Major depression: symptoms, diagnosis, and treatment approaches

¶ … Clinical Depression

Major depressions or unipolar depressions are some of the names by which the term Clinical depression is known, which is a type of depressive disorder. To explain, it is a condition that is to be diametrically observed, in the sense that the expert does not count on a patient's self-report but checks for indications of depression that can be noticed and recognized. (Schatzberg, 2002) Clinical depression is a term that explains a situation serious enough to require medical, that is expert help and may even require pharmacological involvement. Clinical depression, as stated by various medical sources, survives for a period of two weeks and is usually not impetuous because of any external being or thing.

In a year, clinical depression affects at least 19 million American individuals. Not considering whether the individual is young or old, man or woman, regardless of race or income any body can be affected by clinical depression. This affects humans too to a large extent. Individuals who are facing depression tend to have higher rates of divorce and unemployment. Depression can bring about populace to misplace the bliss from their every day life. Though it would be natural to experience grief after the bereavement of a friend or family member, certainly the majority of us undergo sorrow from time to time in our lives, possibly because of a divorce, or having to depart from family and acquaintances, or we may even have to lose a job or even health due to sickness. Majority manages in the midst of these fatalities without actually getting clinically depressed. If the sorrow or miserable mood prolongs for a long epoch, the individual may be coming into contact with clinical depression. (Ramin, 2002)

Most of the Indications of Depression comprise of bad temper, grief, fatigue, poor self-image, self-criticism, disgrace, culpability, manic behavior, and suicidal feelings. (Yaffe; Edwards; Covinsky; Kenneth and Eng, 2003) The indications of depression differ amid persons. One individual might feel restless and will not get sleep, while others may become sluggish and slumber for the most part of the day. Every now and then it can be of assistance to study the alteration in thinking and deeds for obvious symptoms. Body- Insomnia and weariness manifest the most obvious form in which depression can be realized in the body. It influences the psyche, complexity in making judgment, reduces the power of attention or even indulges in "rumination," which refers to the constant ponderings on a particular topic.

Depression can cause individuals to act self-destructively, on impulse, cry hysterically; try to kill themselves, or probably make use of drugs or alcohol to manage the stress. Thoughts of grief, worthlessness, purposelessness and extreme culpability can activate depression. Also, Depression can make dealings with other individuals further complicated and may also cause the individual to venture into a disparaging affiliation or make them opt for public separation. Depression influences all phases of the individual's life, from sleep troubles to relationship troubles. (Rosenthal; Wilson, 2002) There are lots of writings that suggest that in order to handle these long-term disease in some one who is near to you can prove to be psychologically demanding.

When influenced by depression, the physical body, mind and feelings of individuals affected. When an individual is affected on these three areas, it deeply affects the individual, and the person will not have the energy to strike back, and would withdraw totally from the environment. While at job depressed persons are prone to be deliberate and not very productive, and they also seem to be very vacillating and unsure, and also tend to make more mistakes. (Goldberg & Steury, 2002) When at home, they may not show concern in family and may not be able to take pleasure in their companionship and communal proceedings and also may not be stable enough to take part in family affairs. They will also not be capable to display fondness or love for dear ones and may even lack interest in their lovemaking. Also noticed is the fact that they will be inclined to stay away from friends and social gatherings, and will feel very dissatisfied with their hobbies and their leisure activities.

The disability of the individual grows, as the illness gets more relentless. Persons, who are affected only mildly, may be upset by their condition but will be able to perform their various daily activities only with great difficulty. As the disease increases, so do the symptoms, and this would ultimately make it difficult to perform at all and also probably let the individual have problems in attending to even the short-term activities of keeping the body fine. This is when the individual shall incline towards feelings of suicide and self-neglect and hence he/she needs to be kept under supervision which would be best available in a hospital.

