The opposite of depression, fear, sorrow, and grief is healthy enjoyment. What has stopped us from experiencing healthy enjoyments? The answer will probably be some negative relationships from childhood, severity in upbringing and schooling, and some crushing experiences in life. Once we have realised that then we can start to set goals to let ourselves enjoy harmless, healthy, and often simple experiences. Just lying in bed and thoroughly enjoying it is a great start!
Depression and nervous system repression
A habitual repressive response to our emotions generally leads to a state of emotional dulling, flattening of feelings, reduced emotional repertoire, and eventually depression. This is because we are telling the mind to persistently stop our emotions and eventually this actually affects the structure of our nervous system so that is learns not to feel, to dull our feeling, or - as in most cases of depression - to become very confused and give rise to a highly agitated and/or negative experience.
Depression and Emotional Management
Depression is very commonly an expression of this flattening or confusing of thoughts and emotions. We can begin to overcome depression by understanding our mind and our emotions, to "face and embrace" our emotions, knowing that, like thoughts, they cannot harm us or others, unless we choose to harm ourselves. Our fear of our emotions leads to the construction of a psychological structure in our mind that "depresses" our emotions, which leads to psycho-emotional problems and, of course, the experiences of depression.
Depression and STRESS
Episodes of long-term or even intense short-term stress can lead to exhaustion, fatigue, and depression. This is another key area of life that we need to understand and manage properly if we want to avoid depression.
Depression and DIET
Another key aspect of depression is our diet. We must review, not only what we eat, but also the types of things that we connect with or surround our mind and emotions with. For food, it is best to eat fresh fruit, fresh vegetables, plenty of green vegetables, and ensure that we get an adequate amount of protein, carbohydrates, vitamins, and minerals. The nervous sytem is made from certain fat cells and if we put the correct food into our body then our body can create and maintain a healthy nervous system that will help to reduce the experience of depression. An adequate supply of Essential Fatty Acids (EFA's) is essential for a healthy nervous system. Fish oils are a very good source of EFA's: Codliver oil.
Depression and ADequate physical exercise
It is important to take regular physical exercise such as swimming, walking, jogging, or sport activites, to help create and maintain holistic health.
Depression and Alcohol
Alcohol is a depressive drug - it creates the experience of depression within us. If we are suffering from depression it is essential to stop drinking alcohol and preferably to give it up completely. So much unnecessary suffering can be avoided by giving up alcohol.
Depression and Occupation
Trying to find a working occupation that suits our temperament, character, skills, and "who we are", can be a difficult task, yet can be very important to some people to find a suitable occupation which Budhism calls "Right Livelihood." If this is not possible, then we need to learn how to maturely manage the emotions that our working environment provokes. This requires the application of "Emotional Management".
Depression and Relationships
Some relationships can provoke depression. We need to review these relationships and seek out solutions to the problems that they create. Sometimes we may need to break off a relationship if we find that the problems within it are not solvable.
Depression and Pity
An excessive amount of pity for life, whether self-pity or other-pity, is really neither useful or going to change anything. On the other hand, empathy, compassion, and some life philosophy are useful. Some people find a transcendent philosophy or religion useful - considering the bigger picture of life, the universe and everything - that helps bring perspective to our life on Earth.
Depression and Mental Attitude
Thoughts are the centrally controlling elements of our life attitudes, perceptions, opinions, and beliefs - and thoughts can be changed. Our brains work very habitually. Sometimes this works, sometimes we feel stuck in a repeating and habitual set of thoughts that are bringing us suffering instead of peace, happiness, and/or contentment - ie; pleasant conditions.
The good news is that thoughts can be changed, mental habits can be changes, and we can experience different attitudes, perceptions, opinions, beliefs, and feelings.
Many people find "Guided Suggestion", hypnotherapy, and Guided Meditations very useful for helping us experience fresh ways of thinking and feeling. Many such guided meditations and affirmations are available in audio format through CD, tape, DVD, and video. By listening and contemplating these guided suggestions we can begin to think and feel in new or more pleasant ways. Our mind is not set in stone, it is a tool that we can use to experience many differing thoughts, emotions, and attitudes. Unpleasant, painful, or disturbing states of mind can be replaced by pleasant, happier, and more fulfilling ones.
Help is available and it is the responsibility of the sufferer to accept it.
It must also be understood that there are many types of depression and some of the types are actually medical conditions; damaged or genetically inherited conditions of the nervous system. If you suffer from depression, think about how you manage your emotions and also consult your Doctor concerning it. Anti-depressants can begin to get our nervous sytem working better so that we can begin to effectively understand and deal with our problems. If you have suffered depression consistently for more than two weeks then it is time to consult your Doctor and also to review your life and the manner in which you manage your emotions. Most types of depression can be overcome or at least reduced by a course of anti-depressants, counselling, and becoming "emotionally knowledgeable."
A major problem with long term depression is that our mind gets habituated to it and it becomes our daily experience. The mind
begins to habitually reinforce the depression.
The depressed person feels disconnected from life and the most important thing that we can do is to try to connect with life in all areas. This is the path out of depression. To be consciously connecting with every area of life.
It is difficult to begin with but like any habit we must try and by trying then sooner or later we will be connected with life. This requires conscious effort and honesty with ourself and others.
