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FACTS ABOUT DEPRESSION

FACTS ABOUT DEPRESSION

This paper contains important information that you must know about depression. Please read ALL of it carefully, it is based on all of the latest facts about depressi

 

1.     What is Depression?

Depression is an illness that negatively affects both the mind and body. Individuals who are depressed often feel sad much of the time and can also experience disruptions in their eating and sleeping patterns. Interpersonal relationships can become strained when a person is depressed and activities that were once pleasurable are no longer experienced in the same way.

2.   What Causes Depression?

Recent research suggests that a deficiency of one or two chemicals (serotonin and norepinephrine) is associated with depression. These chemicals carry messages from one nerve ending to another across a small gap in the nervous system. When there are adequate levels of these chemicals mood is normal. Unfortunately, when levels of these chemicals are low, depression may result.

We don't know why these chemical levels become deficient. One possibility is that low levels of chemicals may be inherited. Another possibility is that it may be associated with major surgery, an illness (thyroid disease, stroke, cancer, stomach ulcers) or menopause. One of life's normal depressing or sad events such as deaths, divorce or separation, financial catastrophes, or moving may trigger the chemical problem. Most often it occurs for no reason at all!

Basically, there are two reasons why depression occurs. First, the tendency to be depressed is frequently inherited similar to medical conditions like high blood pressure and arthritis. Second, experiencing stressful life events such as sexual abuse, abandonment at a young age, parent died, divorce, or neglect can trigger depression.

Fortunately, we do have medications that correct the chemical deficiencies.

3.   Does Having Depression Mean That a Person is Mentally Ill or Going Crazy?

No, but it will very often make them think that they are!

4.   Is it a Common Illness?

Yes, it is the most common illness seen in medicine. However, it is often confused with other illnesses. One to three out of every ten people suffer from a major depression during their lives - many repeatedly. Furthermore, depression is an illness that occurs more frequently in women than men.

5.   What Trouble Does a Person Have Who Has Depression?

A person with depression will usually feel most of the following things:

A.  They will often feel very sad for no reason, and in fact, will often break into tears without knowing why.

B.  They will usually experience a lack of enthusiasm or feelings of enjoyment, even for doing things that they formerly experienced as pleasurable.

C.  The will also often feel irritable. They will become upset over things that ordinarily would not upset them.

D.  They will often feel very tired all the time, even when they have not yet even worked or exerted themselves very much. That is, they will be just as tired on days when they have rested as on days when they have worked hard.

E.   Their sleep will usually be disrupted in one of two ways: They will either go to sleep, wake up during the night, and remain awake, or else they will sleep too much all the time, even during the day. Often they will awaken just as tired as when they went to sleep!

F.      Their sex drive will be decreased; in fact it will often go away altogether.

G.  They will often have a headache, perhaps not very severe, but present most of the time. It will usually feel like a band all around the head and tend to run down the neck, but it can occur anywhere about the head. Almost any chronic pain elsewhere, such as in the abdomen or back, can be caused by depression. And these pains are not imaginary; they are quite real and often severe.

H.  They will find it difficult to enjoy things. They will feel little enthusiasm, even for things they used to look forward to. They will often feel at their worse on their off day, when they have leisure time on their hands.

I.    They will often be constipated, or have other digestive symptoms such as abdominal pain or diarrhea. They may lose considerable weight. Other times, they may gain weight from overeating in a desperate attempt to feel better.

J.    They will find it difficult to concentrate, to remember, to make decisions, to study, or to get things done.

K.  They will often feel like they are worthless or sinful persons. They will feel guilty, hopeless, helpless, and unwanted; even though they know they have no reason to feel that way. Worse of all, in a very serious depression, they will actually not feel like living at all.

6.   Is This a Serious Illness?

It varies. In a mild depression, the person will often think that they just have a case of the blues or that they are getting a little older. A moderate depression may interfere with managing one's life and the world may just look very bleak. Advanced depression can be quite serious. When truly depressed, one can lose all faith in one's self and one's ability to carry on. Suicidal thoughts may follow and if not treated, a person may kill themselves.

7.   Can a Person do Anything to Fight This Disease?

Seeking help from your physician is a first step. You may be advised to seek counseling and/or medical treatment. If your problem is complex, a psychiatrist specially trained in pharmacology may be suggested. Social workers and clinical psychologists (PhDs) are also very helpful counselors. Reading self help books to understand situations in your life may also be helpful to some people.

8.   What are the Medical Treatments?

There are several drugs which are extremely effective with depression. They are also quite safe compared to most medicines. Untoward reactions are very rare. Unfortunately, it takes nearly two weeks for them to start to work effectively.

9.   Are These Drugs Tranquilizers, Pep Pills, Sleeping Pills, Pain Pills, Hormone Pills, Sex Pills, or Nerve Pills?

No, not at all. They are called antidepressants. Antidepressants actually correct and treat the cause. Many of the above drugs only cover up depressive symptoms. If you are given a tranquilizer (Valium, Librium, Xanax, Ativan, etc.) sleeping pill, pain pill, etc., for symptoms of a physical depression, you might be less nervous but more depressed.

