Frequently Asked Questions About Depression

I think I'm depressed, where can I get help?

Talk to your primary or family physician. He or she will be able to review the signs and symptoms of depression with you, as well as rule out a possible physical cause for your symptoms. Following diagnosis, your physician can then initiate antidepressant therapy or refer you to a psychiatrist and/or threrapist or an EAP (employee assistance program) if you have one, for appropriate evaluation and treatment. Another route is to consult with your clergy, local hospital, community mental health center or telephone hotlines in your area for a referral for an appropriate evaluation.

It seems that more people are depressed nowadays than in the past. Is the rate of depression increasing?

Depression is common. That having been said, it is also important to point out that this is a seemingly simple question that requires a very complicated answer. While research documents an increase in the number of cases of depression reported and the number prescriptions for antidepressants, it is unclear whether this results from either a true increase in depression due to the stresses of modern life or from increased awareness and recognition of depression as a treatable medical illness. In any event, it is clear that major depression is common.

What is the difference between grief and depression?

Grief is a natural reaction to the loss of an important relationship. As human beings, our bonds to each other develop early (virtually at birth), are strong and often influence major decisions in our life. When we lose a significant relationship in our lives, it is natural for us to feel sadness or other depressive symptoms, such as loss of appetite and disturbed sleep. In fact, about 30 percent of people who have lost a significant other will continue to have these symptoms two months after the loss. These symptoms, however, usually lessen within six months.

Although both conditions may have depressed mood, loss of appetite, sleep disturbance and decreased energy, people with depression usually experience a sense of worthlessness, guilt and/or low self-esteem that is not common in normal grief reactions. For some, a grief reaction can develop into a major depression. For example, about 15 percent of grieving individuals will develop major depression after one year of a loss.

When is being depressed a normal reaction and when is it truly major depression?

All of us have days when we feel "depressed." Usually, these feelings are temporary, and we can have a great day tomorrow. Even when we have a bad day, we can still find enjoyment in things. These occasional bad days are part of life and not depression. Remember, a diagnosis of depression requires that you have these symptoms every day, or nearly every day, for a period of two weeks.

Sometimes, these feelings may persist for several days or even a week. This is common following the break-up of a relationship or other unpleasant event. Still, while you may have some of the symptoms of depression, it is unlikely that you have major depression unless a number of the symptoms are present and impair daily functioning. Even if you do not have major depression, you may have an adjustment disorder that would benefit from professional help. A trained professional can differentiate between a period of the blues and clinical depression.

How do most people react when they are diagnosed with depression?

For some people, a definitive diagnosis is a relief: "At last I know what I have," is their reaction, even if it comes months or years after the onset of symptoms. For others, however, the diagnosis comes as a terrible shock. Many people are ashamed of having a mental illness. Both reactions are quite normal.

Even when a definitive diagnosis is made and accepted, there may be additional concerns about the unknowns of the disorder: its course and outcome, worries about work, effects on family and frustrations about physical and emotional limitations. It is not unusual for these concerns to be expressed as anger, which may further deepen the depression. What is important is to know that depression is treatable and carries a good prognosis. Whatever your reaction, you are not alone, as depression is a common and very treatable problem.

What can I expect regarding other people's reaction?

A person suffering from fatigue and weakness, two symptoms of depression that can occur without obvious signs of physical disability, may look fine. Family members and friends may unsuspectingly expect more from the depressed person than he/she is capable of doing. Those symptoms may, then, be seen as character defects. Fatigue, for example, is frequently interpreted as laziness, or lack of initiative; depressed mood is sometimes seen as self-pity. These reactions may lead patients to begin to doubt their own self-worth. It is important to discuss this issue with your therapist and identify ways of handling this. It is important to remember that millions of people are disabled from a chronic injury or disorder and are living life to the fullest if they get proper treatment.


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Change Can Be Hazardous to Your Health

The beginning or end of a relationship is always a time of tension and turmoil. Likewise, any change in your life can cause stress: a new job, starting college, even a vacation. Although change puts spice in our lives, all change demands some adjustment. But, did you realize that too much change of any sort can jeopardize your health? Even events that we welcome may require major changes in our routines and adaptation to new requirements.

Studies reveal that one of the most desired changes in a married couple’s life, the birth of their first child, is also a source of major stress, contributing to reduced marital satisfaction for many couples. On the other hand, stress may result more from anticipating events than from living with them. For example, a review of research on the psychological responses to abortion reveals that distress is generally greatest before the abortion. Severe distress is low for most women following the abortion of an unwanted pregnancy, especially if they have had social support for their decision.

