Depression

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The main symptoms of depression are loss of interest and lack of energy. Other symptoms may include feelings of guilt, inferiority or decreased self-esteem, suicidal thoughts, difficulty concentrating, restlessness, agitation, sleep disturbances, loss of appetite or weight loss. The incidence of depression has increased in recent decades. Around 25% of women and 15% of men will experience depression requiring treatment during their lifetime. If you recognize any of the signs of depression listed in this article, it is important to look at the possibility for help or self-help as soon as possible.

Ups and downs are part and parcel of life and relate to every living soul. There are times when the downs persist, giving you so much emptiness and despair that just doesn’t seem to go away. In such cases, chances are that you have depression and the condition makes it difficult for you to function normally and enjoy a healthy, productive lifestyle. The burden weighs heavily on your faculties and can sometimes be overwhelming. The greatest need in such a scenario is to know that you can get better and all it takes to deal with the issue is recognizing its symptoms and knowing the causes as well as the available treatments. Hence, it is important to act now to treat depression before it is too late, if you notice any of the symptoms.

End your depression and start enjoying your life

What is Depression?

Depression is often misunderstood by most people to relate to the normal feelings of drowsiness and sadness that occur in response to disappointments, setbacks and the everyday struggles of life. Real depression amounts to something much more than sadness; some have described it as being akin to living in a black hole or having an apocalyptic feeling. What  makes it improper to associate depression with sadness is the fact that not everyone feels sad. Rather a great number of people afflicted with depression experience feelings of emptiness, lifelessness, and apathy. For the menfolk this may be actually worse with symptoms such as restlessness, anger, and aggressiveness.

Depression takes a hold on every aspect of life and can disrupt everyday activities such as work, sleep, and eating. People suffering from depression will tell you of a nagging feeling of hopelessness, helplessness, and worthlessness that runs deep and shows no signs of abating.

 

The Signs and Symptoms of Depression

Although depression affects different people differently, there are some common indicators that point towards the existence of depression. Once again, it is important to be able to make a distinction between the lows of everyday life and real depression. The trick is to see how many of the depression symptoms are manifesting themselves and the length of time that they last .  The more symptoms you have and the lengthier the times they manifest mean you are possibly suffering from depression

Some of the common symptoms include:

  • Loss of interest in day to day activities
  • Self-loathing
  • Loss of energy
  • Reckless behavior
  • Concentration problems
  • Feeling hopeless and helpless
  • Unexplained aches and pains
  • Anger or irritability
  • Appetite and/or weight changes
  • Do you have problems getting sleep or maybe sleep excessively?
  • Do you experience enduring feelings of hopelessness and/or helplessness?
  • Are you having issues with your concentration and finding it difficult to execute simple tasks?
  • Have you developed a poor appetite or maybe have suddenly turned into a food conveyor belt?
  • Are you having a tough time getting a hold on your negative thoughts despite your best efforts?
  • Do you find yourself being more short-tempered, irritable and aggressive than usual?
  • Have you suddenly developed a penchant for a reckless lifestyle or consuming more and more quantities of alcohol than previously?
  • Do you suddenly consider life as not being worth living?

 

Answer These Questions for a Quick Check

  • Do you have problems getting sleep or maybe sleep excessively?
  • Do you experience enduring feelings of hopelessness and/or helplessness?
  • Are you having issues with your concentration and finding it difficult to execute simple tasks?
  • Have you developed a poor appetite or maybe have suddenly turned into a food conveyor belt?
  • Are you having a tough time getting a hold on your negative thoughts despite your best efforts?
  • Do you find yourself being more short-tempered, irritable and aggressive than usual?
  • Have you suddenly developed a penchant for a reckless lifestyle or consuming more and more quantities of alcohol than previously?
  • Do you suddenly consider life as not being worth living?

