PsycHe Finer PoinTs

Depression is one of the most common health conditions in the world. Depression isn't a weakness, nor is it something that you can simply "snap out of." Depression, formally called major depression, major depressive disorder or clinical depression, is a medical illness that involves the mind and body. It affects how you think and behave and can cause a variety of emotional and physical problems. You may not be able to go about your usual daily activities, and depression may make you feel as if life just isn't worth living anymore.

Most health professionals today consider depression a chronic illness that requires long-term treatment, much like diabetes or high blood pressure. Although some people experience only one episode of depression, most have repeated episodes of depression symptoms throughout their life.

Effective diagnosis and treatment can help reduce even severe depression symptoms. And with effective treatment, most people with depression feel better, often within weeks, and can return to the daily activities they previously enjoyed.

source:www.mayoclinic.com/health/depression/DS00175

What are the causes of depression?

Some types of depression run in families, indicating that a biological vulnerability to depression can be inherited. This seems to be the case especially with bipolar disorder. Studies have been done of families in which members of each generation develop bipolar disorder. The investigators found that those with the illness have a somewhat different genetic makeup than those who do not become ill. However, the reverse is not true. That is, not everybody with the genetic makeup that causes vulnerability to bipolar disorder will develop the illness. Apparently, additional factors, possibly a stressful environment, are involved in its onset and protective factors are involved in its prevention.

Major depression also seems to occur in generation after generation in some families, although not as strongly as in bipolar I or II. Indeed, major depression can also occur in people who have no family history of depression.

An external event often seems to initiate an episode of depression. Thus, a serious loss, chronic illness, difficult relationship, financial problem, or any unwelcome change in life patterns can trigger a depressive episode. Very often, a combination of genetic, psychological, and environmental factors is involved in the onset of a depressive disorder.

Nothing in the universe is as complex and fascinating as the human brain. The over 100 chemicals that circulate in the brain are known as neurochemicals or neurotransmitters. Much of our research and knowledge, however, has focused on four of these neurochemical systems: norepinephrine, serotonin, dopamine, and acetylcholine. In the new millennium, after new discoveries are made, it is possible that these four neurochemicals will be viewed as the "black bile, yellow bile, phlegm, and blood" of the 20th century.

Different neuropsychiatric illnesses seem to be associated with an overabundance or a lack of some of these neurochemicals in certain parts of the brain. For example, a lack of dopamine at the base of the brain causes Parkinson's disease. Alzheimer dementia seems to be related to lower acetylcholine levels in the brain. The addictive disorders are under the influence of the neurochemical dopamine. That is to say, drugs and alcohol work by releasing dopamine in the brain. The dopamine causes euphoria, which is a pleasant sensation. Repeated use of drugs or alcohol, however, desensitizes the dopamine system, which means that the system gets used to the drugs and alcohol. Therefore, a person needs more drugs or alcohol to achieve the same high feeling. Thus, the addicted person takes more substance but feels less and less high.

The different types of schizophrenia are associated with an imbalance of dopamine (too much) and serotonin (poorly regulated) in certain areas of the brain. Finally, the depressive disorders appear to be associated with altered brain serotonin and norepinephrine systems. Both of these neurochemicals may be lower in depressed people. Please note that abnormalities of these neurochemicals are "associated with" instead of "caused by," because we really don't know whether low levels of neurochemicals in the brain cause depression or whether depression causes low levels of neurochemicals in the brain.

What we do know is certain medications that alter the levels of norepinephrine or serotonin can alleviate the symptoms of depression. Some medicines that affect both of these neurochemical systems appear to perform even better or faster. Other medications that treat depression primarily affect the other neurochemical systems. The most powerful treatment for depression, electroconvulsive therapy (ECT), is certainly not specific to any particular neurotransmitter system. Rather, ECT, by causing a seizure, produces a generalized brain activity that probably releases massive amounts of all of the neurochemicals.

Women are twice as likely to become depressed as men. However, scientists do not know the reason for this difference. Psychological factors also contribute to a person's vulnerability to depression. Thus, persistent deprivation in infancy, physical or sexual abuse, clusters of certain personality traits, and inadequate ways of coping (maladaptive coping mechanisms) all can increase the frequency and severity of depressive disorders, with or without inherited vulnerability.
The effect of maternal-fetal stress on depression is currently an exciting area of research. It seems that maternal stress during pregnancy can increase the chance that the child will be prone to depression as an adult, particularly if there is a genetic vulnerability. It is thought that the mother's circulating stress hormones can influence the development of the fetus' brain during pregnancy. This altered fetal brain development occurs in ways that predispose the child to the risk of depression as an adult. Further research is still necessary to clarify how this happens. Again, this situation shows the complex interaction between genetic vulnerability and environmental stress, in this case, the stress of the mother on the fetus.

source:www.medicinenet.com/depression

What treatments are available for depression?