10. Are Antidepressants Addicting?

Absolutely not. A person cannot become addicted even though they take antidepressants for months or years. However, there is a very real possibility of addiction to tranquilizers (Xanax, Valium, etc.).

11. Do They Have Undesirable Side Effects?

Some people do experience mild side effects such as dry mouth or drowsiness but such side effects often dissipate over time.

12. How Long Will I Have to Take Antidepressants?

For the first treatment, possibly six to nine months. For the second episode, nine months to one year. For three or more episodes, years of treatment may be required. Three or more bouts means that you have a chronic medical disease - just like high blood pressure. Fortunately, antidepressants can be taken safely as long as they are needed, even for a lifetime. That means that the medication will control the disease as long as you take it - it will not cure it. Antidepressants can be safely taken for a lifetime if needed.

13. Can Depression Occur Without Anything in a Person's Life Causing It?

In many cases this is possible. However, many people will have things in their personal life that are bothering them a great deal, and if they happen to get depressed while these things are bothering them, then symptoms can become worse. Often, stressful events can trigger depression. For example, if they are having difficulty with their marriage or their job and are unfortunate enough to get a depression also, then the difficulties with the marriage or job will get much worse! A depression that goes unrecognized and untreated for a long time can cause problems that will worsen your life significantly. Even after your depression is treated, there may be a need for professional counseling to help heal the emotional scars that many patients receive. We are interested in treating all of your problems and chemicals may not be all that is needed. Time will tell.

14. I Have Heard of "Electric Shock" Treatment. Is This Used in Depression?

Yes, but only for most severe depression where suicide is a possibility and a person has not responded to more traditional ways of treating depression (i.e. medication). It is also a safe, painless and effective treatment. However, antidepressant medication is very effective for most patients so electroshock therapy is usually not required.

15. Is Depression Contagious?

Not really, but it is such a common disease that it sometimes appears as though it is. For example, we have very frequently observed a husband and wife to both have depression at the same time. Because depression has a genetic component it is common that both parents and children have to be treated.

16. What Should I Tell My Spouse, Significant Other, Children, About My Depression?

WE STRONGLY RECOMMMEND THAT YOU HAVE THEM READ THIS PAPER TOO!

A person with depression will typically find that their partner is very much affected by the way they feel. Very often, your partner will not realize that your symptoms are caused by an illness, and think that you do not love them anymore! Partners will often blame themselves for the depression that you are experiencing. It is very important that they know that this is simply a disease, just as pneumonia is a disease, and that neither you nor they are responsible for it. We extend an invitation for them to discuss with our staff factors that are involved in depression. Even though they do not really cause your depression, it is still a great help to have your loved ones understand what is happening and why you may need medications or counseling.

ANTIDEPRESSANT MEDICATIONS

Please read the following directions until you are certain that you understand them thoroughly, but call us if there are any questions about your medications.

1.       The name of your antidepressant is listed below. The names underlined are the chemical names for the brand names listed under them:

Imipramine         Clomipramine    Protriptyline       Amoxipin             Nefazodone          Fluoxetine

Tofranil                 Anafranil               Vivactil               Asendin                 Serzone              Prozac

Amitriptyline      Trimipramine     Desipramine        Naprotiline          Sertraline             Venlafaxine

Elavil                    Surmontil              Norpramin            Ludiomil                Zoloft                  Effexor               

                                                    Pertofrane

                                                              

Doxepin              Nortriptyline       Bupropion            Trazodone           Paroxetine           Citalopram     Escitalopram

Sinequan              Aventyl                Wellbutrin             Desyrel                 Paxil                    Celexa              Lexapro

                        

2.       This medication must be taken regularly, not just when you feel like you need it. In other words, never stop taking the medications because you feel better and think you no longer need it. Stop it only when we tell you to. Your treatment with this will last a minimum of six months. This is not a "quick fix" medication. The disease of depression commonly lasts for six months to a year or more. The medication will control the disease, not cure it.

3.       Most of these medications can be taken in one or two daily doses. Those that can make you sleepy are taken at night so that this side effect can help you sleep.

4.       Amitriptyline, Imipramine, Desyrel, Surmontil, Ludiomil, Asendin, Pamelor, Anafranil, and Sinequan tend to cause drowsiness during the first week of treatment. This drowsiness is temporary and will go away for good by the second week. Therefore, never stop taking the drug because of drowsiness. If the drowsiness is unbearable, call us. Serzone, Norpramin, Vivactil, Aventyl, Prozac, and Wellbutrin usually do not cause much drowsiness.

5.       Asendin, Norpramin, Pamelor, Vivactil, Prozac, Zoloft, Paxil, Celexa, Effexor, and Wellbutrin will occasionally cause a person to feel a little bit nervous at the beginning of the treatment. This is also temporary. Safe tranquilizers and a medication called Buspar are available to take in case you do have such nervousness. Call us if you feel you need them. (Most people do not feel nervousness at all.)

6.       Desyrel, Serzone, Prozac, Paxil, Effexor, Lexapro, or Zoloft may cause nausea soon after taking it. If this happens, take it with a little snack. If you can tolerate it for awhile, please do. This pesky side effect usually goes away in a few days. If it does not, discontinue it and let us know that you had to!

