A Belfast teen undergoing treatment for depression is celebrating her 18th birthday in a poignant way

A Belfast teenager who is undergoing treatment for depression is set to mark her 18th Birthday in a very poignant way.
Emma Norris, turned 18 back in March this year, but because she was unwell, her special day wasn't celebrated how she wanted.

Now, the brave teenager has taken the decision to mark her birthday by joining with her friends and talking part in a Mood Walk organised by mental health charity AWARE.
Emma explains: “Participating in a charity walk is probably not how most 18 year olds would choose to celebrate a birthday, but for me this is very important.
"Last year I was diagnosed with depression and it was an extremely difficult time in my life. For that reason I was unable to do anything to properly celebrate my 18 birthday.
“I have received so much support from my friends and family in the last year and by participating in the AWARE Mood Walk, I am able to bring everyone together in a bid to stamp out the stigma that’s still associated with depression."
Earlier this year, Emma, a student at Aquinas Grammar School, released a video to mark Mental Health Awareness week, to tell her story to help educate and inform people about how to talk to someone with an illness, that people can still find very difficult to talk about.
After being diagnosed with depression at the age of 17, Emma found that her family and friends were keen to offer her support but found the subject difficult to approach.
“Through my battle with depression it became apparent that everyone around me wanted to help, but they just didn't know how,” said Emma.
“It is completely understandable and I don't have a problem with that, but maybe it's time to address it."

By uploading the video on a public forum Emma helped to generate a discussion around how to talk to someone with depression in an appropriate and sympathetic manner.
Emma said: "Now that we have ended some of the stigma associated with depression and we are ready to talk, we need to talk openly about what each individual finds offensive or difficult to listen to, which topics we struggle with and which we don't. And that’s just the sufferers' role.
“To the supporters we need to refine our emotional intelligence and be aware, but not scared, of the difficult conversation topics. Each and everyone one of us, sufferers and supporters, need to be aware of what we are talking about and how we say it.”
Source: http://www.belfastlive.co.uk/news/belfast-news/belfast-teen-undergoing-treatment-depression-11460151

Depression

Depression is a common illness worldwide, with an estimated 350 million people affected. Depression is different from usual mood fluctuations and short-lived emotional responses to challenges in everyday life. Especially when long-lasting and with moderate or severe intensity, depression may become a serious health condition. It can cause the affected person to suffer greatly and function poorly at work, at school and in the family. At its worst, depression can lead to suicide. Over 800 000 people die due to suicide every year. Suicide is the second leading cause of death in 15-29-year-olds.
Although there are known, effective treatments for depression, fewer than half of those affected in the world (in many countries, fewer than 10%) receive such treatments. Barriers to effective care include a lack of resources, lack of trained health care providers, and social stigma associated with mental disorders. Another barrier to effective care is inaccurate assessment. In countries of all income levels, people who are depressed are often not correctly diagnosed, and others who do not have the disorder are too often misdiagnosed and prescribed antidepressants.
The burden of depression and other mental health conditions is on the rise globally. A World Health Assembly resolution passed in May 2013 has called for a comprehensive, coordinated response to mental disorders at country level.

Types and symptoms

Depending on the number and severity of symptoms, a depressive episode can be categorized as mild, moderate, or severe.
A key distinction is also made between depression in people who have or do not have a history of manic episodes. Both types of depression can be chronic (i.e. over an extended period of time) with relapses, especially if they go untreated.
Recurrent depressive disorder: this disorder involves repeated depressive episodes. During these episodes, the person experiences depressed mood, loss of interest and enjoyment, and reduced energy leading to diminished activity for at least two weeks. Many people with depression also suffer from anxiety symptoms, disturbed sleep and appetite and may have feelings of guilt or low self-worth, poor concentration and even medically unexplained symptoms.
Depending on the number and severity of symptoms, a depressive episode can be categorized as mild, moderate, or severe. An individual with a mild depressive episode will have some difficulty in continuing with ordinary work and social activities, but will probably not cease to function completely. During a severe depressive episode, it is very unlikely that the sufferer will be able to continue with social, work, or domestic activities, except to a very limited extent.
Bipolar affective disorder: this type of depression typically consists of both manic and depressive episodes separated by periods of normal mood. Manic episodes involve elevated or irritable mood, over-activity, pressure of speech, inflated self-esteem and a decreased need for sleep.

