Depression Also called: Clinical depression, Dysthymic disorder, Major depressive disorder, Unipolar depression

Depression is a serious medical illness that negatively affects how you feel, the way you think and how you act. Depression has a variety of symptoms, but the most common are a deep feeling of sadness or a marked loss of interest or pleasure in activities. Other symptoms include:

• Changes in appetite that result in weight losses or gains unrelated to dieting
• Insomnia or oversleeping
• Loss of energy or increased fatigue
• Restlessness or irritability
• Feelings of worthlessness or inappropriate guilt
• Difficulty thinking, concentrating, or making decisions
• Thoughts of death or suicide or attempts at suicide



Depression is common. It affects nearly one in 10 adults each year—nearly twice as many women as men. It’s also important to note that depression can strike at any time, but on average, first appears during the late teens to mid-20s. Depression is also common in older adults. Fortunately, depression is very treatable.

How Depression and Sadness Are Different

The death of a loved one, loss of a job, or the ending of a relationship are difficult experiences for a person to endure. It is normal for feelings of sadness or grief to develop in response to such stressful situations. Those experiencing trying times often might describe themselves as being “depressed.” But sadness and depression are not the same. While feelings of sadness will lessen with time, the disorder of depression can continue for months, even years. Patients who have experienced depression note marked differences between normal sadness and the disabling weight of clinical depression.

Causes

Depression can affect anyone—even a person who appears to live in relatively ideal circumstances. But several factors can play a role in the onset of depression:

Biochemistry
Abnormalities in two chemicals in the brain, serotonin and norepinephrine, might contribute to symptoms of depression, including anxiety, irritability and fatigue. Other brain networks undoubtedly are involved as well; scientists are actively seeking new knowledge in this area.

Genetics
Depression can run in families.

Personality
People with low self-esteem, who are easily overwhelmed by stress, or who are generally pessimistic appear to be vulnerable to depression.

Environmental factors
Continuous exposure to violence, neglect, abuse or poverty may make people who are already susceptible to depression all the more vulnerable to the illness. Also, a medical condition (e.g., a brain tumor or vitamin deficiency) can cause depression, so it is important to be evaluated by a psychiatrist or other physician to rule out general medical causes.


Treatment

For many people, depression cannot always be controlled for any length of time simply by exercise, changing diet, or taking a vacation. It is, however, among the most treatable of mental disorders; the majority of people with depression eventually respond well to treatment, and almost all patients gain some relief from their symptoms.

Before a specific treatment is recommended, a psychiatrist should conduct a thorough diagnostic evaluation, consisting of an interview and possibly a physical examination. The purpose of the evaluation is to reveal specific symptoms, medical and family history, cultural settings and environmental factors to arrive at a proper diagnosis and to determine the best treatment.

Medication
Antidepressants may be prescribed to correct imbalances in the levels of chemicals in the brain. These medications are not sedatives, “uppers” or tranquilizers. Neither are they habit-forming. Generally antidepressant medications have no stimulating effect on those not experiencing depression.

Antidepressants may produce some improvement within the first week or two of treatment. Full benefits may not be realized for two to three months. If a patient feels little or no improvement after several weeks, his or her psychiatrist will alter the dose of the medication or will add or substitute another antidepressant.

Psychiatrists usually recommend that patients continue to take medication for six or more months after symptoms have improved. After two or three episodes of major depression, long-term maintenance treatment may be suggested to decrease the risk of future episodes.

Psychotherapy
Psychotherapy, or “talk therapy,” is sometimes used alone for treatment of mild depression; for moderate to severe depression, it is often used in combination with antidepressant medications. Psychotherapy may involve only the individual patient, but it can include others. For example, family or couples therapy can help address specific issues arising within these close relationships. Group therapy involves people with similar illnesses. Depending on the severity of the depression, treatment can take a few weeks or substantially longer. However, in many cases, significant improvement can be made in 10 to 15 sessions.

Depression is never normal and always produces needless suffering. With proper diagnosis and treatment, the vast majority of people with depression will overcome it. If you are experiencing symptoms of depression, see your family physician or psychiatrist, describe your concerns and request a thorough evaluation.

Electroconvulsive therapy (ECT)
Electroconvulsive therapy is a medical treatment most commonly used in patients with severe major depression or bipolar disorder that has not responded to other treatments. It involves a brief electrical stimulation of the brain while the patient is under anesthesia. 

Source:http://www.psychiatry.org/depression

Depression linked to higher heart disease death risk in younger women

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Women 55 and younger are twice as likely to suffer a heart attack, die or require artery-opening procedures if they're moderately or severely depressed, according to new research in the Journal of the American Heart Association.