In general, significant levels of stress can result from any important life change, but people vary considerably in the ways they respond to change in their lives. Sometimes people can absorb stress and keep on functioning. Their reactions depend on their resources and the contexts in which stress occurs. If you have the money, time, and friends to help you pick up and go on after a disruption, you will certainly fare better than someone for whom more bad news is the last straw in a series of setbacks they have faced alone.


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Interpersonal Therapy (IPT)

Interpersonal therapists focus on the patient's disturbed personal relationships that both cause and exacerbate (or increase) the depression.

Interpersonal Psychotherapy (IPT) is one of the short term therapies that have been proven to be effective for the treatment of depression. Short term psychotherapy usually involves up to 20 sessions (usually weekly meetings, 1 hour per session) and maintains a focus on 1-2 key issues that seem to be most closely related to the depression.

Interpersonal psychotherapy

The treatment is highly structured. The number and content of treatment sessions are planned carefully. The initial assessment period lasts 1 to 2 sessions. Interpersonal problems are considered under 4 heading:

* bereavement and other loss
* role disputes
* role transitions
* interpersonal deficits such as loneliness

Problems are considered by reference to specific situations and alternative ways of coping are evaluated. Clear goals are set and progress towards them is monitored. New coping strategies are tried out in homework assignments.

Fairburn (1997) described IPT like this: "Interpersonal Psychotherapy (IPT) is a short term focal psychotherapy in which the goal is to help patients identify and modify current interpersonal problems. It was developed in the late 1960s as a treatment for clinical depression, the premise being that since interpersonal difficulties contribute to the onset and maintenance of depression, their resolution is likely to hasten recovery".

It's based on the idea that depression is often linked to things like a fight with your partner or a problem with a workmate. Sometimes the event triggers your depression. But sometimes the depression comes first, and your mood makes fights or work problems more likely. Either way, during interpersonal therapy, your therapist encourages you to learn new and better ways of relating to people.

In trials at Oxford University IPT has been found to be an effective short term alternative to CBT (Cognitive Behavioural Therapy) in Bulimia. IPT for Bulimia such as that practised in the Oxford trials is similar to IPT for depression: it is a non interpretative, non prescriptive therapy, and works through a number of phases.

In the first phase of IPT, the therapist and client identify which problems in the clients interpersonal relationships need exploration. This phase is led by the therapist, who builds a "history" of the client in order to help the client identify interpersonal problems. The next phase is driven by the client; the therapist helps maintain focus and encourages change. Finally, in the last phase, both the therapist and client explore what has been achieved and what has not, and focus on the future and what changes the client can make to promote continuing improvement.

Although IPT is a programmed treatment, it is flexible enough to address patients' individual problems and situations. Treatment begins by taking a history of the problem. The therapist then suggests which of the four problem areas is most relevant and then asks the patient what he or she wishes to accomplish. Since IPT is time-limited (usually only 16 session long), Ms. Clougherty emphasized working on no more than two problems.

The IPT therapist begins each session by asking, "how have you been since our last visit?" Patients usually answer by describing recent dysphoric moods or recent upsetting events. The therapist attempts to link moods to recent events in the problem area.

One very interesting point about IPT is that this model works from the assumption that patients suffer from chronic (mental) illness. At the beginning of treatment, the therapist may tell a patient he or she is too "sick" to accomplish certain tasks, although later the therapist will strongly encourage the patient to take on the same or other tasks.

Since depression is a recurrent illness, it is recommended that successful short term treatment be combined with ongoing, maintenance therapy. Maintenance IPT (IPT-M) can be administered once per month following termination of the short term phase. Preliminary results from ongoing studies suggest that IPT-M may prolong time to recurrence of depression.


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Inspirational thought and depressive illness

Our Thought is the most important and influential factor in depressive illness. It is one's way of thinking about what is happening to one. Since the people with depressive personality, may have the habit of thinking negative and looking on the black side, they may find it difficult to overcome depression.

Another factor which causes depression to take roots is low self esteem - people with low esteem are more prone and susceptible to depression. A person with low esteem tends to think that their wishes and feelings are less important than those of the people around them. They have lost the ability to put themselves first due to various reasons, if they ever had it. They have no idea of how they would feel or act if left to their own devices, because their lives are almost totally laid out for the needs of others.

In brief it is the feeling that one does not deserve anything, that one is not as important as others. It is felt by people who have always been made or expected to put others first.

Mothers of young children and careers of the elderly or disabled are often victims of low esteem. Problem only arises when they find themselves confronted by a choice between what they suddenly discover they really want and their 'duty'. They feel guilty at discovering that they have wants that can only be fulfilled at some cost to those for whom they are caring.

