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.
New research has confirmed a link between depression and the menopausal transition, or perimenopause — that time of erratic periods, chaotic hormone fluctuations, disturbed sleep, and, for some, uncomfortable hot flashes. Among the findings: little or no correlation between hormone levels and depression during perimenopause. However, a host of other factors have been implicated.
In 2006, the Harvard Study of Moods and Cycles reported that one in six participants with no history of depression developed depressive symptoms during perimenopause. In addition to hormone fluctuations, researchers have explored the possible influence of psychosocial factors, hot flashes and their impact on sleep, and genetic vulnerabilities. In 2006, the Study of Women's Health Across the Nation identified several genetic mutations that increase the likelihood of perimenopausal depressive symptoms.
In the March/April 2008 issue of the journal Menopause, scientists published data from the Seattle Midlife Women's Health Study. Most of the 302 participating women were in their late 30s or early 40s in the early 1990s, when the 15-year study began.
Antidepressant medications can decrease libido or impair sexual function. Sometimes this can be overcome by switching medications, changing dosage, or waiting to see if the effect diminishes over time.
Seasonal affective disorder is thought to be caused by decreased exposure to sunlight during the winter months. Light therapy helps some people, and the FDA has approved the antidepressant bupropion for treatment as well.
According to the National Comorbidity Survey Replication, only about 40% of people with major depression receive adequate conventional treatment, so it's important to get a better understanding of the other measures depressed patients are taking. A survey of American women indicates that a high proportion of them use alternative and complementary medicines for depression.
Researchers analyzed a national telephone survey of more than 3,000 women, with Mexican Americans, Chinese Americans, and African Americans somewhat over-represented in order to get a picture of ethnic differences. Of these women, 220 said they had been medically diagnosed with depression in the previous year, and 54% of them had used alternative medicine to treat the symptoms. The authors point out that the percentage would have been even higher if they had been able to include depressed women who never received a medical diagnosis.
The most popular alternatives were manual therapies, including chiropractic, massage, and acupressure, used by 26%; medicinal herbs and teas, used by 20%; and vitamins and nutritional supplements, used by 16%. Other unconventional remedies were yoga, meditation, tai chi, Chinese medicine, Ayurveda, and Native American healing.
Depression can often develop as a result of a heart attack or cardiac surgery, and has more serious effects on heart health and overall health than depression that was present before a heart attack.
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Surviving a heart attack is cause for celebration. It's also a trigger for depression. Up to half of heart attack survivors get the blues, and many go on to develop clinical depression.
Early experiences with antidepressants weren't that promising because older tricyclic drugs such as clomipramine and nortriptyline sometimes threw off heart rhythms and further endangered the heart. This made doctors leery about recommending antidepressants, even when selective serotonin reuptake inhibitors (SSRIs) such as Prozac (fluoxetine), and Zoloft (sertraline), and others came along.
However, a small study published in 2002, dubbed SADHART, suggested that Zoloft could safely treat depression after a heart attack and might be good for the heart to boot. And an analysis of a larger trial, called ENRICHD, lends support to the notion that treating post-heart-attack depression with an SSRI may also reduce the chances of having, or dying from, a heart attack.