Contributing factors and prevention

Depression results from a complex interaction of social, psychological and biological factors. People who have gone through adverse life events (unemployment, bereavement, psychological trauma) are more likely to develop depression. Depression can, in turn, lead to more stress and dysfunction and worsen the affected person’s life situation and depression itself.
There are interrelationships between depression and physical health. For example, cardiovascular disease can lead to depression and vice versa.
Prevention programmes have been shown to reduce depression. Effective community approaches to prevent depression include school-based programmes to enhance a pattern of positive thinking in children and adolescents. Interventions for parents of children with behavioural problems may reduce parental depressive symptoms and improve outcomes for their children. Exercise programmes for the elderly can also be effective in depression prevention.

Diagnosis and treatment

There are effective treatments for moderate and severe depression. Health care providers may offer psychological treatments (such as behavioural activation, cognitive behavioural therapy [CBT], and interpersonal psychotherapy [IPT]) or antidepressant medication (such as selective serotonin reuptake inhibitors [SSRIs] and tricyclic antidepressants [TCAs]). Health care providers should keep in mind the possible adverse effects associated with antidepressant medication, the ability to deliver either intervention (in terms of expertise, and/or treatment availability), and individual preferences. Different psychological treatment formats for consideration include individual and/or group face-to-face psychological treatments delivered by professionals and supervised lay therapists.
Psychosocial treatments are also effective for mild depression. Antidepressants can be an effective form of treatment for moderate-severe depression but are not the first line of treatment for cases of mild depression. They should not be used for treating depression in children and are not the first line of treatment in adolescents, among whom they should be used with caution.

WHO response

Depression is one of the priority conditions covered by WHO’s Mental Health Gap Action Programme (mhGAP). The Programme aims to help countries increase services for people with mental, neurological and substance use disorders, through care provided by health workers who are not specialists in mental health. The Programme asserts that with proper care, psychosocial assistance and medication, tens of millions of people with mental disorders, including depression, could begin to lead normal lives – even where resources are scarce.
Source:  http://www.who.int/mediacentre/factsheets/fs369/en/

Treating Depression Without Antidepressants

There may be hope for hard-to-treat depression as scientists explore novel ways to help people who have the often crippling condition.

Recently, a number of studies have suggested the benefits of Botox, ketamine, and certain sometimes-unexpected means of treating depression.

“I’m excited in general, and I’m curious,” says Peter D. Kramer, MD, author of Listening to Prozac and Against Depression.

Each year, around 16 million U.S. adults battle major depression. Many of them benefit from antidepressants. But as many as a third get depressive symptoms despite medication. And side effects, which can include weight gain, nausea, and insomnia, are troublesome for some patients. That leaves many people with depression searching for alternatives.

But if Kramer is hopeful about the newer, novel ways to treat the condition, he’s also cautious. The studies backing those treatments aren't conclusive, and none of the approaches have been approved by the FDA to treat depression (though some, such as ketamine, have been approved for other uses).

“Things are merely hopeful until they are demonstrated [safe and effective],” Kramer says. “It’s always hard to tell what’s going on, but it’s a very interesting time, and I think some of them will come through.”

Here’s a closer look at what might be used to help treat depression in years to come.

Ketamine. Already in use in certain clinics and in some emergency departments around the country, ketamine is an anesthetic most often used during surgery. It's given through an IV, and it quickly eases symptoms of depression, often in a matter of hours. The benefit is temporary, though.

One recent study found it to be very good at helping curb suicidal thoughts in severely depressed people. But it's expensive, still experimental as a depression treatment, and can cause hallucinations and other side effects.

“Some people are very uncomfortable with the side effects,” says Alan Manevitz, MD, a psychiatrist who specializes in treatment-resistant depression at Lenox Hill Hospital in New York City.

Nitrous oxide, or laughing gas. This is an anesthetic commonly used by dentists. A small study published last December reports that nitrous oxide improved depression symptoms within less than 2.5 hours.

