Tips against Stress

How Stress affects us and what we can do against it..
Video found at www.healthguru.com

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Men and Depression

I already posted an article about how depression affects women...but what about men? How does it affect men? What is the difference and why do so few men seek treatment?
Article found on psychcentral.com by Serena Gordon

Men Can Get the Blues

By Serena Gordon
25 Sep 2001

Depression has traditionally been considered a female disorder. But, men can and do get depressed. The big difference is that men may be less likely to seek treatment for depression because they see mental illness as a sign of weakness.

Depression is not a sign of weakness, however. It is a disease with biochemical causes. More than 17 million Americans suffer from depression every year, according to the American Psychiatric Association (APA). And, the APA estimates that at least one out of every 10 men will have depression during their lifetime.

The Stigma
Many of those men will never get treated for their depression for a variety of reasons. The most important is that men are less willing to admit depression, according to Teodoro Bottiglieri, Ph.D., a senior research scientist and associate professor at Baylor University Medical Center and the author of Stop Depression Now. "There is a stigma attached to having any psychiatric illness. It's a point of vulnerability, like admitting you're impotent in public," he says.

Men, he said, are taught to just grin and bear it, get on with life and provide for their families. Dr. Norman Sussman, a psychiatrist at New York University Medical Center, agrees. "Men are less likely to seek treatment, in part because there's a tendency for men to tough it out," she says.

It's important for men to realize that "depression is a medical disorder that affects one's ability to feel and think in certain ways. It's a form of reversible brain failure," says Sussman. "It's not an indication of their character."

The problem with not coming forward is that depression tends to get worse, and affects all areas of a man's life. Many men will self-medicate with alcohol or drugs, says Sussman. And, men -- especially older men -- have higher rates of suicide than women do.

Another reason men don't get treatment may be that their doctors are missing the signs of depression. Sussman says it's possible that there may be a biased tendency in diagnosing depression, with doctors looking for it more in women than in men because the disease is so much more prevalent in women. Men also tend to downplay their symptoms if they discuss them with their doctors at all.

Depression, particularly in older men, may not always be obvious, says Dr. Steven Roose, a professor of clinical psychiatry at Columbia University and the director of the Neuropsychiatric Research Clinic at the New York State Psychiatric Institute. He says the symptoms are a little bit different, with older men reporting sleep disturbances, pain and loss of energy. Older men may not complain about having a depressed mood, he says. And many primary care physicians lack the training to recognize that it's depression. According to Roose, suicide is an epidemic in men over 60 -- 20 percent of older men who attempted suicide had seen their doctor that day, and 70 percent had seen their doctor during the month leading up to their suicides.

"A review of mood state and ruling out the diagnosis of depression should be as much a standard procedure as taking a blood pressure," says Roose.

Roose adds that undiagnosed depression can also affect other areas of health. For example, men diagnosed with heart disease who are also depressed do much worse in terms of survival, according to Roose.

Signs and Symptoms
It's important that family members -- particularly spouses -- be on the lookout for signs of depression, says Bottiglieri, because many depressed people will not seek help.

Symptoms include:

• sad mood that lasts for more than two weeks
• feelings of hopelessness
• lack of enjoyment from everyday activities, such as playing with children or playing golf
• changes in sleep patterns
• changes in appetite
• trouble concentrating and making decisions
• preoccupation with death and thoughts of suicide

In more severe cases of depression, people can be agitated or very lethargic. Eventually, they may be unable to function in their daily routine.

Treatment
There are a number of medications available to treat depression and according to the APA, up to 90 percent of those treated have significant improvements. Treatment options include tricyclic antidepressants, MAO inhibitors, and the very popular selective serotonin reuptake inhibitors or SSRIs, like Prozac and Zoloft. Alternative treatments such as St. John's Wort and SAM-e are also available. Psychotherapy is sometimes useful in treating depression, though it is most effective when used in conjunction with medication. But, Sussman says, some men have difficulty opening up in psychotherapy.

The problem with some of the medical treatments is that they cause other problems, such as a loss of interest in sex. "SSRIs are well tolerated and safe, but they do have an effect on quality of life," says Sussman. Depending on which medication you take, side effects can include a loss of libido, difficulty or an inability to achieve orgasm, sleep problems, weight gain and a lack of feeling the full range of emotions. Tricylcic antidepressants may have dangerous interactions with heart medication.

"Patients should be told up front of the likelihood of side effects happening," says Sussman. "But, in primary care, people are often not forewarned."

Patients need to talk to their doctors about side effects because there are many choices out there, and if one medication produces unpleasant side effects, it's possible a different medication may not.

SSRIs can also have unexpected benefits. They are fairly effective at treating premature ejaculation, which may be something a man hasn't even discussed with his doctor. Also, according to Roose, they seem to have an antiplatelet effect similar to that of aspirin. So, while taking a medication to cure depression, men may also be improving their cardiovascular health.

St. John's Wort and SAM-e have also been used to treat depression. St. John's Wort doesn't appear to be as effective as was once believed, says Bottiglieri. He says it depends a lot on the dose taken and the actual amount of St. John's Wort in the product.

However, Bottliglieri does believe that SAM-e can be very useful in treating depression and says it's often used as a first-line treatment in Europe. It also has fewer side effects than other medications. He adds that dietary supplements like SAM-e have been criticized because doctors fear patients will self-medicate themselves instead of seeking help. But, he feels they have a place.

"At least they have a choice of something that may help if they're the type of person that won't seek help anyway," he says. He recommends 400 milligrams per day for mild depression, and for more severe depression, he recommends 800-1200 milligrams.

SAM-e also may work well in conjunction with SSRIs and may reduce the need for a high dose of the SSRI. Such a combination would have to be prescribed and monitored by a physician, however.

"Men really should seek medical attention for their depression. It is a life threatening situation that needs to be properly diagnosed and monitored," says Bottiglieri.

Roose concurs. "Depression is an illness and men should not feel it results from weakness. It doesn't reflect on their character any more than a broken leg does," he says.

Tips to Manage your Depression

There are a lot of ways to deal with it e.g. yoga,meditation but there are small things that you can do..that are obvious but we forget them. Look at your sleep cycles..do you have problems getting up in the morning? Here are a few tips how you can manage your depression.
Article found on psychcentral.com written by By Josepha Cheong, M.D., Michael Herkov, Ph.D., and Wayne Goodman, M.D.

Tips for Managing Your Depression

By Josepha Cheong, M.D., Michael Herkov, Ph.D., and Wayne Goodman, M.D.


Do not expect too much from yourself too soon, as this will only accentuate feelings of failure. Avoid setting difficult goals or taking on new responsibilities.

Break large tasks into small ones, set some priorities, and do what can be done, as it can be done.

Recognize patterns in your mood. Like many people with depression, the worst part of the day for you may be the morning. Try to arrange your schedule accordingly so that the demands are the least in the morning. For example, you may want to shift your meetings to midday or the afternoon.

Participate in activities that may make you feel better. Try exercising, going to a movie or a ball game, or participating in religious or social activities. At a minimum, such activities may distract you from the way you feel and allow the day to pass more quickly.

You may feel like spending all day in bed, but do not. While a change in the duration, quality and timing of sleep is a core feature of depression, a reversal in sleep cycle (such as sleeping during daytime hours and staying awake at night) can prolong recovery. Give significant others permission to wake you up in the morning. Schedule "appointments" that force you to get out of the house before 11 a.m. Do this scheduling the night before; waiting until the morning to decide what you will be doing ensures you will do nothing.

Avoid overdoing it or getting upset if your mood is not greatly improved right away. Feeling better takes time. Do not feel crushed if after you start getting better, you find yourself backsliding. Sometimes the road to recovery is like a roller coaster ride.

People around you may notice improvement in you before you do. You may still feel just as depressed inside, but some of the outward manifestations of depression may be receding.

Try not to make major life decisions (such as changing jobs or getting married or divorced) without consulting others who know you well and who have a more objective view of your situation.

Do not expect to snap out of your depression on your own by an exercise of will power. This rarely happens.

Remind yourself that your negative thinking is part of the depression and will disappear as the depression responds to treatment.

Find support from people who understand. Self-help groups can provide a supportive environment for you as well as your family and friends. Hospitals and health departments sponsor self-help groups, and an increasing number are found online.

Celebrities and Depression

There are a lot people in showbusiness that have also experienced or are still experiencing depression ..this article just mentions a few of them and depression and creativity ...is there are a connection?
Find out! I found this article on psychcentral.com by Douglas Eby

Creativity and Depression

by Douglas Eby

"I only know that summer sang in me a little while, that in me sings no more."

