Depression.. About , Types , Symptoms, Effects & Treatment.

 What is Depression? A mental health disorder characterized by persistently depressed mood or loss of interest in activities, causing significant impairment in daily life.

10 common symptoms of depression:

1. Feelings of helplessness and hopelessness. A bleak outlook—nothing will ever get better and there’s nothing you can do to improve your situation.

2. Loss of interest in daily activities. You don’t care anymore about former hobbies, pastimes, social activities, or sex. You’ve lost your ability to feel joy and pleasure.

3. Appetite or weight changes. Significant weight loss or weight gain—a change of more than 5% of body weight in a month.

4. Sleep changes. Either insomnia, especially waking in the early hours of the morning, or oversleeping.

5. Anger or irritability. Feeling agitated, restless, or even violent. Your tolerance level is low, your temper short, and everything and everyone gets on your nerves.

6. Loss of energy. Feeling fatigued, sluggish, and physically drained. Your whole body may feel heavy, and even small tasks are exhausting or take longer to complete.

7. Self-loathing. Strong feelings of worthlessness or guilt. You harshly criticize yourself for perceived faults and mistakes.

8. Reckless behavior. You engage in escapist behavior such as substance abuse, compulsive gambling, reckless driving, or dangerous sports.

9. Concentration problems. Trouble focusing, making decisions, or remembering things.

10. Unexplained aches and pains. An increase in physical complaints such as headaches, back pain, aching muscles, and stomach pain.

 Who are at Risk of Depression?

Depression often surfaces in the context of relationships. Death of loved ones, romantic and marital breakups, betrayals by friends or authority figures can all significantly increase the risk of depression. Depression is far more likely in relationships that are destructive and painful. On a broader level, the culture also poses a risk. Cultures like ours that deemphasize social belonging have high rates of depression.

 9 Depression Types to Know.

 Major Depression

You may hear your doctor call this "major depressive disorder." You might have this type if you feel depressed most of the time for most days of the week.

 Loss of interest or pleasure in your activities

 Weight loss or gain & Trouble getting to sleep or feeling sleepy during the day

 Feelings restless and agitated, or else very sluggish and slowed down physically or mentally

 Being tired and without energy

 Feeling worthless or guilty

 Trouble concentrating or making decisions

 Thoughts of suicide

 Persistent Depressive Disorder

If you have depression that lasts for 2 years or longer, it's called persistent depressive disorder. This term is used to describe two conditions previously known as dysthymia (low-grade persistent depression) and chronic major depression.

You may have symptoms such as:

 Change in your appetite (not eating enough or overeating)

 Sleep too much or too little

 Lack of energy, or fatigue

 Low self-esteem

 Trouble concentrating or making decisions

 Feel hopeless

You may be treated with psychotherapy, medication, or a combination of the two.

 Bipolar Disorder

Someone with bipolar disorder, which is also sometimes called "manic depression," has mood episodes that range from extremes of high energy with an "up" mood to low "depressive" periods.

When you're in the low phase, you'll have the symptoms of major depression.

Medication can help bring your mood swings under control. Whether you're in a high or a low period, your doctor may suggest a mood stabilizer, such as lithium.

The FDA has approved three medicines to treat the depressed phase:

 Seroquel

 Latuda

 Olanzapine-fluoxetine combination

Doctors sometimes prescribe other drugs "off label" for bipolar depression, such as the anticonvulsant lamotrigine or the atypical antipsychotic Vraylar

 Seasonal Affective Disorder (SAD) Seasonal affective disorder is a period of major depression that most often happens during the winter months, when the days grow short and you get less and less sunlight. It typically goes away in the spring and summer. If you have SAD, antidepressants can help. So can light therapy. You'll need to sit in front of a special bright light box for about 15-30 minutes each day  Psychotic Depression People with psychotic depression have the 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) A combination of antidepressant and antipsychotic drugs can treat psychotic depression. ECT may also be an option.