It your birth right to be here and you are allowed to be here and connected with life.
Coming out of long term and habitual depression is a journey that has been likened to walking down a long dark corridor because it takes time for the brain to start thinking clearly again and for us to achieve and maintain a healthy, balanced lifestyle.
Major elements in overcoming depression include:
- Talk to your Doctor: A combined course of anti-depressants and psychotherapy counselling can really help
- Good, deep sleep: Getting the right kind of sleep is crucial to overcoming depression. Try to get some early nights. If you are bothered by noise then purchase some ear-plugs from your chemist. Avoid sleeping pills as they don't give us a proper nights sleep
- Reviewing diet: Fresh food, plenty of fruit and vegetables, proteins, carbohydrates, omega-fats, and vitamin supplements will help you feel better. We need the right nutrition for our body and mind to work properly
- Reducing alcohol intake: Alcohol is a depressant. It never makes us happy for long - if at all - and is always followed by some down time or depression. If possible, whilst we are experiencing depression, it is advisable to stop drinking alcohol. Alcohol can also trigger and cause depression.
- Physical exercise: Do some physical exercise like regular stretching, walking, and swimming
- Learn how to relax naturally: Deep breathing relaxation is a guaranteed way to reduce anxiety and depression. We can't be tense and irritated when we are comfortable and relaxed!
- Be kind to yourself: We need to learn to be kind and loving towards ourself. Sometimes we are taught by others not to like ourselves, this has to change by practicing being kind to yourself. Learning and practicing self-respect, self-like, and self-worth is essential to overcome depression
- Separating the experience from the experiencer: This is essential if we are to understand and manage our thoughts and emotions. We are not our thoughts and emotions! They are experiences and we are the experiencer. We can learn not to identify with our thoughts and emotions and learn to experience and manage them
- Purification of heart and mind: this will help you to understand and not-cooperative with some of the more unpleasant thoughts and attitudes within the human experience!
- Practice small, yet gradual, improvements. Change takes time and is a matter of incremental improvement
Clinical depression is a state of sadness
that has advanced to the point of being disruptive to an individual's
social functioning and/or activities of daily living. The diagnosis may
be applied when an individual meets a sufficient number of the
symptomatic criteria for the depression
spectrum as suggested in the DSM-IV-TR
An individual is often seen to suffer from what is termed a
"clinical depression" without fully meeting the various
criteria advanced for a specific diagnosis on the depression spectrum.
There is an ongoing debate regarding the relative importance of genetic
or environmental factors, or gross brain problems versus psychosocial
Although a mood
characterized by sadness
is often colloquially referred to as depression,
clinical depression is something more than just a temporary state of
lasting two weeks or longer, and of a severity that begins to interfere
with typical social functioning and/or activities of daily living, are
considered to constitute clinical depression.
Clinical depression was originally considered to be a "chemical
imbalance" in transmitters in the brain, a theory based on
observations made in the 1950s of the effects of reserpine
in altering monoamine neurotransmitter levels and affecting depressive
symptoms  .
Subsequent antidepressants have also been found to alter monoamine
levels, particularly of serotonin and noradrenaline  .
Despite a growing body of evidence
suggesting otherwise, it is still a commonly held belief that depression
is only a chemical imbalance. This idea is often promoted in
pharmaceutical advertising, and perpetuated in everyday discussions.
Despite this reliance on "common wisdom", recent research and
commentary has begun to address depression as an issue broader than
Clinical depression affects about 16%
of the population on at least one occasion in their lives. The mean
of onset, from a number of studies, is in the late 20s. About twice
as many females as males report or receive treatment for clinical
depression, though this imbalance is shrinking over the course of recent
history; this difference seems to completely disappear after the age of
50 - 55, when most females have passed the end of menopause.
Clinical depression is currently the leading cause of disability
in the US as well as other countries, and is expected to become the
second leading cause of disability worldwide (after heart
disease) by the year 2020, according to the World
Health Organization .
On a historical note, the modern idea of depression appears similar
to the much older concept of melancholia.
The name melancholia derives from 'black bile', one of the 'four
humours' postulated by Galen.
papyrus (ca 1550 BC) contains a short description of clinical
depression. Though full of incantations and foul applications meant to
turn away disease-causing demons and other superstition, it also evinces
a long tradition of empirical practice and observation.
Signs and symptoms
According to the DSM-IV-TR
criteria for diagnosing a major depressive disorder (see also: DSM
cautionary statement) one of the following two required elements
need to be present:
It is sufficient to have either of these symptoms in conjunction with
four of a list of other symptoms. These include:
- Feelings of overwhelming sadness
or the seeming inability to feel emotion.
- A decrease in the amount of pleasure derived from what were
previously pleasurable activities.
- Changing appetite
and marked weight
gain or weight loss.
- Disturbed sleep
patterns, such as insomnia,
loss of REM sleep, or excessive sleep.
- Changes in activity levels, such as restlessness or a slowing of
either/both mental and physical.
- Feelings of guilt,
helplessness, hopelessness, anxiety,
- A decrease in self-esteem.
- Trouble concentrating or making decisions, or a generalized
slowing and obtunding of cognition.
or ruminating on self-harm.
- Ruminating on death
- Reduced memory.
