Primary Treatments For Depression Essay Paper
In the world of primary care, we have been struggling for years to render adequate care to our depressed patients. We often fail, even though we know that depression is common, painful, disabling, and expensive.1 We also know that there are adequate treatments available. Or are there? For over 2 decades investigators have been testing whether that’s true, and by now the number of studies runs into the thousands.Primary Treatments For Depression Essay Paper So this is a good time to pause and take stock. What do we know about the 2 fundamental modalities—pharmacotherapy and psychotherapy—for treating depression in primary care? In this issue of the Annals, Linde et al present a pair of excellent meta-analyses that summarize and extend our current state of knowledge about the efficacy or effectiveness of these 2 categories of treatment for depression in the primary care setting.2,3 These results, and the studies on which they are based, can help us understand something about how to care for these patients, the persistent shortfalls in our care, and what we might do next about those shortfalls.
ORDER A PLAGIARISM-FREE PAPER HERE
The studies that form the substrate for these 2 meta-analyses are themselves revealing. The analysis of pharmacological treatments includes 66 acceptable studies with 15,161 adult patients.2 These are the best of the randomized controlled trials comparing drugs of different classes to each other or to placebo. One-half of these studies have a high probability of bias of some sort, and another one-third are of uncertain bias status. In most of these studies the dosages are low, even below recommended dosages, and most are short-term trials of 24 weeks or less. Such is the state of pharmacotherapy trials in primary care: you could say this is a weak and messy set of studies. This collection of trials is not sufficient in number or quality to support many of the comparisons we might wish to make or to tell us with confidence which drugs are better for what, and how they should be used. But you could also say this is an elegant, state-of-the-art network meta-analysis, and certain interesting signals do emerge—more in the form of hints and probabilities than certainties. For example, there are no real differences in effectiveness across classes of drugs, and the differences in acceptability, if they exist at all, are hard to interpret. Forty percent of patients receiving placebo show a response—not remission—while 53% of those receiving (low doses of) active drugs respond.Primary Treatments For Depression Essay Paper As the authors note, “effect sizes over placebo alone cannot provide information on the clinical relevance of treatment effects in individual clinical contexts, so that this issue is likely to remain controversial.”2 Also, these are short-term data. And then there’s the curious finding that St. John’s wort seems to work better in German-speaking countries than other countries! Two things we can say with certainty are that we have not exhausted our need for well-done clinical trials in this field, and we do not yet have sufficiently effective pharmacotherapeutic agents for depression.
With respect to psychological treatments, less than one-half as many studies (30), and one-third as many patients (5,159) were eligible for inclusion, and these studies, which are much harder to do well, are messier, more heterogeneous, and more non-comparable than even the pharmacotherapy trials. They are even more difficult to draw inferences from. Classifying treatments by type (eg, cognitive-behavioral therapy (CBT), interpersonal therapy, problem-solving therapy, etc), intensity, and mode of delivery (eg, face-to-face vs remote) necessarily produces difficult intraclass variation; mapping this against a range of diagnoses and severities, and comparing these to a heterogeneous set of usual care conditions (often unspecified) or placebo conditions—all of this creates a matrix of comparisons that is exceedingly “dirty,” that begs for larger cells, clean distinctions, stable categories, and consistent definitions. To even further complicate the analysis, the risk of bias is either high or unknown in two-thirds of these studies, and 1 in 5 did not have major depression, but only minor depression or dysthymia.Primary Treatments For Depression Essay Paper And yet again we have a careful and elegant meta-analysis, and a few provisional conclusions emerge. For example, all psychotherapies conducted face-to-face seem to work. Cognitive-behavioral therapy seems to work no matter how it’s used, even at low intensity. None of these interventions appears to be effective for minor depression or dysthymia. In all cases, effect sizes are small: 10 patients must be treated to achieve 1 response, and 15 to achieve 1 remission.
Compare this to a recent meta-analysis of studies of treatment for depression in mental health care settings, where 182 studies enabled comparison of pharmacotherapy to each other, to placebo, and to psychotherapies of various types.4 Among the many findings emerging from this larger data set, we see moderate to large effect sizes of psychotherapies for almost every tested condition, especially CBT, exceeding that of pharmacotherapy.Primary Treatments For Depression Essay Paper
We should not be misled into thinking that more trials of the kind analyzed here will give us all the knowledge we need to render consistently high-quality care. They will not. They will help (particularly if the quality of the trials is improved), but the knowledge we need for successful care of depressed patients goes beyond the efficacy or effectiveness of known drugs or psychotherapies. As we step back for a wide-angle look at this field, 2 additional considerations come into view. The first concerns psychotherapy itself, and the second concerns how we implement these treatments, however effective they may be, into the fabric of primary care.
Psychotherapies as described and practiced here are complex interventions that often consist of a linked set of several basic therapeutic modules or elements. There is compelling literature that suggests psychotherapy itself can be more flexibly and effectively applied, according to the needs of individual patients, if it is deconstructed into these basic modules or elements, which are then selected and combined into a personalized therapeutic strategy.5,6 Thus, we may soon see the emergence of a new unit of analysis and intervention for psychotherapy—psycho therapeutic “elements” that are simpler, more basic and generic, perhaps easier to master and measure. This could help clean up the problem we see in this present meta-analysis, where interventions of questionable comparability are pooled.Primary Treatments For Depression Essay Paper
ORDER A PLAGIARISM-FREE PAPER HERE
Implementation poses a more formidable set of issues. It is one thing to “know” that a psychotherapy is effective in primary care, when applied under research conditions, using study resources such as patient enrollment personnel, psychotherapists, and evaluators to assure that resource limitations or workflow barriers can be overcome. It is quite another thing for a primary care practice to implement such an evidence-based intervention using existing practice resources, working within the constraints of existing practice workflows, and pressing against the ubiquitous competing demands in these settings. Even the most powerful, desirable, and effective psycho social interventions disrupt a practice’s operations, and sometimes this disruption takes extraordinary time and resources to overcome. In fact, sometimes this disruption cannot be overcome, and the use of the intervention is impossible in a given setting at a given time. Thus, effective interventions are not useful until we know whether and how they can be implemented in real-world clinical settings. There is an emerging field of implementation science that addresses these issues.7 Successful implementation starts with an effective intervention, which is exactly where these 2 meta-analyses leave off, then takes into consideration factors associated with the patient, clinician, clinical setting, health plans, and regulators. We are becoming familiar with implementation issues in primary care as we attempt to transform our clinics to better manage patients chronic diseases, to become patient-centered medical homes, to practice team-based care, or to continuously improve the quality of the care we render. We are learning through hard experience that even effective interventions or simple guidelines are not necessarily easy to implement in a busy primary care practice. This is not the place for a detailed description of the requirements of successful implementation, but it is the place to understand that well-done meta-analyses, such as those presented here, can not only summarize and clarify an emerging field, but can also set the stage for the implementation work that must inevitably follow before successful clinical improvement occurs in primary care.