Research has constantly discovered a connection between depression and negative effects on the body. For instance, depression comprises of stronger chances of increasing high blood pressure or hypertension and may also cause the person to have a heart attack or may cause him to die of a heart disease. Numerous hypotheses have anticipated explaining the link between mind-body, which states that depression, has a considerable affect on the cardiovascular system. Investigation is still on to be able to get the entire picture. This also goes to prove that there is a connection between clinical depression and cardiovascular health. Surveys have proved that in comparison to say about 10% of individuals in the US who are affected with physically health problems there are nearly 20% of them who are heart patients but do not seem to have a heart attack history and another 65% who have heart attacks. These studies are still on and are still continuously examining the connection between clinical depression and cardiovascular health. (Ramin, 2002)

These studies have led to various discoveries like the fact that in originally fit persons the beginning of clinical depression can envisage the growth of heart disease. In general death rate is in a span of six months following a heart attack is higher in depressed patients than others who are not depressed. Lower levels of depression have shown to lead to high blood pressure. If a person is depressed for a month before his coronary artery bypass there is a chance that he will be affected to other cardiac affects like angina for nearly five years after the event too. Even in individuals who have a congestive heart failure, depression may lead them to be admitted in hospital again and also would result in death. (Gold & Charney, 2002)

Moreover, this risk is present in people of all ages alike, as stated by the New York Heart Association Class and Ejection Fraction. Another factor is that clinical depression can also increase the probability of increasing or dying from a heart problem, and also heart problems can invariably increase the chances of clinical depression. A lot of patients feel sorrow, a failure to be in charge of, lack of confidence about disfigurement gained form a heart surgery and also a loss of youth along with million other feelings that ultimately lead to clinical depression. All these feelings are real and are not just thoughts of weakness or disappointment. It is a true fact that when depression is left without proper treatment then it becomes more expensive.

A study conducted by RAND Corporation came to the conclusion that individuals with depressive symptoms tend to take more rest and holidays then others who had severe symptoms like diabetes, arthritis, back problems, lung problems or gastrointestinal disorders. It has been calculated that USA faced nearly 30 to 44 billion dollars of loss during the year 1990, out of which nearly 12 billion dollars were lost because of the number of working days that people took off. Another 11 billion dollars were lost because of reduced productivity, because of various factors that ultimately weaken the individual, which affect his working habits, and bring trouble with attentiveness, reminiscence, and decision-making. The amount of cost shall further increase if the depressed worker starts to indulge himself in alcohol and drugs. More costs shall be incurred if the workers family member or colleague is suffering with depression, because this will result in disruption of working hours, more number of days absent from work, affect the individuals concentration, morale and ultimately decrease productivity. (Werner, 2003)

Interference by professional therapy or counseling is mostly required to assuage the disorder. (Abeles & Victor, 2003) Clinical depression mostly is left without treatment, as most individuals do not recognize the symptoms. Symptoms like sadness and withdrawal may be well-known but others like anxiety, panic, irritability and sleeplessness may not be well-known. There are some individuals who are under the assumption that only those people who have had a long period of illness are faced with clinical depression, but this is not true. There are still other people who feel that depression is common for old people, young adults, new mothers, menopausal women and also those with chronic illness, which is stretching the truth widely as the real truth behind the whole fact is that clinical depression is mostly never normal and also has nothing to do with age or life situation. Moreover people do not know the entire truth as to how clinical depression actually works and also to realize as to the kind of treatment required. Like lots of other diseases if the treatment for this is also given at an earlier stage then the illness is easier to get rid of and also early treatment can prevent serious recurrences.

The main causes for depression are chemical imbalances, stress, drugs, reactions to medication, and mental disorders. Most Psychiatrists felt that the reason behind mental illnesses usually is because of early-childhood encounters. But lately, psychiatrics have come to the conclusion that it is not the parents who are responsible but the brain of the individual. The concept that mental illness was caused by a disparity of chemicals in the brain erupted in the 1950s when nearly the presently used psychiatric drugs were exposed by probability to assuage the symptoms of definite mental illnesses. Taking for example, the monoamine oxidase inhibitors (MAOIs) were initially used as a treatment for tuberculosis, but it was later realized that patients with advanced TB got very happy after consuming them and hence they started to be used as antidepressants - e.g. phenelzine.

