Physical symptoms such as dizziness, headaches, stomachaches, neckaches, arms or legs hurt due to muscle tension, digestive disorders. (ruling out other medical causes)

Persistent unhappiness, negativity, irritability.

Uncontrollable anger or outbursts of rage. Overly self-critical, unwarranted guilt, low self-esteem.

Inability to concentrate, think straight, remember, or make decisions, possibly resulting in refusal to study in school or an inability (due to depression or attention deficit disorder) to do schoolwork.

Slowed or hesitant speech or body movements, or restlessness (anxiety).

Loss of interest in once pleasurable activities.

Low energy, chronic fatigue, sluggishness.

Change in appetite, noticeable

Chronic worry, excessive fear.

Preoccupation with death themes in literature, music, drawings, speaking of death repeatedly, fascination with guns/knives.

Suicidal thoughts, plans, or attempts.

Treatment usually involves medicines, psychotherapy and lifestyle changes.

In most states, after the age of 14, you have the right to see a physician and have it remain completely confidential. You have to remember though, if you intend to use your parents insurance, your parents will of course find out. Also, if you are suspected of harming yourself or others,
the doctor has to break the confidentiality in order to protect you from harm.

Life is not always easy, and sometimes it's difficult to smile when the dark clouds move in to block the sun. But you must have faith that things will get better. Reach inside and draw on your strength and hope. It's still there, waiting to see you through this difficult time. The night may seem long, but think of all the possibilities that the dawn might hold. And in the end, you'll be a stronger person from this,
and you'll be so proud that you made it.

What is Depression?

Depression is a disorder that affects your thoughts, moods, feelings, behavior and physical health. People used to think it was "all in your head" and that if you really tried, you could "pull yourself out of it." Doctors now know that depression is not a weakness, and you can't treat it on your own. It's a medical disorder with a biological basis.

Sometimes, a stressful life event triggers depression. Other times depression seems to occur spontaneously, with no identifiable specific cause. Whatever the trigger, depression is much more than grieving or a bout of the blues.

Depression may occur as repeated episodes over a lifetime, with periods free of depression in between. Or it may be a chronic condition, requiring ongoing treatment over a lifetime. The disorder affects more than 18 million Americans of all ages and races.

Medications are available that are generally safe and effective, even for the most severe depression. With proper treatment, most people with serious depression improve, often within weeks, and can return to normal daily activities

The main types of depression include:

· Major depression. This type of mood disturbance lasts more than 2 weeks. Symptoms may include overwhelming feelings of sadness and grief, loss of interest or pleasure in activities you usually enjoy and feelings of worthlessness or guilt. This type of depression may result in poor sleep, severe fatigue, difficulty concentrating, change in appetite and suicide.

· Dysthymia. Dysthymia (dis-THI-me-uh) is a less severe but more continuous form of depression. It lasts for at least 2 years and often more than 5 years. Symptoms usually aren't disabling, and periods of dysthymia can alternate with short periods of feeling normal. Having dysthymia places you at an increased risk of major depression and suicide.

· Adjustment disorders. Adjustment disorders are often precursors to major depression. If a loved one dies, you lose your job or you're diagnosed with cancer it's perfectly normal to feel tense, sad, overwhelmed or angry. Eventually, most people come to terms with the lasting consequences of life stresses, but some don't. This is what's known as an adjustment disorder — when your response to a stressful event or situation causes symptoms of depression. Some people develop an adjustment disorder in response to a single event. Among others, it stems from a combination of stressors. Adjustment disorders can be acute — lasting less than 6 months — or chronic — lasting longer. Doctors classify adjustment disorders based on the primary symptoms.

· Bipolar Disorder - Having recurrent cycles of depression and elation (mania) is characteristic of bipolar disorder. Because this condition involves emotions at both extremes (poles), it's called bipolar disorder or manic-depressive disorder. Mania affects your judgment, causing you to make unwise decisions. Some people have bursts of increased creativity and productivity during the manic phase. The number of cycles at either extreme may not be equal. Some people may have several cycles of depression before having another manic phase, or vice versa.