7.       All of these medications will tend to cause a person's mouth to feel dry. Desyrel, Serzone, Prozac, Zoloft, Paxil, Lexapro, Effexor, and Wellbutrin will cause less of a problem than others. This is because the salivary glands tend to not secrete as much saliva while you are taking this drug. This side effect is pesky but not serious. Most people deal with it by either chewing gum or taking frequent sips of water. Unfortunately, this side effect will be with you for as long as you take the medications but the benefits of this medication will be worth it.

8.       MOST OF THE GOOD EFFECTS OF THIS MEDICATION WILL NOT SHOW THEMSELVES FOR ONE OR TWO WEEKS, PERHAPS NOT UP TO 4-6 WEEKS. Amitriptyline, Imipramine, Desyrel, Surmontil, Pamelor, Ludiomil, Anafranil, and Sinequan will help you sleep right away and Serzone within two weeks, but all of the other beneficial effects will be delayed for one to occasionally three weeks. When the medication does begin to work, many things will become much better - energy will increase, sex drive will return to normal, headaches will go away, and tendency to cry and feel irritable will go away; in other words you will feel like you are back to normal.

9.       When you do begin to feel back to normal, DO NOT STOP THE MEDICATION. If you do, within three to four days, you will feel worse again.

10.   YOU CANNOT BECOME ADDICTED TO THESE MEDICATIONS. IT MAKES NO DIFFERENCE HOW MUCH OR HOW LONG YOU TAKE THESE MEDICATIONS, HABITUATION IS SIMPLY NOT POSSIBLE. Do not confuse these drugs with so called "pep pills", nerve pills, tranquilizers, pain pills, etc. which in some cases can be addictive.

11.   Your antidepressant, and if needed, a tranquilizer mix very well together. However, remember that you must take antidepressants on a regular basis, whether you feel you need them or not. With a tranquilizer, you decide each time whether you need it or not. As the antidepressant takes effect, you will find you often no longer need the tranquilizer. We discourage the long term use of tranquilizers. Tranquilizers are too easily used to cover up - and sometimes even cause problems.

12.   It is extremely important that we see you again after about the first two weeks of treatment to evaluate whether our diagnosis and treatment is correct and if the dose is correct. Do not stop taking the medication until you see us unless you are having significant side effects.

13.   If anything troublesome happens which you think may be due to the medications, call us and let us know what is happening. Many times the problem will have nothing to do with the medication at all. However, it is true that with a few people there may be such reactions as constipation, blurring of vision, delay of urination, or perspiration. Such "reactions" are usually temporary or can be controlled with other medications. If a very fast pulse occurs with Norpramin, Asendin, or any others, stop taking the medication and call us.

14.   There is no truth to the negative publicity about Prozac. The scare tactics and interviews in the media have been paid for by the "Church" of Scientology. This cult is well financed and is waging a media war against medicine and psychiatry. The FDA and the National Institute of Mental Health reaffirmed in August 1991, after 2 additional years of study, that Prozac is a very safe and effective antidepressant.

15.   Prozac, Zoloft, Paxil, Anafranil, and Effexor can frequently cause problems with your sexual feelings. Of course, depression, itself, may cause some loss of sexual feelings. If, after beginning one of these medications, you lose sexual interest or start having serious problems with orgasm, let us know. It is not your fault! There are other antidepressants that will not cause this side effect (Serzone and Wellbutrin).

16.   You should be able to work, drive, and carry out your usual activities while taking the medication. When first beginning the antidepressant, you should use some caution about driving or engaging in other possible dangerous activities until you see how the medicine will affect you. This especially applies to Amitriptyline and Doxepin, but usually you can do anything you wish, especially after the first two or three days. If you are too sleepy after that, call us and we will change it to another antidepressant that will not cause you to feel so drowsy. It is also important to avoid alcohol while on antidepressants.

17.   Antidepressants are only effective in the treatment of symptoms that stem from a depression. They will not provide relief when symptoms are due to the presence of other medical disorders (i.e. thyroid problems). If, for example, you do not have true depression, but instead are only working too hard, you will receive no beneficial effects from these pills. If you do not have true depression, but instead are simply unhappy, then the pills will give no happiness. If your headache or stomach ache could be due to some other disease, the pills will not relieve the pain. They are effective only when depression is present, and in that situation they usually provide dramatic and gratifying relief to all the symptoms. Thus, you can see the basic difference between these medications and such drugs as alcohol, "nerve pills", sleeping pills, and the like. All of these drugs can be used as an "escape" from life's problems, and as such can be habituating. The antidepressants cannot be used that way. This is their greatest safety feature. Antidepressants allow you to return to your normal personality. This is their greatest gift.

18.   Generally, take your medicines on this schedule:

            A.        One at night for _______ nights; then

                        Two at night for _______ nights; then

                        Three at night.

                        Take the whole dose _______ hours(s) before bed.

B.      Take one every morning.

C.      Take _________ two or three times a day.

Adapted from a lecture by:

Otis L. Baughman, III, MD, modifications by Kristen J. Kratzert, MD, FACOG

 

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