Antidepressant medications
Selective serotonin reuptake inhibitors (SSRIs) are medications that increase the amount of the neurochemical serotonin in the brain. (Remember that brain serotonin levels are often low in depression.) As their name implies, the SSRIs work by selectively inhibiting (blocking) serotonin reuptake in the brain. This block occurs at the synapse, the place where brain cells (neurons) are connected to each other. Serotonin is one of the chemicals in the brain that carries messages across these connections (synapses) from one neuron to another.
The SSRIs work by keeping serotonin present in high concentrations in the synapses. These drugs do this by preventing the reuptake of serotonin back into the sending nerve cell. The reuptake of serotonin is responsible for turning off the production of new serotonin. Therefore, the serotonin message keeps on coming through. It is thought that this, in turn, helps arouse (activate) cells that have been deactivated by depression, thereby relieving the depressed person's symptoms.
SSRIs have fewer side effects than the tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs), which are discussed below. SSRIs do not interact with the chemical tyramine in foods, as do the MAOIs and therefore do not require the dietary restrictions of the MAOIs. Also, SSRIs do not cause orthostatic hypotension (sudden drop in blood pressure when sitting up or standing) and heart-rhythm disturbances, like the TCAs do. Therefore, SSRIs are often the first-line treatment for depression. Examples of SSRIs include fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa), fluvoxamine (Luvox), and escitalopram (Lexapro).
SSRIs are generally well tolerated, and side effects are usually mild. The most common side effects are nausea, diarrhea, agitation, insomnia, and headache. However, these side effects generally go away within the first month of SSRI use. Some patients experience sexual side effects, such as decreased sexual desire (decreased libido), delayed orgasm, or an inability to have an orgasm. Some patients experience tremors with SSRIs. The so-called serotonergic (meaning caused by serotonin) syndrome is a serious neurologic condition associated with the use of SSRIs. It is characterized by high fevers, seizures, and heart-rhythm disturbances. This condition is very rare and has been reported only in very ill psychiatric patients taking multiple psychiatric medications.
All patients are unique biochemically. Therefore, the occurrence of side effects or the lack of a satisfactory result with one SSRI does not mean that another medication in this group will not be beneficial. However, if someone in the patient's family has had a positive response to a particular drug, that drug may be the preferable one to try first.
Dual-action antidepressants: The biochemical reality is that all classes of medications that treat depression (MAOIs, SSRIs, TCAs, and atypical antidepressants) have some effect on both norepinephrine and serotonin, as well as on other neurotransmitters. However, the various medications affect the different neurotransmitters in varying degrees.
Some of the newer antidepressant drugs, however, appear to have particularly robust effects on both the norepinephrine and serotonin systems. These drugs seem to be very promising, especially for the more severe and chronic cases of depression. (Psychiatrists, rather than family practitioners, see such cases most frequently.) Venlafaxine (Effexor) and duloxetine (Cymbalta) are two of these dual-action compounds. Effexor is a serotonin reuptake inhibitor that, at lower doses, shares many of the safety and low side-effect characteristics of the SSRIs. At higher doses, this drug appears to block the reuptake of norepinephrine. Thus, venlafaxine can be considered an SNRI, a serotonin and norepinephrine reuptake inhibitor. Cymbalta tends to act as an equally powerful serotonin reuptake inhibitor and norepinephrine reuptake inhibitor. It is therefore also considered an SNRI.
Mirtazapine (Remeron), another newer antidepressant, is a tetracyclic compound (four-ring chemical structure). It works at somewhat different biochemical sites and in different ways than the other drugs. It affects serotonin, but at a postsynaptic site (after the connection between nerve cells). It also increases histamine levels, which can cause drowsiness. For this reason, mirtazapine is given at bedtime and is often prescribed for people who have trouble falling asleep. Like venlafaxine, it also works by increasing levels in the norepinephrine system. Other than causing sedation, this medication has side effects that are similar to those of the SSRIs but to a lesser degree in many cases.
Atypical antidepressants are so named because they work in a variety of ways. Thus, atypical antidepressants are not TCAs, SSRIs, or SNRIs, but they are effective in treating depression for many people nonetheless. More specifically, they increase the level of certain neurochemicals in the brain synapses (where nerves communicate with each other). Examples of atypical antidepressants include nefazodone (Serzone), trazodone (Desyrel), and bupropion (Wellbutrin). The United States Food and Drug Administration (FDA) has also approved bupropion for use in weaning from addiction to cigarettes. This drug is also being studied for treating attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD). These problems affect many children and adults and restrict their ability to focus or concentrate on one thing at a time.
