Mood disorders: Depression




Symptoms:

depressed mood: sadness, crying, irritability, guilt, pessimism

changes in sleep patterns: hypersomnia or insomnia, especially with early morning awakening

weight loss or gain (without trying) or changes in appetite

fatigue, difficulty concentrating, poor memory, indecisiveness

loss of pleasure in activities that were previously enjoyable

psychomotor retardation (observable slowing of movement, poverty of movement)

suicidal ideation (preoccupation with death, talk of suicide, suicide attempts)


Cause and Onset:

very common, at least 10% of people will have depression sometime during their life

more common in women than men, not sure why (stress, hormones, likeliness to seek treatment?)

onset usually in young adulthood for women, middle age for men

general theory is that depression is due to a combination of genetic and environmental factors

not due to any specific cause, people live through horrible things without getting depressed and people without a history of traumatic experiences get depressed

the grieving process normally involves depression, but the person should show steady improvement after the initial shock of loss

seems to be associated with low levels of brain chemicals called monamines (serotonin, norepinephrine and dopamine) and abnormal stress-hormone regulation


Unipolar Major Depression (UMD)

severe depression, tends to be episodic and responds well to treatment. Symptoms usually include insomnia, weight loss and significant functional impairment during episodes, most likely to need hospitalization

Atypical Depression:

not uncommon, tends to be chronic, somewhat more difficult than UMD to treat, less likely than UMD to need hospitalization. Symptoms usually include hypersomnia, weight gain, ability to be temporarily cheered up, less functional impairment

Dysthymic Disorder:

mild long-lasting chronic depression, can occur with UMD

Seasonal Affective Disorder:

depression that occurs in the winter, especially in northern climates, treated with artificial sunlight, might involve vitamin D

Psychotic  Depression:

Tends to occur with severe UMD (15 % of UMD will have). Most commonly involves delusions: “everything is all my fault, I ruin everything I touch, I should avoid people because my presence poisons them” or mood-congruent hallucinations, such as hearing voices that berate and cast blame, often requires hospitalization



Prognosis

tends to be a recurrent, life-long disorder

treatment is usually successful, allowing patient to lead a normal life

suicide is a risk (most suicide victims suffer from depression)

depression is a significant risk factor for cardiac fatality

depression worsens the prognosis of most illnesses (cancer, infection, diabetes, stroke)


Treatment

Tricyclic antidepressants (TCAs)

called tricyclics because of their chemical three-ring structure

often have unpleasant side effects (arrhythmias, weight gain, dry mouth, sedation)

can be fatal in small overdoses (one of most dangerous meds to overdose on)

most effective for UMD

 

Tofranil (imipramine)

Norpramin (desipramine)

Elavil (amitriptyline)

Pamelor (nortriptyline)

Adapin (doxepin)

Surmontil (trimipramine)

Vivactil (protriptyline)

Monamine oxidase inhibitors (MAOIs)

work by preventing the breakdown (oxidation) of the monamines, only rarely used

often have unpleasant side effects (postural hypotension and fainting, weight gain)

can fatally interact with food and medication (cheese, wine, OTC cold medication) by causing dangerously high blood pressure that can result in a stroke (this is called a hypertensive crisis)

most effective in Atypical Depression

 

Nardil

Parnate

Marplan

Eldepryl

Selective Serotonin Reuptake Inhibitors (SSRIs)

effective for all types of depression

very safe, nearly impossible to overdose on,

few side effects (agitation, worsening of ADD)

relatively recent, first released in the 1980s

more expensive than the TCAs

 

Prozac (fluoxetine)

Paxil

Zoloft

Celexa

Effexor

Others

Wellbutrin: stimulant-like

antiseizure medication (Depakote, Neurotonin, Tegratol) used for treatment-resistant

antipsychotics used with antidepressants for Psychotic Depression

 

Electroconvulsive Therapy (ECT)

ECT consists of several induced seizures to one side of the brain

very effective (nearly 100% helped)

very safe, used for patients who cannot tolerate meds,

might cause some memory loss

used only with treatment resistant or life-threatening depression

cannot be administered without patient/family consent

controversial and rarely used



Generally, antidepressants combined with psychotherapy is the most effective treatment for depression.





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Depression (you are here)
Bipolar Disorder
Schizophrenia
Anxiety Disorders
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