Unlike ketamine, though, nitrous oxide had few side effects. The benefits lasted from 24 hours to a full week in some of the 10 people in the study. Much more research needs to be done on the safety and effectiveness of nitrous oxide, but Manevitz says it’s promising.

“For people who are in suicidal despair or crisis, it may, like ketamine, temporarily relieve that person and act as a bridge until other treatments start working,” he says.

Botox. Best known for temporarily erasing frown lines and crow's feet, onabotulinumtoxinA (Botox) has recently attracted interest as a novel means of lifting major depression. The theory is simple: If you can’t frown, you won’t be sad. And some research has borne this out.

A single Botox injection into the facial "frown muscles" provided lasting relief from depression symptoms, according to a study published last spring in the Journal of Psychiatric Research. Another study found similar effects following Botox injections into frown lines around the eyebrows. Many questions remain, though.

“The Botox is very interesting, and the best evidence [it helps] is as an add-on to antidepressants, but what’s going on?” asks Kramer. “Is it really feedback to the brain, that if you can’t frown, do you feel more resilient? Or is it that people respond to you differently?”

Anti-inflammatory medications. Inflammation has been linked to depression for several years now, says Brown. A recent review of studies, published in JAMA Psychiatry, further backs up the connection. The researchers found that painkillers such as celecoxib, ibuprofen, and naproxen reduced depression symptoms. Another class of anti-inflammatory drugs, called cytokine inhibitors, also showed some benefit.

The authors of the review call their findings "proof of concept," meaning that their results are strong enough to encourage further research. Another recent study reports that omega-3 fatty acids, which have anti-inflammatory properties, helped treat depression linked to chronic hepatitis C.

“If you could actually treat depression symptoms along these lines, that would be interesting,” Kramer says. “Some of the antidepressants are also anti-inflammatories, and some people have thought that maybe it’s just coincidence that they work on [the brain chemicals] serotonin and norepinephrine, and that the real effect is anti-inflammatory.”

Uncertain Future

The treatments listed above aren't the only ones being tested.

Nasal sprays that have protein peptides or small molecules have shown some promise, Kramer and Manevitz say. A method called transcranial direct current stimulation, which uses electricity to change brain activity, is also being tested.

Mindfulness meditation is another promising addition to depression treatment, and exercise is known to help relieve symptoms, too.

If some of the newer treatments seem far-fetched, Manevitz points out that the same was said just a few years ago about transcranial magnetic stimulation (TMS), a non-invasive therapy that uses magnets to affect parts of the brain linked to mood.

“People looked at me cross-eyed and thought it sounded wacky,” he says. “Now, it’s an FDA-approved treatment for depression, and it’s used around the world.”

Which, if any, of these treatments prove effective is anybody’s guess at this point. Researchers have a lot of work ahead of them before any make it to patients in the clinic.

“So many medicines get lost in the pipeline,” Kramer says. “Either it’s hard to engineer them in ways that are not going to harm the kidneys or the liver, or the actual principle under which they are working turns out not to be right. It’s hard to give your heart to any one of them because they tend to disappoint.”

Source: http://www.webmd.com/depression/news/20150225/depression-treat-without-antidepressions