What are my depression treatment options?
When you’re depressed, it can feel like you’ll never get out from under a dark shadow. However, even the most severe depression is treatable. So, if your depression is keeping you from living the life you want to, don’t hesitate to seek help. From therapy to medication to healthy lifestyle changes, there are many different treatment options available.Primary Treatments For Depression Essay Paper
Of course, just as no two people are affected by depression in exactly the same way, neither is there a “one size fits all” treatment to cure depression. What works for one person might not work for another. By becoming as informed as possible, though, you can find the treatments that can help you overcome depression, feel happy and hopeful again, and reclaim your life.
Depression treatment tips
Learn as much as you can about your depression. It’s important to determine whether your depression symptoms are due to an underlying medical condition. If so, that condition will need to be treated first. The severity of your depression is also a factor. The more severe the depression, the more intensive the treatment you’re likely to need.
It takes time to find the right treatment. It might take some trial and error to find the treatment and support that works best for you. For example, if you decide to pursue therapy it may take a few attempts to find a therapist that you really click with. Or you may try an antidepressant, only to find that you don’t need it if you take a daily half hour walk. Be open to change and a little experimentation.
Don’t rely on medications alone. Although medication can relieve the symptoms of depression, it is not usually suitable for long-term use. Other treatments, including exercise and therapy, can be just as effective as medication, often even more so, but don’t come with unwanted side effects. If you do decide to try medication, remember that medication works best when you make healthy lifestyle changes as well.
Get social support. The more you cultivate your social connections, the more protected you are from depression. If you are feeling stuck, don’t hesitate to talk to trusted family members or friends, or seek out new connections at a depression support group, for example. Asking for help is not a sign of weakness and it won’t mean you’re a burden to others. Often, the simple act of talking to someone face-to-face can be an enormous help.
Treatment takes time and commitment. All of these depression treatments take time, and sometimes it might feel overwhelming or frustratingly slow. That is normal. Recovery usually has its ups and downs.Primary Treatments For Depression Essay Paper
Lifestyle changes: An essential part of depression treatment
Lifestyle changes are simple but powerful tools in the treatment of depression. Sometimes they might be all you need. Even if you need other treatment as well, making the right lifestyle changes can help lift depression faster—and prevent it from coming back.
Lifestyle changes to treat depression
Exercise. Regular exercise can be as effective at treating depression as medication. Not only does exercise boost serotonin, endorphins, and other feel-good brain chemicals, it triggers the growth of new brain cells and connections, just like antidepressants do. Best of all, you don’t have to train for a marathon in order to reap the benefits. Even a half-hour daily walk can make a big difference. For maximum results, aim for 30 to 60 minutes of aerobic activity on most days.
Social support. Strong social networks reduce isolation, a key risk factor for depression. Keep in regular contact with friends and family, or consider joining a class or group. Volunteering is a wonderful way to get social support and help others while also helping yourself.
Nutrition. Eating well is important for both your physical and mental health. Eating small, well-balanced meals throughout the day will help you keep your energy up and minimize mood swings. While you may be drawn to sugary foods for the quick boost they provide, complex carbohydrates are a better choice. They’ll get you going without the all-too-soon sugar crash.Primary Treatments For Depression Essay Paper
Sleep. Sleep has a strong effect on mood. When you don’t get enough sleep, your depression symptoms will be worse. Sleep deprivation exacerbates irritability, moodiness, sadness, and fatigue. Make sure you’re getting enough sleep each night. Very few people do well on less than seven hours a night. Aim for somewhere between seven to nine hours each night.
Stress reduction. Make changes in your life to help manage and reduce stress. Too much stress exacerbates depression and puts you at risk for future depression. Take the aspects of your life that stress you out, such as work overload or supportive relationships, and find ways to minimize their impact.
Ruling out medical causes of depression
If you suspect that you may be depressed, and lifestyle changes haven’t worked, make an appointment to see your primary care doctor for a thorough checkup. If your depression is the result of medical causes, therapy and antidepressants will do little to help. The depression won’t lift until the underlying health problem is identified and treated.
Your doctor will check for medical conditions that mimic depression, and also make sure you are not taking medications that can cause depression as a side effect. Many medical conditions and medications can cause symptoms of depression, including sadness, fatigue, and the loss of pleasure. Hypothyroidism, or under active thyroid, is a particularly common mood buster, especially in women. Older adults, or anyone who takes many different medications each day, are at risk for drug interactions that cause symptoms of depression. The more medications you are taking, the greater the risk for drug interactions.Primary Treatments For Depression Essay Paper
Psychotherapy for depression treatment
If there is no underlying medical cause for your symptoms of depression, talk therapy can be an extremely effective treatment. What you learn in therapy gives you skills and insight to feel better and help prevent depression from coming back.
ORDER A PLAGIARISM-FREE PAPER HERE
There are many types of therapy available. Three of the more common methods used in depression treatment include cognitive behavioral therapy, interpersonal therapy, and psycho dynamic therapy. Often, a blended approach is used.
Some types of therapy teach you practical techniques on how to re frame negative thinking and employ behavioral skills in combating depression. Therapy can also help you work through the root of your depression, helping you understand why you feel a certain way, what your triggers are for depression, and what you can do to stay healthy.
Therapy and “the big picture” in depression treatment
One of the hallmarks of depression is feeling overwhelmed and having trouble focusing. Therapy helps you step back and see what might be contributing to your depression and how you can make changes. Here are some of the “big picture” themes that therapy can help with:
Relationships. Understanding the patterns of your relationships, building better relationships, and improving current relationships will help reduce isolation and build social support, important in preventing depression.Primary Treatments For Depression Essay Paper
Setting healthy boundaries. If you are stressed and overwhelmed, and feel like you just can’t say no, you are more at risk for depression. Setting healthy boundaries in relationships and at work can help relieve stress, and therapy can help you identify and validate the boundaries that are right for you.
Handling life’s problems. Talking with a trusted therapist can provide good feedback on more positive ways to handle life’s challenges and problems.
Individual or group therapy for depression treatment?
When you hear the word “therapy” you might automatically think of one-on-one sessions with a therapist. However, group therapy can be very useful in depression treatment as well. Both group and individual therapy sessions usually last about an hour. What are the benefits of each? In individual therapy, you are building a strong relationship with one person, and may feel more comfortable sharing some sensitive information with one person than with a group. You also get individualized attention.
In group therapy, listening to peers going through the same struggles can validate your experiences and help build self-esteem. Often group members are at different points in their depression, so you might get tips from both someone in the trenches and someone who has worked through a challenging problem. As well as offering inspiration and ideas, attending group therapy can also help increase your social activities and network.Primary Treatments For Depression Essay Paper
When the going gets tough in therapy…
As with remodeling a house, when you take apart things that haven’t worked well in your life, it often makes them seem worse before they get better. When therapy seems difficult or painful, don’t give up. If you discuss your feelings and reactions honestly with your therapist, it will help you move forward rather than retreat back to your old, less effective ways. However, if the connection with your therapist consistently starts to feel forced or uncomfortable, don’t be afraid to explore other options for therapy as well. A strong trusting relationship is the foundation of good therapy.