Depression in children
is not as obvious as it is in adults. Here are some symptoms that
children might display:
- Loss of appetite.
- Sleep problems, such as recurrent nightmares.
- Learning or memory problems where none existed before.
- Significant behavioural changes; such as withdrawal, social
isolation and aggression.
An additional indicator could be the excessive use of drugs or alcohol.
Depressed adolescents are at particular risk of further destructive
behaviors, such as eating
disorders and self-harm.
One of the most widely used instruments for measuring depression
severity is the Beck
Depression Inventory, a 21 question multiple choice survey.
It is hard for people who have not experienced clinical depression,
either personally or by regular exposure to people suffering it, to
understand its emotional impact and severity, interpreting it instead as
being similar to "having the blues" or "feeling
down". As the list of symptoms above indicates, clinical depression
is a serious, potentially lethal systemic disorder characterized by
interlocking physical, affective, and cognitive symptoms which have
consequences for function and survival well beyond sad or painful
Types of depression
Major Depression, or, more properly, 'Major Depressive
Disorder' (MDD) is characterized by a severely depressed mood that
persists for at least two weeks, and is generally recognized to contain
an organic (chemical) component. Major Depressive Disorder is specified
as either "a single episode" or "recurrent", as
periods of depression may occur as discrete events or as recurrent over
Diagnosticians recognize several sub-types of Major Depressive
Features Specification - Catatonia is characterized by
motoric immobility evidenced by catalepsy
This MDD sub-type may also manifest excessive, non-prompted motor
activity (akathesia), extreme negativism and/or mutism,
and peculiarities in movement, including stereotypical movements,
prominent mannerisms, and/or prominent grimacing. There may also be
evidence of echolalia
Features Specification - Melancholia is characterized by a
loss of pleasure (anhedonia) in most or all activities, a failure of
reactivity to pleasurable stimuli, a quality of depressed mood more
pronounced than that of grief or loss, a worsening of symptoms in
the morning hours, early morning waking, psychomotor retardation,
anorexia (excessive weight loss, not to be confused with Anorexia
Nervosa), and/or excessive guilt.
Features Specification Atypicality is characterized by mood
reactivity (paradoxical anhedonia) and positivity, significant
weight gain or increased appetite, excessive sleep or somnolence (hypersomnia),
leaden paralysis, and/or significant social impairment as a
consequence of hyper-sensitivity to perceived interpersonal
Features Specification presents with hallucinations
that are either mood-congruent (content coincident with depressive
themes) or non-mood-congruent (content not coincident with
depressive themes). It is clinically more common to encounter a delusional
system as an adjunct to depression than to encounter
hallucinations, whether visual or auditory.
Other Categories of Depression
is a long-term, mild depression that lasts for a minimum two years. By
definition the symptoms are not as severe as with Major Depression,
although those with Dysthymia are vulnerable to co-occurring episodes of
Major Depression. This disorder often begins in adolescence,
and crosses the lifespan.
I Disorder is an episodic illness in which moods may cycle
and depression. In the US, Bipolar Disorder was previously referred to
as "Manic Depression". This term is no longer favored by the
medical community as not all Bipolar individuals will present depressive
symptoms. "Manic Depression" is still often used in the
II Disorder is an episodic illness that is defined primarily by
depression, but evidences episodes of hypomania.
The role of anxiety in depression
The different types of Depression and Anxiety are classified
separately by the DSM-IV-TR, with the exception of hypomania,
which is included under the Bipolar
Disorder category. Despite the different categories, depression and
anxiety can indeed be co-occurring
(occurring together, independently, and without mood
congruence), or co-morbid
(occurring together, with overlapping symptoms, and with mood
congruence). In an effort to bridge the gap between the DSM-IV-TR
categories and what clinicians actually encounter, experts such as Herman
Van Praag of the Maastricht
University have proposed ideas like anxiety/aggression-driven
needed]. This idea, and others like it, refers to an anxiety/depression
spectrum for these two disorders, which differs from the mainstream
perspective of discreet diagnostic categories.
While there is no specific diagnostic category for the co-morbidity
of depression and anxiety in the DSM or ICD, the National
Comorbidity Survey (US) reports that some 58 percent of those with
major depression also suffer from lifetime anxiety citation. Supporting
of this finding, two widely accepted clinical colloquiallisms include:
- agitated depression - referring to a state of
depression that presents as anxiety, that includes akathisia,
suicide, insomnia (not early morning wakefulness), non-clinical
(meaning “doesn’t meet the standard for formal diagnosis”)
and non-specific panic, and a general sense of dread.
- akathitic depression - referring to a state of
depression that presents as anxiety, suicide, and includes
akathisia, but does not include symptoms of panic.
It is also clear that even mild anxiety symptoms can have a major
impact on the course of a depressive illness, and the co-mingling of any
anxiety symptoms with the primary depression is important to consider. A
pilot study by Ellen
Frank PhD, et. al., at the University
of Pittsburgh found that depressed or bipolar patients with lifetime
panic symptoms experienced significant delays in their weeks to
needed] These patients also had higher levels of residual
impairment, or the ability to get back into the swing of things. On a
similar note, Robert
Sapolsky PhD of Stanford
University, and others, also argue that the relationship between
stress, anxiety, and depression could be measured and demonstrated
needed]. To that point, a study
by Heim and
et. al., of Emory
University found that depressed and anxious women with a history of
childhood abuse recorded higher heart rates and the stress hormone ACTH
when subjected to a stressful situation.
as the name suggests, is a state of mind and/or behavior that is
"below" (hypo) mania.
