How common is depression? I feel like I am the only one who has it!

Depression is a very common medical disorder that affects the mind. Most people who do not have this agonizing disorder are not able to appreciate the fact that depression can significantly alter the way one behaves and thinks. It is a life long illness which is not easy to treat. The disorder leads to a variety of emotional and physical problems.  

The precise numbers of individuals who have severe depression are not known but estimates indicate that about 12 million adults in USA have depression. Depression cuts across all barriers and affects all races, cultures and social class. The disorder generally begins in early adulthood but can occur at any age. While hospital data reveal that more women have depression, this is simply because most men do not seek treatment. Depression occurs in various grades and symptoms do vary in intensity.

I have just lost my job and feel depressed. Do I really need treatment for my depression?

Slight depression is of minor consequence. One may become slightly depressed over a loss of job; break up of a romantic relationship or divorce. Other causes of slight depressions include loss of a parent, sibling, marrriage stress, job anxiety, moving or not having a great job. Slight depression may present with feelings of sadness, problems sleeping, irritability, being easily annoyed and feeling tired. Slight depression is reversible and short term. Most people get over slight depression with time and supportive therapy. However, if the depression is severe enough to affect your lifestyle and is getting worse, there is no harm in speaking to your doctor.

I am 27 and think I have mild depression. What sort of symptoms usually occur with depression?

There are some individuals who may develop mild depression which may start gradually for no reason. The individual may start to feel tired, restlessness, feel lonely and have difficulty sleeping. In many cases, the individual loses interest in sex and wants to be left alone. One may be able to go to work but not have any enjoyment. Mild depression may last a lot longer than severe depression but can be overcome with changes in lifestyle, psychotherapy and social support.

 However, some individuals develop severe depression which may induce feelings of not wanting to live anymore. Suicidal ideations are common in severe depression. In severe depression one may feel sad all the time, cry for no apparent reason, have trouble sleeping and focusing, become fatigued, feel worthless, develop headaches or backache and may increasingly have thoughts of self harm/suicide.

What causes depression? I am only 28 years old and have been diagnosed with this disorder

While mild depression has a cause, both moderate and severe depression generally are complex brain disorders which are not well understood. Mild depression may be related to the environment, such as being unable to cope with the job, unemployment, financial problems or loss of a loved one. No one understands why severe depression occurs. Even though many brain imaging studies have been done, the exact neurotransmitters in the brain which play a role in depression are still in question. Some studies do show that severe depression may be more common in families. In most cases, the cause of depression is simply bad luck

Is light treatment of any benefit for non-seasonal depression?

It is well known that light therapy is of benefit to people who have seasonal depression. Now some practitioners are recommending light therapy for people who have non-seasonal depression. The few studies conducted indicate that light therapy is of some benefit for non-seasonal depression. Light therapy administered in the morning was of most benefit to depressed people who were also sleep deprived. The only mild side effect was hypomania in a few individuals. However, at the moment light therapy is considered a supplementary treatment and not a substitute for the established methods of depression treatment. If you want to try out light therapy speak to your doctor.

 

Does ECT for depression hurt and do I need to give consent?

ECT does not hurt because you are asleep. ECT therapy is not used to punish any individual and like any procedure requires consent and approval. The patient has absolute right to refuse the procedure. Not the government, doctor or any other person can force this procedure on anyone. Under the APA's recommended "informed consent" protocol, permission to administer ECT is usually thoroughly reviewed and each case is individually analyzed. The consent is not just an oral mumbling of vague dry confusing concepts. It is the psychiatrist’s responsibility to detail and explain the basic principles of ECT and the possible benefits and risk that may occur. The individual and the family members need to be informed of when, where, and by whom the treatment will be administered and the number of treatments expected. 
Unlike the days gone by, just simple signing a consent does not give the doctor permission to perform an ill understood procedure and thus, all questions must be asked. The patient has the complete right to withdraw a consent and seek alternative care. No consent is binding to the extent that the patient has no choice. Gone are the days when doctors were the sole decision makers. Today, patients have more rights than they care to know.  And if the doctor screws up, you can always go to a lawyer.

Is it true that ECT causes brain damage?