Finding a therapist
One of the most important things to consider when choosing a therapist is your connection with this person. The right therapist will be a caring and supportive partner in your depression treatment and recovery.
There are many ways to find a therapist:
- Word of mouth is one of the best ways to find a good therapist. Your friends and family may have some ideas, or your primary care doctor may be able to provide an initial referral.
- National mental health organizations can also help with referral lists of licensed credentialed providers.
- If cost is an issue, check out local senior centers, religious organizations, and community mental health clinics. Such places often offer therapy on a sliding scale for payment.Primary Treatments For Depression Essay Paper
Medication treatment for depression
Depression medication may be the most advertised treatment for depression, but that doesn’t mean it is the most effective. Depression is not just about a chemical imbalance in the brain. Medication may help relieve some of the symptoms of moderate and severe depression, but it doesn’t cure the underlying problem, and it’s usually not a long-term solution. Antidepressant medications also come with side effects and safety concerns, and withdrawal can be very difficult. If you’re considering whether antidepressant medication is right for you, learning all the facts can help you make an informed decision.
If you are taking medication for depression, don’t ignore other treatments. Lifestyle changes and therapy not only help speed recovery from depression, but also provide skills to help prevent a recurrence.
Should you get antidepressants from your family doctor?
Your family doctor might be the first professionals to recognize your depression. However, while your doctor can prescribe antidepressants, it’s a good idea to explore your options with a mental health professional who specializes in depression. Ask for a referral. You might end up working with a therapist and not needing medication at all. If you do need medication, a psychiatrist has advanced training and experience in depression, treatments, and medications.Primary Treatments For Depression Essay Paper
TMS therapy for depression
If you’re suffering from major depression that has been resistant to therapy, medication, and self-help, then TMS therapy may be an option. Trans cranial magnetic stimulation (TMS) therapy is a noninvasive treatment that directs recurring magnetic energy pulses at the regions of the brain that are involved in mood. These magnetic pulses pass painlessly through the skull and stimulate brain cells which can improve communication between different parts of the brain and ease depression symptoms.
While TMS may be able to improve treatment-resistant depression, that doesn’t mean it’s a cure for depression or that your symptoms won’t return. However, it could provide sufficient improvements in your energy and drive to enable you to begin talk therapy or make the lifestyle changes—such as improving your diet, exercising, and building your support network—that can help preserve your depression recovery in the long term. For more on TMS and depression, read Trans cranial Magnetic Stimulation (TMS) Therapy.
Alternative and complementary treatments for depression
Alternative and complementary treatments for depression may include vitamin and herbal supplements, acupuncture, and relaxation techniques, such as mindfulness meditation, yoga, or tai chi.
Vitamins and supplements for depression treatment
The jury is still out on how well herbal remedies, vitamins, or supplements work in treating depression. While many supplements are widely available over the counter, in many cases their efficacy has not been scientifically proven. If your depression symptoms are in part due to nutritional deficiency, you may benefit from vitamin supplements, but this should be on the advice of your healthcare professional.Primary Treatments For Depression Essay Paper
If you decide to try natural and herbal supplements, remember that they can have side effects and drug or food interactions. For example, St. John’s Wort—a promising herb used for treatment of mild to moderate depression—can interfere with prescription drugs such as blood thinners, birth control pills, and prescription antidepressants. Make sure your doctor or therapist knows what you are taking.
Other alternative depression treatments
Relaxation techniques. As well as helping to relieve symptoms of depression, relaxation techniques may also reduce stress and boost feelings of joy and well-being. Try yoga, deep breathing, progressive muscle relaxation, or meditation.
Acupuncture. Acupuncture, the technique of using fine needles on specific points on the body for therapeutic purposes, is increasingly being investigated as a treatment for depression, with some research studies showing promising results. If you decide to try acupuncture, make sure that you find a licensed qualified professional.
In the United States, over 7 percent of adults and children (over the age of 12) have experienced depression within any two-week period. In fact, depression is one of the most common chronic health conditions listed by doctors on their patient's medical records.
While depression is common, if you think you have it, you may be unsure about where to begin. Here are the steps to getting your mental health treated, so you can feel well.
Seeing Your Primary Care Doctor
If you suspect you may have depression, your first visit should be to your family or primary care physician for a thorough checkup. While most doctors do screen for depression, it's best to be forward and tell your doctor upfront your concerns about your mood. Your doctor is there to help you, so do not hold back.Primary Treatments For Depression Essay Paper
With that, your doctor may ask you several questions related to your depression. Examples of these questions may include:
- How long have you been feeling sad or down?
- Are you sleeping more than usual or having difficulty sleeping?
- How is your appetite? Have you lost weight or gained weight?
- How is your energy level?
- Are you having trouble concentrating or making decisions?
- Do you think of death or have thoughts of suicide?
Your answers to these questions (and others) will help your doctor pinpoint whether or not you have major depressive disorder, often referred to simply as depression.
Even so, before confirming a diagnosis, your doctor will need to rule out other health problems. This is because there are symptoms of several medical conditions that can mimic those of depression. This is especially true in older adults with new onset depression.
Some of these health conditions include:
- Vitamin deficiencies (for example, vitamin B12 deficiency)
- Anemia
- Low blood sugar
- Hypothyroidism
- Calcium or other electrolyte abnormalities
- Kidney or liver problems
While blood tests cannot be used to diagnose depression, they may be ordered by your doctor to rule out some of these above conditions.
Less commonly, an imaging test may be ordered, like a brain MRI, to rule out structural brain diseases, like stroke, especially if there are neurological signs on a person's physical examination or evidence of cognitive problems.Primary Treatments For Depression Essay Paper
In addition, some medications may cause symptoms of depression as a side effect. Be sure to tell your doctor all of the medications you are taking, including both prescription and over-the-counter drugs.
Lastly, it's worthy to note that sometimes other mental health conditions can be difficult to tease apart from depression.
For instance, bipolar disorder may be misdiagnosed initially as depression. This is because symptoms of mania may be overlooked, as a person's depressive symptoms are the ones that feel so bad and first bring them in initially. Substance abuse, either intoxication or withdrawal, can also cause symptoms that overlap with depression.
Try to remain patient as your doctor sorts through your symptoms.
Referral to a Mental Health Professional
After a complete medical history and physical examination, if your doctor diagnoses you with depression, you may then be referred to a mental health professional, like a psychiatrist
The role of a psychiatrist is to further evaluate your mood and determine whether or not medication is needed. If you would also benefit from psychotherapy (research suggests that the combination of medication and therapy is most effective for treating depression), psychiatrists are generally able to handle this as well, although some may elect to refer you to another mental health professional, like a psychologist.