 

The Way Forward

If you suspect you or a loved one is going through depression, it is important to seek professional help without any delay. It is not unknown for depressed people to take regrettable decisions such as attempting or committing suicide. It is also important to seek counselling if you have just had experiences that can affect your ability to function normally.

 

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Depression affects many of us, and in some cases medication is needed. Antidepressant acts on the "balance" in the brains "neurochemistry", but how do they work? And what characterizes a depression? Anyway, depression remains an illness that needs better treatment options. The trend is for newer agents to either be more specific or have a better side effect profile.

To be considered a medically treatable disorder, depression must exceed the short-term ‘blues’ we all feel when our goals are not met or life takes a turn for the worse. The distinguishing features of clinical depression include:

  • Symptoms must rise to the level that they interfere with eating, sleeping or daily activities.
  • Symptoms must appear daily (or nearly so) for a period of two weeks or more.
  • To be primary depression, symptoms must not be due to substance abuse (or withdrawal) or directly attributable to the recent loss of a loved one. (Note, some clinicians will include other major life stressors, such as job loss or medical diagnosis.)
  • Primary depression cannot be the result of another medical condition – such as hypothyroidism. A medical history should rule out hormonal causes before treatment of depression begins (including medication history).The modern paradigm for the biology of depression revolves around three neurotransmitters and their actions in the brain. The phrase, ‘chemical imbalance’ is often used to describe the effects of various levels of these neurotransmitters, but it is misleading in that there is no agreed upon ‘balance’ to measure, other than a reduction of symptoms. This is important, because, unlike blood-sugar levels (a single measurable number), it takes a skilled practitioner to evaluate individual patients and drug effects.
  • Those suffering depression will report either a depressed mood (profound hopelessness) or an inability to act in the world. This latter isn’t merely unwillingness, it is felt as an uncontrollable physical and mental lassitude and ranges from deep ennui to obvious disengagement. Patients will report they can no longer enjoy those activities which used to bring pleasure.

Neurotransmitters

Serotonin, norepinephrine and dopamine are the three main neurotransmitters targeted by the commonly prescribed antidepressants. While it is known that depression is related to various levels of these neurotransmitters (hence the phrase, chemical imbalance) the relationship is not perfectly clear. As an example, one depressed patient may show lower than normal levels of norepinephrine and respond well to a drug which increases norepinephrine levels. Other patients with depression show a higher than normal level of norepinephrine.

The picture is far from simple and not clear. With 30 neurotransmitters to consider, the brain remains a very complex place to do business. Therapy is based on results – often, several medications must be tried until a ‘match’ is found. And even with the large number of drugs available, approximately 30% of patients will not get chronic relief with medications.

Agents

  • Tri-cyclic Antidepressants (TCAs) – The first class of medications used primarily to treat depression, these drugs were initially marketed in the late 1950s. The first, Imipramine, is still in use today. They find application in serious or intractable depression, but are limited because of a significant side effects profile, including tremor and cardiac arrhythmia.

TCAs act to increase serotonin and norepinephrine (strong) as well as dopamine (weak). They have an antihistamine effect peripherally and interact strongly with alcohol. In low doses, they are sometimes used as a sleep aid.

  • Mono-Amine Oxidase Inhibitors (MAOIs) – These drugs block the action of mono-amine oxidase, the primary enzyme which degrades serotonin, norepinephrine and dopamine (as well as other neurotransmitters). By blocking this enzyme, MAOIs keep naturally occurring neurotransmitters in the synaptic junction longer, leading to a greater effect for however much transmitter is produced.

MAOIs, like TCAs, have a poor side effects profile, which limits their use. The blocking of mono-amine oxidase occurs throughout the body and, because the breakdown of amines is inhibited, a buildup occurs. Foods to be avoided contain tryptamine and tyramine. There are also a large number of other drugs which are metabolized by amine oxidation and patients on MAOIs must be screened for interactions.