So far, ECT has been thoroughly analyzed and there is no evidence to reveal that the procedure causes brain damage. Even though the procedure does induce a seizure, the brain is not damaged. CT scans, MRIs and PET scans have revealed that there is no structural damage after ECT. Most studies indicate that the amount of electricity induced to cause the seizure is not harmful to the brain because of its short duration and intensity. The myth that most people turn into brain damaged zombies is absolute nonsense.
There are many different views and reasons why people object to ECT and it is wrong to generalize.  Many people say that ECT is an inhumane and degrading treatment which belongs to the past. They claim that the side effects of ECT are severe and that these are hidden from the public. They also claim that patients are locked up against their will and continually shocked. Various claims of brain damage are made and they would like to see ECT banned. 


Unfortunately, individuals who make such statements do not have a clue about psychiatry-much less know the difference between the arse and the mouth. 


Psychiatrists may not know a lot about mental health disorders, but what little they know has made the discipline safer and more effective than all the previous centuries.

I am thinking about ECT for my depression, but what should I ask my doctor?

ECT is not a common form of treatment for depression but still every year close to 100,000 individuals in North America undergo this therapy each year. Because of misconceptions and myths associated with ECT, many individuals do not know that the therapy is safe and beneficial. If you wish to consider ECT for your  depression,  discuss with your doctor and consider the following benefits:

-         rapid relief of symptoms

-         alternative therapy when drug therapy fails

-         if you are unable to tolerate side effects of drugs, ECT is a good alternative

-         benefits are long lasting but not permanent

Can acupuncture help my depression?

The failure of conventional drug therapy to reverse depression has led many people to turn towards alternative remedies. Acupuncture has been widely touted to cure almost everything underneath the sun including the American economy. Reports from China are always positive on acupuncture. Today, alternative health care practitioners and every Tom, Dick and Harry have set up acupuncture clinics on street corners for the treatment of all types of medical disorders. As far as depression is concerned analysis of all the recent trials leads to one conclusion- the benefit from acupuncture was as good as one obtained from a sugar pill. There is at present insufficient evidence to recommend acupuncture as a treatment for depression.

Moreover acupuncture is not cheap. Each session can cost anywhere from $80-$150 and just like the plastic surgeon, nothing is ever cured in one session. One must undergo at least 20-30 sessions with no guarantee of any benefit.

Best advice is leave acupuncture for the suckers. If you are depressed go and see a real psychiatrist. The anti depressant medications may have side effects but at least they work- acupuncture does not.

I just had two sessions of ECT for my depression. Will I ever regain my memory?

ECT therapy is known to be associated with immediate memory loss, confusion and loss of concentration. These problems usually appear 2-3 weeks after therapy. The intensity of memory loss does vary from person to person but most people do develop some degree of memory loss.

Unfortunately, you will never regain all the memory you lost. The more sessions you have, the greater will be the loss in memory. In most people, the memory loss persists for 2-4 years and but in others it continues to persist. Memory loss is one of the negatives about ECT therapy and must be weighed against the benefits. For most people the reversal of depression is worth sacrificing some amount of memory loss. But the final choice is strictly yours.

Can my depression return if I stop my medications? I want to stop these medications because of side effects.

Unfortunately, you can rest assured you will develop some type of reaction. It could be that your depression symptoms return or you may develop withdrawal symptoms from the drug. The symptoms of depression are easy to identify, as they will be similar to what you had before. 

Drug withdrawal symptoms can vary from anxiety, flu like illness, fast heart rate, tremors, lack of sleep, sweating, and a generalized sensation of feeling unwell. These symptoms may last anywhere form 3-28 days. The symptoms are not life threatening and simply indicate that your body is now adjusting to a life without drugs in the body.

Of all anti depressants, withdrawal symptoms are most common after discontinuation of Paxil and Effexor.

It is difficult to predict who will develop these withdrawal symptoms. However, experts recommend that the best way to discontinue an anti depressant is to gradually taper the dose over a few weeks or months. If you find the symptoms of drug withdrawal unbearable, you may want to take a small dose of Prozac because it will neutralize these side effects and also diminish the signs of depression.