· Seasonal Affective Disorder - Seasonal affective disorder (SAD) is a pattern of depression related to changes in seasons and a lack of exposure to sunlight. It may cause headaches, irritability and a low energy level.

Many people with depression have symptoms of anxiety as well. Anxiety that develops after age 40 is often related to depression rather than being an independent problem.

Causes

There's no single cause for depression. The illness often runs in families. Experts believe a genetic vulnerability combined with environmental factors, such as stress or physical illness, may trigger an imbalance in brain chemicals called neurotransmitters, resulting in depression. Imbalances in three neurotransmitters — serotonin, norepinephrine and dopamine — seem to be linked to depression. Scientists don't fully understand how imbalances in neurotransmitters cause symptoms of depression. It's not certain whether changes in neurotransmitters are a cause or a result of depression.

Here are factors that contribute to depression:

· Heredity. Researchers have identified several genes that may be involved in bipolar disorder, and they're looking for genes linked to other types of depression. But not everyone with a family history of depression develops the disorder.

· Stress. Stressful life events, particularly a loss or threatened loss of a loved one or a job, can trigger depression.

· Medications. Long-term use of certain medications, such as some drugs used to control high blood pressure, sleeping pills or, occasionally, birth control pills, may cause symptoms of depression in some people.

· Illnesses. Having a chronic illness, such as heart disease, stroke, diabetes, cancer or Alzheimer's disease, puts you at higher risk of developing depression. Studies reveal an as-yet-unexplained link between depression and heart disease. Depression occurs in up to half of people who've had heart attacks. Left untreated, depression may put you at a higher risk of death in the early years after a heart attack. Having an under active thyroid (hypothyroidism) — even mild hypothyroidism — can also cause depression.

· Personality. Certain personality traits, such as having low self-esteem and being overly dependent, self-critical, pessimistic and easily overwhelmed by stress, can make you more vulnerable to depression.

· Postpartum depression. It's common for mothers to feel a mild form of distress that usually occurs a few days to weeks after birth. During this time you may have feelings of sadness, anger, anxiety, irritability and incompetence. A more severe form of the baby blues, called postpartum depression, occurs in approximately 10 percent of childbearing women.

· Alcohol, nicotine and drug abuse. Experts once thought that people with depression used alcohol, nicotine and mood-altering drugs as a way to ease depression. But studies show that using these substances may actually contribute to depression and anxiety disorders.

· Diet. Deficiencies in folate and vitamin B-12 may cause symptoms of depression. Low levels of both nutrients are linked to a poorer response to antidepressant medications.

When to Seek Medical Advice

If you feel sad, helpless, tired or worthless, if your eating and sleeping habits have changed greatly and if you show little interest in once enjoyable activities, see your doctor to determine if depression is the cause. If you know someone who exhibits the characteristics of depression, encourage them to see their doctor.

Diagnosis

To diagnose depression, your doctor may perform a physical examination, including tests to rule out conditions that can cause symptoms that mimic depression.

If your doctor sees signs of severe depression or suspects the possibility of suicide, he or she may refer you to a psychiatrist (a medical doctor who specializes in mental illness) or even recommend immediate hospitalization.

Your doctor or psychiatrist diagnoses depression based on the hallmark signs and symptoms of the disease, plus the presence of other signs and symptoms that typically accompany depression.

Complications

Depression is a serious illness that can take a terrible toll on individuals and families. Untreated, depression can lead to a downward spiral of disability, dependency and suicide. Up to 70 percent of people who commit suicide may have some form of depression.

As many as one in eight teens may have depression. The suicide rate for young adults ages 15 to 24 has risen in recent years. Among older people, depression often is overlooked and therefore untreated. This may explain why the suicide rate for older people is more than 50 percent higher than for the general population.