 Peripartum (Postpartum) Depression Women who have major depression in the weeks and months after childbirth may have peripartum depression. Antidepressant drugs can help similarly to treating major depression that is unrelated to childbirth.  Premenstrual Dysphoric Disorder (PMDD) Women with PMDD have depression and other symptoms at the start of their period. Besides feeling depressed, you may also have:  Mood swings  Irritability  Anxiety  Trouble concentrating  Fatigue  Change in appetite or sleep habits  Feelings of being overwhelmed Antidepressant medication or sometimes oral contraceptives can treat PMDD.  'Situational' Depression This isn't a technical term in psychiatry. But you can have a depressed mood when you're having trouble managing a stressful event in your life, such as a death in your family, a divorce, or losing your job. Your doctor may call this "stress response syndrome." Psychotherapy can often help you get through a period of depression that's related to a stressful situation.  Atypical Depression This type is different than the persistent sadness of typical depression. It is considered to be a "specifier" that describes a pattern of depressive symptoms. If you have atypical depression, a positive event can temporarily improve your mood. Other symptoms of atypical depression include:  Increased appetite  Sleeping more than usual  Feeling of heaviness in your arms and legs  Oversensitive to criticism Antidepressants can help. Your doctor may suggest a type called an SSRI (selective serotonin reuptake inhibitor) as the first-line treatment. She may also sometimes recommend an older type of antidepressant called an MAOI (monoamine oxidase inhibitor), which is a class of antidepressants that has been well-studied in treating atypical depression.

Areas of the brain affected by depression Amygdala: The amygdala is part of the limbic system, a group of structures deep in the brain that's associated with emotions such as anger, pleasure, sorrow, fear, and sexual arousal. The amygdala is activated when a person recalls emotionally charged memories, such as a frightening situation. Activity in the amygdala is higher when a person is sad or clinically depressed. This increased activity continues even after recovery from depression. Thalamus: The thalamus receives most sensory information and relays it to the appropriate part of the cerebral cortex, which directs high-level functions such as speech, behavioral reactions, movement, thinking, and learning. Some research suggests that bipolar disorder may result from problems in the thalamus, which helps link sensory input to pleasant and unpleasant feelings. Hippocampus: The hippocampus is part of the limbic system and has a central role in processing long-term memory and recollection. Interplay between the hippocampus and the amygdala might account for the adage "once bitten, twice shy." It is this part of the brain that registers fear when you are confronted by a barking, aggressive dog, and the memory of such an experience may make you wary of dogs you come across later in life. The hippocampus is smaller in some depressed people, and research suggests that ongoing exposure to stress hormone impairs the growth of nerve cells in this part of the brain.

 Nerve cell communication The ultimate goal in treating the biology of depression is to improve the brain's ability to regulate mood. We now know that neurotransmitters are not the only important part of the machinery. But let's not diminish their importance either. They are deeply involved in how nerve cells communicate with one another. And they are a component of brain function that we can often influence to good ends. Neurotransmitters are chemicals that relay messages from neuron to neuron. An antidepressant medication tends to increase the concentration of these substances in the spaces between neurons (the synapses). In many cases, this shift appears to give the system enough of a nudge so that the brain can do its job better.  How the system works. If you trained a high-powered microscope on a slice of brain tissue, you might be able to see a loosely braided network of neurons that send and receive messages. While every cell in the body has the capacity to send and receive signals, neurons are specially designed for this function. Each neuron has a cell body containing the structures that any cell needs to thrive. Stretching out from the cell body are short, branchlike fibers called dendrites and one longer, more prominent fiber called the axon. A combination of electrical and chemical signals allows communication within and between neurons. When a neuron becomes activated, it passes an electrical signal from the cell body down the axon to its end (known as the axon terminal), where chemical messengers called neurotransmitters are stored. The signal releases certain neurotransmitters into the space between that neuron and the dendrite of a neighboring neuron. That space is called a synapse. As the concentration of a neurotransmitter rises in the synapse, neurotransmitter molecules begin to bind with receptors embedded in the membranes of the two neurons (see Figure 2). The release of a neurotransmitter from one neuron can activate or inhibit a second neuron. If the signal is activating, or excitatory, the message continues to pass farther along that particular neural pathway. If it is inhibitory, the signal will be suppressed. The neurotransmitter also affects the neuron that released it. Once the first neuron has released a certain amount of the chemical, a feedback mechanism (controlled by that neuron's receptors) instructs the neuron to stop pumping out the neurotransmitter and start bringing it back into the cell. This process is called reabsorption or reuptake. Enzymes break down the remaining neurotransmitter molecules into smaller particles.  When the system falters. Brain cells usually produce levels of neurotransmitters that keep senses, learning, movements, and moods perking along. But in some people who are severely depressed or manic, the complex systems that accomplish this go awry. For example, receptors may be oversensitive or insensitive to a specific neurotransmitter, causing their response to its release to be excessive or inadequate. Or a message might be weakened if the originating cell pumps out too little of a neurotransmitter or if an overly efficient reuptake mops up too much before the molecules have the chance to bind to the receptors on other neurons. Any of these system faults could significantly affect mood.  Kinds of neurotransmitters. Scientists have identified many different neurotransmitters. Here is a description of a few believed to play a role in depression:  Acetylcholine enhances memory and is involved in learning and recall.  Serotonin helps regulate sleep, appetite, and mood and inhibits pain. Research supports the idea that some depressed people have reduced serotonin transmission. Low levels of a serotonin byproduct have been linked to a higher risk for suicide.