That excerpt from one of her sonnets expresses how much poet Edna St. Vincent Millay (1892-1950) probably knew of depression.

Marie Osmond has described her experiences suffering from postpartum depression in her book Behind the Smile: "I'm collapsed in a pile of shoes on my closet floor. I have no memory of what it feels like to be happy. I sit with my knees pulled up to my chest. It's not that I want to be still. I am numb."

That kind of numbness, that sense of endless hopelessness and erosion of spiritual vitality are some of the reasons depression can have such a devastating impact on creative inspiration and expression.

There are reports that as many as a quarter of American women have a history of depression. According to an article on the Allhealth.com website, "The risk of depression among teen girls is high, and this risk lasts into early adulthood." A study of young women living in Los Angeles found that almost half had at least one episode of major depression within five years after high school graduation.

Psychiatrist Kay Redfield Jamison, herself a person with bipolar disorder or manic depression, notes in her book Touched with Fire that the majority of people suffering from mood disorder "do not possess extraordinary imagination, and most accomplished artists do not suffer from recurring mood swings."

She writes, "To assume, then, that such diseases usually promote artistic talent wrongly reinforces simplistic notions of the 'mad genius.' But, it seems that these diseases can sometimes enhance or otherwise contribute to creativity in some people. Biographical studies of earlier generations of artists and writers also show consistently high rates of suicide, depression and manic-depression."

According to the website Famous (Living) People Who Have Experienced Depression, women in the arts who have declared publicly they have had some form of the mood disorder include Sheryl Crow; Ellen DeGeneres; Patty Duke; Connie Francis; Mariette Hartley; Margot Kidder; Kristy McNichol; Kate Millett; Sinead O'Connor; Marie Osmond; Dolly Parton; Bonnie Raitt; Jeannie C. Riley; Roseanne and Lili Taylor.

Development of a mood disorder may start early in life. C. Diane Ealy, Ph.D., in her book The Woman's Book of Creativity writes: "Many studies have shown us that a young girl's ideas are frequently discounted by her peers and teachers. In response, she stifles her creativity. The adult who isn't expressing her creativity is falling short of her potential.

"Repressed creativity can express itself in unhealthy relationships, overwhelming stress, severe neurotic or even psychotic behavior, and addictive behaviors such as alcoholism. But perhaps the most insidious and common manifestation of repressed creativity in women is depression."

Marie Osmond also wrote about another aspect, the impact on her esteem and sense of self: "My mother has always been my role model, and I believe my survival in the entertainment business is in large part due to my desire to be a strong woman like my mother. She is my hero.

"I can vividly recall what it felt like to be alone and in a crumpled heap on the closet floor. I remember thinking that my mother would never have fallen apart like that. I was sure no one would understand what I was going through. I could have managed the pain. It was the shame that was destroying me."

Fortunately, depression can be effectively managed for most people, through medication, cognitive behavioral therapy or other approaches. According to an issue of the Blues Buster newsletter, formerly published by Psychology Today magazine, research studies have shown significant reductions in depression through engaging in aerobic activities such as walking and jogging, and resistance exercise, such as weight training.

In a press release, Rosie O'Donnell has commented about her own experience, "the dark cloud that arrived in my childhood did not leave until I was 37 and started taking medication. My depression slowly faded away. I have been on medication for two years now. I may be on it forever. The pills did not make me a zombie, they did not change the reality of my past, they did not take away my curiosity.

"What the pills did was to allow me to deal with all of those issues when and where I wish. My life is once again manageable. The gray has gone away, I am living in bright Technicolor.''

In her book "Life After Manic Depression" actress Patty Duke also affirms that getting the right diagnosis and treatment allowed recovery of her life and spirit: "The rate of growth in my mind and my heart in the last seven years is beyond measuring."

Douglas Eby writes about psychological and social aspects of creative expression and personal achievement. His site is Talent Development Resources: http://talentdevelop.com.

20 Tips to Tame Your Stress

It is known that stress also plays an important role in connection with depression. Here are a few tips that you can integrate in your daily life.
I found this article on psychcentral.com by Lynn Ponton

20 Tips to Tame Your Stress

1. Perform diaphragmatic or “deep breathing” exercises.
2. Lie face down on the floor and begin breathing deeply and slowly, with your hands resting under your face. Do this for five minutes.
3. Sit in a reclining chair. Put a hand on your abdomen and a hand on your chest. As you breathe, make sure the hand on your abdomen is moving up and down rather than one on your chest. If the hand on your abdomen is moving you are breathing deeply and slowly.
4. Try progressive or “deep muscle” relaxation. Progressively tense and relax each muscle group in your body. Learn the difference between muscle tension and relaxation.
5. Meditate. Use visualization. Sit quietly with your eyes closed, imagining the sights, sounds and smells of your favorite place, such as a beach or mountain retreat.
6. Exercise regularly or take up yoga.
7. Consult a psychologist about the use of biofeedback.
8. Make time for music, art or other hobbies that help relax and distract you.
9. Learn to identify and monitor stressors. Come up with an organized plan for handling stressful situations. Be careful not to overgeneralize negative reactions to things.
10. Make a list of the important things you need to handle each day. Try to follow the list so you feel organized and on top of things. Put together a coping plan step by step so you have a sense of mastery.
11. Keep an eye on things that might suggest you’re not coping well. For example, are you smoking or drinking more or sleeping less?
12. Keep a list of the large and little hassles in your day versus the major stressful events in your life; this helps you focus on the fact that you’re keeping track of and managing those as well as you can.
13. Set aside a time every day to work on relaxation.
14. Avoid caffeine, alcohol, nicotine, junk food, binge eating and other drugs.
15. Say no occasionally.
16. Get the right amount of sleep. For most people, this is seven to 10 hours a night.
17. Cultivate a sense of humor; laugh.
18. Research has shown that having a close, confiding relationship protects you from many stresses.
19. Don’t run from your problems! This only makes them worse.
20. Talk to your family and friends. See if they can help.

In general, if you are having trouble handling stress, you can seek help from your family physician or a mental health professional-such as a psychiatrist or psychologist-in your area.

How to Recover from Depression without using Drugs

A lot of people (including me) are taking antidepressants. This is not a bad thing and sometimes it is better to combine that with the help of a therapist or hypnotherapist.
I found an article at www.depression-guide.com for people that would like to stop with the medication (with the approval of your doctor of course) and try to live without:

How to Recover From Depression Without Drugs?

Depression is a very common illness afflicting millions of people each year. It can sap your strength, put stress on relationships and make you lose your sense of self. Here are some things you can try to lift your spirits and make you enjoy life again, without drugs or therapy. depression is the world's most common psychological problem. It impacts the lives of literally millions of people, every day. It takes the joy and hope out of so many lives.

Depression often goes undiagnosed or untreated. And even when it is diagnosed, too many people are treated with drugs alone without the support and help of a qualified therapist or hypnotherapist.

Steps to recover from Depression without prescription drugs

1. Decide what you would do if you could do anything in the world you wanted, and then start to do it. No matter how impossible that goal seems, if you cut it into small enough steps, you can find a way to start. Take one minute at a time.
2. Spend time doing the things you enjoy, and avoid doing things you don't. Socialize with people you like, and stay away from people you don't. Live every minute like it's your last.
3. Remember you have two choices in life. You can spend the next five minutes being happy, or the next five minutes being sad. Whether happy or sad, you are using the same amount of energy in that five minutes.
4. Work at a place you enjoy and where you like most of the people. It's depressing if you don't like your job or the people there.
5. Acquaint yourself with your mood ebb and flow and embrace it. If you have more energy in the morning, utilize mornings.
6. Maintain a regular schedule - awake at the same time each morning, take your meds at the same time, go to sleep at the same time.
7. Have fun and laugh often. Rent funny movies. Laugh and smile often. It's contagious.

Tips on curing depression without using drugs

• The psychiatrist should make you feel comfortable and should not be judgmental. Get a good vibe from your psychiatrist as you will constantly be disclosing confidential information to this person and must feel comfortable while doing so.
• After you and your psychiatrist are comfortable with one another, ask if it's fine to slightly adjust your meds if necessary.
• If you don't like your psychiatrist, switch immediately. Your mental health is the most important thing you own. If your psychiatrist hasn't found the right medication, get a consultation with someone else.
• Attend a support group in your area with like-minded people. It's great to talk to people and learn how they cope with their illness.
• Set a small goal at your support group to accomplish by the next meeting. If there's no support groups near you, start your own.
• If you're feeling suicidal, take your cellphone with you and leave the house. Get away from anything lethal. Spend time with positive people when feeling suicidal.
• You must get regular lab tests if you're on certain drugs such as lithium, Depakote and Tegretol.
• Hot weather may be hazardous to people on lithium, Lamictal and antipsychotics. Drink plenty of water, wear sunscreen with an SPF rating of 15 or more.

