Disorders & Medication Depression. Most people can identify with depression as we all suffer from the 'blues' from time to time and have low moods.Usually these low moods resolve themselves and we return to our normal selves.However,in clinical depression the low mood persists over a period of time and often needs professional help to resolve it.Professional help should be sought if the depression lasts longer than two weeks and begins to affect normal bodily functions such as sleep and if there are suicidal ideas.Depression will affect 1 in 5 adults during their lifetime and is twice as common in woman as men. Depression has psychological symptoms as well as physical ones.The main psychological symptoms are low mood,anhedonia (the inability to enjoy things that were previously pleasurable),emotional numbness,despair,negative thinking,lack of concentration,poor memory and a feeling of blackness and dread. Physical symptoms include a general slowing of physical activity,sleep disturbance (inablity to sleep,poor sleep pattern or early waking),changes in appetite,weight changes (gain or loss of weight),loss of libido,tiredness, constipation and irregular periods.It is known that there is a change in neurotransmitter activity in depression but whether this is the cause of or consequence of the depression is unclear.Antidepressants increase the levels of some of these neurotrasnmitters in the brain,but although the brain levels of transmitters increase shortly after the administration of the drug the depression takes much longer to resolve.The transmitters thought to be important in depression are dopamine,serotonin and noradrenaline.The hormone cortisol is also thought to be implicated in depression. Some people have a genetic predisposition towards depression and certain personality types may be more susecptible.Children who lose a parent in childhood have also be shown to be more prone to depression.Physical illness and excessive stress may also contibute to a low mood.Some medications can cause depression as a side effect. Depression may be classified as mild,moderate or severe.Reactive depression is caused by an identifiable life event such as a bereavement where as the cause of an endogenous depression is not apparent and may lie in the subconscious.Psychotic depression is the most serious type of depression and the person may lose contact with reality and suffer from hallucinations and delusions.Psychotic depression always needs urgent treatment. Treatments for depression fall into three categories-psychological,drug therapy and physical.Psychological or talking therapies are becoming increasingly popular.Cognitive therapy involves trying to change depressive thought patterns whereas behavioural therapy tries to change unhealthy types of behaviour.A combination of these two types of therapy is often employed.Other types of psychological therapies include psychoanalysis and counselling. Drug therapy is the most common type of treatment and is often the first approach tried.There are three main types of antidepressant drugs-the tricyclics,MAOIs(monoamine oxidase inhibitors) and the SSRIs (selective serotonin reuptake inhibitors).Their mode of action is unclear but all these drugs increase neurotransmitter levels in the brain. Common tricyclic antidepressants include amitriptyline,imipramine and lofepramine.The most widely used SSRIs are fluoxetine(Prozac) and paroxetine (Seroxat).Others in use include sertraline(Lustral) and citaprolam(Citpramil). MAOIs in use are phenelzine,isocarboxazid and tranylcypromine.Patients on MAOIs need to be on a diet low in tyramine as these drugs inhibit the breakdown of tyramine in the body and high levels can be dangerous.The SSRIs are now the drugs of choice,as they are safer in overdose than tricyclics. Physical treatment of deprssion involves the use of ECT(electroconvulsive therapy).This therapy is of long standing as is generally only used in the most severe of cases and where there is a very real danger to the patient's life. The patient is put under general anaesthetic and given a muscle relaxant and an electric current is passed through the temple of the head.This induces a convulsion which is thought to have a therapeutic affect on the depression.The mode of action of ECT is unknown.The after effects can be unpleasant and it can cause some memory loss. SAD or seasonal affective disorder is a depression that seems to be bought on by a lack of daylight and affects people in the autumn and winter.Another type of depressions can occur in woman shortly after the birth of a child (postnatal depression).A depression will often resolve itself and treatment may not be necessary.However,if it becomes disabling it should be treated.The support of family and friends is important and most people make a full recovery. Back to the Disorders & Medication menu