Sadness touches our lives at different times, but usually comes and goes. Depression, in contrast, often has enormous depth and staying power. It is more than a passing bout of "the blues." Depression can leave you feeling continuously burdened and can squash the joy you once got out of pleasurable activities.
When depression strikes, doctors usually probe what's going on in the mind and brain first. But it's also important to check what's going on in the body, since some medical problems are linked to mood disturbances. In fact, physical illnesses and medication side effects are behind up to 15% of all depression cases.
Depression isn't a one-size-fits-all illness. Instead, it can take many forms. Everyone's experience and treatment for depression is different. Effective treatments include talk therapy, medications, and exercise. Even bright light is used to treat a winter-onset depression known as seasonal affective disorder. Treatment can improve mood, strengthen connections with loved ones, and restore satisfaction in interests and hobbies.
New discoveries are helping improve our understanding of the biology of depression. These advances could pave the way for even more effective treatment with new drugs and devices. Better understanding of the genetics of depression could also usher in an era of personalized treatment.
Research on crying focuses on several different areas, including the chemicals in emotional tears and their purpose, and whether or not depressed people cry more. Tears provoked by emotion contain higher levels of proteins and the mineral manganese. In 2011, Israeli researchers reported results in the journal Science that suggested tears are capable of sending chemical signals. They conducted an experiment that involved having men sniff women's tears and a saline solution. Tests showed that the men reacted differently to a whiff of the real tears. Their testosterone levels dipped, and brain scans showed less activity in areas associated with sexual arousal. The researchers' theory: women's tears may counteract men's aggressive tendencies. Others have speculated on the role of tears in evolution and natural selection. Depression makes people sad, so it's presumed that depressed people cry more than those who aren't depressed. There's also an abiding belief that more severe bouts with depression can have just the opposite effect and rob people of their capacity to cry. Researchers found that an inability to cry was associated with severe depression.
Results of several studies suggest that taking fish oil does not benefit people who already have some form of heart disease, but eating fish is still likely to offer health benefits to most people. It could fight other types of cardiovascular disease or problems like depression. And it is a good treatment for high triglycerides.
People who have been taking antidepressants for some time may wish to stop taking them due to unpleasant side effects such as sexual changes (decreased desire and difficulty having an orgasm), headache, insomnia, drowsiness, vivid dreaming, or just not feeling. This can be accomplished, but it is best to taper the dosage slowly and be aware of withdrawal symptoms, that can include depression and anxiety.
Discontinuing an antidepressant usually involves reducing your dose in increments. Your clinician can instruct you in tapering your dose and prescribe the appropriate dosage pills. Here are suggested dosage reductions for some of the most popular antidepressants.
Takotsubo cardiomyopathy, also called broken-heart syndrome, is a weakening of the left ventricle that is usually the result of severe stress. Its symptoms resemble those of a heart attack, and treatment is usually the same as that for heart failure, possibly beta blockers, ACE inhibitors, and diuretics (water pills).
Everyone experiences pain at some point, but in people with depression or anxiety, pain can become particularly intense and hard to treat. People suffering from depression, for example, tend to experience more severe and long-lasting pain than other people.
The overlap of anxiety, depression, and pain is particularly evident in chronic and sometimes disabling pain syndromes such as fibromyalgia, irritable bowel syndrome, low back pain, headaches, and nerve pain. For example, about two-thirds of patients with irritable bowel syndrome who are referred for follow-up care have symptoms of psychological distress, most often anxiety. About 65% of patients seeking help for depression also report at least one type of pain symptom. Psychiatric disorders not only contribute to pain intensity but also to increased risk of disability.
Researchers once thought the reciprocal relationship between pain, anxiety, and depression resulted mainly from psychological rather than biological factors. Chronic pain is depressing, and likewise major depression may feel physically painful. But as researchers have learned more about how the brain works, and how the nervous system interacts with other parts of the body, they have discovered that pain shares some biological mechanisms with anxiety and depression.
