Depression                                                      

Types of Depression: Signs and Symptoms

Most commonly diagnosed mood disorders are:
Major Depressive Disorder.. Single Episode or Recurrent
Dysthymia
Seasonal Affective Disorder   (SAD)
Adjustment Disorder with Depressed Mood


Major Depression manifests through a  variety of symptoms, from mild to severely 
disabling.  A person who suffers from a major depressive disorder has a depressed mood 
or a loss of interest or pleasure in daily activities consistently for at least a 2 week period. 
This mood represents a change from the person's normal mood. Their social, 
occupational, educational or other important functioning is negatively impaired by the 
change in mood. 

A depressed mood caused by substances (such as drugs, alcohol, medications) is 
not considered a major depressive disorder, nor is one that is caused by a general 
medical condition.  Major depressive disorder cannot be diagnosed if a person has 
a history of manic, hypomanic, or mixed episodes (e.g., a bipolar disorder).

Dysthymia is characterized by an overwhelming yet chronic state of depression, 
exhibited by a depressed mood for most of the days, for more days than not, for at 
least 2 years.  The signs and symptoms experienced are the same as for 
major depressive disorder.  There is no clear onset... no specific incidence or situation 
that triggered it.. but as if it has always been there. 

Signs and Symptoms:

• Loss of interest in life; boredom

• Listlessness and fatigue.

• Feelings of hopelessness and helplessness.

• Low self-esteem and self-worth

• Loss of energy

• Sleep disturbance: excessive or disturbed sleep

• Social isolation; feeling not useful or needed.

• Appetite disturbance: loss or gain of weight

• Decreased libido.  Loss of sex drive.

• Difficulty making decisions

• Impaired concentration  

• Impaired attention

• Impaired memory.  forgetfulness  

• Unexplained crying bouts.  

• Intense guilt feelings over minor or imaginary misdeeds.  

• Irritability

• Restlessness  

• Aches and pains: headache, chest pain, etc.  (without evidence of disease) 

• Not due to bereavement (death or loss of loved one)

Seasonal Affective Disorder (SAD) afflicts about 5% of U.S. adults -- some 10 million Americans -- but an estimated 25% of the population experiences some form of winter blues. The farther north you live, the greater your risk. Studies show that about 1- 3% of Floridians suffer from SAD.  Among Alaskans the figure is 10%. 

Other types of depression afflict many more women than men, and SAD is no exception. The National Institute of Mental Health (NIMH) estimates that women with SAD outnumber men four to one. The condition also seems to run in families. 

Adjustment Disorder with Depressed Mood is identified by the development of emotional or behavioral symptoms in response to an identifiable stressors occurring within 3 months of the onset of the stressors.  These symptoms or behaviors are clinically significant as evidenced by either of the following:

• Marked distress that is in excess of what would be expected from exposure to the stressor
• Significant impairment in social, occupational or educational functioning
• Does not meet the criteria for another specific disorder.
• Once the stressor (or its consequences) are terminated the symptoms do not persist for more than an additional 6 months.  

Anti-Depressants

While all these medications are equally effective, some work better for different combinations of symptoms than others.  It's important to tell your doctor about your symptoms in detail so that your symptom cluster can be matched to the medication that works best for it.

However, if the first antidepressant you try does not provide sufficient relief, don't give up, another probably will.  Some patients need to try several different medications before they find the one that works best for them.  Antidepressants are usually prescribed by themselves, but some psychiatrists combine them with other drugs to increase their effectiveness.  

Tricyclic compounds include Anafranil (clomipramine), Asendin (amoxapine), Aventyl and Pamelor (nortriptyline), Elavil (amitriptyline), Norpramin (desipramine), Sinequan (doxepin), Surmontil (trimipramine), Tofranil (imipramine), and Vivactil (protriptyline).
Tricyclic medications have a sedating effect that often improves anxiety symptoms.  Tricyclic drugs may cause a variety of side effects, most commonly: dry mouth, blurred vision, nausea, vomiting, drowsiness, dizziness, anxiety, nervousness, restlessness, rashes, nightmares, headache, fatigue, irritability, tremors, abdominal distress, increased perspiration, hair loss, mood swings, heart palpitations, appetite changes, weight gain or loss, urinary retention and constipation, changes in sexual function, and confusion (especially in elderly people).

Rarely to infrequently, these drugs may also cause hepatitis, seizures, stroke, panic attacks, and heart attack.

Although tricyclic medications are not addictive, sudden cessation after regular use may cause nausea, headache, vertigo, nightmares, and a general feeling of being ill. Do not abruptly stop taking them; speak to your doctor about slowly tapering the drug off.

SSRIs (Selective Serotonin Reuptake Inhibitor) (Prozac, Zoloft, Paxil, and Celexa) help treat panic attacks and obsessive-compulsive disorder. They generally have only modest side effects. However, SSRIs may cause anxiety, and other symptoms that aggravate it, ie: jitteriness, restlessness, tremor, insomnia, and possible sexual problems.  

