depression in affective people may increase the risk for developing heart disease. Depression is very common in seniors, with the disorder of the condition strongly correlating to poor health and decreased functioning, both traits frequently seen in elderly nursing home residents. A controlled trial of levodopa plus carbidopa in the treatment of winter seasonal affective disorder: Preparing for your appointment You may start by seeing your family doctor or a mental health professional escitalopram as a psychiatrist or psychologist. Hypothyroidism a condition caused when the thyroid gland does not produce enough hormone can cause depression. Seasonal affective disorder SAD is a seasonal form of clinical depression typically seen in the fall and winter, escitalopram in seasonal affective disorder. In general, doctors prescribe antidepressants for SAD treatment only after non-invasive treatments like lifestyle changes, psychotherapy and light therapy have seasonal. This is the first winter in 10 years where my mood has not changed at all from how I was in the summer months. Paroxetine Paxil appears to have the strongest association with increased suicidal risk, particularly in younger adults, escitalopram in seasonal affective disorder. Since then I have affective college, got a full time job, living on my on my own.
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