The Causes of Depression

We know it can happen to all of us...problems with family, friends, in the partnership, death of a beloved person, or job loss...that can all be reasons for a depression

I found an interesting article at www.omnimedicalsearch.com by Alina Morrow thats shows what could lead to depression and that it is more complex than we thought :

Causes of Depression and Risk Factors

In the past, doctors believed depression was triggered by thoughts and emotions that trouble the person. Recent studies have proven that the mechanisms that lead to depression are more complex. Even if today’s technology and knowledge allows us a better understanding, scientists are still unable to establish the exact causes that trigger depression. However, scientists are sure that a combination of several factors contributes to depression onset and evolution.

Depression can be caused by a number of different factors which include:

1. Genetic vulnerability: Clinical experience and trials have proven that depression runs in the family. However, genetic studies were recently able to establish that a person inherits a vulnerability to depression, but not the disorder. This means that a history of depressive disorders in the family increases the risk of developing depression. People with a family member suffering from depression are one-and-a-half to three times more likely to suffer from depression themselves than a member of general population.

2. Chemical changes in the brain: Additional research indicates that depression can be caused by an imbalance in neurotransmitters . Neurotransmitters are chemical substances used by the brain cells to communicate with one another. The two neurotransmitters with a major role in depression are: serotonin and norepinephrine. A serotonin deficit can cause sleep problems, irritability, anxiety (associated with depression), while a norepinephrine deficit can cause fatigue and a low mood. However, the neurotransmitter deficit is not the only cause of the chemical imbalance. One of the following situations can also play a major role in depression:

I). There are not enough receptor sites in the brain to receive neurotransmitters.
II). The neurotransmitters boomerang back to their starting point before reaching the receptors.
III). There is a deficit of chemicals that help in manufacturing neurotransmitters.
IV). The number of molecules that facilitate the neurotransmitter production is too small.

Medical studies also suggest that an important role in causing depression is played by a hormone, called cortisol, that is normally produced by the body in response to stress, fear and anger. Usually the level of cortisol varies during day, being high in the morning and decreases during the day. In depressed people, this hormone is present in high amounts all day long. Also, the researches have proven that the amount of cortisol increases in people that experience a long-term stress.

3. Environmental situations:
Certain life situations can cause depression, such as:

• The loss of someone loved by physical separation or death.
• The loss of possessions, belongings and positions (divorce, retirement, or job loss).
• The loss of personal goals and dreams.
• Lack of social support.

4. Substance abuse: People that drink alcohol, use illegal drugs or have a substance abuse problem can develop depression.

5. Physical factors
Certain physical factors can cause depression. Some of these factors include:

• Lack of exercise: There is a significant relationship between an inactive life style and depression. Physical activity changes the brain chemistry causing improvements in mild to moderate depression patients. Research has proven that regular physical exercise influences the level of serotonin (the neurotransmitter that plays an important role in depression) leading to improved moods and feelings of well-being. Physical exercise burns the stress related chemicals (such as adrenaline) which helps the body to relax, increases the amount of endorphins, and boosts the body temperature which seems to help the body by influencing the brain chemicals. Exercising not only influences the brain chemistry, but also improves the person’s self-esteem, confidence, and can break down the pessimism because they are playing an active role in their recovery through positive and pleasant experiences.

• Nutritional deficiencies: Depression can be aggravated by nutritional deficiencies. The nutritional deficiencies include:
  - Excessive consumption of sucrose (sugar): Excessive amounts of sugar or sweet foods can aggravate depression.
  - Excessive amount of magnesium or vanadium.
  - Amino acids imbalance: Certain amino acids have similar properties with neurotransmitters, and play an important role in treating depression. A deficiency of these amino acids may lead to depression. They include:
  (1) Gamma-aminobutyric acid (GABA), a natural anti-anxiety chemical, is present in low amounts in depressed people.
  (2) L-tryptophan is a precursor to the serotonin synthesis that needs to be kept to a normal level in order to treat/prevent depression and maintain emotional balance.
  (3) Tyrosine is a precursor of two neurotransmitters, norepinephrine and dopamine, both playing an important role in controlling the mood.
  (4) DL-phenylalanine (DLPA or phenylalanine) is a precursor to the norepinephrine synthesis (neurotransmitters with an important role in depression). Norepinephrine controls the mood. A study conducted on depressed patients showed rapid improvement in those who received a supplement of phenylalanine and vitamin B6.
  - Food allergies
  - Excessive consumption of caffeine: A high intake of caffeine has being strongly linked to depression. A study conducted on healthy college students showed that moderate to high coffee drinkers obtained higher scores on a depression scale than those with a low coffee intake. Other studies have showed that depressed patients tend to drink higher amounts of coffee (more than 700mg per day).
  - Deficiencies of folic acid, vitamin B, vitamin C, calcium, copper, iron, magnesium, potassium, or biotin.

6. Medical disorders: People that suffer from medical disorders (such as diabetes, stroke and cardiovascular disease, hormonal disorders, lung disease, multiple sclerosis, rheumatoid arthritis, cancer, brain tumors, Parkinson’s disease, temporal lope epilepsy, systemic lupus erythematosus, AIDS, influenza, mononucleosis, syphilis -late stage, tuberculosis, viral hepatitis, viral pneumonia, Candida, hypothyroidism, hyperthyroidism, fibromyalgia, hypoglycemia) and psychological disorders (such as anxiety disorders, phobias) also experience depression.

• Diabetes and Depression
  - People that suffer from adult onset diabetes have a 25 percent higher risk for depression.
  - Seventy percent of the patients that suffer diabetic complications suffer from depression.

• Heart Diseases and Depression
  - Forty to 65 percent of the patients that have experienced a heart attack suffer from depression.
  - Clinically depressed patients that have suffered a heart attack have a three to four time greater risk to die within the next six months.
  - Eighteen to 20 percent of the patients that suffer from coronary heart diseases, but did not experienced a heart attack suffer from depression.

• Stroke and Depression
  - Ten to 27 percent of patients that have experienced a stroke suffer from depression for at list one year after.
  - Fifteen to 40 percent of the stroke survivors experience depression symptoms within the next two months that follows the stroke.

• Cancer and Depression
  - One in four patients that suffer from cancer experience clinical depression (depression is not a side effect of the cancer treatment and it is not caused by the disease itself).

7. Medication: Certain medication (such as tranquilizers and sedatives, antipsychotic drugs, antihistamines, Beta-blockers, high blood pressure medications, birth control pills, anti-inflammatory agents, corticosteroids, adrenal hormone agents, Cimetidine, Cycloserine -an antibiotic, Indomethacin, Reserpine, Vinblastine, Vincristine) can cause depression as a side effect when administrated.

Article: Woman and Depression

Here is an article about woman and depression that I found on apa.org . Photo from Flickr taken by stofiska.

Gender Differences, Biological, Psychological and Social Factors, Treatment and Prevention Strategies Examined



WASHINGTON - More than 19 million Americans suffer from depression yearly and women are twice as likely as men to experience a major depressive episode. Depression may occur at any age during a woman's life with certain events like puberty, pregnancy, perimenopause, trauma, substance abuse and quality of relationships increasing the risk, according to the leading authorities on the etiologies and treatments for depression.

Furthermore, depression can occur among women from all educational, economic and racial and ethnic groups and the consequences can include an increased risk of suicide, morbidity from medical illness and risk for poor self-care and reduced adherence to medical regimes. These findings are among those summarized in a new report, Summit on Women and Depression: Proceedings and Recommendations, just published by the American Psychological Association, and reflecting the research reviewed by 35 internationally renowned experts from a variety of disciplines who contributed papers to the Summit. By reviewing the latest research on depression, the experts offer explanations on the possible causes of depression, suggest new research directions and recommend how current research findings can be incorporated into health policy and health care practices.

Major depression can impair a person's social and physical functioning even more severely than serious medical conditions such as hypertension, diabetes or arthritis, and can result in disability and significant loss of income, according to the research cited in the report. Furthermore, a World Health Organization Report examining "The Global Burden of Disease" found that "depression presents the greatest disease burden for women when compared with other diseases."