Lithium (Eskalith, Lithobid), valproate (Depakene, Depakote), carbamazepine (Epitol, Tegretol), neurontin (Gabapentin), and lamictal (Lamotrigine) are mood stabilizers and anticonvulsants. They have been used to treat bipolar depression. Certain antipsychotic medications, such as ziprasidone (Geodon), risperidone (Risperdal), quetiapine (Seroquel), and aripiprazole (Abilify), may treat psychotic depression. They have also been found to be effective mood stabilizers and are therefore sometimes been used to treat bipolar depression, usually in combination with other antidepressants.
Monoamine oxidase inhibitors (MAOIs) are the earliest developed antidepressants. Examples of MAOIs include phenelzine (Nardil) and tranylcypromine (Parnate). MAOIs elevate the levels of neurochemicals in the brain synapses by inhibiting monoamine oxidase. Monoamine oxidase is the main enzyme that breaks down neurochemicals, such as norepinephrine. When monoamine oxidase is inhibited, the norepinephrine is not broken down and, therefore, the amount of norepinephrine in the brain is increased.
MAOIs also impair the ability to break down tyramine, a substance found in aged cheese, wines, most nuts, chocolate, and some other foods. Tyramine, like norepinephrine, can elevate blood pressure. Therefore, the consumption of tyramine-containing foods by a patient taking an MAOI drug can cause elevated blood levels of tyramine and dangerously high blood pressure. In addition, MAOIs can interact with over-the-counter cold and cough medications to cause dangerously high blood pressure. The reason for this is that these cold and cough medications often contain drugs that likewise can increase blood pressure. Because of these potentially serious drug and food interactions, MAOIs are usually only prescribed after other treatment options have failed.
Tricyclic antidepressants (TCAs) were developed in the 1950s and '60s to treat depression. They are called tricyclic antidepressants because their chemical structures consist of three chemical rings. TCAs work mainly by increasing the level of norepinephrine in the brain synapses, although they also may affect serotonin levels. Doctors often use TCAs to treat moderate to severe depression. Examples of tricyclic antidepressants are amitriptyline (Elavil), protriptyline (Vivactil), desipramine (Norpramin), nortriptyline (Aventyl, Pamelor), imipramine (Tofranil), trimipramine (Surmontil), and perphenazine (Triavil).
Tetracyclic antidepressants are similar in action to tricyclics, but their structure has four chemical rings. Examples of tetracyclics include maprotiline (Ludiomil) and mirtazapine (Remeron), a drug that was discussed above under dual-action antidepressants.
TCAs are safe and generally well tolerated when properly prescribed and administered. However, if taken in overdose, TCAs can cause life-threatening heart-rhythm disturbances. Some TCAs can also have anticholinergic side effects, which are due to the blocking of the activity of the nerves that are responsible for control of the heart rate, gut motion, visual focus, and saliva production. Thus, some TCAs can produce dry mouth, blurred vision, constipation, and dizziness upon standing. The dizziness results from low blood pressure that occurs upon standing (orthostatic hypotension). Anticholinergic side effects can also aggravate narrow-angle glaucoma, urinary obstruction due to benign prostate hypertrophy, and cause delirium in the elderly. TCAs should also be avoided in patients with seizure disorders or a history of strokes.
Stimulants such as methylphenidate (Ritalin) or dextroamphetamine (Dexedrine) are used primarily for the treatment of depression that is resistant to other medications. The stimulants are most commonly used along with other antidepressants or other medications, such as mood stabilizers, antipsychotics, or even thyroid hormone. They are sometimes used alone but rarely. The reason they are usually used sparingly and with other medications for depression is that unlike the other medications, they may induce an emotional rush and a high in both depressed and nondepressed people. Therefore, the stimulants are potentially addictive drugs.
Electroconvulsive therapy (ECT)
In the ECT procedure, an electric current is passed through the brain to produce controlled convulsions (seizures). ECT is useful for certain patients, particularly for those who cannot take or have not responded to a number of antidepressants, have severe depression, and/or are at a high risk for suicide. ECT often is effective in cases where trials of a number of antidepressant medications do not provide sufficient relief of symptoms. This procedure probably works, as previously mentioned, by a massive neurochemical release in the brain due to the controlled seizure. Highly effective, ECT relieves depression within one to two weeks after beginning treatments in many people. After ECT, some patients will continue to have maintenance ECT, while others will return to antidepressant medications.
In recent years, the technique of ECT has been much improved. The treatment is given in the hospital under anesthesia so that people receiving ECT do not feel pain. Most patients undergo six to 10 treatments. An electrical current is passed through the brain to cause a controlled seizure, which typically lasts for 20 to 90 seconds. The patient is awake in five to 10 minutes. The most common side effect is short-term memory loss, which resolves quickly. ECT can usually be safely done as an outpatient procedure.
Psychotherapies