 Norepinephrine constricts blood vessels, raising blood pressure. It may trigger anxiety and be involved in some types of depression. It also seems to help determine motivation and reward.  Dopamine is essential to movement. It also influences motivation and plays a role in how a person perceives reality. Problems in dopamine transmission have been associated with psychosis, a severe form of distorted thinking characterized by hallucinations or delusions. It's also involved in the brain's reward system, so it is thought to play a role in substance abuse.  Glutamate is a small molecule believed to act as an excitatory neurotransmitter and to play a role in bipolar disorder and schizophrenia. Lithium carbonate, a well-known mood stabilizer used to treat bipolar disorder, helps prevent damage to neurons in the brains of rats exposed to high levels of glutamate. Other animal research suggests that lithium might stabilize glutamate reuptake, a mechanism that may explain how the drug smooths out the highs of mania and the lows of depression in the long term.  Gamma-aminobutyric acid (GABA) is an amino acid that researchers believe acts as an inhibitory neurotransmitter. It is thought to help quell anxiety. How neurons communicate 1. An electrical signal travels down the axon. 2. Chemical neurotransmitter molecules are released. 3. The neurotransmitter molecules bind to receptor sites. 4. The signal is picked up by the second neuron and is either passed along or halted. 5. The signal is also picked up by the first neuron, causing reuptake, the process by which the cell that released the neurotransmitter takes back some of the remaining molecules.  Genes' effect on mood Every part of your body, including your brain, is controlled by genes. Genes make proteins that are involved in biological processes. Throughout life, different genes turn on and off, so that — in the best case — they make the right proteins at the right time. But if the genes get it wrong, they can alter your biology in a way that results in your mood becoming unstable. In a genetically vulnerable person, any stress (a missed deadline at work or a medical illness, for example) can then push this system off balance.