Some of the findings that examine the possible culprits of depression are:

* Genetic Factors: Based on data that major depression clusters in families, having a first-degree relative with depression (parent, sibling) is a risk factor for depression. Although results from family or twin studies have not been definitive in showing the exact contribution of genetics to depression. Evidence is accumulating that there is a genetic risk that may be different for women and men. For women, it will be particularly instructive to understand the interaction of genetic, hormonal and experiential factors in their heightened risk for depression.
* Sex Hormones: The link between increased rates of depression and puberty, mood and the menstrual cycle as well as mood and pregnancy suggests a role of gonadal hormones in depression. Specifically, changes in gonadal hormones, disturbances in the hypothalamic-pituitary-gonadal (HPG) axis and attendant effects on neuromodulators (e.g. serotonin) may all be key mechanisms in the initiation of depression. For example, pregnancy and delivery produce dramatic changes in estrogen and progesterone levels, as well as changes in the HPG axis, that may underlie postpartum depression.
* Life Stress and Trauma: Case-control and community-based studies have shown that more than 80 percent of major depression cases were preceded by a serious adverse life event. Traumatic events, such as childhood sexual abuse, adult sexual assault, male partner violence and physical illness also can lead to depression. Initial research has suggested that early trauma has a greater impact on risk for depression than later occurring trauma. Research has also indicated that women may be more likely than men to experience depression in response to a stressful event.
* Interpersonal Relationships and Cognitive Styles: One cognitive style more common in women than men that increases the risk for depression is ruminative thinking - repetitively and passively focusing on symptoms of distress and their possible causes and consequences. Ruminative thinking is also associated with longer and more severe episodes of depression. Current research has demonstrated that relationships are more paramount to women's self-concept than men and that women are more likely to experience stress in response to adverse events occurring in the lives of others and place their needs secondary to those of others. These interpersonal orientations illustrate major psychological differences between men and women that may help account for differences in vulnerability to depression.

Common treatments for depression in women include psychotherapies and antidepressants. Both psychotherapy and antidepressant treatments are equally effective for mild to moderate depression. In particular, with regard to psychotherapy, controlled clinical trials provide evidence for the efficacy of interpersonal and cognitive behavioral interventions. Other evidence suggests that some structured behavioral marital and family therapies are effective in treating depression. There is also some evidence that psychotherapy is useful in preventing relapse or recurrence of major depression in patients who had successfully been treated with antidepressants. Cognitive behavior therapy has been shown to have a lasting effect that prevents subsequent onset or return of symptoms regardless of whether medication was used.

Approximately 30-35 percent of individuals taking antidepressants do not respond to this form of treatment. Others seek alternative treatments. Alternative therapies include meditation and relaxation, exercise, acupuncture and herbal agents, such as St. John's Wort. Despite the popularity of these alternative treatments, many are untested or not sufficiently tested, which creates a need for research to examine the efficacy, effectiveness and safety of these agents, specifically for women in different age groups.

The contributors to this report recommend more effort to develop, evaluate and implement interventions that will prevent the recurrence of major depression in women at risk by virtue of a prior episode. Targeted prevention was also recommended, focusing on times of heightened risk for depression, such as adolescence. Preventive strategies in women about to become mothers were seen as needed particularly for women who had risk by virtue of previous depression, especially previous postpartum depression.

Development of services for women with depression should consider the importance of affordable access to care and trained primary care providers who can recognize symptoms and offer appropriate antidepressant medication along with referrals to mental health providers. For women with serious depression, rehabilitation services must be enhanced that include residential care and independent living supports.

Lastly, according to the report, public education campaigns are an invaluable source for improving recognition and understanding of major diseases. The contributors recommend different strategies to educate the public about depression in women, which could ultimately increase the number of women who seek treatment. Professional organizations, the media, federal agencies, foundations, private industries, labor unions and health care organizations can play a role in educating the public on depression.

Report: "Summit on Women and Depression: Proceedings and Recommendations," Carolyn Mazure, Ph.D., Professor of Psychiatry, Director of Women's Health Research and Associate Dean for Faculty Affairs at Yale School of Medicine; Gwendolyn Keita, Ph.D., Director of Women's Programs and Associate Executive Director, Public Interest Directorate at American Psychological Association; Mary Blehar, Ph.D. Chief, Women's Health Program National Institute of Mental Health

Article: New findings further explain strong link between depression, heart disease, and stroke

Here is an article I found at theheart.org written by Pauline Anderson

February 18, 2009

Maywood, IL - New findings confirming the presence of elevated levels of two inflammatory markers in physically healthy patients with depression and the identification of another marker not previously strongly associated with inflammation may further explain the robust link between depression and cardiovascular disease and stroke.

The study also found that although levels of these inflammatory markers were not significantly lowered in patients who took an antidepressant for eight weeks, there were indications that they would normalize after a longer period of time.

These results, published online December 31, 2008 in the World Journal of Biological Psychiatry, suggest physicians should not be too quick to take patients off antidepressant medications, as these drugs could be protecting them from persistent low-grade inflammation, which has been linked to heart disease and stroke, study investigator Dr Angelos Halaris (Loyola University Medical Center, Maywood, IL) said.

The study consisted of two parts. In the first, researchers measured five inflammatory biomarkers in 22 patients with major depressive disorder (MDD) who did not have CAD, arthritis, diabetes, or hypertension.

The researchers then compared these levels with 17 age- and sex-matched subjects who were also physically healthy who did not have depression. They found that baseline levels of tumor necrosis factor-alpha (TNF-), interleukin-1beta (IL-1), and monocyte chemoattractant protein-1 (MCP-1) were significantly higher in the MDD patients than controls, but there were no significant differences in levels of the other biomarkers.

Markers take longer than mood to normalize

Although TNF- and IL-1 had previously been associated with depression, this is the first time elevated MCP-1 levels were clearly linked to this disorder, said Halaris. "This substance is involved rather early in the process of inflammation," he said. "I'm excited about this finding; this substance in particular, in conjunction with the other two markers [TNF- and IL-1], could be viewed as a harbinger of worse things to come if nothing is done preventively."

In the second part of the study, 17 patients with MDD took the selective serotonin- and norepinephrine-reuptake inhibitor venlafaxine (Effexor, Wyeth Pharmaceuticals) for eight weeks. All subjects had a therapeutic response, with at least a 50% reduction depression scores.

However, levels of TNF-, IL-1, and MCP-1 all remained elevated. "In spite of the fact that these patients recovered from their depression, these markers did not return to normal at the same time that their mood improved," said Halaris.

However, in those patients who continued on the therapy beyond eight weeks, inflammatory-marker levels did go down.

"The surprise was that it didn't coincide timewise with the mood normalization," said Halaris. "I think that after six months, maybe a little longer, all markers would return to normal, assuming the patient continued to take the medication and didn't suffer a relapse for some other reason."

These findings suggest physicians should think twice before giving in to pressure from patients who are feeling better and want to come off antidepressants, said Halaris.

Routine cardiovascular screening recommended

It's not entirely clear why some individuals with depression go on to develop heart disease while others don't, Halaris said. However, he continued, "Depression has been shown to be perhaps the highest risk factor of all known factors for cardiovascular disease, raising the risk two- to threefold. It's a bigger risk factor than even smoking and hypertension."

The study findings highlight the role of routine screening for heart disease in people with depression. In addition, he said, new screening tests are on the horizon. "We hope that in the not-too-distant future, blood tests that specifically assess the body's inflammation status, such as the so-called proinflammatory cytokines, will also become a reimbursable routine blood test."

Article : New Depression Findings Could Alter Treatments

Here is an article I found on nytimes.com by Benedict Carey

Published: August 8, 2006

The results of two new studies may signal a substantial shift in the way psychiatrists and researchers think about treatment for severely depressed patients.

In one, government researchers found that an injection of a powerful anesthetic drug dissolved feelings of despair in a small group of severely depressed patients in a matter of hours, and that the effect lasted for up to a week in some participants.

Doctors cautioned that the study was very small, and that the drug, ketamine, is a tightly controlled substance sometimes used as a club drug that can cause hallucinations, confusion and dangerous reactions, especially when ingested in unknown doses.

In the other, psychiatrists in New York found evidence that antidepressant drugs significantly increased the risk that some children and adolescents would attempt or commit suicide. Doctors have debated this risk for years, but the authors of the study were skeptical of it, and their report may sway others.

Both studies are being published in The Archives of General Psychiatry.

In the first study, Dr. Carlos A. Zarate of the National Institute of Mental Health led a team of researchers who treated 18 chronically depressed men and women with the anesthetic ketamine.