Many forms of psychotherapy are effectively used to help depressed individuals, including some short-term (10 to 20 weeks) therapies. Talking therapies (psychotherapies) help patients gain insight into their problems and resolve them through verbal give-and-take with the therapist. Behavioral therapists help patients learn how to obtain more satisfaction and rewards through their own actions. These therapists also help patients to unlearn the behavioral patterns that contribute to their depression.
Interpersonal and cognitive/behavioral therapies are two of the short-term psychotherapies that research has shown to be helpful for some forms of depression. Interpersonal therapists focus on the patient's disturbed personal relationships that both cause and exacerbate the depression. Cognitive/behavioral therapists help patients change the negative styles of thinking and behaving that are often associated with depression.
Psychodynamic therapies are sometimes used to treat depression. They focus on resolving the patient's internal psychological conflicts that are typically thought to be rooted in childhood. Long-term psychodynamic therapies are particularly important if there seems to be a lifelong history and pattern of inadequate ways of coping (maladaptive coping mechanisms) in negative or self-injurious behavior.

source: www.medicinenet.com/depression/page6.htm#tocf

ANXIETY

Anxiety is a feeling of nervousness, apprehension, fear, or worry. Some fears and worries are justified, such as worry about a loved one or in anticipation of taking a quiz, test, or other examination. Problem anxiety interferes with the sufferer's ability to sleep or otherwise function. It is noteworthy that teenagers are particularly susceptible to having irritability as a symptom of a number of emotional problems, including anxiety. Anxiety may occur without a cause, or it may occur based on a real situation but may be out of proportion to what would normally be expected. Severe anxiety can have a serious impact on daily life.

What Are the Symptoms of GAD?

• Excessive, ongoing worry and tension
• An unrealistic view of problems
• Restlessness or a feeling of being "edgy"
• Irritability
• Muscle tension
• Headaches
• Sweating
• Difficulty concentrating
• Nausea
• The need to go to the bathroom frequently
• Tiredness
• Trouble falling or staying asleep
• Trembling
• Being easily startled

Source: www.medicinenet.com/anxiety/article.htm#tocc

What Causes Anxiety?

There is no one cause for anxiety, however there are a few factors that contribute to a person developing anxiety. Scientists have three potential causes, and have broke them down into three parts, brain chemistry, heredity, and life experiences.
Scientists and researchers are learning more about the factors that cause the development of an anxiety disorder. With new technologies and with more awareness of anxiety disorders, experts can learn more about the psychological and biological effects along with the development of an anxiety disorder. As researchers are learning more about the causes of this disorder they are therefore able to provide better treatment, and possibly in the future, provide prevention measures.
The following are thought to be triggers of anxiety disorders:

• Brain Chemistry
• Heredity
• Life Experiences

Brain Chemistry and/or Chemical Imbalance:

In a large number of cases, individuals with symptoms of anxiety disorders are usually prescribed medications that change or alter the chemicals of the brain. Because symptoms of anxiety disorders are, in most cases, helped by medication, experts believe that brain chemistry seems to play a part in the trigger of anxiety disorders.

Chemical messengers, or Neurotransmitters, in the brain that regulate thought and feeling sometimes have a problem with brain messages sent out because of a chemical imbalance. Two of the primary neurotransmitters that affect thought and feeling are serotonin and dopamine. When these chemicals have an imbalance, one can feel depressed or anxious.

Scientific evidence tells us that anxiety-related problems such as stress, panic, and exaggerated fears are the result of a imbalance between the right and left hemispheres of the brain. Positron emission tomography or (PET) scans are being done to study this evidence.
Heredity and/or Genetics:

There is evidence that anxiety disorders run in families. If parents or other close relatives have an anxiety disorder, children are at higher risk of developing an anxiety disorder in the future.