  • Selective Serotonin Reuptake Inhibitors (SSRIs) – This newer class of compounds acts to keep available serotonin in the synaptic junction by slowing its reabsorbtion back into the neuron. This is the second of two removal mechanisms for serotonin. The first, degradation is blocked by MAOIs. Unlike MAOIs and TCAs, SSRIs tend to primarily affect serotonin levels (although specificity varies with different drugs).

In comparison to MAOIs and TCAs, this class has very few side effects that rise to the level of having to discontinue the medication. This makes them first line agents for depression and even non-specialists may feel comfortable prescribing them. An even newer class, serotonin-norepinephrine reuptake inhibitors (NSRIs) is also used in depression.

One cautionary note: Because agents in different classes have different modes of action with the same result (increased synaptic neurotransmitters) a washout period is required when switching medications. Consider what would happen if a patient were on an MAO along with an SSRI. The neurotransmitter, serotonin would be blocked from degradation (the MAOI) and reabsorbtion (SSRI). This can lead to supra-additive effects. Consequently, patients have to be weaned from one before starting the other. This can mean a period of essentially no benefit and patients are likely to relapse until the second agent begins to take effect.

Atypical and Treatment Resistant Depression

The agents mentioned above are all considered traditional antidepressants and most patients (in the US) receive them through their primary care physician (60+%). Atypical depression and resistant depression (two to four agents have failed) usually require the services of a psychiatrist or psychologist trained in these more intractable cases.

Often, medications will then be tried that are not classically thought of as antidepressants (benzodiazepines or antipsychotics). Atypical depression, for instance, may respond to lithium. Beyond this, treatment options extend from talk therapy sessions all the way through electroconvulsive therapy (shock therapy).

Depression remains an illness that needs better treatment options. Medications are still a good area of research as are transcranial magnetic stimulation and magnetic seizure therapy. Reducing adverse reactions is also an important consideration because patients will likely take medication for months or years. The trend is for newer agents to either be more specific or have a better side effect profile.

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Depression can be cured by medication and psychotherapy, but meditation can also have a very healing effect.

Depression is commonly used term to describe a range of feelings pertaining to a sense of low well being. Beck and Alford have attempted to provide a comprehensive description of the term as typified by altered mood, negative self image and reduced activity levels. The feelings may vary from sadness to an extended period of despondency at varying levels. Specific events may lead to a feeling of ‘being low’. An event like a birthday that is forgotten by a close friend, a recent loss or separation without concurrent support from friends or family is a situation that may exacerbate depression. Some people are prone to depression regardless of the comfort and care they receive in their surroundings. Cases of depression are treated as mental disorders when the sense of reality is adversely affected. There are chronicles of highly intelligent people who berate their low mental capabilities and successful ones who feel bad about being failures. So, how do we care for our minds in this state?

The Way We Think

Take the case of Mrs. X who is hauled up by her supervisor for an error in her work. Mrs. X’s reaction is to feel hurt and withdraw. She starts telling herself she is useless because she makes too many mistakes. She remembers that this has been a problem since her childhood. She carries her anguish about the error and her inability to her home and finds it difficult to sleep. She sees a box of chocolates and binges. She tries to cry but finds it difficult to do so. She recalls all the past situations when she has been hauled up for mistakes and berates herself harshly. The next morning sees her wishing she did not have to go to work, in fact not wanting to get out of the bed. There is a downward spiral in her trend of thought.

Now, if Mrs. X were to view the situation objectively, she would probably realize that the error is because of flawed work planning or insufficient time to check her output. She would also realize that she has entered into a habit of accepting blame without ascertaining whether there are solutions to help her work better. Her current trend of thought impacts all aspects of her life and draws her deeper into a vortex of self-hate. She is unable to talk to her family about it because she knows they will be critical of her. She has no friends she can fall back on, she never could make friends.

