My website www.MentalHealthIndia.net provides extensive information about depression and the treatment of depression. If you prefer to look for information by general category, rather than by searching FAQs, please go to the Depression section/page.

1. What are the symptoms of a serious clinical depression?
   

2. What is bipolar depression?
   

3. What are the symptoms of a manic episode?
   

4. What medications are used to treat depression?
   

5. What medications are used to treat bipolar depression?
   

6. How does depression affect teenagers?
   

7. Is it normal for older adults/senior citizens to get depressed?
   

8. Are women at greater risk for depression?
   

9. How do psychologists differ from psychiatrists?
   

10. Is medication required for depression?
    

11. Is psychotherapy much better than medication for depression?
    
    

A Major Depression is marked by a combination of symptoms that occur together, and last for at least two weeks without significant improvement. Symptoms from at least five of the following categories must be present for a major depression, although even a few of the symptom clusters are indicators of a depression, but perhaps not a major depression.

• Persistent depressed, sad, anxious, or empty mood
  

• Feeling worthless, helpless, or experiencing excessive or inappropriate guilt
  

• Hopeless about the future, excessive pessimistic feelings
  

• Loss of interest and pleasure in usual activities
  

• Decreased energy and chronic fatigue
  

• Loss of memory, difficulty making decisions or concentrating
  

• Irritability or restlessness or agitation
  

• Sleep disturbances, either difficulty sleeping, or sleeping too much

• Loss of appetite and interest in food, or overeating, with weight gain
  

• Recurring thoughts of death, or suicidal thoughts or actions

This list is a guide to help you understand depression. It is not offered for you to diagnose yourself. If you have some of these symptoms, don't focus on how many symptoms you have. Instead, talk to a psychologist about how you have been feeling, to see if he/she can help.

What is bipolar depression?

The distinguishing characteristic of Bipolar Disorder, as compared to other mood disorders, is the presence of at least one manic episode. Additionally, it is presumed to be a chronic condition because the vast majority of individuals who have one manic episode have additional episodes in the future. The statistics suggest that four episodes in ten years is an average, without preventative treatment. Every individual with bipolar disorder has a unique pattern of mood cycles, combining depression and manic episodes that is specific to that individual, but predictable once the pattern is identified . Research studies suggest a strong genetic influence in bipolar disorder.

Bipolar disorder typically begins in adolescence or early adulthood and continues throughout life. It is often not recognized as a psychological problem, because it is episodic. Consequently, those who have it may suffer needlessly for years without treatment.

A manic episode is an abnormally elevated, expansive or irritable mood, not related to substance abuse or a medical condition, that lasts for at least a week, and includes a number of disturbances in behavior and thinking that results in significant life adjustment problems.

Features of a Manic Episode (at least three symptom clusters present)

• Extreme irritability & distractibility
  

• Excessive "high" or euphoric feelings
  

• Sustained periods of unusual, even bizarre, behavior with significant risk-taking
  

• Increased energy, activity, rapid talking & thinking, agitation
  

• Decreased sleep
  

• Unrealistic belief in one's own abilities
  

• Poor judgment
  

• Increased sex drive
  

• Substance abuse
  

• Provocative or obnoxious behavior
  

• Denial of any problems

This list is not intended for you to self-diagnose. If you or a close friend or family member have several of these symptoms, please consult a psychologist as soon as possible to determine whether treatment is indicated.

What medications are used to treat depression?

There are a number of different types of antidepressant medications available. They differ in their side effects and, to some extent, in their level of effectiveness. Tricyclic antidepressants (named for their chemical structure) used to be the most commonly used medications for treatment of major depressions. Monoamine oxidase inhibitors (MAOIs) were often used for "atypical" depressions in which there are symptoms like oversleeping, anxiety, panic attacks, and phobias. More recently, newer antidepressants have been developed. Several of them are called "selective serotonin reuptake inhibitors" (SSRIs). Some examples of SSRIs are fluoxetine, fluvoxamine, paroxetine, and sertraline. (Fluvoxamine has been approved for obsessive-compulsive disorder, and paroxetine has been approved for panic disorder.) Though structurally different from each other, all the SSRI antidepressant effects are due to their action on one specific neurotransmitter, serotonin. Two other antidepressants that affect two neurotransmitters serotonin and norepinephrine have also been approved by the FDA. They are venlafaxine and nefazodone. All of these newer antidepressants seem to have less bothersome side effects than the older tricyclic antidepressants.

The tricyclic antidepressant clomipramine affects serotonin but is not as selective as the SSRIs. It was the first medication specifically approved for use in the treatment of obsessive-compulsive disorder (OCD). Fluoxetine and fluvoxamine have now been approved for use with OCD.