Five participants recovered from depression in the first day and were still significantly improved a week later. Most patients also received a placebo treatment during the study, an injection of saline solution, and showed no improvement.

Dr. Zarate said experimenting with novel approaches was crucial because the current crop of antidepressant drugs worked slowly and weakly, if at all, for millions of patients.

Ketamine affects the brain in a way entirely different from drugs like Prozac, and it has shown some antidepressant effects in animal studies. It had not been tried for depression in humans.

“What the study tells us is that we can break this sound barrier, in effect, and get an almost immediate response that we cannot get with other drugs,” Dr. Zarate said.

Ketamine is not approved for depression, and it has a checkered past in psychiatric research. The drug often induces hallucinations, like whispering voices and light trails, and researchers used it in the 1990’s to induce psychotic reactions in people with schizophrenia — an experiment widely criticized as unethical.

Dr. Zarate said that neither doctors nor patients should use it for depression outside of carefully controlled research settings and that the results of the current trial should be considered suggestive. “This drug should be seen as a tool for understanding what mechanisms might be involved in rapid relief,” and not as a treatment, Dr. Zarate said.

The study of suicide risk, led by Dr. Mark Olfson of Columbia University and the New York State Psychiatric Institute, was based on an analysis of Medicaid records of more than 4,400 people who were hospitalized for depression in 1999 and 2000.

The researchers found no link between the antidepressant drugs and suicidal behavior in depressed patients 19 or older. But children and adolescents in the study who were taking antidepressants were about 50 percent more likely than those not on the drugs to try to kill themselves. And they were about 15 times as likely as those not on the medications to complete the act, although the number of suicides was too small to draw definitive conclusions, the authors cautioned.

In addition, there could be differences between the two groups that the Medicaid records didn’t reveal: the children who received the drugs may have been more severely ill, skewing the results, they said.

In 2004, the Food and Drug Administration required strong warnings on the labels of antidepressant drugs alerting parents and doctors of a possible suicide risk in some children. Since then many psychiatrists have been skeptical of the suicide link.

“I was surprised by what we found,” Dr. Olfson said. “I set out thinking we’d find that the drugs” significantly reduced suicide risk.

The findings may prompt researchers to look at which children are most at risk, rather than continuing to debate whether the risk exists, he said.

Meditation

Another method that helps me is meditation. Whenever I feel stressed or I need a moment for myself meditation always helped me to gain the feeling of relaxation and comfort back. There are different methods to learn Meditation...you can buy a book and study it or you can join a group. Whatever you are feeling comfortable with...it is up to you.

Here is an article I found on www.nhs.uk

Meditation and depression

“Buddhist meditation techniques can be just as effective at combating depression as medication,” the Daily Mail reported. It said a study has found that “mindfulness-based cognitive therapy (MBCT)” helps people to focus on the present rather than looking to past or future events. The newspaper continued that 15 months after an eight-week trial in people with long-term depression, 47% of those who had the therapy relapsed compared to 60% of those taking antidepressants.

This well-designed trial has been oversimplified by the news reports. The trial did not compare MBCT alone with antidepressants alone, but examined how relapse rates compared between combined MBCT and antidepressants and simply continuing with antidepressants. Therefore, MBCT cannot be said to be “as effective as medication”. It did, however, significantly reduce the amount of time the participants spent on antidepressants with the same relapse rates.

How comparable Buddhist meditation is to MBCT is also questionable, as the therapy involves a schedule of group education by a trained therapist, of which meditation is only a part.
Where did the story come from?

This research was carried out by Willem Kuyken and colleagues from the University of Exeter, the Peninsula Medical School, Kings College London, and Devon Primary Care Trust. The work was funded by the UK Medical Research Council. The study was published in the peer-reviewed, Journal of Consulting and Clinical Psychology.
What kind of scientific study was this?

In this randomised controlled trial, the researchers compared the effectiveness of cognitive therapy and ‘maintenance antidepressant’ medication with maintenance antidepressants alone for preventing relapse in people with recurrent depression. Maintenance antidepressants, means the continued use of antidepressants by people who have recovered following treatment for an episode of depression, but the drug is continued at a lower dose with the aim of preventing recurrence.

The therapy that the researchers were interested in was Mindfulness Based Cognitive Therapy (MBCT). It consists of classes involving group-based education in skills for easing distress and preventing the recurrence of depression. It aims to make people more aware of the thoughts and feelings that are counterproductive and contribute to depression and self-criticism. In this study, sessions included mindfulness practises (including yoga and meditation), teaching and discussion, weekly homework and a review of the participants’ experiences.

The researchers recruited 123 people over 18 years of age with recurrent depression who had been diagnosed using recognised criteria. All the participants had a history of at least three previous episodes of depression. They had received MBCT treatment for the previous six months and were now in either full or partial remission and taking antidepressant medication. The researchers excluded those with other psychiatric disorders or substance abuse.

The participants were randomly allocated to either continue on antidepressants alone or have an additional eight-week MBCT course. The course was made up of eight, once weekly two-hour sessions, and four follow-up sessions the next year.

The MBCT included support in decreasing or discontinuing antidepressants. This subject was initially raised with participants during weeks four to five of the regime. Participants were asked to consider decreasing or discontinuing their medication as soon as they and their physician deemed appropriate following MBCT and within six months of the course ending. An ‘adequate dose’ of MBCT was considered to be participation in four of the eight sessions. Medication adherence was monitored by the participants’ self-report at each three-month follow-up and scored on an adherence scale.

The participants were followed up at three-monthly intervals for 15 months. The main outcome that was examined was the relapse or recurrence of depression. Secondary outcomes including cost effectiveness and quality of life measures were also examined, but are not discussed here.
What were the results of the study?

Of the 123 participants, 85% completed the study, with exclusions/drop-outs balanced between the two treatment groups. There was generally good adherence to study protocol. The average number of days that antidepressants were taken was significantly shorter in the MBCT group (266 days) compared to those taking antidepressants alone (411 days). At the end of six months, 75% of the MBCT group had stopped taking antidepressants.

There was a general trend towards reduction in the risk of relapse/recurrence among those treated with MBCT and antidepressants compared to antidepressants alone. Over the total 15-month follow-up, 47% of the MBCT patients relapsed compared to 60% of those on antidepressants alone; however, this difference was not statistically significant.
What interpretations did the researchers draw from these results?

The authors conclude that in people with recurrent depression, MBCT in addition to antidepressants produces comparable outcomes to antidepressants alone in terms of relapse and recurrence rates, and therefore significantly reduces antidepressant use.

What does the NHS Knowledge Service make of this study?
This was a well-designed randomised controlled trial. It demonstrated that MBCT with antidepressants produces comparable outcomes to antidepressants alone in terms of relapse and recurrence rates. MBCT also has significant benefit in terms of helping to reduce antidepressant use.

However, this trial has been over simplified by the news report:

* This study was in a very select group of people. All had recurrent episodes of depression, for which they had recently received antidepressant treatment, and were currently receiving lower dose antidepressants. The results cannot therefore be generalised to people with depression who do not fulfil these specific criteria.
* Although there was a trend towards reduced relapse and recurrence rates with MBCT, this difference was not statistically significant when compared to taking antidepressants alone.
* The news incorrectly refers to the treatment as meditation. Although meditation was involved, this was only a part of the sessions, which involved a complex schedule of group education by a trained clinical psychologist or occupational therapist. This cannot be considered comparable to unsupervised meditation alone at home.
* As the researchers state, it is likely the participants had a greater adherence to their medication compared to what would be found in general practise due to the measures that the researchers took to enhance adherence.
* The trial could not be blinded and so the participants knew the nature of the trial when they chose to take part. This could have led to some people with an interest in psychological interventions to take part and therefore introduce some possible bias in the results (i.e. believing that MBCT was helping them).

This is the first trial to investigate what is a relatively new therapy (MBCT) and compare it to another active treatment (antidepressant medication). It should be noted, however, that the study only examined whether combined MBCT and antidepressants had a different outcome to taking antidepressants alone. It did not make a direct comparison between MBCT and antidepressants and so it cannot be concluded that one is more effective than the other. Further research into MBCT is required for a clearer picture.

Alternative to Antidepressant: SAMe

I found some information about SAMe at altmedicine.about.com

The supplement SAMe is a synthetic form of a compound formed naturally in the body from the essential amino acid methionine and adenosine triphosphate (ATP), the energy-producing compound found in all cells in the body. It was first discovered in 1953.

SAMe is believed to work by being a methyl group donor in many reactions in the body. After donating the methyl group, it is converted to a compound called S-adenosyl-homocysteine.