Certain warning signs may indicate serious depression and the possibility of suicide. Take any threat of suicide seriously, even if the person is already being treated for depression. If you see any of the following danger signs, call a doctor, mental health clinic or suicide hot line immediately:

· Pacing, agitated behavior, frequent mood changes and sleeplessness for several nights
· Actions or threats of assault, physical harm or violence
· Threats or talk of death or suicide, such as "I don't care anymore," or "You won't need to worry about me much longer"
· Withdrawal from activities and relationships
· Putting affairs in order, such as saying goodbye to friends, giving away prized possessions or writing a will
· A sudden brightening of mood after a period of being depressed
· Unusually risky behavior, such as buying or handling a gun or driving recklessly

Treatment

The development of newer antidepressant medications and mood-stabilizing drugs in the last 20 years has revolutionized treatment of depression. Medication can relieve symptoms of depression, and it has become the first line of treatment for most types of the disorder.

Treatment may also include psychotherapy, which may help you cope with ongoing problems that may trigger or contribute to depression. A combination of medications and a brief course of psychotherapy usually is effective if you have mild to moderate depression. If you're severely depressed, initial treatment usually is with medications or electroconvulsive therapy. Once you improve, psychotherapy can be more effective.

Doctors usually treat depression in two stages. Acute treatment with medications helps relieve symptoms until you feel well. Once your symptoms ease, maintenance treatment typically continues for 6 to 12 months to prevent a relapse. It's important to keep taking your medication even though you feel fine and are back to your usual activities. Episodes of depression recur in the majority of people who have one episode, but continuing treatment for at least 6 months greatly reduces your risk of a rapid relapse. If you've had three or more previous episodes of depression, your doctor may suggest long-term treatment with antidepressants.

Medications

· Selective serotonin reuptake inhibitors (SSRIs). Doctors often consider selective serotonin reuptake inhibitors, such as fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft) and citalopram (Celexa), as the first-line treatment for depression because they have fewer serious side effects. They seem to work by increasing the availability of the neurotransmitter serotonin in your brain. Drugs similar to SSRIs include serotonin and norepinephrine reuptake inhibitors (SNRIs), such as nefazodone (Serzone), trazodone (Desyrel) and venlafaxine (Effexor), and dopamine reuptake inhibitors, such as bupropion (Wellbutrin).

· Tricyclic and tetracyclic antidepressants. These medications also affect neurotransmitters but by a different mechanism than SSRIs. Doctors often prescribe them to treat moderate to severe depression. Among tricyclic antidepressants are amitriptyline (Elavil, Endep), desipramine (Norpramin), nortriptyline (Aventyl, Pamelor), protryptyline (Vivactil), trimipramine (Surmontil) and a combination of perphenazine and amitriptyline (Triavil). Tetracyclics include maprotiline (Ludiomil) and mirtazapine (Remeron).

· Monoamine oxidase inhibitors (MAOIs). These drugs, which include phenelzine (Nardil) and tranylcypromine (Parnate), prevent the breakdown of neurotransmitters. The drugs have potentially serious side effects if combined with certain other medications or food products. Doctors rarely use them unless other options have failed. Your doctor may prescribe them if you have chronic depression and eat or sleep excessively.

· Stimulants. If you're severely depressed, your doctor may initially prescribe a stimulant such as methylphenidate (Ritalin) or dextroamphetamine (Dexedrine) in addition to an antidepressant because most antidepressants are slow to work. After 1 to 4 weeks, your doctor may then switch you to just an antidepressant.

· Lithium and mood-stabilizing medications. Doctors prescribe lithium (Eskalith, Lithobid), valproate (Depakene, Depakote) and carbamazepine (Epitol, Tegretol) to treat bipolar depression. These medications provide relief 50 percent to 80 percent of the time. Medications called atypical antipsychotics such as olanzapine (Zyprexa), risperidone (Risperdal) and quetiapine (Seroquel) were initially developed for treatment of psychotic disorders. Doctors sometimes also use them to treat bipolar disorder.

Statistically, most antidepressants have a similar level of effectiveness. However, a medication that works for someone else might not work for you. Doctors choose antidepressants based on your family history and the match between your symptoms and the medication's side effects. For example, if you have insomnia, a sedating antidepressant may help you. But if you're lethargic, then a more energizing antidepressant may be more helpful.

Most antidepressants are slow to work. You may see a response in 2 weeks, but many people don't see a full benefit for 6 to 8 weeks. If your response to medication isn't resulting in satisfactory progress after 6 to 8 weeks, your doctor may suggest either adding another antidepressant or replacing the first medication with another drug from a different chemical family.