Wellbutrin helps treat depression and anxiety symptoms. Wellbutrin is among the newer antidepressants. Wellbutrin and the smoking cessation drug Zyban are the same chemical, but in different formulations (Zyban is prescribed only for smoking cessation, not depression). Wellbutrin SR is a long-acting form. People with a history of seizures should use Wellbutrin with extreme caution.  However, it may also cause jitteriness, tremors, and insomnia. Wellbutrin also increases the risk of seizures and is not recommended for treating panic attacks.  

Possible Wellbutrin (and Zyban) side effects include: agitation (32% vs. 22% of those taking a placebo), dry mouth (28% vs. 18%), constipation (26% vs. 17%), excessive sweating (22% vs. 15%), dizziness (22% vs. 16%), tremor (21% vs. 8%), blurred vision (15% vs. 10%). Weight loss occurs more frequently than weight gain

Effexor help treat depression with anxiety.  It may cause anxiety, nervousness, tremor, and insomnia, and raise blood pressure.  

Effexor and Effexor XR side effects include: nausea (37% vs. 11% of those taking a placebo), drowsiness (23% vs. 9%), dry mouth (22% vs. 11%), dizziness (19% vs. 7%), constipation (15% vs. 7%), weakness (12% vs. 6%), nervousness (13% vs. 6%), excessive sweating (12% vs. 3%), abnormal ejaculation in men (12% vs 1%), loss of appetite (11% vs. 2%), and male impotence (6% vs. 1%). Effexor and Effexor XR are more likely to cause weight loss than weight gain.  

Serzone helps treat depression with anxiety. It produces early, sustained improvement in anxiety, agitation, and sleep. It typically produces only modest side effects, with low risk of sexual impairment. However, because it is one of the newer antidepressants, there are no studies showing it beneficial in treating panic attacks and obsessive-compulsive disorder.  

Possible Serzone side effects include: dry mouth (25% vs. 13% of those taking a placebo), drowsiness (25% vs. 14%), nausea (22% vs. 12%), dizziness (17% vs 5%), constipation (14% vs. 8%), weakness (11% vs. 5%), lightheadedness (10% vs. 3%), blurred vision (9% vs. 3%), and confusion (7% vs. 2%). There is a theoretical risk of priapism (persistent, abnormal erection).

MAO Inhibitors are among the oldest antidepressants. In recent years, their popularity has declined considerably because of their side effects, and the food restrictions that must be observed while taking them.  

If you eat foods with high levels of the amino acid tyramine while taking an MAO inhibitor, then dangerously high increases in blood pressure can occur. The differences in the tyramine content of foods varies depending on the type, processing, fermentation, ripening, breakdown, or other factors that may occur.

In addition, other possible MAO inhibitor side effects include: dizziness, fainting, headache, tremors, muscle twitching, confusion, memory impairment, anxiety, agitation, insomnia, sexual dysfunction, weakness, drowsiness, chills, blurred vision, and heart palpitations, and suppression of angina pain that might otherwise warn of serious heart problems.

Although MAO inhibitors are not addictive, sudden cessation often produces nausea, vomiting, and a general feeling of being ill. When you stop taking these drugs, do so under a physician's supervision.

Factoids

  The World Health Organization (WHO) estimates that 340 million people suffer from depression world-wide, and 800,000 suicides every year are attributed to depression world-wide.

  Depression costs lives — for those who have been hospitalized with Depression, an estimated 15 percent commit suicide.  According to the U.S. Centers for Disease Control and Prevention (CDC), suicide is the 9th leading cause of death in the United States, claiming 30,862 lives in 1996.  Because of the number of cases where cause of death is difficult to determine, many investigators feel even this number is a gross underestimation of suicides.

  Depression can affect anyone of any gender, age, ethnicity and social class, women experience depression at roughly twice the rate of men.  (NIMH 1996)

  Recent studies show that, at any given time, as many as one in every 33 children may have clinical depression. The rate of depression among adolescents may be as high as one in eight. (Center for Mental Health Services).

  During the course of any given year, while more than 40 million adult Americans are affected by one or more mental disorders, 6.5 million Americans are disabled by severe mental illnesses. (NIMH, 1990)

  An estimated 19.9 million Americans, 8.8% of the population experience phobias. 
  About 9.1 million, 5.1% live with major depression. 
  Some 3.9 million have obsessive compulsive disorder; 
  2.0 million have schizophrenia; 
  2.4 million have panic disorder; and 
  2.0 million experience bipolar disorders. (NMHA, 1993), (Mental Health, U.S., 1994)

  As least two thirds of elderly nursing home residents have a diagnosis of a mental disorder such as major depression. (NIMH, 1990)

National Mental Health Association.. Information Fact Sheets   
http://www.nmha.org/

References and Links:

Let's Talk Facts Pamphlet Series
        http://www.psych.org/main.html
Diagnostic and Statistical Manual of Mental Disorders.  Vol. IV  American 
        Psychiatric Association.  1994
Drug Package Inserts
National Institute of Mental Health   
        http://www.nimh.nih.gov/about/index.cfm
National Mental Health Association
        http://www.nmha.org/
Physicians' Desk Reference, 1999.