DEPRESSION

Major Depression

• Feeling depressed most of the time for most days of the week.
• Other Symptoms:
  • Loss of interest or pleasure in activities
  • Weight loss or gain
  • Trouble sleeping or daytime sleepiness
  • Feelings of being “sped up” or “slowed down”
  • Constant tiredness or lack of energy
  • Feelings of worthlessness or guilt
  • Trouble concentrating or making decisions
  • Suicidal thoughts
• Doctors may make a diagnosis if a person has five or more of these symptoms on most days for 2 weeks or longer. Also , at least one of the symptoms must be a depressed mood or loss of interest in activities.

Persistent Depressive Disorder

• Depression that lasts for 2 years or longer. It used to be known as dysthymia.
• Symptoms:
  • Change in your appetite
  • Excessive or lack of sleep
  • Fatigue or Lack of energy
  • Low self-esteem
  • Trouble concentrating or making decisions
  • Feel hopeless

Bipolar Disorder

• Mood episodes that range from extremes of high energy with an “up” mood to low “depressive” periods.
• The low phase consists of symptoms of major depression

Seasonal Affective Disorder (SAD)

• Period of major depression that most often happens during the winter months, when the days grow short and you get less and less sunlight.

Psychotic Depression

• Presents with symptoms of major depression along with “psychotic” symptoms, such as:
  • Hallucinations (seeing or hearing things that aren’t there)
  • Delusions (false beliefs)
  • Paranoia (wrongly believing that others are trying to harm you)

Postpartum Depression

• Major depression in the weeks and months after childbirth

Premenstrual Dysphoric Disorder (PMDD)

• Occurs in women who experience depression and other symptoms at the start of their period
• Other symptoms:
  • Mood swings
  • Irritability
  • Anxiety
  • Trouble concentrating
  • Fatigue
  • Change in appetite or sleep habits
  • Feelings of being overwhelmed

DIAGNOSIS

Physician may do/request:

• History & Physical Exam
  • Talking with the patient may be the most important diagnostic tool the doctor has.
  • The doctor must hear about specific symptoms of depression by talking with a patient and learning about other things that are relevant to making a depression diagnosis.

RECOMMENDED MEDICATIONS

Anti-depressants

• It is important to keep these points in mind:
  • Only about 30% of people with depression go into full remission after taking their first course of antidepressants. That’s according to a 2006 study funded by the National Institutes of Health. Those who got better were more likely to be taking slightly higher doses for longer periods.
  • Some antidepressants work better for certain individuals than others. It’s not uncommon to try different depression medicines during treatment.
  • Some people need more than one medicine for depression treatment.
  • Antidepressants carry a boxed warning about increased risk compared to placebo for suicidal thinking and behavior in children, adolescents, and young adults 18-24 years old.
  • Consult your doctor for the risks and benefits of treatment and the optimization of the medication that best relieves your symptoms.

Types of Anti-depressants:

• Selective serotonin reuptake inhibitors (SSRIs)
  • Most common class used for depression. Examples include citalopram (Celexa), escitalopram (Lexapro), paroxetine (Paxil, Pexeva), fluoxetine (Prozac, Sarafem), vortioxetine (Brintellix), and sertraline (Zoloft).
• Serotonin and norepinephrine reuptake inhibitors (SNRIs)
  • Newer type of antidepressant. Examples include venlafaxine (Effexor), desvenlafaxine (Pristiq and Khedezla), duloxetine (Cymbalta), and, levomilnacipran (Fetzima)
• Tricyclic antidepressants (TCAs)
  • Among the first medications used to treat depression. Examples are amitriptyline (Elavil), desipramine (Norpramin, Pertofrane), doxepin (Adapin, Sinequan), imipramine (Tofranil), nortriptyline (Aventyl, Pamelor), protriptyline (Vivactil), and trimipramine (Surmontil).
• Monoamine oxidase inhibitors (MAOIs)
  • Among the earliest treatments for depression. Examples are phenelzine (Nardil), tranylcypromine (Parnate) , isocarboxazid (Marplan), and transdermal selegiline (the EMSAMskin patch).
  • Not prescribed very often because of the risk of dangerous reactions

Other medications:

• Bupropion (Wellbutrin, Aplenzin
• Mirtazapine (Remeron)
• Trazodone (Desyrel)