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  1. #1
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    Depression can creep in through many different doors

    Depression can creep in through many different doors
    By Elinor Stanton
    Monday, April 2, 2007

    Why do people get depressed? Depression occurs for a variety of reasons. It can develop in response to a specific situation or life event, such as loss of a loved one, disappointment in career or plans, or any major stressor. This type of depression is referred to as ?reactive? as it has a definite cause and is usually time-limited. In fact reactive depression often dissipates when its triggers have been resolved.

    More often than not however, depression is due to a mix of external events and internal physiological changes. A stressor such as divorce or loss of a job places an unusual demand on the brain to produce certain neurochemicals. In addition stress changes the whole balance of hormones in the body, increasing some such as cortisol, and decreasing others that are needed for effective coping. These in turn influence brain chemicals.

    Genetics also play a role. Studies of the human genome indicate that at least 60 percent of us have genetic weaknesses that predispose our minds and bodies to less than effective functioning especially when stressed. For example, the neurochemicals serotonin, norepinephrine and dopamine are involved in maintaining a positive mood but any or all of these can be thrown off balance by stress or illness.

    Chronic abuse, physical or emotional, stresses the body and nervous system, interfering with a healthy balance of neurochemicals. Individuals raised in abusive or dysfunctional families tend to manifest a greater propensity to depression than the general population.

    Another source of depression is bipolar disorder, formerly known as manic-depressive illness. Again, heredity and neurochemicals together create a vulnerable mix that given the right combination of external circumstances can erupt into major depression, mania or both.

    Medical issues can cause, predispose or contribute to depression. It?s critical to be alert to the possibility of medically induced depression. The possibilities of medical factors range from diabetes, thyroid imbalance, vitamin deficiencies to heart disease, neurological problems, even certain forms of cancer.

    Depression in the elderly may be an early sign of dementia. Anyone depressed for the first time should have a complete physical exam to rule out medical causes.

    Hormonal imbalances not infrequently induce depression in women, and possibly men also. Premenstrual dysphoric disorder (PMS) falls into this category, as do postpartum blues and depression. Postpartum depression carries the potential to be very serious and is also strongly associated with undiagnosed bipolar disorder. Postpartum psychosis is a rare variant of postpartum depression. It?s one cause of maternal harm to infants. Unfortunately the media hype around such cases labels these mothers as merciless and cruel rather than the very ill individuals they actually are.

    What are the signs of depression? In general any changes in sleep, appetite, mood, energy, motivation, concentration, libido and interest in life should be seen as warning signs that depression is a possibility. Any change that lasts longer than two weeks should be investigated by a professional.

    Depression is most effectively treated with a combination of antidepressants and therapy. In mild to moderate forms therapy alone may be effective. However, if after three to four weeks of therapy no improvement is noted medications should be seriously considered. When depression is severe, antidepressants should be immediately initiated. Also a suicide assessment is crucial in this case to rule out the need for hospitalization.

    A wide array of antidepressant medications is available. If bipolar disorder is present medications called mood stabilizers are also used, either alone or combined with other medications. Depression is now more treatable than ever and no one need suffer from it in this day and age.

    New laws of confidentiality have made providers wary to such an extreme that some refuse to speak with spouses or parents of patients. This problem can be resolved by explaining to patients the need for family cooperation, telling patients exactly what will be discussed and obtaining written permission from them to keep family informed. Even better is to include close relatives or other appropriate parties in some or all appointments.

    Not only patients but their families should be educated regarding medications. Everyone involved must be aware of possible side effects and early signs of relapse to be prepared any eventuality. There are times when a provider should be informed of changes in status but the patient is either unaware of his/her condition or is afraid or unwilling to call.

    Elinor Stanton is a psychiatric nurse practitioner on Marco Island. She has 29 years of experience as a therapist in private practice and with a large health maintenance organization in Boston. Visit her Web site at http://www.etseven.net.

  2. #2
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    Re: Depression can creep in through many different doors

    Very interesting article especially this part:

    Studies of the human genome indicate that at least 60 percent of us have genetic weaknesses that predispose our minds and bodies to less than effective functioning especially when stressed.
    Thanks for the post David

  3. #3
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    Re: Depression can creep in through many different doors

    Good article... I can relate to a lot of it unfortunately...

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