In addition to medications, depression treatment may include:

Psychotherapy

There are several types of psychotherapy. Each type involves a short-term, goal-oriented approach aimed at helping you deal with a specific issue. Prolonged psychotherapy is seldom necessary to treat depression. If an underlying factor contributing to your depression is an inability to get along with others or difficulty finding your place in life, then prolonged psychotherapy could help you.

The success of therapy depends on finding a doctor, psychiatrist or psychologist you're comfortable with. Both medications and psychotherapy can take 4 to 8 weeks to have an effect. Specialized and supervised group therapy, such as bereavement groups, stress management classes, marital counseling and family therapy, may also help.

Electroconvulsive therapy

Despite the images that many people conjure up, electroconvulsive therapy is generally safe and effective. In fact, it's the "gold standard" for treatment of severe depression.

In this therapy you receive a light general anesthesia and a muscle relaxant. An electrical current is passed through your brain for 1 to 3 seconds. The stimulus causes a controlled seizure, which typically lasts for 20 to 90 seconds. You wake up in 5 to 10 minutes and rest for about half an hour. Most people require 6 to 10 treatments.

Experts aren't sure how this therapy relieves symptoms of depression. The seizure may affect levels of neurotransmitters in your brain. The most common side effect is confusion that lasts a few minutes to several hours. A few people have some memory loss for several weeks. This therapy is usually used for people who don't respond to medications and for those at high risk of suicide. It may be the only treatment available for severely depressed older people who can't take medications because of heart disease.

Light therapy

This therapy may help if you have seasonal affective disorder (SAD). This disorder involves periods of depression that recur at the same time each year, usually when days are shorter in the fall and winter. Scientists believe fewer hours of sunlight may increase levels of melatonin, a brain hormone thought to induce sleep and depress mood. Treatment with a specialized type of bright light, which suppresses production of melatonin, may help if you have this disorder.

Self-Care

Once treatment for depression begins, you still have to manage on a day-to-day basis. Here are some guidelines:

· See your doctor regularly. Your doctor can monitor your progress, provide support and encouragement and adjust your medication if necessary.
· Take your medications. Finding the best medication for you may take several tries. It may take 4 to 8 weeks for you to start seeing results. Once you feel better, continue to take your medication as prescribed.
· Don't become isolated. Try to participate in normal activities.
· Take care of yourself. Eat a healthy diet and get the right amount of sleep and exercise. Exercise can help treat some forms of depression, ease stress and help you relax.
· Avoid alcohol and recreational drugs. Abuse of alcohol and drugs will slow or prevent your recovery.

QUESTIONS AND ANSWERS ABOUT MAJOR DEPRESSION

These are several questions and answers about the disease called depression. Please read all of these carefully, since it is very important that you understand your disease as thoroughly as possible.

l. WHAT IS DEPRESSION?

It is a disease affecting the entire mind and body, causing a person to feel miserable in many ways. Changes in brain chemistry make it happen. It is a brain disease.

2. WHAT CAUSES DEPRESSION?

We do not know. We used to think it was due to something unhappy in a person's life or to some psychological hang-up. We now know, however, that this disease happens to people who have no reason "to be depressed." In other words, depression can strike normal and healthy people.

3. DOES HAVING A DEPRESSION MEAN THAT A PERSON IS GOING "CRAZY"?

No, but it will very often make him think he is.

4. IS IT A COMMON DISEASE?

Yes, it is the most common disease seen in all of medicine; however, it is often confused with other illnesses. For example, many people who think, or who are told, they have low blood, vitamin deficiency, sinus headaches, low sugar, menopause, burnout, and "all run-down and need a rest" actually have depression that causes their troubles.

5. WHAT TROUBLE DOES A PERSON HAVE WHO HAS DEPRESSION?

A person who has depression will usually feel most of the following things:

He will feel very tired all the time, even when he has not worked or exerted himself very much.
He will be just as tired on days when he has rested as on days when he has worked hard.

His sleep will usually be affected in one of two ways. He will either go to sleep and then wake up during the night and remain awake, or else he will sleep too much - even during the day.
He will not get restful sleep.