An objective view would allow her to come up with better results. She would realize that her emotional reactions are probably based in childhood events where she was blamed for small mistakes and has adopted the attitude of being at fault. She has grown up to find that she is often at fault and fails to see that errors can be rectified or avoided. Of late, she has started developing severe headaches and often feels weepy without reason. Her food habits are erratic and she drives herself into binge eating situations. She is unable to recall a single event in her life that caused her to feel happy.

How Meditation Can Help

Meditation involves being in a comfortable position and focusing on breath as it enters and exits from the body. The body is guided into a state of restfulness and the person starts to go through a feeling of peacefulness. Some people may feel a headache coming on, but this goes away quickly. Some go through moments of catharsis while others feel itchy all over the body. Most of us prefer to keep ourselves occupied in activity that allows us to drown out past memories, chatter in our minds and a host of self negating beliefs. When we meditate, our feelings and thoughts come to the fore. In most cases, symptoms of discomfort disappear in a short while and the person starts looking forward to being engulfed in peace and quiet for a while. The person is guided to accept thoughts as they play out in the mind without becoming part of them. Repeated efforts yield the fruit of calmness, acceptance and widened perspective.

To understand the effect of meditation we must first understand the work of our nervous system in helping us to feel good. Our nervous system consists of tiny nerve cells that transfer impulses with the use of chemicals called neurotransmitters. The neurotransmitter, serotonin, is associated with a feeling of well being. Research on meditation has identified that this neurotransmitter is released during the practice of meditation and similar soothing activity.

In the case of Mrs. X, meditation will work on the physical discomfort that she faces and help alleviate the problem. She will be introduced to the idea that she is a valuable person and will find her mind slowly opening to a state of acceptance of herself. The utilization of psychotherapy in conjunction with meditation aids an opening up of the person’s mind to the mental games that one is being trapped in. As she continues in her practice with professional help, she will start to see her strengths and discover new sides of herself that she has not been aware of. She is likely to go through cathartic moments as she recognizes self-defeating thought patterns and sees others like herself.

Mrs. X should avoid trying to enter the phase of deep meditation until she has reached a stage of self awareness that allows her to stop dejection getting the better of her. The process of meditation works at the pace of a person’s acceptance of completeness. It increases the awareness of sameness between different individuals. She will slowly become aware that her concentration is under her control and can be improved with effort on her side.

Aspects to be Aware of

Meditation has a direct impact on the blood pressure of a person. It is proven to be beneficial for people with high blood pressure. Meditation should not be considered to be a ‘benign intervention’ explain Snyder and Lindquist in their book ‘Complementary/ alternate therapies in nursing’ (2006, p. 136-138). Patients who are on dosage for diabetes and hypertension must have their dosage reviewed after meditation. The authors are of the view that vital signs like blood pressure and heart rate should be monitored through the day in the initial phase for patients suffering from these diseases. They mention studies that have shown a connection between meditative practices and the reduction of HIV/AIDS killer cell activity. The practice is highly recommended for people undergoing chronic physical pain and stress or anxiety.

The authors recommend against the use of meditation for people who have hypotension since the blood pressure is likely to reduce further. In some cases, people go through hallucinations that require psychiatric treatment and medication to return them to a state of normalcy.

Postural hypotension is typified by giddiness due to a rapid shift to a vertical position after meditation. People who face this problem must get up from meditation in slow phases to avoid a sudden drop in blood pressure. People who are in a state of altered reality perception may find it difficult to follow the instructions to meditate at the start.

Until the person is able to concentrate and follow through with the instructions, it can be challenging to use guided meditation. In such cases, soothing music or continuous chants may be utilized in conjunction with prescribed medication. All in all, it is essential to practice meditation with the guidance an experienced practitioner who can gauge the pace at which you should practice and recommend a suitable method.

References

McNamara, Patrick, (2006). Where God and Science Meet. Greenwood Publishing Group.

Snyder, Mariah & Lindquist, Ruth (2006). Complementary/Alternative Therapies in Nursing. Springer Publishing Company.