Mood is affected by dozens of genes, and as our genetic endowments differ, so do our depressions. The hope is that as researchers pinpoint the genes involved in mood disorders and better understand their functions, treatment can become more individualized and more successful. Patients would receive the best medication for their type of depression. Another goal of gene research, of course, is to understand how, exactly, biology makes certain people vulnerable to depression. For example, several genes influence the stress response, leaving us more or less likely to become depressed in response to trouble. Perhaps the easiest way to grasp the power of genetics is to look at families. It is well known that depression and bipolar disorder run in families. The strongest evidence for this comes from the research on bipolar disorder. Half of those with bipolar disorder have a relative with a similar pattern of mood fluctuations. Studies of identical twins, who share a genetic blueprint, show that if one twin has bipolar disorder, the other has a 60% to 80% chance of developing it, too. These numbers don't apply to fraternal twins, who — like other biological siblings — share only about half of their genes. If one fraternal twin has bipolar disorder, the other has a 20% chance of developing it. The evidence for other types of depression is more subtle, but it is real. A person who has a first-degree relative who suffered major depression has an increase in risk for the condition of 1.5% to 3% over normal. One important goal of genetics research — and this is true throughout medicine — is to learn the specific function of each gene. This kind of information will help us figure out how the interaction of biology and environment leads to depression in some people but not others.  Temperament shapes behavior Genetics provides one perspective on how resilient you are in the face of difficult life events. But you don't need to be a geneticist to understand yourself. Perhaps a more intuitive way to look at resilience is by understanding your temperament. Temperament — for example, how excitable you are or whether you tend to withdraw from or engage in social situations — is determined by your genetic inheritance and by the experiences you've had during the course of your life. Some people are able to make better choices in life once they appreciate their habitual reactions to people and to life events. Cognitive psychologists point out that your view of the world and, in particular, your unacknowledged assumptions about how the world works also influence how you feel. You develop your viewpoint early on and learn to automatically fall back on it when loss, disappointment, or rejection occurs. For example, you may come to see yourself as unworthy of love, so you avoid getting involved with people rather than risk losing a relationship. Or you may be so self-critical that you can't bear the slightest criticism from others, which can slow or block your career progress. Yet while temperament or world view may have a hand in depression, neither is unchangeable. Therapy and medications can shift thoughts and attitudes that have developed over time.  Stressful life events At some point, nearly everyone encounters stressful life events: the death of a loved one, the loss of a job, an illness, or a relationship spiraling downward. Some must cope with the early loss of a parent, violence, or sexual abuse. While not everyone who faces these stresses develops a mood disorder — in fact, most do not — stress plays an important role in depression. As the previous section explained, your genetic makeup influences how sensitive you are to stressful life events. When genetics, biology, and stressful life situations come together, depression can result.

Stress has its own physiological consequences. It triggers a chain of chemical reactions and responses in the body. If the stress is short-lived, the body usually returns to normal. But when stress is chronic or the system gets stuck in overdrive, changes in the body and brain can be long-lasting.  How stress affects the body Stress can be defined as an automatic physical response to any stimulus that requires you to adjust to change. Every real or perceived threat to your body triggers a cascade of stress hormones that produces physiological changes. We all know the sensations: your heart pounds, muscles tense, breathing quickens, and beads of sweat appear. This is known as the stress response. The stress response starts with a signal from the part of your brain known as the hypothalamus. The hypothalamus joins the pituitary gland and the adrenal glands to form a trio known as the hypothalamic-pituitary-adrenal (HPA) axis, which governs a multitude of hormonal activities in the body and may play a role in depression as well. When a physical or emotional threat looms, the hypothalamus secretes corticotropin-releasing hormone (CRH), which has the job of rousing your body. Hormones are complex chemicals that carry messages to organs or groups of cells throughout the body and trigger certain responses. CRH follows a pathway to your pituitary gland, where it stimulates the secretion of adrenocorticotropic hormone (ACTH), which pulses into your bloodstream. When ACTH reaches your adrenal glands, it prompts the release of cortisol. The boost in cortisol readies your body to fight or flee. Your heart beats faster — up to five times as quickly as normal — and your blood pressure rises. Your breath quickens as your body takes in extra oxygen. Sharpened senses, such as sight and hearing, make you more alert. CRH also affects the cerebral cortex, part of the amygdala, and the brainstem. It is thought to play a major role in coordinating your thoughts and behaviors, emotional reactions, and involuntary responses. Working along a variety of neural pathways, it influences the concentration of neurotransmitters throughout the brain. Disturbances in hormonal systems, therefore, may well affect neurotransmitters, and vice versa. Normally, a feedback loop allows the body to turn off "fight-or-flight" defenses when the threat passes. In some cases, though, the floodgates never close properly, and cortisol levels rise too often or simply stay high. This can contribute to problems such as high blood pressure, immune suppression, asthma, and possibly depression. Studies have shown that people who are depressed or have dysthymia typically have increased levels of CRH. Antidepressants and electroconvulsive therapy are both known to reduce these high CRH levels. As CRH levels return to normal, depressive symptoms recede. Research also suggests that trauma during childhood can negatively affect the functioning of CRH and the HPA axis throughout life.  Early losses and trauma Certain events can have lasting physical, as well as emotional, consequences. Researchers have found that early losses and emotional trauma may leave individuals more vulnerable to depression later in life. Childhood losses. Profound early losses, such as the death of a parent or the withdrawal of a loved one's affection, may resonate throughout life, eventually expressing themselves as depression. When an individual is unaware of the wellspring of his or her illness, he or she can't easily move past the depression. Moreover, unless the person gains a conscious understanding of the source of the condition, later losses or disappointments may trigger its return. The British psychiatrist John Bowlby focused on early losses in a number of landmark studies of monkeys. When he separated young monkeys from their mothers, the monkeys passed through predictable stages of a separation response. Their furious outbursts trailed off into despair, followed by apathetic detachment. Meanwhile, the levels of their stress hormones rose. Later investigators extended this research. One study