He will feel very irritable. He will get upset very easily over
little things that ordinarily would not upset him.

He will feel very sad for no reason, and, in fact, may break into tears without knowing why.

His normal sex drive will be decreased; in fact, it often will go away altogether.

He will often have a headache that is present most of the time.
Almost any chronic pain elsewhere such as in the stomach or back can be caused by depression.
These pains are not imaginary; they are quite real and often severe.

He will find it difficult to enjoy things. He will feel little
enthusiasm even for things he used to look forward to.

His will often be constipated or have other digestive symptoms such as abdominal pain or diarrhea.
He may lose or gain weight.

He will find it difficult to concentrate, make decisions, remember things and getting things done. He will feel like he is an ineffective, worthless person, even though there is no reason to feel that way.

6. IS THIS REALLY A SERIOUS DISEASE?

Yes. In a mild depression. the person will often think he just has a case of the blues, or that he is just getting older. His efficiency will be affected. In a more severe depression, it is a very serious disease. This disease can cause a previously healthy and happy person to kill himself.

7. CAN A PERSON DO ANYTHING TO FIGHT BRAIN DISEASE?

Not by his own efforts. This is a disease over which a person has no control,
and it will do him no good to "try to fight this myself."

8. IS THERE ANY EFFECTIVE TREATMENT?

Very much so. There are several medicines which are usually very effective in treating depression.
They are also very safe medicines.

9. ARE THERE MEDICINES, TRANQUILIZERS, SLEEPING PILLS, PAIN PILLS, HORMONE PILLS?

No, none of these. They are called antidepressants.

10. ARE ANTIDEPRESSANTS ADDICTING?

Absolutely not. A person can not become addicted even though he takes these medications for months or years. People who take insulin and high blood pressure pills are not addicted; neither are people who take antidepressants. A person who does not have depression would feel no effect if he took an antidepressant. They work on the brain chemistry that gets out of balance and results in depression.

11. DO ANTIDEPRESSANTS HAVE SIDE EFFECTS?

Unfortunately, they have pesky side effects; they rarely have serious side effects. The chief side effects are dry mouth, constipation and drowsiness. Dry mouth can be effectively overcome by drinking water or sucking non caloric mints. Constipation is corrected by adding bulk to one's diet. The sleepy effects are taken care by taking the medicine before bedtime. The body usually adjusts to all these side effects.
Some newer antidepressants do not have side effects.

12. ARE ANTIDEPRESSANTS THE SAME AS "PEP PILLS" OR "UPPERS?"

Absolutely not. Pep pills give anybody a sudden boost of energy whether they have depression or not.
Pep pills are all dangerous, and not used for depression.
Antidepressant pills, on the other hand will do nothing to a person without a depression,
but will help a person who has depression by returning his brain chemical to normal.

13. HOW LONG DOES A PERSON HAVE TO TAKE ANTIDEPRESSANTS?

It varies. Sometimes as little as three months, other times longer than a year.
These medications can be taken safely for as long as they are needed, even for a lifetime.

14. DOES THIS DISEASE HAPPEN TO A PERSON WITHOUT
ANYTHING IN HIS PERSONAL LIFE CAUSING IT?

Yes. However, many people have things in their personal life that are bothering them a great deal,
and if they happen to get depression while these things are bothering them, then everything gets much worse. For example, if a person is having difficulty in their marriage or job and they get a depression also, then the difficulties with the marriage or job
will get worse, because their ability to cope with their difficulties is impaired.

15. WHAT SHOULD I TELL MY SPOUSE OR RELATIVES ABOUT DEPRESSION?

Have them read this too. A person with depression will almost always find that their spouse or relatives are very much affected by the way he feels. Most often relatives will not realize that a person's symptoms are due to a disease, and will think you simply do not love them any more. They may think the fault is somehow theirs. it is very important that they know that depression is simply a disease - just as pneumonia or diabetes are diseases, and that you or they are not responsible for it. We would welcome them to come back with you on your return visit and discuss this with them in detail. it is a great help to have your loved ones understand what is happening, why you need medication, etc.