While some people will do fine being treated by their primary care physician, others may benefit from seeing a psychiatrist especially if symptoms are not improving with the first trial of an antidepressant, or the depression is severe from the start.Primary Treatments For Depression Essay Paper
In short, if you are diagnosed with depression, it seems prudent to start with, or at least get a referral to, a mental health professional.
Treatment of Depression Is Complex
It's important to note the treatment of depression is not as simple as writing a prescription for Prozac (fluoxetine). The individual causes of depression are diverse and poorly understood. The medications used to treat it are just as diverse, so matching a drug with an individual is not a clear-cut decision.
A person's specific symptoms, co-existing illnesses, tolerance of side-effects, and medications previously tried are just a few factors that are considered when your doctor chooses your antidepressant.
Also, treatment can take some time. While many people begin to feel better within one to two weeks, it can take six to twelve weeks to feel the full effect of your medication.
Even so, be sure to follow closely with your doctor, especially if you are experiencing bothersome side effects. Also, if you are noticing very little or no improvement in your symptoms after two to four weeks, your doctor may increase your dose, add another medication to increase its effect, or switch your medication.Primary Treatments For Depression Essay Paper
Sadness is a natural part of the human experience. People may feel sad or depressed when a loved one passes away or when they’re going through a life challenge, such as a divorce or serious illness. However, these feelings are normally short-lived. When someone experiences persistent and intense feelings of sadness for extended periods of time, then they may have major depressive disorder (MDD).
MDD, also referred to as clinical depression, is a significant medical condition that can affect many areas of your life. It impacts mood and behavior as well as various physical functions, such as appetite and sleep. People with MDD often lose interest in activities they once enjoyed and have trouble performing everyday activities. Occasionally, they may also feel as if life isn’t worth living.
MDD is one of the most common mental disorders in the United States. In 2015, nearly 7 percent of Americans over age 18 had an episode of MDD.
Some people with MDD never seek treatment. However, most people with the disorder can get better with treatment. Medications, psychotherapy, and other methods can effectively treat people with MDD and help them manage their symptoms.
Your doctor or a mental health professional can make a MDD diagnosis based on your symptoms, feelings, and behavior patterns. They will ask you certain questions or give you a questionnaire so they can better determine whether you have MDD.
To be diagnosed with MDD, you need to meet the symptom criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual helps medical professionals diagnose mental health conditions. According to its criteria, you must have 5 or more of the following symptoms, and experience them at least once a day for a period of more than 2 weeks:Primary Treatments For Depression Essay Paper
- You feel sad or irritable most of the day, nearly every day.
- You are less interested in most activities you once enjoyed.
- You suddenly lose or gain weight or have a change in appetite.
- You have trouble falling asleep or want to sleep more than usual.
- You experience feelings of restlessness.
- You feel unusually tired and have a lack of energy.
- You feel worthless or guilty, often about things that wouldn’t normally make you feel that way.
- You have difficulty concentrating, thinking, or making decisions.
- You think about harming yourself or committing suicide.
The exact cause of MDD isn’t known. However, there are several factors that can increase the risk of developing the condition. A combination of genes and stress can affect brain chemistry and reduce the ability to maintain mood stability. Changes in the balance of hormones might also contribute to the development of MDD.
ORDER A PLAGIARISM-FREE PAPER HERE
MDD may also be triggered by:
- alcohol or drug abuse
- certain medical conditions, such as cancer or hypothyroidism
- particular types of medications, including steroids
MDD is often treated with medication and psychotherapy. Some lifestyle adjustments can also help ease certain symptoms. People who have severe MDD or who have thoughts of harming themselves may need to stay in the hospital during treatment. Some might also need to take part in an outpatient treatment program until symptoms improve.Primary Treatments For Depression Essay Paper
Medication
Primary care providers often start treatment for MDD by prescribing antidepressant medications.
Selective serotonin reuptake inhibitors (SSRIs). These antidepressants are frequently prescribed. SSRIs work by helping inhibit the breakdown of serotonin in the brain, resulting in higher amounts of this neurotransmitter.
Serotonin is a brain chemical that’s believed to be responsible for mood. It may help improve mood and produce healthy sleeping patterns. People with MDD often have low levels of serotonin. An SSRI can relieve symptoms of MDD by increasing the amount of available serotonin in the brain.
SSRIs include well-known drugs such as fluoxetine (Prozac) and citalopram (Celexa). They have a relatively low incidence of side effects that most people tolerate well.
Other medications. Tricyclic antidepressants and medications known as atypical antidepressants may be used when other drugs haven’t helped. They can cause several side effects, including weight gain and sleepiness.
Note: Some medications used to treat MDD aren’t safe for women who are pregnant or breastfeeding. Make sure you speak with your healthcare provider if you become pregnant, you’re planning to become pregnant, or you’re breastfeeding your child.
Psychotherapy
Psychotherapy, also known as psychological therapy or talk therapy, can be an effective treatment for people with MDD. It involves meeting with a therapist on a regular basis to talk about your condition and related issues. Psychotherapy can help you:
- adjust to a crisis or other stressful event
- replace negative beliefs and behaviors with positive, healthy ones
- improve your communication skills
- find better ways to cope with challenges and solve problems
- increase your self-esteem
- regain a sense of satisfaction and control in your life
Your healthcare provider may also recommend other types of therapy, such as cognitive behavioral therapy or interpersonal therapy. Another possible treatment is group therapy, which allows you to share your feelings with people who can relate to what you’re going through.Primary Treatments For Depression Essay Paper
Lifestyle changes
In addition to taking medications and participating in therapy, you can help improve MDD symptoms by making some changes to your daily habits.
Eating right: Consider eating foods that contain omega-3 fatty acids, such as salmon. Foods that are rich in B vitamins, such as beans and whole grains, have also been shown to help some people with MDD. Magnesium has also been linked to fighting MDD symptoms. It’s found in nuts, seeds, and yogurt.
Avoiding alcohol and certain processed foods: It’s beneficial to avoid alcohol, as it’s a nervous system depressant that can make your symptoms worse. Also, certain refined, processed, and deep-fried foods contain omega-6 fatty acids, which may contribute to MDD.
Getting plenty of exercise: Although MDD can make you feel very tired, it’s important to be physically active. Exercising, especially outdoors and in moderate sunlight, can boost your mood and make you feel better.
Sleeping well: It’s vital to get at least 6 to 8 hours of sleep per night. Talk to your doctor if you’re having trouble sleeping.
People with MDD can feel hopeless at times, but it’s important to remember that the disorder can typically be treated successfully. To improve your outlook, it’s critical to stick with your treatment plan. Don’t miss therapy sessions or follow-up appointments with your healthcare provider. You should also never stop taking your medications unless you’re instructed to do so by your therapist or healthcare provider.