found that the CRH system and HPA axis got stuck in overdrive in adult rodents that had been separated from their mothers too early in life. This held true whether or not the rats were purposely put under stress. Interestingly, antidepressants and electroconvulsive therapy relieve the symptoms of animals distressed by such separations.  The role of trauma. Traumas may also be indelibly etched on the psyche. A small but intriguing study in the Journal of the American Medical Association showed that women who were abused physically or sexually as children had more extreme stress responses than women who had not been abused. The women had higher levels of the stress hormones ACTH and cortisol, and their hearts beat faster when they performed stressful tasks, such as working out mathematical equations or speaking in front of an audience. Many researchers believe that early trauma causes subtle changes in brain function that account for symptoms of depression and anxiety. The key brain regions involved in the stress response may be altered at the chemical or cellular level. Changes might include fluctuations in the concentration of neurotransmitters or damage to nerve cells. However, further investigation is needed to clarify the relationship between the brain, psychological trauma, and depression.  Seasonal affective disorder: When winter brings the blues Many people feel sad when summer wanes, but some actually develop depression with the season's change. Known as seasonal affective disorder (SAD), this form of depression affects about 1% to 2% of the population, particularly women and young people. SAD seems to be triggered by more limited exposure to daylight; typically it comes on during the fall or winter months and subsides in the spring. Symptoms are similar to general depression and include lethargy, loss of interest in once-pleasurable activities, irritability, inability to concentrate, and a change in sleeping patterns, appetite, or both. To combat SAD, doctors suggest exercise, particularly outdoor activities during daylight hours. Exposing yourself to bright artificial light may also help. Light therapy, also called phototherapy, usually involves sitting close to a special light source that is far more intense than normal indoor light for 30 minutes every morning. The light must enter through your eyes to be effective; skin exposure has not been proven to work. Some people feel better after only one light treatment, but most people require at least a few days of treatment, and some need several weeks. You can buy boxes that emit the proper light intensity (10,000 lux) with a minimal amount of ultraviolet light without a prescription, but it is best to work with a professional who can monitor your response. There are few side effects to light therapy, but you should be aware of the following potential problems:  Mild anxiety, jitteriness, headaches, early awakening, or eyestrain can occur.  There is evidence that light therapy can trigger a manic episode in people who are vulnerable.  While there is no proof that light therapy can aggravate an eye problem, you should still discuss any eye disease with your doctor before starting light therapy. Likewise, since rashes can result, let your doctor know about any skin conditions.  Some drugs or herbs (for example, St. John's wort) can make you sensitive to light.  If light therapy isn't helpful, antidepressants may offer relief.

 Medical problems Certain medical problems are linked to lasting, significant mood disturbances. In fact, medical illnesses or medications may be at the root of up to 10% to 15% of all depressions. Among the best-known culprits are two thyroid hormone imbalances. An excess of thyroid hormone (hyperthyroidism) can trigger manic symptoms. On the other hand, hypothyroidism, a condition in which your body produces too little thyroid hormone, often leads to exhaustion and depression. Heart disease has also been linked to depression, with up to half of heart attack survivors reporting feeling blue and many having significant depression. Depression can spell trouble for heart patients: it's been linked with slower recovery, future cardiovascular trouble, and a higher risk of dying within about six months. Although doctors have hesitated to give heart patients older depression medications called tricyclic antidepressants because of their impact on heart rhythms, selective serotonin reuptake inhibitors seem safe for people with heart conditions. The following medical conditions have also been associated with mood disorders:  degenerative neurological conditions, such as multiple sclerosis, Parkinson's disease, Alzheimer's disease, and Huntington's disease  stroke  some nutritional deficiencies, such as a lack of vitamin B12  other endocrine disorders, such as problems with the parathyroid or adrenal glands that cause them to produce too little or too much of particular hormones  certain immune system diseases, such as lupus  some viruses and other infections, such as mononucleosis, hepatitis, and HIV  cancer  erectile dysfunction in men. When considering the connection between health problems and depression, an important question to address is which came first, the medical condition or the mood changes. There is no doubt that the stress of having certain illnesses can trigger depression. In other cases, depression precedes the medical illness and may even contribute to it. To find out whether the mood changes occurred on their own or as a result of the medical illness, a doctor carefully considers a person's medical history and the results of a physical exam. If depression or mania springs from an underlying medical problem, the mood changes should disappear after the medical condition is treated. If you have hypothyroidism, for example, lethargy and depression often lift once treatment regulates the level of thyroid hormone in your blood. In many cases, however, the depression is an independent problem, which means that in order to be successful, treatment must address depression directly. 10 Natural Depression Treatments