In other words, a person in a hypomanic state will often display
behavior that has all the earmarks of a full-blown mania (marked
elevation of mood that is characterized by euphoria, overactivity,
disinhibition, impulsivity, a decreased need for sleep, hypersexuality,
etc.), but these symptoms, while disruptive and seemingly out of
character, will not be so pronounced as to be considered a diagnosibly
Another important point is that hypomania is a diagnostic category
that includes both anxiety
and depression. It often presents as a state of anxiety that occurs
within the context of a clinical depression. Patients in a hypomanic
state often describe a sense of extreme generalized and/or specific
anxiety, re-recurring panic attacks, night terrors, guilt, and agency
(as it pertains to co-dependence
All of this happens while they are in a state retarded or somnolent
depression. This is the type of depression where a person is lethargic
and unable to move through life. The terms “retarded” and
“somnolent” are shorthand for states of depression that include
lethargy, hypersomnia, a lack of motivation, a collapse of ADLs
(activities of daily living), and social withdrawal. This is similar to
the shorthand used to describe an "agitated" or "akathitic"
In considering the hypomania-depression connection, one other
distinction should be made. That is the differentiation among anxiety,
Anxiety is a physiological state that is caused by the sympathetic
nervous system. Anxiety does not need an outside influence to occur.
Panic is related to the "fight
or flight" mechanism. It is a reaction, induced by an outside
stimulus, and is a product of the sympathetic
nervous system, and the cerebral
cortex. More plainly, panic is an anxiety state that we are thinking
about. Finally, stress is a psycho-social
reaction, influenced by how a person filters non-threatening external
events. This filtering is based on his/her own ideas, assumptions, and
expectations. Taken together, these ideas, assumptions, and expectations
are referred to as social constructionism.
On a final note, researchers at the University
of California, San
Diego under the guidance of Hagop
Akiskal MD, have found convincing evidence for the co-occurrence of
hypomanic symptoms associated with a diagnosis of depression where the
diagnosis does not meet criteria for a Bipolar diagnosis.[citation
needed] Symptoms under consideration, such as
irritability, mis-directed anger, and compulsivity, also may not present
sufficiently to be considered a hypomanic episode, as described by a Bipolar
II Disorder. As noted in the Frank study [citation
needed] mentioned above, this particular course of the
disease, with the breakthrough of anxiety, may have a significant impact
on the overall course of the depression.
This idea of co-occurring anxiety and depresion is supported in a
study by Giovanni
Cassano MD of the University
of Pisa, and his collaborators on the Spectrum Project, who found a
correlation between lifetime hypomanic and manic symptoms, and the
severity of the depression.[citation
- “The presence of a significant number of manic/hypomanic items
in patients with recurrent unipolar depression seems to challenge
the traditional unipolar-bipolar dichotomy...”
These authors, along with many other researchers,[citation
needed] argue in support of a revision of the approach to
psychiatric diagnosis into what is being referred to the mood spectrum,
so as to “...[make] more accurate diagnostic evaluation[s].” This
approach, although controversial, has begun to be given consideration by
many behavioral health professionals.
Causes of depression
No specific cause for depression has been identified, but there are a
number of factors believed to be involved.
– The tendency to develop depression may be inherited; there is
some evidence that this disorder may run in families. [citation
Brain chemicals called neurotransmitters allow electrical
signals to move from the axon of one nerve cell to the neuron
of another. A shortage of neurotransmitters impairs brain
– There may be changes or imbalances in chemicals which transmit
information in the brain, called neurotransmitters.
Many modern antidepressant
attempt to increase levels of certain neurotransmitters, like serotonin
and norepinephrine. While the causal relationship is unclear, it is
known that antidepressant medications do relieve certain symptoms of
depression, although critics point out that the relationship between
serotonin, SSRIs, and depression is usually greatly oversimplified
when presented to the public (see here).
affective disorder (SAD) is a type of depressive disorder that
occurs in the winter when daylight hours are short. It is believed
that the body's production of melatonin,
which is produced at increased levels in the dark, plays a major
part in the onset of SAD, and that many sufferers respond well to
bright light therapy, also known as phototherapy.
High levels of Omega-6
fatty acids in the brain have also been linked to depression.
factors – Low self-esteem
and self-defeating or distorted thinking are connected with
depression. While it is not clear which is the cause and which is
the effect, it is known that sufferers who are able to make
corrections to their thinking patterns can show improved mood and
self-esteem. Psychological factors include the complex development
of one's personality and how one has learned to cope with external
environmental factors, such as stress.
- Early experiences – Events such as the death of a parent,
or rejection, neglect,
chronic illness, and severe physical, psychological, or sexual abuse
can also increase the likelihood of depression later in life. Post-traumatic
stress disorder (PTSD) includes depression as one of its major
- Life experiences – Job loss, financial difficulties, long
periods of unemployment,
the loss of a spouse or other family member, divorce or the end of a
committed relationship, or other traumatic
events may trigger depression. Long-term stress, at home, work or
school, can also be involved.