Even the neuroleptics were initially initiated as antihistamines but later it was realized that they serendipitously assuaged the symptoms of schizophrenia after which they started to be used for those individual - e.g. chlorpromazine. Like the chlorpromazine even the tricyclic antidepressants also have been noticed to have an analogous composition and were experimented in people who complained of schizophrenic. It came to the notice of many nurses that those individuals who ere depressed became less so and hence they started to being used in those with depression. Even Benzodiazepines was discovered by accident when it was realized that animals that it usually calmed down animals that complained of aggression and who were frightened and it also kept the Siamese fighting fish from fighting. After this they were tried on humans and it was realized that when it was used in large doses it reduces anxiety.

The drug companies whose chemists had developed these drugs and were looking for a market financed many of the early trials of all these drugs. These drugs were at first tried out in various hospitals all over Europe in various patients who were suffering from chronic disease which were usually schizophrenia or TB. This led to various psychiatrists coming to the conclusion that if chemicals could help the people with mental condition, and then they were in some way responsible for that mental condition. After this a lot of research was conducted and a several drug companies started to try and analyze the reaction of their drugs. (Gold & Charney, 2002) It was realized that Neuroleptics blocked the dopamine receptors and this lead to the dopamine theory of schizophrenia. Also it was realized that Antidepressants also increased the monoamines, and the serotonin, and that gave rise to an increase in the serotonin theory of depression. Later it was also realized that these Benzodiazepines also bound GABA receptors like barbiturates and also provoked a lot of analogous drugs which were mostly used in severe anxiety conditions and also these drug companies also were responsible to spread the idea that mental imbalance was caused by the brain chemicals and also came up with new illness, thus making the psychiatrist easily adapt to the idea as an easier form of treatment.

This also started off a kind of transformation in the world of science and as people realized that the symptoms that they earlier thought of as psychological, actually had physical, chemical basis to them and it was what actually motivated them to further their research in that field.

The year 1963 was one that actually can be called as the age when the U.S. was in its psychopharmacological infancy stage and the LIFE magazine also started to educate the public about the concept of brain chemical imbalances. Many of the physiatrists also had started to test out the various medicines and drugs, specially the LSD and were very surprised at the way these were actually gaining reactions and also were amazed at the reaction of the individual's behavior, emotions and personality. This lead to a theory that stated that since there were such huge variations in behavior even after consumption of such a small drug which obviously affected the brain, then this would obviously mean that there were changes in the variation of behavior because of the chemicals induced in the brain chemistry. The concept that there could be some other external force, which was responsible for this, was absolutely not even considered and only the fact that the brain was responsible was kept in mind. (Tohen, 2003)

Many psychologists like B.F. Skinner have stated that scientists could and should control human behavior and also try and predict how the individual's mood or how his reaction would be in future or else this should be at least tried and maintained with the help of drugs. Psychiatrist Nathan Klien in the year 1967 who was actually an MK-Ultra participant came up with a calculation that showed as to how psychiatry actually intended at using the drug for behavior control and not for treating mental illness. Klien was actually involved in studying the various effects of psychiatry drugs on human beings and came to the realization that the present usage of drugs were pretty much moderate when compared to the number of chemicals that shall actually be available for the human body by the year 2000. By accepting the fact that human moods, motivation and emotion are actually caused by neuro-chemical state of the brain and these drugs actually just make the brains neutral condition. When we are going to stop using these and actually bring into consideration as to which kind of neuro-chemical states that we want for the people, it will bring a stop to this drug abuse.

There is a chemical balance or imbalance generating the ontology or subjective reality of ours, according to the current theory among doctors. According to this theory; the effect is total or exclusive. We get a clear explanation on the way the formation of our subjective reality takes place by way of this theory, like threading is done in the warp for weaving a fabric. According to the theory some neuro-chemical transmitters cross the synaptic space and activate the ensuing set of neurons; and as these neurons get activated, a condition of Depression, which is known in DSM-III-R as Dysthymia or Depressive Neurosis, develops in our ontology. This is a condition that can be described as a disturbance of mood that involves a depressed mood or in the case of children and adolescents; it could be an irritable mood. Low self-esteem, poor concentration or difficulty in making decisions, Insomnia or hypersomnia, low energy or fatigue, poor appetite or overeating and feeling of hopelessness are some of the symptoms associated with this type of depressed mood. (Tohen, 2003)