Depression: New Medications On The Horizon

With the advent of monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants (TCAs) in the 1950s, depression treatment was revolutionized. These medicines target the monoamine system, including the neurotransmitters serotonin, norepinephrine and dopamine.
For decades, the dominant hypothesis of depression has been that low levels of monoamines in the brain cause this debilitating disorder.
In the ‘80s, the selective serotonin reuptake inhibitor (SSRI) fluoxetine (brand name: Prozac) heralded a new era of safer drugs which also target the monoamine system. Since then, various SSRIs and serotonin-norepinephrine reuptake inhibitors (or SNRIs) have been developed as new antidepressants. While these drugs aren’t more effective than older antidepressants, they are less toxic.
But SSRIs and SNRIs don’t work for everyone, so MAOIs and TCAs still are prescribed.
Two out of three patients with depression do not fully recover on an antidepressant medication according to findings from STAR*D, the largest clinical trial study of treatments for major depressive disorder, funded by the National Institute of Mental Health. (One-third of patients do have a remission of their depression symptoms.)
These results “are important because previously it was unclear just how effective (or ineffective) antidepressant medications are in patients seeking treatment in real-world settings,” said James Murrough, M.D., board-certified psychiatrist and a research fellow at the Mount Sinai School of Medicine Mood and Anxiety Disorders Program.
As Murrough explained, depression treatment can be thought of in thirds: “for one third of patients, symptoms remit; another third don’t have as good of an outcome, experiencing residual symptoms and waxing and waning course or chronic course and are at risk for relapse whether they’re on or off medication; and then a third don’t get much benefit at all.”
He added that around “10 to 20 percent have persistent clinically significant symptoms that aren’t decreased by current treatment — these are the patients that we are the most worried about.”
So there’s a real need to find treatments that work for these patients. Since the 1950s and 1980s breakthroughs, researchers haven’t discovered drugs that target chemical systems in the brain other than the monoamine system.
“We haven’t been able to find any new systems, because we don’t understand the underlying biology of depression,” Murrough said.
But researchers are studying other mechanisms of depression and various drugs have recently been approved to treat depression. Below, you’ll learn about these drugs along with several chemical systems research is exploring.

Recently Approved Drugs for Depression

Recently approved drugs for depression are generally “me-too” drugs. A “me-too drug is a drug whose mechanism of action (what it does at the molecular level in the brain) is not meaningfully different than its predecessor,” Dr. Murrough said.
Prime examples of me-too drugs are desvenlafaxine (Pristiq), an SNRI, and escitalopram (Lexapro), an SSRI, he said. Pristiq is simply Effexor’s main metabolite. Lexapro is essentially a close relative derivative of citalopram (Celexa). Interestingly, sales still skyrocketed when Lexapro came out.
As Murrough said, there is value in some me-too drugs. Generally, all drugs within the classes SSRIs and SNRIs are me-too drugs. But the side effect profiles for each drug have slight differences, which can help patients.
For instance, Prozac tends to be more activating, so a doctor may prescribe it for patients with low energy, Murrough said. In contrast, paroxetine (Paxil) makes people more tired, so it’s prescribed to patients who have trouble sleeping, he said.
The drug Oleptro was approved this year for depression. It doesn’t target new mechanisms, and it isn’t even a me-too drug, Murrough said. It’s a reformulation of trazodone, an atypical antidepressant that’s been used as a sleeping aid by psychiatrists and other doctors. Because it’s so sedating, its earlier form would just put patients to sleep. “It is unclear if the new formulation will offer any benefit for patients over the original,” Murrough said.
These recently approved medicines “characterize the state of drugs in psychiatry,” Murrough said, and speak to “what’s wrong with antidepressant drug development today.” Novel treatments just aren’t on the market.

Augmentation of Depression Drugs

Recently, the biggest development in depression treatment has been the use of augmenting agents, said David Marks, M.D., assistant professor at the Department of Psychiatry & Behavioral Sciences at the Duke University Medical Center.
Specifically, some research has found that adding atypical antipsychotic drugs, like aripiprazole (Abilify) and quetiapine (Seroquel), to an antidepressant can boost its effectiveness.
Atypical antipsychotics are used to treat schizophrenia and bipolar disorder. “Abilify has three strong studies that show how well it works in patients that have partially responded to antidepressants,” Marks said. According to Murrough, augmentation has become a common strategy in depression treatment.