Being raised in a family where fear and anxiety are shown on a constant day to day basis can affect a person in adulthood. The brain and its learned behavior is inherited which is reason enough to believe anxiety is heredity. By changing the way one thinks, and changing thought patterns with Cognitive Behavior Therapy, one can overcome anxiety.

Life Experiences:

Researchers believe that the relationship between anxiety disorders and a life of abuse, violence, or poverty is grounds for further study, as these life experiences may affect an individual's exposure to these disorders. Experts believe that anxiety is a learned behavior that can be unlearned. Events in childhood may lead to certain fears that, over time, develop into a anxiety disorder.
In some cases anxiety can be triggered by caffeine, cocaine, and amphetamines. It is a known fact that cocaine use over time can cause feelings of panic, and this terror often continues for years after the drug is stopped. Exhaustion and other stimulants, and even the side effects of certain medications can cause the symptoms of anxiety. Being taught to hold back negative feelings such as anger, or an excessive need for approval, can also be possible triggers.

However, there may be no clear reason why a person feels anxious. It could be a combination of one's personality, the things that have happened to them, or life-changes such as pregnancy, a new job, or loss of a loved one.

Some people who have the symptoms of anxiety have feelings of being out of control. This might be due to rising debts, along with work or study pressures. For another, anxiety could stem from a stressful situation or experience.

source: www.livingwithanxiety.com/anxiety-causes.htm

Treatment

Naturally treatment will vary according to the cause and symptoms being experienced with a particular type of anxiety disorder. For instance treatments may include:

• Treat the medical condition causing the disorder (i.e. hyperthyroidism, depression, bipolar disorder, etc.)
• Remove the offending substance (i.e. nicotine, marihuana, caffeine)
• Resolve the ongoing stress (financial stress, examination)
• Psychotherapy (talking therapy) to resolve unresolved psychological issues
• Medication
• Psychotherapy + medication is often more effective than either treatment alone

Medication Treatment

A variety of medications are available for treating anxiety disorders. Sometimes you may need to try one or more medications to find the treatment most suitable for you.

Medication Type

Benzodiazepines
Alprazolam (Xanax)
Bromazepam (Lectopam)
Lorazepam (Ativan)
Oxazepam (Serax)
Temazepam (Restoril)
Chlordiazepoxide hcl (Librium)
Clorazepate (Tranxene)
Diazepam (Valium)

Common Side Effects
• drowsiness
• fatigue
• confusion
• disorientation dizziness
• decreased concentration, decrease memory
• dry mouth
• blurred vision

Precautions and information
Avoid tasks requiring alertness, i.e. driving.
Do not drink alcohol
Physical and psychological dependence can occur

Medication Type

Benzodiazepines
Alprazolam (Xanax)
Bromazepam (Lectopam)
Lorazepam (Ativan)
Oxazepam (Serax)
Temazepam (Restoril)
Chlordiazepoxide hcl (Librium)
Clorazepate (Tranxene)
Diazepam (Valium)

Common Side Effects

• drowsiness
• fatigue
• confusion
• disorientation dizziness
• decreased concentration, decrease memory
• dry mouth
• blurred vision

Precautions and information

Avoid tasks requiring alertness, i.e. driving.
Do not drink alcohol
Physical and psychological dependence can occur

Medication Type

Antihistamine
Hydroxyzine (Atarax)


Common Side Effects

Side effects are generally mild and go away during treatment
• Drowsiness
• dry mouth
• headache

Precautions and information

Do not drink alcohol
Avoid tasks requiring alertness, i.e. driving

Medication Type

Antidepressants
Fluoxetine (Prozac)
Fluvoxamine (Luvox)
Paroxetine (Paxil)
Sertraline (Zoloft) Clomapramine (Anafranil) Venlafaxine (Effexor

Common Side Effects

• drowsiness
• trouble sleeping
• tremor
• nausea
• dry mouth
• dizziness

Precautions and information

Anxiety treatment is often more effective when an antidepressant is used along with a benzodiazepine than it is if a benzodiazepine is used alone.

Medication Type

Beta Blockers
Propranolol (Inderal)

Precautions and information

Though normally used to treat high blood pressure this medication is effective at treating anxiety in special situations such as giving a presentation, by decreasing heart rate, shaking hands etc.

Treatment Goals
1. Get rid of the anxiety disorder
2. Decrease the intensity of symptoms
3. Prevent, shorten and decrease intensity of recurrences.


Source: www.anxietytreatment.com/Treatments