- Medical conditions – Certain illnesses including
cardiovascular pathologies ,
and organic brain damage caused by either degenerative conditions
such as Parkinson disease or by traumatic blunt force injury may
contribute to depression, as may certain prescription drugs such as birth
control pills and steroids.
- Diet – The increase in depression in industrialised
societies has been linked to diet; in particular to reduced levels
of omega-3 fatty
acids in intensively
farmed food and processed foods .
This link has been, at least partly, validated by studies using
dietry supplements in schools
and by a double blind test in a prison.
- Alcohol and other drugs – Alcohol can have a negative
effect on mood, and misuse or abuse of alcohol, benzodiazepine-based
tranquillizers and sleeping medications can all play a major role in
the length and severity of depression. The link between frequent cannabis
use and depression is also widely documented, although the direction
of causality remains in question.[citation
depression (also known as postnatal depression) –
About ten percent of new mothers experience some form of depression
needed] When it occurs, the onset is typically within
three months after delivery, and it may last for several months.
About two new mothers out of a thousand have depression so severe it
- Living with a depressed person – Those living with
someone suffering from depression experience increased anxiety,
and life disruption, increasing the possibility of also becoming
- Social environment – Evolutionary
theory suggests that depression is a protective mechanism: if an
individual is involved in a lengthy fight for dominance of a social
group and is clearly losing, depression causes the individual to
back down and accept the submissive role. In doing so, the
individual is protected from unnecessary harm. In this way,
depression maintains the social hierarchy.
- Other evolutionary theories – Another evolutionary theory
is that the cognitive response that produces modern day depression
evolved as a mechanism that allows people to assess whether they are
in pursuit of an unreachable goal. Still others claim that
depression can be linked to perfectionism.
People that accept satisfactory outcomes in
lieu of "the best" outcome tend to lead happier lives.
of depression varies broadly, and is different for each individual.
Various types and combinations of treatments may have to be tried. There
are two primary modes of treatment, typically employed in conjunction
with one another: medication
A third treatment, electro-convulsive
therapy (ECT) may be used where chemical treatment fails.
Other alternative treatments used for depression include exercise and
the use of vitamins, herbs, or other nutritional supplements.
The effectiveness of treatment often depends on factors such as the
amount of optimism and hope the sufferer is able to maintain, the
control s/he has over stressors, the severity of symptoms, the amount of
time the sufferer has been depressed, the results of previous
treatments, and the degree of support of family, friends, and
While treatment is generally effective, there are some cases where
the condition fails to respond. Treatment-resistant depression requires
a full assessment which may lead to the addition of psychotherapy,
higher medication doses, changes of medication or combination therapy, a
trial of ECT/electroshock,
or even a change in the diagnosis with subsequent treatment changes.
Although this process helps many, some people's symptoms continue
In emergency situations with suicidal persons, psychiatric
hospitalization is used simply to keep suicidal people safe until
they cease to be dangers to themselves. Another treatment program is partial
hospitalization, in which the patient sleeps at home but spends the
day, either five or seven days a week, in a psychiatric hospital setting
in intense treatment. This treatment usually involves group
and academics (in child and adolescent programs).
Medication which relieves the symptoms of depression has been
available for several decades. These drugs are listed in order of
historical development. Typical first line therapy for depression is the
use of an SSRI type drug, such as sertraline
oxidase inhibitors (MAOIs) such as Nardil may be used if other
antidepressant medications are ineffective. Because there are potenially
fatal interactions between this class of medication and certain foods
and drugs, they are rarely prescribed anymore. A new MAOI has recently
been introduced. Moclobemide
(Manerix), known as a reversible
inhibitor of monoamine oxidase A (RIMA), follows a very specific
chemical pathway and does not require a special diet.
antidepressants are the oldest, and include such medications as amitriptyline
They are used less commonly now, due to side-effects which may include
rate, drowsiness, dry mouth, and memory
impairment. Most importantly, they have a high potential to be lethal in
moderate overdose. The reason why tricyclic antidepressants are still
used is their high potency, especially in severe cases of clinical
serotonin reuptake inhibitors (SSRIs) comprise the current
standard family of antidepressants. It is thought that one cause of
depression is that an inadequate amount of serotonin,
a chemical which the brain uses to transmit signals between nerve cells,
is produced. These drugs are said to work by preventing the reabsorption
of serotonin by the nerve cell, thus maintaining the levels the brain
needs to function effectively, although two researchers recently
demonstrated that this is a marketing technique rather than a scientific
portrayal of how the drugs actually work. .
Recent research indicates that these drugs may interact with
transcription factors known as "clock genes"
that may be important for the addictive properties of drugs of abuse and
possibly in obesity.