On days when you feel particularly sad despite treatment, it can be helpful to call the National Suicide Prevention Lifeline or a local crisis or mental health service. These free, 24-hour phone lines take calls from anyone feeling depressed or anxious. A friendly, supportive voice could be just what you need to get you through a difficult time.
Although there are known, effective treatments for depression, fewer than half of those affected in the world (in many countries, fewer than 10%) receive such treatments. Barriers to effective care include a lack of resources, lack of trained health-care providers, and social stigma associated with mental disorders. Another barrier to effective care is inaccurate assessment. In countries of all income levels, people who are depressed are often not correctly diagnosed, and others who do not have the disorder are too often misdiagnosed and prescribed antidepressants.
The burden of depression and other mental health conditions is on the rise globally. A World Health Assembly resolution passed in May 2013 has called for a comprehensive, coordinated response to mental disorders at country level.
Types and symptoms
Depending on the number and severity of symptoms, a depressive episode can be categorized as mild, moderate, or severe.
A key distinction is also made between depression in people who have or do not have a history of manic episodes. Both types of depression can be chronic (i.e. over an extended period of time) with relapses, especially if they go untreated.
Recurrent depressive disorder: this disorder involves repeated depressive episodes. During these episodes, the person experiences depressed mood, loss of interest and enjoyment, and reduced energy leading to diminished activity for at least two weeks. Many people with depression also suffer from anxiety symptoms, disturbed sleep and appetite and may have feelings of guilt or low self-worth, poor concentration and even medically unexplained symptoms.
Depending on the number and severity of symptoms, a depressive episode can be categorized as mild, moderate, or severe. An individual with a mild depressive episode will have some difficulty in continuing with ordinary work and social activities, but will probably not cease to function completely. During a severe depressive episode, it is very unlikely that the sufferer will be able to continue with social, work, or domestic activities, except to a very limited extent.Primary Treatments For Depression Essay Paper
Bipolar affective disorder: this type of depression typically consists of both manic and depressive episodes separated by periods of normal mood. Manic episodes involve elevated or irritable mood, over-activity, pressure of speech, inflated self-esteem and a decreased need for sleep.
Contributing factors and prevention
Depression results from a complex interaction of social, psychological and biological factors. People who have gone through adverse life events (unemployment, bereavement, psychological trauma) are more likely to develop depression. Depression can, in turn, lead to more stress and dysfunction and worsen the affected person’s life situation and depression itself.
There are interrelationships between depression and physical health. For example, cardiovascular disease can lead to depression and vice versa.
Prevention program mes have been shown to reduce depression. Effective community approaches to prevent depression include school-based program mes to enhance a pattern of positive thinking in children and adolescents. Interventions for parents of children with behavioral problems may reduce parental depressive symptoms and improve outcomes for their children. Exercise program mes for the elderly can also be effective in depression prevention.Primary Treatments For Depression Essay Paper
Diagnosis and treatment
There are effective treatments for moderate and severe depression. Health-care providers may offer psychological treatments (such as behavioral activation, cognitive behavioral therapy [CBT], and interpersonal psychotherapy [IPT]) or antidepressant medication (such as selective serotonin re uptake inhibitors [SSRIs] and tricycle antidepressants [TCAs]). Health-care providers should keep in mind the possible adverse effects associated with antidepressant medication, the ability to deliver either intervention (in terms of expertise, and/or treatment availability), and individual preferences. Different psychological treatment formats for consideration include individual and/or group face-to-face psychological treatments delivered by professionals and supervised lay therapists.
Psycho social treatments are also effective for mild depression. Antidepressants can be an effective form of treatment for moderate-severe depression but are not the first line of treatment for cases of mild depression. They should not be used for treating depression in children and are not the first line of treatment in adolescents, among whom they should be used with extra caution.
WHO response
Depression is one of the priority conditions covered by WHO’s mental health Gap Action Program me (mhGAP). The Program me aims to help countries increase services for people with mental, neurological and substance use disorders, through care provided by health workers who are not specialists in mental health. WHO, among other agencies, has developed brief psychological intervention manuals for depression that may be delivered by lay workers. An example is, Problem Management Plus, which describes the use of behavioral activation, relaxation training, problem solving treatment and strengthening social support. Moreover, the manual Group Interpersonal Therapy (IPT) for Depression describes group treatment of depression. Finally, Thinking Healthy covers the use of cognitive-behavioral therapy for perinatal depression. Primary Treatments For Depression Essay Paper
An estimated 25% of all cancer patients will experience major depression at some point in their illness.[1-5] People with cancer are three times more likely than the general population and almost two times more likely than other hospitalized medical patients to develop major depression.[6,7] The prevalence of depression is even higher in cancer patients with the greatest disability and distressing physical symptoms, especially uncontrolled pain.
Because many clinicians believe that they themselves would be depressed if they had cancer, depression is sometimes viewed as being “appropriate” in cancer patients. However, it is never appropriate for cancer patients to suffer with significant depression. Cassem notes that although massive bleeding is an “appropriate” sequela of a ruptured spleen, it is unthinkable to just stand by and allow a patient to bleed to death.[8]
Similarly, depression is treatable. Untreated, it can lead to decreased compliance with medical care, prolonged hospital stays, and increased morbidity and, possibly, mortality.[9-11] Some patients who are depressed are more likely to request euthanasia or physician-assisted suicide; depressed cancer patients are more likely to commit suicide than other depressed patients.[12,13]
Given the seriousness of depression, it is important for caregivers to recognize and treat it. Past studies have shown that oncologists and primary care providers have difficulty recognizing depressive symptoms in cancer patients.[14,15] Major depression is a clinical entity with specific signs, symptoms, and treatments. It is more than just sadness. Just as one would not immediately diagnose pneumonia in a patient who has a cough, a patient who is crying may not necessarily have a major depressive episode.
Defining Depression
The two major diagnoses for significant depressive symptoms are adjustment disorder (reactive depression) and major depression. When mental health professionals diagnose depressive syndromes, they usually use the criteria set forth in the fourth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM IV).[16] As shown in Table 1, the DSM IV defines major depression as having at least five of the following symptoms ³ 2 weeks: (1) depressed mood most of the day; (2) loss of interest or pleasure; (3) change in appetite and/or change in weight; (4) insomnia or hypersomnia; (5) psychomotor retardation or agitation; (6) loss of energy; (7) feelings of worthlessness or guilt; (8) poor concentration; and (9) thoughts of death or suicidal ideation. Referred to as the “neurovegetative symptoms” of depression, some of these symptoms are related to bodily functions.Primary Treatments For Depression Essay Paper
In order to meet the criteria for major depression, one of the patient’s symptoms must be either depressed mood or loss of interest/pleasure, and the individual must also be experiencing distress or impairment in social, occupational, or other important areas of functioning. Major depression is usually distinguished from an adjustment disorder by the degree, duration, or amount of symptoms.