There is definitely a relation between our mind and our body. The relationship between the way one thinks effects the way a person and his body reacts. This is perhaps the most important aspect of all psychological, and possibly physical, illness, yet most people ignore it completely.

We should now begin to acknowledge that the way we think, the expressions we have on our faces, and perhaps even the ways in which we move, may, in their turn, actually change the chemicals that are released inside us, and especially in our brains where our emotions are controlled.

The sufferer is in an emotional prison. It is the hardest of all to break out of - but is not impossible. Try developing the habit of positive affirmation. You can know about these techniques in our section - power of positive thinking. And also try out some self help techniques to develop your self-esteem. Finally and the most important is that ' Believe in yourself'.

Remember the bottomline remains same:

Always believe in yourself.


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Bright Light Therapy

Phototherapy or bright light therapy has been shown to suppress the brain's secretion of melatonin. Treatment consists of sitting in front of a full-spectrum light for about four hours per day, preferably in the mornings. This is a substitute for bright natural sunlight, the lack of which seems to cause a particular form of depression.

Dr. Normal E. Rosenthal's seminal 1985 paper defining Seasonal Affective Disorder (SAD) was the first to describe application of bright artificial light in the treatment of winter depression. Rosenthal's hypothesis was that lengthening the daily photoperiod (in effect mimicking summer day length in the northern latitudes) would effect a remission of winter depressive symptoms.

Treatment sessions can last from 15 minutes to three hours, once or twice a day, depending on individual needs and equipment used. The average length of a session for a system delivering 10,000 lux illumination is, for example, much shorter than for 2,500 lux (30 minutes vs. two hours). In clinical trials at our institute, with over 100 SAD patients who used a 10,000 lux system with UV-filtered light diffusion and angular tilt, for 30 minutes each day, about 3/4 showed major improvement of depressive symptoms. In another experiment, we found that 30 minutes was an unnecessarily long exposure for some patients (who responded fully at 15 minutes), while several required 1-hour exposures to show the effect.

Light Therapy using light box

Light treatment should be used daily in Winter (and dull periods in summer) starting in early Autumn when the first symptoms appear. It consists of sitting two to three feet away from a specially designed light box, usually on a table, allowing the light to shine directly through the eyes.

The user can carry out normal activity such as reading, working, eating and knitting while stationary in front of the box. It is not necessary to stare at the light although it has been proved safe.

Treatment is usually effective within three or four days and the effect continues provided it is used every day. Tinted lenses, or any device that blocks the light to the retina of the eye, should not be worn.

Light Therapy for Seasonal Affective Disorder

Light Therapy found to be effective in cases of seasonal affective disorder (SAD). Dramatic improvement can be seen within a week or two.

Spending an hour outside each day can often produce beneficial results in some individuals. However, one cannot get early morning outside light in the winter. Not everyone's job will allow for an hour-long outside walk. Only highly motivated people will continue their daily walk when it the rains or snows.

This is not a treatment that is widely available on the National Health services in the UK, but it is possible to buy your own lamp to use at home. However, it is best to be sure that the depression from which you suffer is SAD. It is also possible that if you become a member of the SAD Association they may allow you to hire a light for a trial period to see if it might help you.

Other Benefits of Bright Light Therapy

Increasingly, light therapy is being used to reset our body clocks - sometimes along with melatonin and sometimes on its own-no matter how or why they've been put off track. Scientists are discovering that light therapy may have potential for treatment of several other disorders in addition to that of SAD. Another area where bright light therapy has proven itself beneficial is in the area of sleep disorders. Advanced sleep phase syndrome (ASPS) is characterized by premature sleep onset and early morning awakening. Future applications of bright light therapy may well include any area where a disease or syndrome recurs seasonally, shows winter exacerbation, or plausibly is related to insufficient or ill-timed outdoor light exposure regardless of the season.

* Early Morning Insomnia
* Night-owl insomnia
* Jet Lag
* Productivity Enhancement
* Bulimia
* Late-shift drowsiness
* Nonseasonal depression
* Prolonged menstrual cycles


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Electroconvulsive Therapy

Electroconvulsive therapy, or ETC

When rapid lifting of the depression is deemed necessary to prevent suicide, electroconvulsive therapy may be a treatment of choice.

When a depressed patient is incapadtated, suiddal, or psychotically depressed or when antidepressants are contraindicated or ineffective, ECT commonly is the treatment of choice for depression. Usually, 6 to 12 treatments are needed, although in many cases improvement is evident after only a few treatments. Even so, ECT has been associated with later short term memory loss, arrhythmias, and seizure activity. Researchers hypothesize that ECT affects the same receptor sites as antidepressants.