"Women in this age group are also more likely to have depression, so this may be one of the 'hidden' risk factors that can help explain why women die at a disproportionately higher rate than men after a heart attack," said Amit Shah, M.D., M.S.C.R., study author and assistant professor of Epidemiology at Emory University in Atlanta, Ga.
Investigators assessed depression symptoms in 3,237 people with known or suspected heart disease (34 percent women, average age 62.5 years) scheduled for coronary angiography, an X-ray that diagnoses disease in the arteries that supply blood to the heart. After nearly three years of follow-up, researchers found:

• In women 55 and younger, after adjusting for other heart disease risk factors, each 1-point increase in symptoms of depression was associated with a 7 percent increase in the presence of heart disease.
• In men and older women, symptoms of depression didn't predict the presence of heart disease.
• Women 55 and younger were 2.17 times as likely to suffer a heart attack, die of heart disease or require an artery-opening procedure during the follow-up period if they had moderate or severe depression.
• Women 55 and younger were 2.45 times as likely to die from any cause during the follow-up period if they had moderate or severe depression.

"All people, and especially younger women, need to take depression very seriously," Shah said. "Depression itself is a reason to take action, but knowing that it is associated with an increased risk of heart disease and death should motivate people to seek help."
"Providers need to ask more questions. They need to be aware that young women are especially vulnerable to depression, and that depression may increase the risk to their heart," Shah said.

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"Although the risks and benefits of routine screening for depression are still unclear, our study suggests that young women may benefit for special consideration" remarked Viola Vaccarino, M.D., Ph.D., senior author of the study and Wilton Looney Chair of Epidemiology at Emory University. "Unfortunately, this group has largely been understudied before."
In 2008, the American Heart Association issued a scientific statement recommending that depression be formally considered as a risk factor, like diabetes or hypertension, for increased heart disease risk. "Our data are in accordance with this recommendation, but suggest that young/middle aged women may be especially vulnerable to depression as a risk factor," Vaccarino added."
The research group is examining whether women have more cardiovascular changes than men in response to a short-term mental stress, such as giving a public speech.

Source: http://www.sciencedaily.com/releases/2014/06/140618165107.htm

Our terrifying addiction to antidepressants: GPs dole out 25% more 'happy pills' in just three years

ritons are increasingly relying on antidepressants – with the number of prescriptions soaring by a quarter in just three years.

NHS figures reveal that 53million were issued last year – a record high – compared with just 42.8million in 2010, and 20.1million in 1999.

Some psychiatrists say that people suffering what used to be a bout of the everyday blues are now being diagnosed with a medical condition and prescribed treatment.

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Soaring: NHS figures reveal a sharp increase in the number of antidepressants, such as Prozac, being handed out in Britain

There is also concern that GPs are handing out pills such as Prozac and Seroxat too freely when they should be referring patients for counselling or other therapies.

Doctors say they have no choice but to prescribe medication because the waiting times for talking therapies are so long and patients are reluctant to leave without treatment.

 

But some experts say there is little evidence that the pills even work and they can cause debilitating side effects such as agitation, tiredness and suicidal thoughts.

Dr Joanna Moncrieff, an author on mental health drugs and consultant psychiatrist at North East London NHS Foundation Trust, said: ‘Being depressed from time to time is a universal human experience.

‘Diagnosing people with a medical disorder and prescribing a pill may appear to offer an easy answer, but it stores up more problems than it solves.

As a society, our dependence on antidepressants makes us less resilient and less resourceful in the face of the everyday challenges of modern living.

In my clinical experience, many people just carry on taking their antidepressant because they are too fearful to stop, and research in general practice confirms that people are taking these drugs for longer and longer periods.’

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Dangers: experts have spoken out about how people using the pills can become too afraid to stop, even when they do not need them any more

Labour MP Jim Dobbin, chairman of the all-party parliamentary group on involuntary tranquilliser addiction, said there were ‘serious problems’ with addiction to antidepressants.

‘We need closer regulation of this,’ he said. ‘The pharmaceutical industry is very powerful and puts  too much pressure on the medical profession to prescribe them.’

A report by the Health and Social Care Information Centre last year showed that in some parts of the UK as many as one in six adults is on antidepressants.

One such area is the South Wales borough of Blaenau Gwent, where the NHS issues almost 10,000 prescriptions for different types of ‘happy pills’ each month.

It is one of the most economically depressed areas of the UK and local GP Greg Graham has spoken of the problems that lead to the heavy use of medication.

‘There remains a lot of low morale, issues of poor health and lack of opportunities,’ he said.

A charity has set up a drop-in centre in one of the towns, Brynmawr, for people on antidepressants to receive counselling or just have a cup of tea. It is said to be used by a ‘significant number’ of people in their early 20s.