This family of drugs includes fluoxetine
(Lexapro), and sertraline
(Zoloft). These antidepressants typically have fewer adverse side
effects than the tricyclics or the MAOIs, though such effects as
drowsiness, dry mouth, and decreased ability to function sexually may
reuptake inhibitors such as reboxetine
(Edronax) act via norepinephrine
(Also known as noradrenaline). NeRIs are thought to have a
positive effect on concentration and motivation in particular.
reuptake inhibitors (SNRIs) such as venlafaxine
(Effexor) and duloxetine
(Cymbalta) are a newer form of anti-depressant which work both on
noradrenaline and on serotonin. They typically have similar side-effects
to the SSRIs although there may be a withdrawal syndrome on
discontinuation which may require a tapering of the dose.
and Drug Administration approved Emsam, a transdermal
MAOI patch developed by the British
company Somerset Pharmaceuticals, to be marketed in the U.S. by Bristol-Myers
supplements are claimed to provide more raw material to the body's
natural serotonin production process. There is a reasonable indication
that 5-HTP may not be effective for those who haven't already responded
well to an SSRI.
methionine (SAM-e) is a derivative of the amino acid methionine
that is found throughout the human body, where it acts as a methyl donor
and participates in other biochemical reactions. It is available as a
prescription antidepressant in Europe, and an over-the-counter dietary
supplement in the United States. Clinical trials have shown SAM-e to be
as effective as standard antidepressant medication, with many fewer side
Its mode of action is unknown.
fatty acids (found naturally in oily
oil etc.) have also been found to be effective while used as a
dietary supplement (although only fish-based omega-3 fatty acids have
shown anti-depressant efficacity) .
has gathered some attention .
A healthy diet is
essential for removing depression. Many symptoms of depression are
directly linked to malnutrition.
an optimal level of which has had an antidepressant effect in studies .
Some antidepressants have been found to work more effectively in some
patients when used in combination with another drug. Such "augmentor"
drugs include tryptophan
(Tryptan) and buspirone
typically the benzodiazepines,
may be prescribed to ease anxiety and promote sleep. Because of their
high potential for fostering dependence, these medications are intended
only for short-term or occasional use. Medications are often employed
not for their primary function, but to exploit what are normally side
fumarate (Seroquel) is designed primarily to treat schizophrenia
and bipolar disorder, but a frequently-reported side-effect is somnolence.
Hence, this non-addictive drug can be used in place of an addictive
anti-anxiety agent such as clonazepam
such as risperidone
(Risperdal) and olanzapine
(Zyprexa), and Quetiapine
(Seroquel) are prescribed as mood
stabilizers and are also effective in treating anxiety.
(typical or atypical) may be also prescribed in an attempt to augment an
to make antidepressant blood concentration higher, or to relieve psychotic
symptoms often accompanying clinical depression. However, they may have
serious side effects, particularly at high doses, which may include
spasms, restlessness, tardive
dyskinesia, and weight gain.
Antidepressants by their nature are stimulants. Anti-anxiety
medications by their nature are depressants. Close medical supervision
is critical to proper treatment if a subject is presenting both
illnesses as the medications tend to work against each other.
remains the standard treatment for bipolar
disorder, and is often used in conjunction with other medications,
depending upon whether mania or depression is being treated. Lithium's
potential side effects include thirst,
light-headedness, and nausea
Some of the anticonvulsants
such as carbamazepine
valproate (Epilim), and lamotrigine
(Lamictal) are also used as mood stabilisers, particularly in bipolar
Failure to take medication, or failure to take it as prescribed, is
one of the major causes of relapse.
Should one feel a change or discontinuation of medication is necessary,
it is critical that this be done in consultation with a doctor.
or counselling, one receives assistance in understanding and
resolving problems which may be contributing to depression. This may be
done individually or with a group, and is conducted by health
professionals such as psychiatrists, psychologists, social workers, or
psychiatric nurses. It is important to enquire about both the
therapist's training and approach; a very close bond often forms between
practitioner and client, and it is important that the client feel
understood by the clinician.
Counsellors can help a person make changes in thinking patterns, deal
with relationship issues, detect and deal with relapses, and understand
the factors that contribute to depression.
There are many therapeutic approaches, but all are aimed at improving
an individual's personal and interpersonal functioning. Cognitive
therapy, also known as Cognitive Behaviour Therapy,
focuses on how people think about themselves and their relationships to
the world. It works to counteract negative thought patterns and enhance
self-esteem. Therapy can be used to help a person develop or improve interpersonal
skills in order to allow them to communicate more effectively
and reduce stress. Narrative
therapy gives attention to each individual's "dominant
story" by means of therapeutic conversations which also may involve
exploring "unhelpful" ideas and how they came to prominence. Behavioral
therapy is based on the assumption that behaviors are learned.
This type of therapy attempts to teach individuals new and healthier
types of behaviours. Supportive
therapy encourages people to discuss their problems and provides
them with emotional support. The focus is on sharing information, ideas,
and strategies for coping with daily life. Family
systems therapy helps people live together more harmoniously and
undo patterns of destructive behaviour.