Making the diagnosis of depression can be more complicated in cancer patients, however. Many of the neurovegetative symptoms of depression— especially loss of energy, loss of appetite, and sleep disturbance—overlap with common symptoms of cancer or other medical illnesses, and with side effects of medical treatments used in cancer patients.
Because these criteria may not be specific for depression in medical illnesses, a set of psychological criteria is often used in their place. Endicott suggested substituting the psychological symptoms of self-pity, brooding, crying spells, and pessimism for the neurovegetative symptoms.[17] Some clinicians highlight the importance of the cognitive symptoms of depression, such as depressed thoughts, hopelessness about appreciating any degree of quality in their lives, guilt or worthlessness, or persistent suicidal ideation. It is important to remember that someone who is acutely dying often becomes withdrawn and hypoactive and may exhibit neurovegetative symptoms. This is usually part of the dying process, not an episode of major depression.
Assessing Depression in Cancer Patients
Since depression is both prevalent and treatable in cancer patients, caregivers should routinely screen patients for its presence. Several predisposing factors have been correlated with the development of depression in cancer patients. These include a history of psychiatric illness, early maladjustment to cancer, poor social support, and low performance status.[18]Primary Treatments For Depression Essay Paper
Assessment for depression with a rapid mental status examination is feasible and should be done in the context of a regular medical visit. Using the questions listed in Table 2, the clinician can rapidly (ie, within 5 to 10 minutes) assess the patient for depression.[19] Three areas should be assessed: (1) the patient’s mood, (2) physical signs of depression (which must be evaluated clinically to determine whether fatigue, insomnia, and low libido are caused by depression or by the cancer or cancer treatment), and (3) the severity of depression.
Suicidal risk must also be assessed, as patients do not readily discuss suicidal thoughts with their caregivers. The clinician should explore how serious the thoughts are and whether the individual has personal factors (ie, prior psychiatric disorder, particularly depression or substance abuse; recent bereavement; and/or few social supports) or medical factors (ie, poorly controlled pain, advanced stage of disease with debilitation, mild delirium with poor impulse control, and/or hopelessness or helplessness in the context of depression) that may contribute to the depression. These risk factors for suicide are summarized in Table 3.[19]
If suicidal ideation is present, a psychiatrist should be asked to evaluate the patient. If the individual appears to be at high risk, he or she should be sent to an emergency room for evaluation and possible hospitalization.
In a busy practice where this type of questioning may seem too time-consuming to ask of all patients routinely, screening tools could be given to patients in the waiting room for quick, timely assessment. Patients who report some depressive symptoms or distress on those screening instruments could be evaluated further in an interview.
Some screening tools used in oncology settings include the Hospital Anxiety and Depression Scale (HADS), Primary Care Evaluation of Mental Disorders (PRIME-MD), and the Zung Self-Rating Depression Scale.[20-22]. Memorial Sloan-Kettering Cancer Center has been using a one-item, rapid screening tool, the “distress thermometer,” that has been easily completed by patients in clinic waiting rooms.[23]
One interesting study found that the one question that correlated most highly with the presence of major depression in terminally ill patients was simply, “Are you depressed?”[24] This single-item screening tool outperformed questionnaires and other screening tools for the eventual diagnostic outcome of evaluations.Primary Treatments For Depression Essay Paper
Differential Diagnosis
Once depressive symptoms have been identified, the clinician should eliminate other possible diagnoses besides major depression. Symptoms typically associated with depression can be seen with other situations related to cancer. This section reviews common medical problems and psychiatric disorders that must be considered and ruled out before diagnosing major depressive disorder in a cancer patient.
Reaction to Bad News—When confronted initially with a diagnosis of cancer, most patients experience a short period of shock, such that the diagnosis may actually be disbelieved for several days. The second phase that follows is characterized by more visible distress: sadness, depressed mood, anxiety, anorexia, insomnia, and irritability that may last up to 2 weeks. There is a sense of sadness and uncertainty about the future, and patients’ thoughts often are preoccupied with illness, death, and anticipated losses. All of these feelings are normal at this time. Some patients cannot carry out daily activities and have trouble processing information and concentrating.
Within a few weeks, however, most patients have adapted to the new reality, and symptoms resolve, usually as treatment is undertaken and optimism about the future begins to return.[25] This is not a major depressive episode. Committing a person in this situation to a long course of antidepressants for symptoms that are usually limited in duration to a few weeks is not beneficial to the patient and only increases the risk of drug-induced side effects. Support from oncologists and nurses or brief psychotherapy, on the other hand, can be helpful.Primary Treatments For Depression Essay Paper
The same series of reactive depressive symptoms can recur at transition points in the illness that carry a negative connotation: ie, notification of failed or failing treatment results; evidence of continued disease on bone marrow aspirate; development of graft-vs-host disease; or evidence of disease progression or relapse. Debilitating symptoms, such as recurrent nadir fevers, a new significant pain, or severe, continuous nausea and vomiting, can also engender feelings of despair and an inability to cope.
These normal responses are usually adequately addressed by listening to the patient’s concerns, acknowledging their appropriateness, explaining the situation, and offering reassurance about treatment. This support, called “normalizing” feelings, is helpful as the physician validates the legitimacy of the patient’s distress.
Physical Illness—As noted above, it is important to try to distinguish between symptoms resulting from the medical illness and neurovegetative symptoms of depression. If the diagnosis is still in question after applying the Endicott substitution criteria, it may be beneficial to institute a trial of antidepressant therapy to see whether symptoms improve.
Adjustment Disorder—When a patient has significant depressive symptoms that develop after an identifiable stressor, such as a cancer diagnosis or recurrence, but does not fully meet the criteria for a major depressive episode, a diagnosis of adjustment disorder is made. If symptoms are severe or prolonged enough, a trial of antidepressants may be beneficial. Sometimes an adjustment disorder can progress into a major depressive episode.
Medical Causes of Depressive Symptoms—Many aspects of medical illnesses, including the disease itself, metabolic abnormalities, treatments, and medications for the illness, can lead to depressive symptoms. Because the depression is the direct result of medical illness, psychiatrists technically call it a mood disorder secondary to a medical condition. Treatment in such cases would first focus on correcting the medical problem, but psychiatric interventions, such as antidepressants, anxiolytics, and hypnotics, would also be employed.Primary Treatments For Depression Essay Paper
Pain—Several common medical conditions and medications can produce mild to severe depressive symptoms (Table 4).[19] The most common cause of depressed mood in cancer patients is uncontrolled pain. It is accompanied by anxiety and a sense of anguish that life is intolerable unless the pain is relieved. Relief of the pain, or even acknowledgment of its existence and an attempt to relieve it, often leads to an improvement in depressive symptoms.