Why Do People Use SAMe

Osteoarthritis

There have been a number of studies on the effectiveness of SAMe in the treatment of osteoarthritis. SAMe appears to diminish osteoarthritis pain as effectively as non-steroidal anti-inflammatory medication. It appears to be well-tolerated.

Depression

There have been a number of studies on the use of SAMe for depression. It has been hypothesized that SAMe increases the availaibility of neurotransmitter serotonin and dopamine.

Liver disease
Some evidence suggests that SAMe may help people with liver disease. Preliminary research suggests it may help to normalize liver enzyme levels and help with cholestasis.

Side Effects and Safety Concerns

The safety of SAMe during pregnancy and during breastfeeding is unknown.

People with bipolar disorder, anxiety disorders and other psychiatric conditions should only use SAMe under the supervision of their healthcare provider. SAMe has been associated with hypomania and mania.

The most common side effects are digestive complaints, particularly nausea. Other side effects include skin rash, lowered blood sugar, dry mouth, blood in the stool, thirst, increased urination, headache, hyperactivity, anxiety and insomnia.

People with Parkinson's disease should avoid SAM-e.

Published 06/22/2004

What should I look for?

* The words "enteric-coated" on the label.
* A reliable company. Consumer Lab did a comparison of common brands of SAM-e.

What is a typical dose?
Most studies have used daily doses of no less than 800 mg per day. However, many practitioners recommend starting with 400 mg per day and then increasing the dose depending on the results.

SAM-e should be taken on an empty stomach. If nausea or heartburn occur, drinking more water may help. Many people notice that SAM-e can be stimulating, so it should be taken earlier in the day to avoid insomnia.

Alternative to Antidepressant: Valerian

Valerian is a well known and widely used herbal tranquilizer in Europe. In the last few years it also gained popularity in the United States.

Here is more information about Valerian from www.medicinenet.com :

USES: Valerian root has been used for anxiety, restlessness and sleeping problems (insomnia). Some herbal/diet supplement products have been found to contain possibly harmful impurities/additives. Check with your pharmacist for more details regarding the particular brand you use. The FDA has not reviewed this product for safety or effectiveness. Consult your doctor or pharmacist for more details.

HOW TO USE: Take by mouth, generally 30 to 60 minutes before bedtime. This product should not be taken for more than 2 weeks. Follow all directions on the product package. If you are uncertain about any of the information, consult your doctor or pharmacist. If your condition persists or worsens or if you think you may have a serious medical problem, seek immediate medical attention.

SIDE EFFECTS: Headache, blurred vision, nausea, change in heartbeat, and morning grogginess may occur. If any of these effects persist or worsen, contact your doctor promptly. Very unlikely but report: dark urine, stomach pain. If you notice other effects not listed above, contact your doctor or pharmacist.

PRECAUTIONS: If you have liver problems, consult your doctor before using this product. Limit alcohol intake, as it may aggravate the effects of this product. Caution is advised when performing tasks requiring alertness (e.g., driving). Liquid preparations of this product may contain sugar and/or alcohol. Caution is advised if you have diabetes, alcohol dependence or liver disease. Ask your doctor or pharmacist about the safe use of this product. This product is not recommended for use during pregnancy. Consult your doctor before using this product. Because of the potential risk to the infant, breast-feeding while using this product is not recommended. Consult your doctor before breast-feeding.

DRUG INTERACTIONS: Before using this product, tell your doctor or pharmacist of all prescription and nonprescription medications you may use, especially of drugs causing drowsiness such as: medicine for sleep, sedatives, tranquilizers, anti-anxiety drugs (e.g., diazepam), narcotic pain relievers (e.g., codeine), psychiatric medicines, anti-seizure drugs, muscle relaxants and antihistamines that cause drowsiness (e.g., diphenhydramine). Check all nonprescription medicine labels carefully, especially cough-and-cold preparations, since many contain antihistamines (e.g., diphenhydramine). Consult your pharmacist if you are uncertain.

OVERDOSE: If overdose is suspected, contact your local poison control center or emergency room immediately. US residents can call the US national poison hotline at 1-800-222-1222. Canadian residents should call their local poison control center directly. Symptoms of overdose may include weak heartbeat, lightheadedness, blurred vision, stomach cramping, chest tightness, hand tremor, and paralysis.

NOTES: Liver function tests should be performed with prolonged use of this herbal product.

MISSED DOSE: Not applicable.

STORAGE: Refer to storage information printed on the package. If you have any questions about storage, ask your pharmacist.

Alternative to Antidepressant: Kava

Another herb that could help with depression. It is a member of the pepper tree family and native to the South Pacific.

I've read that small doses can produce a sense of well-being and larger doses can produce lethargy, drowsiness and reduce muscle tension. In 2002 reports linked kava to liver damage. As a result Kava has been banned in Germany, Italy and England.

I found more about Kava at www.scientistlive.com :

Research finds Kava safe and effective

Researchers at the University of Queensland in Australia have found a traditional extract of Kava, a medicinal plant from the South Pacific, to be safe and effective in reducing anxiety.

To be published online this week in the Springer journal Psychopharmacology, the results of a world-first clinical trial which found that a water-soluble extract of Kava was effective in treating anxiety and improving mood. The Kava was prescribed in the form of tablets.

Lead researcher Jerome Sarris, a PhD candidate from UQ's School of Medicine, said the placebo-controlled study found Kava to be an effective and safe treatment option for people with chronic anxiety and varying levels of depression.

"We've been able to show that Kava offers a natural alternative for the treatment of anxiety, and unlike some pharmaceutical options, has less risk of dependency and less potential of side effects," Mr. Sarris said.

Each week participants were given a clinical assessment as well as a self-rating questionnaire to measure their anxiety and depression levels. The researchers found anxiety levels decreased dramatically for participants taking five tablets of Kava per day as opposed to the placebo group which took dummy pills.

"We also found that Kava had a positive impact on reducing depression levels, something which had not been tested before," Mr. Sarris said. In 2002 Kava was banned in Europe, UK and Canada due to concerns over liver toxicity.

While the three-week trial raised no major health concerns regarding the Kava extract used, the researchers said larger studies were required to confirm the drug's safety.
"When extracted in the appropriate way, Kava may pose less or no potential liver problems. I hope the results will encourage governments to reconsider the ban," Mr. Sarris said.

"Ethanol and acetone extracts, which sometimes use the incorrect parts of the Kava, were being sold in Europe. That is not the traditional way of prescribing Kava in the Pacific Islands. Our study used a water-soluble extract from the peeled rootstock of a medicinal cultivar of the plant, which is approved by the Therapeutic Goods Administration of Australia and is currently legal in Australia for medicinal use."

Reference
1. Sarris J et al. (2009). The Kava Anxiety Depression Spectrum Study (KADSS): a randomised, placebo-controlled crossover trial using an aqueous extract of Piper methysticum. Psychopharmacology. DOI 10.1007/s00213-009-1549-9

Alternative to Antidepressant: St. John's Wort

It could be an alternative to antidepressants: St. John's Wort
A study showed that it is effective as standard antideressants and maybe has fewer side-effects.
Here is an article I found at www.sciencedaily.com

Herbal Extract As Effective As Commonly Prescribed Anti-depressant

ScienceDaily (Feb. 19, 2005) — February 10, 2005 -- A specially manufactured extract from the herb St John's Wort is at least as effective in treating depression as a commonly prescribed anti-depressant, according to new research published on bmj.com today.

St John's Wort* and the anti-depressant drug Paroxetine** were used in a trial to treat patients with moderate or severe depression. The researchers asked 301 participants of both sexes from German mental health centres to take part in the trial. The two drugs were taken by the patients aged 18-70 over a six week period during 2000 -2003.

At the end of the trial half (61 out of 122) of those who took St John's Wort found their symptoms in decline, whilst only a third (43 out of 122) of those taking Paroxetine went into remission.

Participants also suffered more side-effects by taking Paroxetine with 269 adverse effects being reported over the treatment period. Those taking St John's Wort reported 172 adverse effects – the most common in both cases being stomach disorders.

The authors support the use of St John's Wort as an alternative to treat depression and welcome more research in this area.