Separate data from the Organisation for Economic Co-Operation and Development shows that the UK has the seventh highest prescribing rate for antidepressants in the Western world.

There are 71 daily doses for every 1,000 people, compared with 38 daily doses per 1,000 people a decade ago.

In France and Germany the figure is 50 doses a day, while in Italy it is 42 doses a day.

Sophie Corlett, from the mental health charity Mind, said: ‘The number of prescriptions for antidepressants issued in the UK has been rising for many years. These new figures show no sign of this trend slowing and we need to know why we are seeing persistent increases.

‘We know that people are more aware of other treatment options and many do not want to be treated with drugs but cannot, and should not have to, wait months for therapy.’

Source: http://www.dailymail.co.uk/health/article-2609114/Our-terrifying-addiction-antidepressants-GPs-dole-25-happy-pills-just-three-years.html

A double eSTRESSo: Warning - your daily coffee is a powerful drug and can even spark panic attacks

Caffeine is a drug most of us take daily. For at their essence, tea and coffee are  simply convenient, stigma-free vessels for funnelling caffeine into our bodies.
You may think that is fantastic – an easy, cheap way to rev up your day – but research shows we massively underestimate the drug’s effects  on our bodies and brains.
It is an extremely powerful, psychoactive substance.
In moderation, it makes us feel good. In excess, it  is unpleasant, and in large enough doses it can even be fatal.
While a 16th of a teaspoon of pure caffeine powder gives a solid boost to a regular user, raising that to just  a quarter teaspoon will lead to unpleasantness – racing heart, sweating, acute anxiety.
And it is this latter side effect that is particularly concerning, given the soaring incidence of worry and depression.
One adult in 20 now suffers anxiety, a feeling of unease or fear that can be mild or severe. The medical term is generalised anxiety disorder and it affects about three million people in the UK.
At the same time we have a national obsession with tea, coffee and energy drinks, yet few of us stop and think about the impact of caffeine on our minds.
That energy kick alters the brain – and it works hard and fast.

 

Caffeine is unusually mobile in the body; the small molecule reaches the brain in just 20 minutes and easily hurdles the blood-brain barrier. Once there, it blocks the uptake of adenosine, a neurotransmitter that tells the brain we are drowsy.
This simple trick prevents us from feeling tired – suddenly no task seems insurmountable.
But caffeine also has physiological effects – it stimulates your central nervous system so your alertness increases, reaction time decreases and focus sharpens. Your blood pressure will increase slightly, your heart may race: all symptoms commonly associated with anxiety.

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Bad brew: A quarter teaspoon of pure caffeine powder will lead to unpleasantness ¿ racing heart, sweating, acute anxiety

So while those physiological changes come together to give many of us a reliable boost, caffeine can have serious psychological effects.
And it’s not just a problem for people particularly susceptible to caffeine.
John Greden, of the University of Michigan, says too much caffeine can make almost anyone anxious.
In his paper Anxiety Or Caffeinism: A Diagnostic Dilemma, he points out that it’s often overlooked that ‘high doses of caffeine – or “caffeinism” – can produce pharmacological actions that cause symptoms essentially indistinguishable from those of anxiety neuroses’.
Greden has encountered cases such as a 27-year-old nurse who complained of lightheadedness, tremulousness, breathlessness, headache and irregular heartbeat. She was first diagnosed with an anxiety reaction but later discovered the cause was coffee.
She had been consuming an average of ten to 12 cups of strong black coffee a day. Once she withdrew from drinking coffee, her symptoms vanished. Other subjects had similar symptoms on  14 cups of coffee a day and once caffeine intake was reduced, symptoms improved dramatically.
Clearly, these are extreme examples. Most people stop at three or four cups of coffee daily.
But they illustrate an important point: while many people complaining of anxiety benefit from psychopharmacological agents, for others, subtracting one drug – caffeine – may be of greater benefit.
So the ideal first-line treatment  for anxiety in a patient who uses caffeine is to eliminate it and see how he or she responds, before prescribing anti-anxiety medication.

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Bad habit: Research shows we massively underestimate caffeine's effects on our bodies and brains