Metabolic and Endocrinologic Abnormalities—Metabolic abnormalities that can alter mood include hypercalcemia, related to either bone metastases or a neuroendocrine effect of the tumor; potassium and sodium imbalances; anemia; and vitamin B12 deficiency. Endocrinologic abnormalities that should be looked for include hyperthyroidism or hypothyroidism, Cushing’s syndrome, hyperparathyroidism, and adrenal insufficiency.[26] Depression occurs with greater frequency and severity in patients with pancreatic cancer, although the mechanism is not fully understood.
Neurologic problems can also mimic or produce depression. Depressive symptoms can be seen with primary central nervous system lesions or brain metastases, particularly right-sided or frontal lesions. Neurologic problems unrelated to cancer, such as cerebral vascular disease, Parkinson’s disease, and Huntington’s disease, have also been known to produce depression.
Drugs Used in Cancer Treatment—Medications commonly used in cancer treatment can also cause depressive symptoms. The glucocorticosteroids, prednisone and dexamethasone frequently cause alterations in mood, which range from euphoria to irritability to severe depression, as well as delirium and psychosis. Interferon-alfa (Intron A, Roferon-A) and interleukin-2 (aldesleukin [Proleukin]), which are also frequently given to cancer patients, may cause depressive symptoms, as well as cognitive deficits.Primary Treatments For Depression Essay Paper
Although a significant number of chemotherapeutic agents are known to have potentially severe side effects, relatively few of these drugs cause depression. Those that do are vincristine, vinblastine, and asparaginase (Elspar).[27] Procarbazine (Matulane), ironically a mild monoamine oxidase inhibitor, also has been reported to cause depression.[28] Other medications, such as methyldopa, reserpine, barbiturates, benzodiazepines, propranolol, and some antibiotics, such as amphotericin B, can cause depressive symptoms as well.
Often, a reduction in the dose or discontinuation of the causative medication will reduce the depressive symptoms. However, if the dose cannot be tapered, antidepressant therapy may be necessary.
Delirium may present with such symptoms as depressed mood and crying. However, patients with delirium manifest a waxing and waning course of attentional and cognitive disturbances and also experience hallucinations, usually visual. Depression can sometimes have psychotic features, but hallucinations are not typically visual. Moreover, unlike depression, delirium develops over a relatively short period.
Dementia—When patients have difficulty with memory and concentration, it may be difficult to tell whether the symptoms are due to dementia or major depression. A thorough medical evaluation, along with a cognitive examination, such as the Mini-Mental Status Examination, should be done. The history, including the onset, time course of depressive and cognitive symptoms, course of illness, and responses to treatment, is often helpful in making this determination.[16] In patients with dementia, there is usually a history of slowly declining cognitive function, whereas in those with major depressive episode, there is usually an abrupt onset of cognitive difficulties associated with the depression.Primary Treatments For Depression Essay Paper
Neuropsychological testing may be helpful in distinguishing between dementia and the pseudodementia of depression. Depressed patients are usually able to do the cognitive tasks with significant coaxing and motivation.
Bipolar Disorder—It is important to ask the patient about any personal history of manic episodes or a family history of bipolar disorder (ie, symptoms of episodic euphoria, grandiosity, increased energy and physical activity despite sleeplessness, spending sprees, or hypersexuality), as the treatments for depression and bipolar disorder differ. Antidepressants may actually exacerbate the mood of a bipolar patient. Mood stabilizers are the treatment of choice and referral to a psychiatrist is suggested.
Personality Disorders—The experience of cancer can often exacerbate preexisting coping abilities in patients with personality disorders. Patients with personality disorders, particularly borderline personality disorder, describe lifelong histories of depression and long-standing patterns of intense, conflictual relationships, self-destructive behaviors, and chronic feelings of emptiness. They may, however, also experience a comorbid episode of depression and require psychotropic medication.
Patients with personality disorders are frequently the most difficult to manage, and nonmedical interventions are often most useful. These include having regularly scheduled visits; establishing good communication between all caregivers to prevent the pitting of one caregiver against another; setting limits on behaviors; and sometimes having a designated coordinator of care.Primary Treatments For Depression Essay Paper
This article provides an overview of current challenges in the diagnosis and treatment of depressed older adults in primary care and considers suggestions for clinicians, researchers, and policy makers to improve care for this population. Despite the enormous toll of depression on individuals and society and the availability of effective treatments, depressed older adults remain largely untreated or under treated. They rarely see mental health professionals, but have relatively frequent contact with primary care providers. In primary care, the chronic and recurrent nature of depression and a number of patient, provider, and policy-related barriers interfere with effective depression treatment. Recent research suggests that improving care for individuals with late life depression will require education and engagement of older adults and their primary care providers as active partners in caring for depression. It will also require additional human resources and systematic models of care dedicated to proactively managing depression as a chronic illness. Finally, it will require training of mental health professionals to effectively collaborate with their colleagues in primary care in treating depressed older adults. Further improvement in depression care would likely result from the implementation of true parity for mental health treatments for older adults.
Among women in the United States, depression is at epidemic levels: Approximately 12 million women in the U.S. experience clinical depression each year, and more than 12 percent of women can expect to experience depression in their lifetime. Moreover, many experts believe the numbers are likely higher, given the degree of under-reporting about the condition, the fact that depression in women is often misdiagnosed and the fact that fewer than half of women who experience clinical depression will ever seek care.
The public health implications are undeniable. Beyond the condition’s isolated impact, depression can have lasting physical and mental health effects that ripple through an individual’s lifetime, with research also indicating that a mother’s depression can affect the mental and physical development of her child.Primary Treatments For Depression Essay Paper
In response to these concerns, Interim Dean Sandra Weiss of the UC San Francisco School of Nursing is leading three major studies aimed at shedding important light on some of the most pressing issues facing American women with depression and the clinicians who treat them.
National Study Characterizes Symptoms
The first study takes a systematic look at the etiology, triggers, symptoms, comorbidities and treatment of women who experience depression in the hope that a more comprehensive and detailed understanding of the disorder can improve screening in primary care settings and lead to more precisely targeted treatments. Weiss is co-principal investigator of this nationwide, multisite study that involves nine leading universities. Funded by the National Network of Depression Centers and its participating sites, the study enrolls women ranging from adolescence through old age – primarily women who are not already undergoing treatment with a mental health professional.
Sandra Weiss “This is not the typical group of women in most depression studies,” says Weiss. “Instead, we are trying to understand symptom presentation for depression and comorbid anxiety by screening women at non psychiatric settings, such as ob-gyn, primary care or pediatric settings where the women’s children receive care.”Primary Treatments For Depression Essay Paper
Some of the questions the study explores are: How many of these women meet the criteria for depression and, of those, how many actually make it to treatment? What types of treatment are most common, and how is treatment linked to the severity and nature of their symptoms? If the study can offer some definitive answers to these questions, it could modify screening and referral guidelines and, perhaps, make the case for more integrated behavioral and mental health resources in primary and specialty care settings. Some studies have shown that integrating behavioral health in primary care can be successful in catching mental health problems before they become more severe and, therefore, more difficult to treat.