* Clinical name hypericum extract WS 5570

** Paroxetine is a Selective Serotonin Reuptake Inhibitor (SSRI) drug – a class of anti-depressants

Support

Now we know what a depression is and how to treat it but what about the other family members or friends? Sometimes it is very difficult for the depressed person to describe the feelings he or she is feeling...and or family members and friends it is difficult to understand the behavior of the depressed person. I found two articles I would like to share with you: I like this first one because it is written from a patient's point of view
- Explaining Depression to Family and Friends written by Kimberly Tyler at MyDepressionConnection.com


I found the second one at All About Depression / How to Help a Depressed Person
Here is the article:

The most important thing anyone can do for the depressed person is to help him or her get an appropriate diagnosis and treatment. This may involve encouraging the individual to stay with treatment until symptoms begin to abate (several weeks), or to seek different treatment if no improvement occurs. On occasion, it may require making an appointment and accompanying the depressed person to the doctor. It may also mean monitoring whether the depressed person is taking medication. The depressed person should be encouraged to obey the doctor's orders about the use of alcoholic products while on medication.

The second most important thing is to offer emotional support. This involves understanding, patience, affection, and encouragement. Engage the depressed person in conversation and listen carefully. Do not disparage feelings expressed, but point out realities and offer hope. Do not ignore remarks about suicide. Report them to the depressed person's therapist. Invite the depressed person for walks, outings, to the movies, and other activities. Be gently insistent if your invitation is refused. Encourage participation in some activities that once gave pleasure, such as hobbies, sports, religious or cultural activities, but do not push the depressed person to undertake too much too soon. The depressed person needs diversion and company, but too many demands can increase feelings of failure.

Do not accuse the depressed person of faking illness or of laziness, or expect him or her "to snap out of it." Eventually, with treatment, most depressed people do get better. Keep that in mind, and keep reassuring the depressed person that, with time and help, he or she will feel better.

source: National Institute of Health Publication No. NIH-99-3561

Understanding Your Own Feelings Towards a Depressed Person

Taking care of a depressed person is often very stressful and frustrating. Many who are close to a depressed person have tried everything they know in order to get the person to seek help. They have also struggled with trying to make things better for the depressed person, often to the point of their own exhaustion. Sometimes, caretakers become depressed themselves as they find that their efforts have made little difference. Family and friends of depressed people miss the former person they knew. They see the dark cloud of depression not only affecting the person's life, work and family, but they see it eating away at their own relationship as well.

Those who are close to a depressed person often struggle with their own feelings toward the person. Feelings of concern, frustration, and fear combined with futile efforts to make things better can lead to stronger feelings of anger, helplessness, despair, resentment, and guilt. Please know that these feelings are very normal. No one can make another person get help for depression, and no one can take away another person's depression.

People who are depressed may behave in ways that are uncharacteristic for them when they are not depressed. It is not uncommon for a depressed person to be irritable, angry, argumentative, withdrawn, unmotivated, lethargic, and self-defeating. They may say things that are hurtful, harsh, irrational, or unusual. For those who are not depressed, these behaviors are hard to understand and very difficult to bear.

As a relative or friend of a depressed person you should pay attention to your own feelings. If you find that you are feeling overwhelmed, overly frustrated, depressed, anxious, exhausted, or guilty, then it is time to start taking better care of yourself. You cannot help another person if you are struggling yourself.


Taking Care of Yourself

Please keep these things in mind:

Your feelings and reactions are normal. Friends and family of those who are depressed experience a range of emotions, from compassion and empathy to anger, frustration, and even hatred. These feelings can be expected since it is very difficult not to take personally a depressed person's behaviors. A depressed person's life is being negatively affected by depression, but so is yours.

You don't have to be alone. Dealing with depression on your own can be a lonely and isolating task. Your friends may not understand, yet you need the support of others. Depression is a common illness, and there are many others who also have a depressed person in their lives. You may wish to join a support group and connect with others who understand your struggles.

It's not your fault. It is not uncommon for family and friends of depressed people to feel guilty or wonder if they hold some responsibility for another person's depression. Depression does not occur because of anything you say or do. Depression is a medical condition, like diabetes or heart disease, that needs to be treated.

Your feelings will change with time. Family and friends of depressed people go through various emotional phases. Initial reactions include disbelief or denial. It may seem that depression will just magically go away if it goes unacknowledged. After some time, people may experience some anger or resentment that life as they know it has changed. People also may feel grief that the person they once knew seems lost to them. After a depressed person seeks treatment and begins to feel better, family and friends often feel relieved and lucky or blessed that things are improving again.

Don't lose hope. Depression is a very treatable illness! Psychotherapy and/or medication have been shown to be quite effective. Eighty percent or more of those who seek help for treatment can feel better within several weeks.

Take good care of yourself. You will need to set boundaries and limits on how much you can and will do. this is a healthy and necessary thing to do. It is okay to take a vacation from caretaking once in a while. Schedule time for yourself and do things that bring you enjoyment and satisfaction. This is not being "selfish," it is being healthy and compassionate towards yourself. You may also choose to seek counseling in order to have a place to process and manage your own feelings.

Antidepressants und suicidal behavior

Can Antidepressants cause suicidal behavior among young adults? I found an interesting article at www.washingtonpost.com by Shankar Vedantam

Study Says Cases Double for Those 18 to 25 Using Medicine to Control Depression

By Shankar Vedantam
Washington Post Staff Writer
Thursday, December 14, 2006; Page A16

Widely used antidepressants double the risk of suicidal behavior in young adults, from around three cases per thousand to seven cases per thousand, according to a huge federal analysis of hundreds of clinical trials. It marks the first time regulators have acknowledged that the drugs can trigger suicidal behavior among patients older than 18.

Officials at the Food and Drug Administration said yesterday that the higher risk was found in patients 18 to 25 and that the risk faded among older patients. The finding comes two years after the agency ordered a "black box" warning on the drug labels following the discovery of a heightened risk of suicidal behavior among children taking the pills.

After reviewing the latest data, an expert federal panel yesterday recommended that agency officials tell doctors and the public of the risk but also find a way to note that the risk declines with age, and that leaving depression untreated is also risky.

While the studies on the relationship between the drugs and suicide appear contradictory, the experts said one possibility is that the drugs may pose a risk early in treatment but have a protective effect in the long term.

The agency is leaning toward expanding its black box warning, said Thomas Laughren, director of FDA's division of psychiatric drug products. Officials said they will try to write language that would urge clinicians to use the drugs carefully, not abandon them.

The new finding created a dilemma for the regulators. Even as it vindicated some of what critics of drugs such as Prozac, Paxil and Zoloft have said for years, the earlier official warnings about the drugs appear to have led to a drop in their use -- and there are troubling signs that this can lead to an increase in suicides.

After concerns were raised in the Netherlands about the suicide risk, there was a 22 percent drop from 2003 to 2005 in antidepressant prescriptions for patients under 18 and a 50 percent increase in suicides, said Robert Gibbons, a professor of psychiatry at the University of Illinois in Chicago. The number of suicides went from 34 to 51.

'What we are seeing is the early signs of an epidemic of suicide in children who are no longer being treated for their depression," Gibbons said in an interview. U.S. suicide data for 2005 is not yet available, but Gibbons said the FDA's black box warning had caused a similar decline in prescriptions among children here. He predicted dozens more suicides as a result and warned that any expansion of the black box would have a similar impact on adults.

Robert Temple, director of FDA's Office of Medical Policy, said regulators are in a bind. On the one hand, they need to tell physicians about the new results to warn them to monitor patients closely for suicidal behavior, but if that means doctors stop prescribing the drugs altogether, "I don't know what you are supposed to do."

Emotions ran high at the meeting of expert advisers yesterday, with both advocates for the drugs and their critics warning the federal regulators that a wrong move would cost lives.

Critics of the drugs said they were deeply distrustful of both the medical profession and FDA itself because of conflicts of interest with the pharmaceutical industry. Allen Jones, of the consumer advocacy group Alliance for Human Research Protection, said, "the love affair between the pharmaceutical industry and our government institutions has to end."

Gwen Olsen, a former pharmaceutical industry representative, told the panel she had influenced doctors by offering them free food, gifts and gimmicks to get access and then presented them with skillfully manipulated data. Olsen said she had a change of heart after her 20- year-old niece committed suicide following a withdrawal reaction from the antidepressant Paxil. She said her niece first tried to hang herself from a ceiling fan. When the fan broke, Olsen said, she doused herself in oil and set herself alight.

Two experts critical of the drugs, British psychiatrist David Healy and Joseph Glenmullen, a psychiatrist who lectures at Harvard University, said the FDA analysis played down the magnitude of the suicide risk. Information uncovered in lawsuits, they said, suggested that several suicides in industry trials were never disclosed.

"Industry controls the data, and industry with the aid of FDA have miscoded the data so all the articles in all the journals that purport to represent clinical trial data are misleading," Healy said in an interview. His own analysis, published in the British Medical Journal in 2005, found a two-fold increase in risk among all adults taking the drugs.