Bizarrely, there is a genetic predisposition to caffeine-induced psychological effects, such as acute anxiety and even panic attacks. Research shows some people are more susceptible due to differences in their adenosine receptors. This helps explain why some people have no trouble sleeping after coffee late at night, while others lie awake for hours after an afternoon cup of tea.
Caffeine is also associated with panic attacks, in which people feel they are losing control and that something horrible is happening. The attacks are transient, but can be utterly debilitating and are remarkably common.
A study published in 2007 looked at three distinct groups: a control group of healthy people with no history of panic disorder, people with a history of panic disorder,  and first-degree relatives of the panic-disorder group who had no history of panic attacks. Subjects were given decaffeinated or high-caffeine coffee (equivalent to six Red Bulls or 1.2 litres of moderately strong coffee).  None had panic attacks or increased anxiety after the decaf. But 52 per cent of the panic-disorder patients suffered a panic attack after the caffeinated coffee.
The unexpected finding was that 41 per cent of the first-degree relatives of the panic-disorder patients also suffered panic attacks.
They had no history of panic attacks, and yet one strong dose of caffeine induced an attack – showing not only that some people have  a genetic predisposition to caffeine-induced anxiety, but the very real, very distressing impact caffeine can have. Research has shown it can even induce hallicunations.
Australian researchers studied  the combination of stress and caffeine in a group with no psychiatric problems and found that high caffeine levels in association with elevated levels of stressful life events interacted to produce higher levels of ‘hallucination’ in non-clinical participants.
You may not want to think that your comforting drink could be anything but.
Yet any caffeine user who believes that it’s totally benign should try going without it for a few days. Withdrawal often including headaches, muscle pain, weariness, apathy and depression.
Our love affair with caffeine is unlikely to end. But we need to remember that it is a complicated drug and can affect us in strange ways.

Source: http://www.dailymail.co.uk/health/article-2576323/A-double-eSTRESSo-Warning-daily-coffee-powerful-drug-spark-panic-attacks.html

Energy drinks 'increase health problems and drug and alcohol abuse'

Energy drinks can lead to mental health problems and drug and alcohol abuse in teenagers, researchers have warned.
Their findings have been published just a day after it emerged a teenager's heart stopped three times after downing 10 Jagerbombs mixed with Red Bull.
Jayde Dinsdale, 18, was drinking the Jagermeister spirit and energy drink shooter, which cost £2.20 for two, on a night out with friends, in Yeovil, Somerset.
But as the alcohol wore off, the high levels of caffeine in her system took control of her heart rate - causing it to accelerate dangerously out of control, medics have since said.
She suffered three heart attacks and temporarily 'died' on her bathroom floor after she downed ten high-caffeine Jagerbombs on a 'two-for-one' promotion night.
The new research, published in the journal Preventive Medicine, found that students prone to depression - and those who smoke marijuana or drink alcohol - are more likely to consume energy drinks.
Among the 8,210 high school students surveyed, nearly two thirds reported using energy drinks at least once in the past year, with more than one in five consuming them once or more per month.
And worryingly, it was the younger high school students who were more likely to consume energy drinks than older ones.

 

Last month researchers at the University of Michigan reported that teenagers who drink energy drinks are much more likely to also drink alcohol and use drugs. They are also more likely to start smoking.
They suggested this could be because  teenagers who are ‘sensation-seekers’ or ‘risk orientated’ are more likely to drink energy drinks.
In turn, having these character traits means they are also more likely to experiment with other substances.

As the alcohol wore off, the high levels of caffeine in Miss Dinsdale's system caused her heart rate to accelerate dangerously. She suffered three heart attacks, temporarily 'died' and needs an internal defibrillator

Energy drinks have been associated with a number of negative health effects, including cardiovascular symptoms, sleep impairment and nervousness and nausea. The side effects are caused by the beverages' high concentration of caffeine.
Study author Dr Sunday Azagba said: 'Marketing campaigns appear designed to entice youth and young adults. It's a dangerous combination, especially for those at an increased risk for substance abuse.'

The researchers from the University of Waterloo and Dalhousie University in Canada, are calling for limits on teens' access to the drinks and reduction in the amount of the caffeine in each can.
Dr Azagba said: 'The trends we are seeing are more than cause for concern, particularly because of the high rate of consumption among teenagers.

Another recent study found teenagers who drink energy drinks are much more likely to also drink alcohol and use drugs. They are also more likely to start smoking

'These drinks appeal to young people because of their temporary benefits like increased alertness, improved mood and enhanced mental and physical energy.'
In recent years energy drink sales have skyrocketed, with sales predicted to reach $20 billion in 2013 in the United States alone.
Dr Azagba said: 'In our opinion, at the very least steps should be taken to limit teens' access to energy drinks.'
She added there was also a need to increase public awareness and education about the potential harms of these drinks and to minimise the amount of caffeine available in each drink.
'This won't eliminate the problem entirely, but steps like these can help mitigate harm that appears to be associated with consumption of these drinks.
'This is something we need to take seriously. Change won't happen without a concerted effort.

The study was based on data from the 2012 Student Drug Use Survey, consisting of a representative sample of junior and senior high school students from three provinces in Atlantic Canada.

Source: http://www.dailymail.co.uk/health/article-2575578/Energy-drinks-increase-risk-drug-abuse-mental-health-problems.html