Transcranial magnetic stimulation
transcranial magnetic stimulation (rTMS) is currently under study as
a possible treatment for depression. Initially designed as a tool for
physiological studies of the brain, this technique shows promise as a
means of alleviating depression. In this therapy, a powerful magnetic
field is used to stimulate the left prefrontal cortex,
an area of the brain which typically shows abnormal activity in
rTMS has been proposed as an alternative to ECT that would have fewer
side effects. No sedation is required, and the only reported side
effects are a slight headache in some patients, and facial muscle
contraction during treatment. However clear evidence that it is an
effective treatment is still awaited.
work in Poland has suggested that weak, variable magnetic fields may
offer relief from depression in those that have been unresponsive to
medication. However, some of the existing work has been questioned
with claims that the effect is not as significant once environmental
conditions are controlled
Vagus nerve stimulation
nerve stimulation therapy is a treatment used since 1997 to control seizures
patients and has recently been approved for treating resistant cases of
clinical depression. The VNS device is implanted in a patient's chest
with wires that connect it to the vagus
nerve, which it stimulates to reach a region of the brain associated
The device delivers controlled electrical doses to the vagus nerve at
therapy (ECT), also known as electroshock or electroshock
therapy employs short bursts of a controlled current of electricity
(this is typically fixed at 0.9 ampere) into the brain to induce a
brief, artificial seizure
while the patient is under general
ECT has acquired a fearsome reputation, in part, from its use as a
tool of repression
in the former USSR,
and its fictional depiction in films such as One
Flew Over the Cuckoo's Nest, but remains a common treatment
where other means of treatment have failed, or where the use of drugs is
unacceptable (such as in pregnancy).
Also, in contrast to "direct" electroshock of years ago, most
countries now only allow ECT to be administered under anaesthesia. In a
typical regimen of treatment, a patient receives three treatments per
week over three or four weeks. Repeat sessions may be required. Short-term
memory loss, disorientation and headache are very common side
effects. In some cases, permanent memory loss has occurred, but detailed
neuropsychological testing in clinical studies have not been able to
prove permanent effects on memory. ECT offers the benefit of a very fast
response, however, this response has been shown not to last unless
either maintenance electroshock or maintenance medications are used.
While antidepressants usually take around a month to take effect, the
results of ECT have been shown to be much faster. For this reason, it is
the treatment of choice in emergency circumstances (for example in
catatonic depression where the patient has ceased oral intake of fluid
There remains much controversy over electroshock. Advocacy groups and
scientific critics, such as Dr Peter
call for restrictions on its use or complete abolishment. Like all forms
of psychiatric treatment, electroshock can be given without a patient's
consent, but this is subject to legal conditions dependent on the
Other methods of treatment
and artificial light) is shown to be effective in seasonal
affective disorder, and sometimes may be effective in other types of
depression, especially atypical depression or depression with
(overeating, oversleeping, weight gain, apathy).
Important note: an antidepressant effect is caused by
stimulation of the retina
by the visible
light, not by the ultra-violet
portion. Thus, it is not necessary (and may be even dangerous in some
cases) to get sunburn.
It can be enough just to walk at daytime or to take light therapy using
a light box. However, recent discoveries of the existence and importance
of the third kind of photoreceptor in our eyes, the intrinsically
photosensitive retinal ganglion cells(ipRGC)- critical to human
chronobiology - strongly suggest that bluish light is more helpful,
and manufacturers are beginning to respond to this.
It is widely believed that physical activity and exercise
helps depressive patients and promotes quicker and better relief from
depression. It is also thought to help antidepressants and psychotherapy
to work better and faster. It can be difficult to find the motivation to
exercise if the depression is severe, but sufferers should be encouraged
to take part in some form of regularly-scheduled physical activity if
possible. A workout need not be strenuous; many find walking,
for example, to be of great help. Exercise produces higher levels of
chemicals in the brain, notably dopamine,
In general this leads to improvements in mood, which is effective in
Note that prior to beginning an exercise regime, it is wise to
consult a doctor. He or she can establish whether a person possesses any
health problems that could rule out some types of exercise.
is increasingly seen as a useful treatment for depression. The current
professional opinion of meditation is that it represents at least a
complementary method of treating depression, a view that has been
clearly underscored by the Mayo Clinic. Since the late 1990s, much
research has been carried out to determine how meditation affects the
brain (for more information see the main article on meditation). While
the effects on the mind are somewhat complex, they are often quite
positive, encouraging a calm, reflective
state of mind which can be of great help against depression. It's
notable that while many religions
actively encourage/use meditative practice, it is not necessary to be a
member of any faith to partake in meditation.
Insulin shock treatment is an old and currently mostly
abandoned treatment of severe depressions, psychoses,
states and other mental
disorders. It consists of induction of hypoglycemic
coma by intravenous
infusion of insulin.
The treatment is potentially unsafe and can be lethal in some cases
(about 1% of patients undergoing insulin
coma), even with proper monitoring. That was the main reason why it
was abandoned from current medical practice. In contrast, ECT
is considered to be very safe.
Nevertheless, insulin shock therapy is still officially used in Russia
and some other countries, and can be administered to a very
treatment-resistant patient under his written consent in many Western
Atropinic shock therapy, also known as atropinic coma therapy,
is an old and currently rarely-used method. It consists of induction of atropinic
coma by rapid intravenous infusion of atropine.
The atropinic shock treatment is considered relatively safe but the
problem with its administration is that it requires prolonged coma (4-5
hours), careful monitoring and preparation, and it has many unpleasant
side effects, like blurred vision due to atropine.
Thus it is rarely used now. But it can be used under written consent in
Western countries in some very treatment-resistant cases, and is still
officially used in Russia and some other countries.
is more likely if treatment has not resulted in the full remission of
In fact, current guidelines for antidepressant use recommend 4 to 6
months of continuing treatment following symptom resolution to prevent
relapse of depression.