Another of the newer antidepressants, bupropion, is chemically unrelated to the other antidepressants. It has more effect on norepinephrine and dopamine than on serotonin. Bupropion has not been associated with weight gain or sexual dysfunction. It is contraindicated for individuals with, or at risk for, a seizure disorder or who have been diagnosed with bulimia or anorexia nervosa.

The medication used most often over the years to combat a manic "high" is lithium. It is unusual to find mania without a subsequent or preceding period of depression. Lithium evens out mood swings in both directions, so that it is used not just for acute manic attacks or flare-ups of the illness, but also as an ongoing treatment of bipolar disorder.

Not all patients with symptoms of mania benefit from lithium. Some have been found to respond to another type of medication, the anticonvulsant medications that are usually used to treat epilepsy. Carbamazepine is the anticonvulsant that has been most widely used. Individuals with bipolar disorder who cycle rapidly, (changing from mania to depression and back again over the course of hours or days, rather than months) seem to respond particularly well to carbamazepine.

In 1995, the anticonvulsant divalproex sodium was approved by the Food and Drug Administration for manic-depressive illness. Clinical trials have shown it to have an effectiveness in controlling manic symptoms equivalent to that of lithium; it is effective in both rapid-cycling and non-rapid-cycling bipolar.

Approximately 4 out of 100 teenagers get seriously depressed each year. Sure, everybody feels sad or blue now and then. But if you're sad most of the time, and it's giving you problems with :

• Your grades

• Your relationships with your family and friends

• Alcohol, drugs, or sex

• Controlling your behavior in other ways

then the problem may be - DEPRESSION

WHEN YOU'RE DEPRESSED..

You feel sad or cry a lot and it doesn't go away.

You feel guilty for no real reason; you feel like you're no good; you've lost your confidence.

Life seems meaningless or like nothing good is ever going to happen again.

You have a negative attitude a lot of the time, or it seems like you have no feelings.

You don't feel like doing a lot of the things you used to like - such as music, sports, being with friends, going out, and you want to be left alone most of the time.

It's hard to make up your mind. You forget lots of things, and it's hard to concentrate.

You get irritated often. Little things make you lose your temper; you overreact.

Your sleep pattern changes; you start sleeping a lot more or you have trouble falling asleep at night. Or you wake up really early most mornings and can't get back to sleep.

Your eating pattern changes; you've lost your appetite or you eat a lot more.

You feel restless and tired most of the time.

You think about death, or feel like you're dying, or have thoughts about committing suicide.

If you are one of the depressed teenagers, meet a psychologist immediately.

It isn't normal to become depressed at any age. Many of the life stressors that can cause depression are present in a larger percentage of the elderly population, which has probably given rise to this myth. In fact, the vast majority of senior citizens are satisfied with their lives. But, loss of a loved one, financial problems, social isolation, poor health, physical disability, and lack of life goals all seem to increase the likelihood of developing depression. Since many senior citizens struggle with these problems, people often ignore depression in the elderly, thinking it is inevitable. If you, or a senior citizen you know, have several symptoms of depression, talk to someone who can help... make an appointment with a psychologist for a consultation.

Major depression and dysthymia affect twice as many women as men. This two-to-one ratio exists regardless of racial and ethnic background or economic status. The same ratio has been reported in twelve countries all over the world. Men and women have about the same rate of bipolar disorder (manic depression), though its course in women typically has more depressive and fewer manic episodes. Also, a greater number of women have the rapid cycling form of bipolar disorder, which may be more resistant to standard treatments.

Many factors unique to women are suspected to play a role in developing depression. Research is focused on understanding these factors, including: reproductive, hormonal, genetic or other biological factors; abuse and oppression; interpersonal factors; and certain psychological and personality characteristics. But, the specific causes of depression in women remain unclear. Many women exposed to these stress factors do not develop depression. Remember, depression is a treatable psychological problem, and treatment is effective for most women. If you are one of the depressed women, see a psychologist immediately.

Psychiatrists are physicians (M.D.’s) who have completed at least four years of postgraduate training. They are the only mental health specialists licensed to prescribe drugs and to give full physical examinations.

Psychologists work in some 40 different specialties. They may be experimenters studying rats in mazes or electrical impulses in nerve cells; animal-behavior specialists watching wild chimpanzee; or environmental psychologists observing people in crowded cities. Those who treat mental disorders are called clinical psychologists or psychotherapists. They have Ph.D.’s or the equivalent and have more training in psychological research and personality assessment than M.D.’s. They are trained to help patients with various therapies.