Being depressed can make you feel helpless. You're not. Along with therapy and sometimes medication, there's a lot you can do on your own to fight back. Changing your behavior -- your physical activity, lifestyle, and even your way of thinking -- are all natural depression treatments. These tips can help you feel better -- starting right now. 1. Get in a routine. If you’re depressed, you need a routine, says Ian Cook, MD. He's a psychiatrist and director of the Depression Research and Clinic Program at UCLA. Depression can strip away the structure from your life. One day melts into the next. Setting a gentle daily schedule can help you get back on track. 2.Set goals. When you're depressed, you may feel like you can't accomplish anything. That makes you feel worse about yourself. To push back, set daily goals for yourself. "Start very small," Cook says. "Make your goal something that you can succeed at, like doing the dishes every other day." As you start to feel better, you can add more challenging daily goals. 3. Exercise. It temporarily boosts feel-good chemicals called endorphins. It may also have long-term benefits for people with depression. Regular exercise seems to encourage the brain to rewire itself in positive ways, Cook says. How much exercise do you need? You don’t need to run marathons to get a benefit. Just walking a few times a week can help. 4. Eat healthy. There is no magic diet that fixes depression. It's a good idea to watch what you eat, though. If depression tends to make you overeat, getting in control of your eating will help you feel better. Although nothing is definitive, Cook says there's evidence that foods with omega-3 fatty acids (such as salmon and tuna) and folic acid (such as spinach and avocado) could help ease depression. 5. Get enough sleep. Depression can make it hard to get enough shut-eye, and too little sleep can make depression worse. What can you do? Start by making some changes to your lifestyle. Go to bed and get up at the same time every day. Try not to nap. Take all the distractions out of your bedroom -- no computer and no TV. In time, you may find your sleep improves. 6. Take on responsibilities. When you’re depressed, you may want to pull back from life and give up your responsibilities at home and at work. Don't. Staying involved and having daily responsibilities can help you maintain a lifestyle that can help counter depression. They ground you and give you a sense of accomplishment. If you're not up to full-time school or work, that’s fine. Think about part-time. If that seems like too much, consider volunteer work. 7. Challenge negative thoughts. In your fight against depression, a lot of the work is mental -- changing how you think. When you're depressed, you leap to the worst possible conclusions. The next time you're feeling terrible about yourself, use logic as a natural depression treatment. You might feel like no one likes you, but is there real evidence for that? You might feel like the most worthless person on the

planet, but is that really likely? It takes practice, but in time you can beat back those negative thoughts before they get out of control. 8. Check with your doctor before using supplements. "There's promising evidence for certain supplements for depression," Cook says. Those include fish oil, folic acid, and SAMe. But more research needs to be done before we'll know for sure. Always check with your doctor before starting any supplement, especially if you’re already taking medications. 9. Do something new. When you’re depressed, you’re in a rut. Push yourself to do something different. Go to a museum. Pick up a used book and read it on a park bench. Volunteer at a soup kitchen. Take a language class. "When we challenge ourselves to do something different, there are chemical changes in the brain," Cook says. "Trying something new alters the levels of [the brain chemical] dopamine, which is associated with pleasure, enjoyment, and learning." 10. Try to have fun. If you’re depressed, make time for things you enjoy. What if nothing seems fun anymore? "That's just a symptom of depression," Cook says. You have to keep trying anyway.