Based on these basic principles, the theory also says that by properly blocking the release of these transmitters or their passage across the synaptic space, the development of Depression also can be blocked. Here, as the pool of neurons, due to the neurological activity of which the depressive state is brought out, are rendered functionless and hence the Depression does not arise. But, is it possible that merely by rendering this pool of neurons functionless we can prevent the state of depression?. It is not possible, nor is it logical. For this type of an experience really something else has to take place. Neither we are sure about the scientific accuracy of the claim implied in it, nor the current fashion of thought in medicine does not match our concern here. (Peter; Bryne, 2002)

So we need to analyze whether mental illness is caused by the chemical imbalance in the brain. Though it is possible, it not that simple. Individuals have been diagnosed with chemical imbalances in spite of the actuality that there is no test that exists to stand as truth to this assertion and also there is no genuine formation as to what a correct chemical balance would be. (Lyons; Cukrowicz; Reeves & Joiner, 2002). Opposing the popular thought that scientists have not been able to come up with a consistent genetic, anatomical, biochemical, or other functional marker that can actually differentiate healthy people from the mentally ill.

But this does not really stop the psychiatrist from coming up with basically unverified statements that depression, anxiety disorders, bipolar illness, alcoholism, and a multitude of additional disorders are actually mainly biological or even genetic disorders, and in some time this shall be proven. Studies so far have been kind of helpful but have not really proved much and the conclusions that are drawn in one lab are usually not the same as another. For example even when studying schizophrenics many of these do not really show acts of abnormality. (Telford; Hutchinson; Jones; Howe, 2002)

This brings to the question as to what relates to serotonin. Does lack of the neurotransmitter serotonin cause depression. Most of the recent studies have said to prove that depression is the result of the imbalances in the brain's serotonin levels. (Rapoport; McCullagh; Streiner & Feinstein, 2003) This serotonin is supposed to be responsible for the moods. Lack of serotonin is said to lead to depression and a sudden increase or decrease may lead to bipolar disorders or manic depression. The selective serotonin reuptake inhibitors or the SSRI's are said to help in controlling the brain's serotonin levels and also are said to relieve the individual under depression. But this also has ultimately resulted in various complex data and some of which are not really convincing. The brain is said to consist of various different neurotransmitters and neuro-modulators and these are all highly interconnected. (Werner, 2003)

In such a situation the antidepressant Wellbutrin or bupropion is said to have less reaction on the serotonin and there are a lot of studies that have been conducted that stand to prove that Wellbutrin is no less effective than the other antidepressants. (Rifkin, 2003) So this brings us back to the question as to why we think of serotonin as the major reason, although we have Prozac, Zoloft, Paxil, Luvox, Celexa and Lexapro all of which show serotonin re-uptake in the synaptic terminals. This leads us to believe that the companies responsible for this obviously wanted to promote the serotonin concept. Therefore, we can conclude that our mental states depend upon our physical, chemical, and electrical properties of the brain.

The mind is not separate from the nervous system. The substantiation though is pretty much overpowering for this particular approach, but besides the fact that this does not really mean that mental illness are actually become fashionable because of the simple chemical imbalance theories. (Leuchter; Cook, Witte; Morgan & Abrams, 2002). These theories still don't stand to fit in exterior rudiments, taking for example, argument with family, bad sleeping habits, not being able to be involved in a romantic relationship or minor problems with the job, and all this will ultimately lead to emotional problems. This brings us to back to the situation that if chemical imbalance is not responsible for depression then it is the duty of the medical community to come to a conclusion as to what exactly is causing all this depression.

There are thoughts that the actual human ontology is much different from the naive and ludicrously reductionist concept of chemical imbalance. Though major depression is an upsetting sickness, it can be treated. Nearly 80 to 90% of the people suffering from severe depression can be easily cured and can be brought back to their normal life. (Grucza, 2002) There are a lot of types of treatments available and the kind chosen usually depends on the individual and his illness. Basically there are three types of treatments for depression that are medication, psychotherapy and electro-convulsive therapy or ECT, and all of these can be used separately or together.