The Glutamate System and Depression

Researchers have looked at the role of the glutamate system in depression. Glutamate is abundant in the brain and is one of the most common neurotransmitters. It’s involved in memory, learning and cognition.
Some research has implicated the dysfunction of the glutamate system in medical conditions, such as Huntington’s chorea and epilepsy, and psychological disorders, such as schizophrenia and anxiety disorders.
Recent research suggests that drugs targeting a specific type of glutamate receptor in the brain — called the NMDA receptor — may have antidepressant effects.
Studies have explored ketamine, an NMDA antagonist, in treating treatment-resistant depression and acute suicidal ideation. Ketamine has a long history in analgesia and anesthesiology.
Currently, when a person is at imminent risk for attempting suicide or has attempted suicide, they’re admitted to a psychiatric hospital and closely monitored. But, as Murrough explained, medically, there’s nothing doctors can do to help with suicidal ideation or intense depressed mood. Antidepressants typically four to six weeks to work.
Ketamine appears to have fast antidepressant effects — within hours or a day. Thus, it may help protect patients from suicidal thinking or acute dysphoria when they’re in the hospital. Unfortunately, its effects only last seven to 10 days.
This research is “highly experimental, and probably less than 100 patients in the country have participated in controlled depression studies of ketamine,” Murrough said. The patients in these studies typically have treatment-resistant depression: They haven’t responded to several antidepressants and have moderate to severe symptoms of depression.
They’re admitted to the hospital and receive ketamine intravenously from an anesthesiologist, while their vital signs are closely monitored.
Ketamine is a drug of abuse, known by such street names as “Special K.” It induces trance-like or hallucination states. It also produces mild to moderate cognitive side effects, like other anesthetics. People report feeling “out of it,” intoxicated and disconnected in general.
These side effects actually “introduce a potential bias to the study design” because participants know they’re getting the treatment (when saline is given in the placebo condition), Murrough said.
To eliminate this bias, Murrough and his team are conducting the first-ever study to compare ketamine to a different anesthetic — the benzodiazepine midazolam (Versed) — which has similar transient effects as ketamine, he said. The study is currently recruiting participants.
Murrough cautioned that ketamine isn’t meant to be a treatment administrated at your doctor’s office. In a recent article in the journal Nature Medicine, he said ketamine treatment may be “akin to electroconvulsive shock treatment.”
Studying ketamine may reveal mechanisms underlying depression and help to find drugs that can be prescribed as antidepressants to a wider patient population.
Pharmaceutical companies have started exploring other NMDA receptor antagonists for treatment-resistant depression. For instance, in July 2010, the pharmaceutical company Evotec Neurosciences began testing a compound in a Phase II study, which evaluates the safety and efficacy of a drug.
Source:  http://psychcentral.com/lib/depression-new-medications-on-the-horizon/0005794

Depression Treatment Options

Once you have a depression diagnosis, your doctor will discuss various depression treatment options with you. 

The kind of depression treatment that's best for you depends on the type of depression you have. For example, some patients with clinical depression are treated with psychotherapy, and some are prescribed antidepressants. Others are prescribed antidepressants and psychotherapy. Still others who don't respond to standard depression treatments may opt to try brain stimulation techniques such as electroconvulsive therapy (ECT), also called electroshock therapy, transcranial magnetic stimulation (TMS), or vagus nerve stimulation (VNS). 

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In people with bipolar depression, traditional antidepressants are not always effective and sometimes can make mood swings worse; doctors therefore often prescribe other types of medicines to treat bipolar depression, including mood stabilizers (such as Depakote, lithium or Lamictal) or some atypical antipsychotics (such as Seroquel or Symbyax) that are proven remedies for bipolar depression.

Whatever depression treatment your doctor prescribes, it's important to understand that there are no "instant" solutions. You may have to try different antidepressants to find the most effective drug for you. In addition, you'll have to take the antidepressant for several weeks to see if it benefits you at all. Being patient is important. Trust your doctor to know your personal history. With that, he or she can find the best depression treatment options that help improve your mood.

What Are Depression Drugs?

Depression drugs can help lift your mood and ease the sadness and hopelessness you feel. You'll need to work with your doctor to find the depression medicine that is most effective with the fewest side effects.

For in-depth information, see WebMD's Depression Medicines.

How Do Antidepressants Work?

Many chemicals are involved in the brain circuits that regulate mood. Three known important chemicals are norepinephrine, serotonin, and dopamine, which are neurotransmitters. Neurotransmitters transmit electrical signals between brain cells.

Researchers have found a link between a chemical imbalance in these brain chemicals and depression. Antidepressant medications increase the availability of neurotransmitters or by changing the sensitivity of the receptors for these chemical messengers. It is believed that modifying these brain chemicals can help improve mood, although the exact way they work is still unclear.

Source: http://www.webmd.com/depression/guide/depression-treatment-options