There are some people who because of severe physical illness are unable to tolerate the side-effects of the medications used to treat mood disorders.

In studies of people treated with electroconvulsive therapy it has been found that 80% of such people report that they were helped by the treatments. About 75% say that ECT is no more frightening than going to the dentist.

How Electroconvulsive Therapy Works?

ECT works by sending an electrical charge to the brain that causes a brief and controlled seizure. Although it may sound frightening, patients receive it while under general anesthesia, and awaken with no memory of the procedure.

A series of ECTs usually consists of six to twelve treatments over several weeks. Many complain of memory loss following ECT.

Headaches, muscle soreness, nausea, and confusion are possible side effects immediately following an ECT procedure. Memory loss, typically transient, has also been reported in ECT patients. ECT causes severe memory problems for months or years in one out of every 200 patients treated.

Information on Electroconvulsive therapy, or ETC

Although the use of ECT is declining in the UK, it is still the treatment of choice in severe life-threatening depressive illness, particularly when psychotic symptoms are present. It is sometimes essential treatment when the patient is dangerously suicidal or refusing to eat and drink. The treatment involves the passage of an electric current across two electrodes applied to the anterior temporal areas of the scalp, in order to induce an epileptic fit. The fit is the essential part of the treatment. Before the treatment is given, the patient is given a general anaesthetic and receives a muscle relaxant to prevent injury during the fit. Treatments are normally given twice a week for 3-6 weeks.

Other important points on Electroconvulsive Therapy (ECT)

ECT is a controversial treatment, yet it is remarkably safe and free of serious side-effects. Postictal confusion and headache are not uncommon, but transient. Short-term retrograde amnesia and a temporary defect in new learning can occur during the weeks of treatment, but these are short-lived effects.

Generally speaking ECT is used as a 'last resort', especially on children and adolescents, and only after all other first-line therapies and treatments have failed to help.


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Alternative Treatments for Depression

A health treatment that is not classified as standard western medical practice is referred to as "alternative" or "complementary." Alternative treatment for depression refers to health-care practices considered outside the scope of conventional Western medicine. Many are being integrated into traditional-medicine settings as their safety, effectiveness, and scientific validity are recognized.

Alternative treatments for depression rely on the fact that depression, at crux, is a biochemical illness. Whether the main triggers are physical or emotional, these triggers then induce a broad range of neurochemical changes that, in turn, leads to the feelings of depression and to the physical and psychological disruptions that being depressed then causes.
Once one thinks about the biochemistry it should not be surprising that alternative treatments for depression often play an important role.

There are many alternative treatments available for depression. Each of these alternative treatment of depression addresses human suffering in different ways, but generally they seek to re-establish a balance or harmony within the body and in the lifestyle of the person being treated.

Alternative treatments for depression are as follows:

* Acupuncture - The World Health Organization lists depression among the conditions for which acupuncture is effective. Some studies have shown it markedly lessens symptoms. Acupuncture can be a valuable alternative if you are unable to take antidepressants or have not found them helpful.
* Biofeedback
* Homeopathy
* Ayurveda
* Dietary factors - Because depressive symptoms can be exacerbated by nutritional deficiencies, good nutrition is important. Pay attention to eating a well-balanced diet. Quitting smoking is also advised.
* Aromatherapy - an alternative treatment for depression - Aromas can lower stress levels, affect mood, and even change perceptions of pain. The simple scents of fruits and flowers may lighten mild depression; try inhaling the aromas of jasmine, rose, or clary sage to ease your symptoms. Frankincense and sweet marjoram, inhaled or used topically, may be helpful in reducing stress, while lavender and German chamomile oils can bring on a relaxed state.
* Vitamins and Depression: like Vitamin-B(folic acid) and other supplements
* Colour Therapy
* Diet and Depression - it affects physical health and many aspects of mental health. A vitamin or herbal supplement might promote recovery of physical or mental health and/or help manage symptoms.

Colour Therapy, for example - Warm colors of yellow, orange, and red stimulate mood in color baths, lighting, room decor and clothing. People with hypertension should avoid too much red. These same colors in food provide anti-oxidants that reduce the effects mood swings brought on by allergies. Other research has found that using a negative air ionizer to lessen indoor allergies helps reduce mood swings.

Faith and spirituality have always been important in mental and physical healing. Today many spiritual leaders incorporate psychotherapy, offering professional counseling tailored to a belief system.


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