About Depression




Dr. Lorraine Innes – The Westchester Leader In Transcranial Magnetic Stimulation

What is depression? Major depression (or clinical depression) is a medical condition which results in a person feeling a constant and profound sense of hopelessness and despair. Each year over 17 million American adults experience a period of clinical depression.

Impact of Depression

  • Causes tremendous emotional pain

  • Disrupts the lives of millions of people

  • Adversely effects the lives of family and friends

  • Reduces work productivity and increases absenteeism

  • Has a significant negative impact on the economy costing an estimated $44 billion dollars a year

With major depression, you may have symptoms that make it difficult for you to function normally at work, school or with your family. It can negatively impact your sleep, diet, friendships and activities. Many people have a clinical depression only once in their life. Others may have it throughout their lifetime.

Major depression affects about 6.7% of the US population over age 18 according to the National Institute of Mental Health. Depression is one of the most common psychiatric problems. The cost in human suffering cannot be estimated.

Serious depression can destroy family life as well as the life of the depressed person. Although depression is very treatable, nearly two thirds of depressed people do not get proper treatment.

Women are almost twice as likely as men to suffer from depression. However, some experts believe that depression in men is significantly under-reported. Major depression can occur at any age including childhood, adolescence, adulthood and older age. Major depression has no racial, ethnic or social economic boundaries.

Major depression is only one type of depressive disorder. Other depressive disorders include:

Dysthymia (chronic depression): a milder form of depression the affects millions of people. Sufferers are usually able to function adequately but might seem chronically unhappy.

Bipolar (manic depressive): this is a major mood disorder, characterized by dramatic mood swings. The mood swings associated with it alternate from major depression to mania, or extreme elation. Mood swings can range from very mild to extreme and they can happen gradually or suddenly within a time frame of minutes to hours.

Post Partum Depression (PPD): this is a complex mix of physical, emotional, and behavioral changes that happen in a woman after giving birth. PPD is a form of major depression that has its onset within 4 weeks after delivery.

Seasonal Depression or Seasonal Affective Disorder (SAD): this is a mood disorder that happens every year at the same time. There are exceptions, but usually SAD starts in the fall or winter and ends in spring or early summer.

For additional information about types of depression please visit the following websites:

 Causes of Depression: Scientists have not yet determined the root cause of major depression. However, there is strong evidence there may be several contributors to the illness. Psychological, biological and environmental factors may all contribute to its development. Whatever the specific causes, research has firmly established that major depression is a biological brain disorder.

Serotonin, norepinephrine and dopamine are three neurotransmitters (chemical messengers that transmit electrical signals between brain cells) thought to be involved with major depression. Several theories attempting to explain depression are based on an imbalance of these chemical messengers. It is thought that most antidepressant medications work by increasing the availability of neurotransmitters or by changing the sensitivity of the receptors for these chemicals.

Scientists have also found evidence of a genetic predisposition to major depression. There is an increased risk for developing depression when there is a family history of the illness. Not everyone with a genetic predisposition develops depression, but some people probably have a biological make-up that leaves them particularly vulnerable to developing depression. Life events, such as the death of a loved one, chronic stress, and alcohol and drug abuse, may trigger episodes of depression. Some illnesses such as heart disease and cancer and some medications may also trigger a depressive episode. Often, however, depressive episodes occur spontaneously and are not triggered by a life crisis or physical illness.


What are the Symptoms of Depression: Depression ranges in seriousness from mild, temporary episodes of sadness to severe persistent depression. The term clinical depression or major depression and major depressive episode are used to describe the more severe form of depression.

All of us have had “the blues” or feel sad from time to time for no apparent reason. For a diagnosis of clinical depression, you must meet the criteria spelled out in the Diagnostic Statistical Manual (the guide book used to diagnose mental illness in America).

To meet the criteria for major depression you must have 5 or more of the symptoms listed below over a two week period. At least one of the symptoms must be either a depressed mood or a loss of interest or pleasure. Keep in mind, some types of depression may not fit the strict definition.

Symptoms:

  • Depressed mood most of the day, nearly every day

  • Loss of interest or pleasure in most activities

  • Significant weight loss or gain

  • Sleeping too much or not being able to sleep nearly every day

  • Crying spells

  • Changes in eating habits

  • Slowed thinking or moments that others can see

  • Fatigue or low energy nearly every day

  • Decrease sexual desire

  • Feelings of worthlessness or inappropriate guilt

  • Loss of concentration or indecisiveness

  • Recurring thoughts of death or suicide

The symptoms of clinical depression can improve with the appropriate treatment. Depression is a treatable condition.

 Treatments for Depression: Depression is most often treated with psychotherapy (talk-therapy) and antidepressant medications administered together. Although antidepressants can be effective for many patients, they do not work for everybody. Additionally, since antidepressants are typically taken by mouth, they circulate in the bloodstream throughout the body, often resulting in unwanted side effects.

More than 4 million patients do not receive adequate benefit from antidepressant medications and/or cannot tolerate the side effects caused by them. For these patients, non-drug treatments are available. Some of these treatments include: electroconvulsive therapy (ECT), vagus nerve stimulation (VNS) and transcranial magnetic stimulation (TMS).

During electroconvulsive therapy (ECT) the patient’s brain is electrically stimulated to cause an intentional seizure. Patients receiving ECT must be sedated with general anesthesia and paralyzed with muscle relaxants. Recovery from an ECT treatment session occurs slowly, and patients are usually closely monitored for minutes or a few hours after a treatment. Short-term confusion and memory loss are common, and long-term disruptions in memory have been shown to occur and may persist indefinitely in some people. Because of the side effects associated with ECT, a significant amount of caregiver support is required.

Patients receiving vagus nerve stimulation (VNS) are required to have a medical device implanted within their chest. Through a wire, this device is attached to the vagus nerve in the neck. Electrical pulses sent from the device travel up the vagus nerve to the brain. Some risks associated with VNS include persistent voice alteration and potential nerve paralysis. Also, since VNS is an implanted device, patients face surgical risks when choosing to undergo treatment.

Transcranial magnetic stimulation (TMS) therapy uses a pulsed magnetic field to non-invasively stimulate the area of the brain thought to control mood. TMS is administered without medication in a physician’s office while the patient remains awake and alert. TMS is delivered in 37 minute treatment sessions given daily over 4 to 6 weeks. The most common side effects associated with TMS treatment are scalp pain or discomfort at the treatment site —generally mild to moderate and occurring less frequently after the first week of treatment. There is a remote risk of seizure with TMS, occurring in approximately 0.1% of patients.