You could argue that the physical and mental changes that occur during menopause aren't really "symptoms." The term is usually associated with a disease, which menopause is not. Also, it is often hard to say which changes are a direct result of a drop in hormone levels and which are natural consequences of aging. Some of the symptoms overlap or have a cascade effect. For example, vaginal dryness may contribute to a lower sex drive, and frequent nighttime hot flashes may be a factor in insomnia.
Hot flashes and vaginal dryness are the two symptoms most frequently linked with menopause. Other symptoms associated with menopause include sleep disturbances, urinary complaints, sexual dysfunction, mood changes, and quality of life. However, these symptoms don't consistently correlate with the hormone changes seen with menopause transition.
Also called vasomotor symptoms, hot flashes may begin in perimenopause, or they may not start until after the last menstrual period has occurred. On average, they last three to five years and are usually worse during the year following the last menstrual period. For some women they go on indefinitely.
Pain, especially chronic pain, is an emotional condition as well as a physical sensation. It is a complex experience that affects thought, mood, and behavior and can lead to isolation, immobility, and drug dependence.
In those ways, it resembles depression, and the relationship is intimate. Pain is depressing, and depression causes and intensifies pain. People with chronic pain have three times the average risk of developing psychiatric symptoms — usually mood or anxiety disorders — and depressed patients have three times the average risk of developing chronic pain.
Almost every drug used in psychiatry can also serve as a pain medication. Relieving anxiety, fatigue, depression, or insomnia with mood stabilizers, benzodiazepines, or anticonvulsants will also ease any related pain. The most versatile of all psychiatric drugs, the antidepressants have an analgesic effect that may be at least partly independent of their effect on depression since it seems to occur at a lower dose.
It's often said that depression results from a chemical imbalance, but that figure of speech doesn't capture how complex the disease is. Research suggests that depression doesn't spring from simply having too much or too little of certain brain chemicals. Rather, there are many possible causes of depression, including faulty mood regulation by the brain, genetic vulnerability, stressful life events, medications, and medical problems. It's believed that several of these forces interact to bring on depression.
To be sure, chemicals are involved in this process, but it is not a simple matter of one chemical being too low and another too high. Rather, many chemicals are involved, working both inside and outside nerve cells. There are millions, even billions, of chemical reactions that make up the dynamic system that is responsible for your mood, perceptions, and how you experience life.
For too many women, joyfully anticipated pregnancy and motherhood bring depression as an unexpected accompaniment. Children as well as mothers suffer. Depression during pregnancy may result in poor prenatal care, premature delivery, low birth weight, and, just possibly, depression in the child. Depression after childbirth (postpartum depression) can lead to child neglect, family breakdown, and suicide. A depressed mother may fail to bond emotionally with her newborn, raising the child's risk of later cognitive delays and emotional and behavior problems. Fortunately, if the depression is detected soon enough, help is available for mother and child.
Depression in pregnant women is often overlooked, partly because of a widespread misconception that pregnancy somehow provides protection against mood disorders. In reality, almost 25% of cases of postpartum depression in womem start during pregnancy, and depression may peak at that time, according to a study published in the British Medical Journal.
More than 9,000 women recorded their moods during the fourth and eighth month of pregnancy and again two and eight months after giving birth. The questionnaire, which was specially designed for pregnant women and new mothers, concentrated on thoughts and feelings—emotional swings, crying spells, low self-esteem, hopelessness, irritability, and inability to enjoy normally pleasurable activities. The researchers paid less attention to physical symptoms, because they did not want to mistake physical effects of pregnancy (such as appetite loss, fatigue, and insomnia) for symptoms of depression. Depression ratings were highest at the eighth month of pregnancy and lowest eight months after childbirth. Fourteen percent of the women scored above the threshold for probable clinical depression just before the child's birth, compared with 9% two months later.