"The idea you would have a risk in one age group but not another is just wrong," Healy said.

Other medical experts and patient advocates, however, warned that black box warnings could scare patients away from necessary treatment.

Christopher Kratochvil, a psychiatrist who spoke on behalf of the American Academy for Child and Adolescent Psychiatry; John Mann, a Columbia University psychiatrist who spoke on behalf of the American Foundation for Suicide Prevention; and Donna Barnes, president of the National Organization for People of Color Against Suicide, all said additional warnings might harm patients by making them fearful of treatment.

Unlike the case with children, in whom antidepressants have generally failed to show they are superior to sugar pills in short-term trials, the drugs have a track record of working in adults. A recent federal study showed that while the drugs do leave much to be desired, treatment provided in the best care settings helped two-thirds of depressed patients recover.

"I feel I am listening to a chapter from [the novel] 'Animal Farm' saying, 'industry bad, industry bad,' " said Carolyn Robinowitz, president-elect of the American Psychiatric Association, in an interview. "Pharmaceutical research has brought us a lot of good things."

To be on the safe side always ask your doctor about side-effects or how to take the medication. Further information on how to take medication safely you can find on CIGNA

Antidepressant

The only thing my doctor did was prescribing me the medication without really telling me what it does to my body and why I should take it. That wasn't enough information for me an so I did a research on the internet. One of the first things I read was '...not enough serotonin is produced'. I found a good article about antidepressants on about.com written by Nancy Schimelpfening. Photo from Flickr taken by Amanda M Hatfield

Antidepressant Basics

Antidepressant Classes

There are three basic molecules, known chemically as monoamines, which are thought to play a role in mood regulation: norepinephrine, serotonin and dopamine. Antidepressant medications are categorized by how they affect these chemicals. The following are the major antidepressants classes.

Monoamine Oxidase Inhibitors

The monoamine oxidase inhibitors (MAOIs) were some of the first antidepressant medications developed. The neurotransmitters responsible for mood, primarily norepinephrine and serotonin, are also known as monoamines. Monoamine oxidase is an enzyme which breaks these substances down. Monoamine oxidase inhibitors, as the name implies, inhibits this enzyme, thus allowing a greater supply of these chemicals to remain available.

Tricyclics

Tricyclics, also known as heterocyclics, came into broad use in the 1950's. These antidepressant drugs inhibit the nerve cell's ability to reuptake serotonin and norepinephrine, thus allowing a greater amount of these two substances to be available for use by nerve cells.

Selective Serotonin Reuptake Inhibitors

SSRI stands for Selective Serotonin Reuptake Inhibitor. These medications work, as the name implies, by blocking the presynaptic serotonin transporter receptor. This drug differs from the tricyclics in that it's action is specific to serotonin only. It's effect on norepinephrine is indirect, through the fact that falling serotonin "permits" norepinephrine to fall so preserving serotonin preserves norepinephrine.

Newer Mechanisms

Five newer antidepressants which do not fit into the above categories are: buproprion (Wellbutrin), nefazodone (Serzone), trazodone (Desyrel), venlafaxine (Effexor), and mirtazapine (Remeron).

The mechanism of bupropion's antidepressant activity is poorly understood, but is thought to be mediated through noradrenergic or dopaminergic pathways or both.(1)

Nefazodone and it's precursor trazodone both inhibit neuronal reuptake of serotonin and, to a lesser extent, norepinepherine. They also blocks postsynaptic 5-HT2 receptors.

Venlafaxine is a compound that is structurally unrelated to other antidepressants.(2) Like the TCAs, venlafaxine inhibits the neuronal uptake of both serotonin and norepinepherine. Venlafaxine has dose-dependent, sequential effects on the uptake pumps for serotonin and then norepinephrine.. At 75 mg/day, venlafaxine is predominantly a serotonin reuptake inhibitor (SRI) like the SSRIs. At 375 mg/day, it produces comparable norepinephrine uptake inhibition to an NSRI such as desipramine.(3)

Mirtazapine's unique mechanism of action does not involve enzyme inhibition or blockade of neurotransmitter reuptake. Mirtazapine increases the release of norepinepherine from central noradrenergic neurons by blocking the presynaptic inhibitory alpha-2 autoreceptors. It spares the alpha-1 postsynaptic receptor and therefore results in net increase noradrenergic transmission.

References:

1. Ascher JA, Cole JO, Colin JN, et al: Bupropion: A review of its mechanism of antidepressant activity. J Clin Psychiatry. 1995; 56(9):395-401.
2. Holiday SM, Benfield P. Venlafaxine. A review of its pharmacology and therapeutic potential in depression. Drugs. 1995; 49(2): 280-294.
3. Preskorn, S: Outpatient Management of Depression: A Guide for the Primary-Care Practitioner. PCI, 1999. Chap. 8.5.

You've probably probably heard the term "neurotransmitter" before, but what does this really mean? Neurotransmitters are chemical messengers within the brain that facilitate communication between nerve cells. Let's illustrate with serotonin. Figure 1 depicts the junction between two nerve cells. Packets of serotonin molecules are released from the end of the presynaptic cell (the axon) into the space between the two nerve cells (the synapse). These molecules may then be taken up by serotonin receptors of the postsynaptic nerve cell (the dendrite) and thus pass along their chemical message. Excess molecules are taken back up by the presynaptic cell and reprocessed.

Several things might potentially go wrong with this process and lead to a serotonin deficit. Just to enumerate a few possibilities:

• Not enough serotonin is produced,
• There are not enough receptor sites to receive serotonin,
• Serotonin is being taken back up too quickly before it can reach receptor sites,
• Chemical precursors to serotonin (molecules that serotonin is manufactured from) may be in short supply, or
• Molecules that facilitate the production of serotonin may be in too short supply.

As you can see, if there is a breakdown anywhere along the path, neurotransmitter supplies may not be adequate for your brain's needs. Inadequate supplies lead to the symptoms that we know as depression.

Furthermore you can find an article about the side-effects and how antidepressant work - also at depression.about.com

I hope that will help you to understand what is going on in your body and how the different medication works.

What is a Depression?

Here is a definition that I found on Wikipedia:

Depression is a term that can refer to a wide variety of abnormal variations in an individual's mood. If changes in an individual's mood are persistent and cause distress or impairment in functioning, then a mood disorder may be present. Individuals with mood disorders experience extremes of emotions, for example sadness, that are higher in intensity and longer in duration than normal.

Mood disorders are generally classified as either a type of unipolar depression or bipolar depression. Unipolar depression is characterized by periods of depressed mood, profound sadness, or loss of interest in activities. Bipolar depression is characterized by periods of depressed mood that alternate with periods of extremely elevated mood, increased energy, and euphoria. These periods of elevated mood are referred to as mania. Within both unipolar and bipolar categories, specific sets of symptoms are characteristic of particular disorders, each of which has its own diagnostic profile, treatments, and prognosis. The Diagnostic and Statistical Manual of Mental Disorders (DSM), now in its fourth revised edition, describes the diagnostic criteria for each disorder.

Depressive disorders are very common medical conditions. Unipolar depression will affect 20% of individuals at some point during their life span while bipolar depression will affect 4% of individuals. Unipolar depression is twice as common in females than males, but bipolar depression is equally common in both sexes. The etiology of depressive disorders is most likely multifactorial with both complex genetic factors and environmental stressors (for example, emotional stress, substance abuse, psychological, physical, or sexual abuse) likely contributing to the neuronal changes seen in affected individuals. In an individual who has a high genetic predisposition to a depressive disorder, little or even no environmental stress may provoke a depressive illness. In an individual with a low genetic predisposition to depressive disorders, a major stressor may or may not provoke a depressive illness. Individuals with first degree relatives (i.e., parents, siblings, children) with a depressive disorders are more likely to be a risk for experiencing a depressive disorder themselves. Regardless of whether the causal factors for a depressive illness are genetic or environmental, both produce physiologic changes in the neurotransmitter systems within the brain.

Advances in pharmacological and psychotherapeutic treatments have allowed for very high rates of success in treating depressive disorders. However, only about one-quarter of individuals with a depressive disorder seek treatment. Of those who do seek treatment, over 90% can be successfully treated. Psychiatrists, medical doctors who specialize in treating mental illness, and clinical psychologists, who are trained in various modalities of psychotherapy, are experienced in treating depressive disorders. A general practitioner, family doctor, or other primary care physician can also initiate treatment for individuals with depressive disorders.