Depression

Depression, in its clinical form, will afflict somewhere between seven and eighteen percent of the population in the developed world before their fortieth birthdays. In some places, as many as 25% of women and 20% of men suffer from clinical depression, making it the number one cause of disability in many countries

Clinical depression is projected to be second only to heart disease in terms of numbers of disabled by 2020.

Depression is defined as extreme sadness or despair so debilitating that it has a disruptive influence on a person’s ability to live a normal life. Clinical depression is more than just ‘feeling sad’, it is a state of constant negativity which can lead to self-abuse, substance abuse or even suicide.

The types of treatment available for sufferers of depression can be split into two categories of help, psychotherapy and medication, usually deployed in conjunction with one another. Lifestyle modifications, such as a change of diet or getting more exercise, can also be hugely beneficial.

It is common for different patients to respond in vastly differing ways to treatments. Depression is a complex illness and treatment is rarely simple or by the book. Persistent depression will warrant a complete checkup by a qualified medical professional, and almost certainly a psychiatrist as well.

Sometimes sufferers become so depressed that their lives are in immediate danger. In such circumstances, hospitalization is often the only option to ensure their safety until such time as their depression becomes less severe. Some patients are partially hospitalized, which may mean that they spend the day in a hospital and nights at home in their own bed, or perhaps that they stay at a hospital during the week and are allowed home at weekends.

The gold standard in terms of today’s drug treatments for depression are SSRIs, or selective serotonin reuptake inhibitors. Serotonin is a chemical that occurs naturally in the brain, which uses it as part of the process that transmits signals across neuron pathways.

Most doctors agree that one of the common causes of depression is probably a lack of serotonin in the brain, and SSRIs work to combat this problem by preventing the re-uptake of serotonin by what is known as the pre-synaptic nerve. This ensures that more serotonin is available at the site of the synapse itself.

Selective serotonin re-uptake inhibitors in common usage include fluoxetine (Prozac), sertraline (Zoloft), citalopram (Celexa) and paroxetine (Paxil). These relatively new types of anti-depression drug are known to cause less side-effects than the older tricyclics and MAIOs that used to be commonly prescribed, however some patients may experience anxiety, insomnia, drowsiness and dry-mouth, among other things. These side-effects are quite likely to diminish as the course of treatment progresses.

SNRIs, or serotonin norepinephrine re-uptake inhibitors, are a slightly different kind of anti-depressant, which act on both 5-HT and norepinephrine. They share many possible side-effects with selective serotonin re-uptake inhibitors, and additionally are more likely to cause dependence in the patient, necessitating a gradual reduction of dosage before the course of treatment can be completed.

Types of SNRI, along with their popular trade names, are: duloxetine (Cymbalta) and venlafaxine (Effexor).

NASSA, noradrenergic and specific serotonin antidepressants, work in a slightly different manner again to the above two. They increase serotonin and norepinephrine neurotransmission by means of blocking the pre-synaptic alpha 2 adrenergic receptors, and simultaneously blocking selective serotonin receptors in order to minimize side effects. Mirtazapine (Remeron, Zispin, Avanza) is the only currently available type of NASSA on the market.

NRIs, norepinephrine reuptake inhibitors, increase alertness and concentration in addition to the antidepressant qualities. They can also increase aggression. An example of a NRI is reboxetine (Edronax).

NDRI, norepinephrine dopamine reuptake inhibitors, as their name suggests, inhibit the re-uptake of norepinephrine and dopamine by the neurons. Wellbutrin and Zyban are examples of this kind of drug, both based on bupropion.

An older type of antidepressant drug is the tricyclic antidepressant. Tricyclic antidepressants work by blocking the re-uptake of particular neurotransmitters, for example serotonin and norepinephrine. Tricyclics are less usually prescribed nowadays due toe the availability of newer, safer and more effective antidepressant drugs such as SSRIs and SNRIs. Possible side-effects of tricyclics are blurred vision, dizziness, high heart rate and sexual dysfunction.

In cases of severe and persistent clinical depression, tricyclics are still prescribed despite their risks, due to their substantial potency and the fact that some patients simply do not respond to the newer drugs. Examples of tricyclic antidepressants still being prescribed today include desipramine and amitriptyline.

MAOI is short for Monoamine oxidase inhibitor, a potent antidepressant that is not prescribed often these days due to potentially fatal side-effects if used in conjunction with certain food substances, or other medications. An example of a MAOI is phenelzine (Nardil).

Sam-e, S-adenosyl methionine, is derived from methionine, an amino acid that occurs naturally in the body. SAM-e is available over-the-counter in the US, and as a prescription medication in most of Europe, and has been demonstrated to be of similar effectiveness to many more traditional antidepressants, with the bonus of having fewer recorded side-effects.

The metal zinc, when taken as a supplement, has been demonstrated to possess antidepressant qualities, as has magnesium.
Ginkgo Biloba is a natural antidepressant which facilitates the usage of sugars and oxygen within cells.

St John’s Wort can sometimes be an effective treatment for depression, but should be used with caution as it can have serotonin-related side-effects when taken with MAIOs or SSRIs.

Sometimes a vitamin B-12 deficiency can manifest with symptoms of depression.
Any course of antidepressant treatment should be continued until its conclusion, even if the patient feels better. Not continuing with a course of antidepressants can lead to a relapse and even worsening of symptoms. Accepted wisdom is that four to six months of treatments should be continued even if the patient feels 100% well again.

Depression