Not really! Except in the more severe depressions, and bipolar depression, medication is usually an option, rather than a necessity. Antidepressant medication does not cure depression; it only helps you to feel better by controlling certain symptoms. There is a big difference between feeling better and getting better. Antidepressant medication can bring a patient from major depression to moderate depression, but cannot make him absolutely normal or happy. It is here, where psychotherapy is very useful in bringing a patient from moderate depression to normalcy. If you are depressed because of life problems, such as relationship conflicts, divorce, loss of a loved one, job pressures, financial crises, serious medical problems in yourself or a family member, legal problems, or problems with your children, taking a pill will not make those problems go away.

However, some symptoms of depression, such as sleep and appetite disturbances, significant concentration problems, and chronic fatigue, interfere with your ability to make the life changes necessary to eliminate the depression. In more serious depression, suicidal thoughts and urges, and preoccupation with death, may require medication in addition to psychotherapy. Antidepressant medication can help relieve those symptoms, and allow you to make needed life changes. The decision to take medication, in addition to participating in psychological treatment, should be discussed with your treating psychologist and your primary care physician. Your thoughts and feelings regarding medication, after considering information about both the benefits and risks involved, are an important part of a collaborative treatment approach between psychologist and client. If medication is part of your treatment, either your primary care physician or a psychiatrist will supervise the medical part of your treatment, while you continue psychotherapy with a psychologist. If you have a chronic medical condition or a serious illness, and you are taking medication for that condition, then the medical specialist treating that problem should be involved in your treatment. The medical specialist may supervise all of your medications, or coordinate the medical treatment with the physician providing the antidepressant medications.

Yes, very much! Except in the more severe depressions, and bipolar depression, medication is usually an option, rather than a necessity. Antidepressant medication does not cure depression; it only helps you to feel better by controlling certain symptoms. If you are depressed because of life problems, such as relationship conflicts, divorce, loss of a loved one, job pressures, financial crises, serious medical problems in yourself or a family member, legal problems, or problems with your children, taking a pill will not make those problems go away. Here, it is psychotherapy that is most useful.

Psychological treatment of depression (psychotherapy) can assist the depressed individual in several ways. First, supportive counseling helps ease the pain of depression, and addresses the feelings of hopelessness that accompany depression. Second, cognitive therapy changes the pessimistic ideas, unrealistic expectations, and overly critical self-evaluations that create depression and sustain it. Cognitive therapy helps the depressed person recognize which life problems are critical, and which are minor. It also helps him/her to develop positive life goals, and a more positive self-assessment. Third, problem solving therapy changes the areas of the person's life that are creating significant stress, and contributing to the depression. This may require behavioral therapy to develop better coping skills, or Interpersonal therapy, to assist in solving relationship problems.

At first glance, this may seem like several different therapies being used to treat depression. However, all of these interventions are used as part of a cognitive treatment approach. Some psychologists use the phrase, cognitive-behavioral therapy and others simply call this approach, cognitive therapy. In practice, both cognitive and behavioral techniques are used together.

Once upon a time, behavior therapy did not pay any attention to cognitions, such as perceptions, evaluations or expectations. Behavior therapy only studied behavior that could be observed and measured. But, psychology is a science, studying human thoughts, emotions and behavior. Scientific research has found that perceptions, expectations, values, attitudes, personal evaluations of self and others, fears, desires, etc. are all human experiences that affect behavior. Also, our behavior, and the behavior of others, affects all of those cognitive experiences as well. Thus, cognitive and behavioral experiences are intertwined, and must be studied, changed or eliminated, as an interactive pair.

Unfortunately, many poorly trained counselors never move beyond providing supportive counseling. This alone will not eliminate the depression. As a result, the depression, and the therapy, continues indefinitely, with little improvement. Supportive counseling "feels" helpful, and as part of the overall treatment plan does help. But, unless the depressed person makes critical life changes, the depression will continue. These changes are both internal and external. Internal changes are usually needed in problem assessment self-evaluation, the evaluation of others, and the expectations the depressed person has for himself/herself, others and about life. External changes may be needed in problem solving skills, stress management, communication skills, life management skills, and the skills needed to develop and sustain relationships.

The length of treatment will vary, according to the severity of the depression, and the number and kind of life problems that need to be addressed. Most people will begin to experience some relief with 6 to 10 sessions, and approximately 70-80% of those treated notice significant improvement within 20-30 sessions. Mild depression may be treated in fewer sessions, and more significant depression may require extended treatment. Treatment sessions are usually scheduled once per week, although they may be scheduled more frequently initially, or if the person is experiencing significant life crises.