Combined evidence from many randomized
controlled trials indicates that continuing antidepressant
medications after recovery substantially reduces (halves) the chances of
relapse. This preventative effect probably lasts for at least the first
36 months of use.
Some anecdotal evidence exists to suggest that chronic disease is
accompanied by relapses after prolonged treatment with antidepressants (Tachyphylaxis).
Psychiatric texts suggest that physicians respond to this by increasing
dosage, complementing the medication with a different class, or changing
the medication class entirely. The reason for relapse in these cases is
as poorly understood as the change in brain physiology induced by the
medications themselves. Possible reasons may include ageing of the brain
or worsening of the condition. Most SSRI psychiatric medications were
developed for short term use (a year or less), but are widely prescribed
for indefinite periods.
Books by psychologists/psychiatrists
- Beck, A. T., Rush, A. J., Shaw, B. F., Emery, G. (1987). Cognitive
therapy of depression. New York: Guilford.
- Burns, David D. (1999). Feeling Good : The New Mood
- Klein, D. F., & Wender, P. H. (1993). Understanding
depression: A complete guide to its diagnosis and treatment. New
York: Oxford University Press.
- Kramer, Peter D (2005). Against Depression. New York:
- Weissman, M. M., Markowitz, J. C., & Klerman, G. L. (2000). Comprehensive
guide to interpersonal psychotherapy. New York: Basic Books.
- Sarbadhikari S. N. (2005).Ed, Depression and Dementia:Progress
in Brain Research, Clinical Applications and Future Trends.
Hauppauge, Nova Science Publishers. 
Books by persons suffering or having suffered from depression
- Wurtzel, E. (1997) Prozac Nation: Young and Depressed in
America: A Memoir. Riverhead Books. ISBN
- Lewinsohn, P. M., Munoz, R. F, Youngren, M. A., Zeiss, A. M.
(1992). Control your depression. New York:
Agate (1995). A Woman in Amber: Healing the Trauma of War and
Exile New York: Penguin Books.
1-56947-046-4 (hc.); 0 14 02.6190 7 (pbk.)
- Rowe, Dorothy (2003). Depression: The way out of your prison.
- Sealey, Robert (2002). Finding Care for Depression, Mental
Episodes & Brain Disorders, Toronto: Sear Publications
- Shields, Brooke (2005). Down Came the Rain: My Journey Through
Postpartum Depression. Hyperion. ISBN
- Smith, Jeffery (2001). Where the roots reach for water: A
personal and natural history of melancholia. New York: North
- Solomon, Andrew (2001). The noonday demon: An atlas of
depression. New York: Scribner.
William (1992). Darkness visible: A memoir of madness.
New York: Vintage Books/Random House.
Lewis (2001). Malignant sadness: The anatomy of depression.
London: Faber and Faber.
Eckhart (1999). The Power of Now: A Guide to Spiritual
Enlightenment, New World Library, October, 1999 ISBN
1577311523 (HC) ISBN
Schildkraut, J.J. (1965).
"The catecholamine hypothesis of affective disorders: a review
of supporting evidence". Am J Psychiatry 122 (5):
Hirschfeld, R.M.A (2000). "History
and Evolution of the Monoamine Hypothesis of Depression". J
Clin Psychiatry 61 (Suppl. 6): 4-6.
Bland, R.C. (1997). "Epidemiology
of Affective Disorders: A Review". Can J Psychiatry 42:
Murray, C.J.L., Lopez, A.D.
(1997). "Alternative projections of mortality and disability by
cause 1990-2020: Global Burden of Disease Study". Lancet
Manev, R, Manev H (2004). "5-Lipoxygenase
as a putative link between cardiovascular and psychiatric
disorders". Critical Reviews in Neurobiology 16
(2004). "The Ready Meal" Kate Barker Not on the Label,
214, Penguin. ISBN
Fatty Acids for Enhancing Classroom Achievement. URL accessed on
Delle Chiaie, Roberto, Paolo
Pancheri and Pierluigi Scapicchio (2002). "Efficacy and
tolerability of oral and intramuscular S-adenosyl- L-methionine
1,4-butanedisulfonate (SAMe) in the treatment of major depression:
comparison with imipramine in 2 multicenter studies". Am J
Clin Nutr 76 (5): 1172S–1176S.
Mischoulon, D, Fava M. (2002).
"Role of S-adenosyl-L-methionine in the treatment of
depression: a review of the evidence". Am J Clin Nutr 76
Keller, M.B. (2003). "Past,
Present, and Future Directions for Defining Optimal Treatment
Outcome in Depression". JAMA 289:
Martin, JL, Barbanoj MJ,
Schlaepfer TE, Thompson E, Perez V, Kulisevsky J (June 2003).
"Repetitive transcranial magnetic stimulation for the treatment
of depression. Systematic
review and meta-analysis".
British Journal of Psychiatry 182: 480-91. PMID
Geddes, JR, Carney SM, Davies C,
Furukawa TA, Kupfer DJ, Frank E, Goodwin GM (22 February 2003).
"Relapse prevention with antidepressant drug treatment in
depressive disorders: a systematic
review". Lancet 361 (9358): 653–61. PMID