In addition, Weiss hopes she and her fellow researchers will be able to add to emerging knowledge about how best to target treatment options to a particular set of symptoms, at a particular time in life – a form of precision medicine for women’s depression. The study is using standardized, validated tools to determine, for example, whether there are different symptom clusters that may reflect different sub types of women’s depression, and how symptoms might differ at different times in a woman’s life. The findings that emerge could help create more evidence-based clinical guidelines than current treatment approaches, which tend to rely on the same guidelines for both men and women or an individual provider’s clinical wisdom.
She adds that the study could also help clinicians understand potential red flags for depression. “One of the interesting things to me is that it’s widely believed that people get more depressed as they get older, but so far we’ve found that older women are less depressed,” says Weiss. “We also found the importance of a key social determinant: When women are unemployed, they have over twice the odds of experiencing depression. Although there has been evidence of this effect for men, it has often been assumed that employment per se is not particularly salient for women’s mental health.”
While the study, which began in 2014, will take place over an extended period of time, an initial paper, based on the first wave of participants, has been accepted for publication in the Journal of Women’s Health. The paper demonstrates the feasibility of creating a large-scale, multisite infrastructure and managing a complex registry of data from diverse professionals and clinical sites.Primary Treatments For Depression Essay Paper
“It’s very exciting to be creating a pooled data set in collaboration with the country’s top experts in depression,” says Weiss. “We already have 1,500 participants and plan to increase the number substantially, as well as follow the cohort over time.”
Transmitting Psychological Distress from Mother to Child
The importance of this larger study grows when one considers two other studies for which Weiss is principal investigator, both funded by the National Institutes of Health (NIH). The first examines how exposure of a fetus to stress-related hormones may affect development of brain areas that shape an infant’s response to stress after birth – with lasting consequences for later mental and physical health.
Based on her previous research, Weiss hypothesizes that stress-related hormones during pregnancy – either from corticosteroids prescribed as part of treatment or from a mother’s own hormonal production – may program development of the stress-response system in preterm babies.
“Prescribed corticosteroids help promote fetal lung development and reduce the risk of death in premature infants, but our initial data suggests that babies whose mothers receive corticosteroids have difficulty mounting a normal response to stressors, as shown in suppressed cortisol levels and dampened heart rate variability,” says Weiss. “This difficulty wasn’t found among babies whose mothers didn’t receive corticosteroids, causing us to be concerned that exposure to these hormones could modify development of the infant’s stress-response system, known as the HPA [hypothalamic-pituitary-adrenal] axis.”Primary Treatments For Depression Essay Paper
She adds that stress hormones that a mother secretes in response to her own psychological distress can also affect development of the infant’s HPA axis. Because stress can modify a number of important biological systems, Weiss’ team is also studying its effects on the infant’s microbiome and telomere length. Telomeres – caps at the ends of each strand of DNA – protect the chromosomes and affect how cells age.
“There is growing evidence from animal research,” Weiss notes, “that stress is linked to higher levels of pathogenic bacteria in the microbiome, which, in turn, have a detrimental effect on health. But almost no data is available to explain how fetal exposure to stress and its related hormones may affect early development of the microbiome in human infants.” Weiss is examining the effect of maternal stress on diminished cellular integrity by measuring telomere length.
To assess how hormonal exposure in the womb will affect all of these important aspects of development over time, Weiss’ team is following infants through their first year of life. She is hopeful that the results of this study will help clinicians identify who may be at greatest risk from any adverse effects of corticosteroids and, therefore, help clinicians better weigh the risks and benefits of these treatments. “We can also tailor interventions for those mothers who are most vulnerable in light of their stress and depression profiles,” she says.
Effects of Depression on Mother-Infant Interaction
In her second NIH-funded study, Weiss is looking at the impact of maternal depression on a mother’s interaction with her infant.
“Parenting involves some of the most complex skills and abilities of any role in life,” says Weiss. “It can be very difficult for women who are struggling with their own emotional challenges to provide care that is sensitive to the child’s needs, assures effective cognitive and other stimulation, expresses positive regard and reduces their child’s distress in optimal ways.”Primary Treatments For Depression Essay Paper
With investigators from two other American universities, Weiss is studying how adversities such as poverty and trauma, a mother’s other mental health problems and her infant’s unique characteristics may influence whether a mother’s depression has a negative impact on the way she relates to her child. By understanding the effect of these moderating factors, clinicians will be better able to identify mothers at particular risk for parenting problems. Preventive interventions can then be tailored to target the most vulnerable families as well as the specific parenting qualities that need attention.
“I have great expectations for the research we are doing,” says Weiss. “I believe that the findings from our studies can ultimately make a real difference in helping women who experience depression and stress, and in preventing adverse sequelae for their children. This is what it’s all about for me; it’s why I derive such purpose and fulfillment as a scientist.”
What is depression?
Depression is an illness that causes you to feel sad, lose interest in activities that you've always enjoyed, withdraw from others, and have little energy. It's different from normal feelings of sadness, grief, or low energy. Depression can also cause people to feel hopeless about the future and even think about suicide.Primary Treatments For Depression Essay Paper
Many people, and sometimes their families, feel embarrassed or ashamed about having depression. Don't let these feelings stand in the way of getting treatment. Remember that depression is a common illness. It affects the young and old, men and women, all ethnic groups, and all professions.
If you think you may be depressed, tell your doctor. Treatment can help you enjoy life again. The sooner you get treatment, the sooner you will feel better.
What causes depression?
Depression is a disease. It's not caused by personal weakness and is not a character flaw. When you have depression, there may be problems with activity levels in certain parts of your brain, or chemicals in your brain called neurotransmitters may be out of balance.
Most experts believe that a combination of family history (your genes) and stressful life events may cause depression. Life events can include a death in the family or having a long-term health problem.Primary Treatments For Depression Essay Paper
Just because you have a family member with depression or have stressful life events doesn't mean you'll get depression.
You also may get depressed even if there is no reason you can think of.
What are the symptoms?
The symptoms of depression may be hard to notice at first. They vary among people, and you may confuse them with just feeling "off" or with another health problem.
The two most common symptoms of depression are:
- Feeling sad or hopeless nearly every day for at least 2 weeks.
- Losing interest in or not getting pleasure from most daily activities that you used to enjoy, and feeling this way nearly every day for at least 2 weeks.
A serious symptom of depression is thinking about death or suicide. If you or someone you care about talks about this or about feeling hopeless, get help right away.
If you think you may have depression, take a short quiz to check your symptoms:
- Interactive Tool: Are You Depressed?
How is it treated?
Depression can be treated in various ways. Counseling, psychotherapy, and antidepressant medicines can all be used. Lifestyle changes, such as getting more exercise, also may help.
Work with your health care team to find the best treatment for you. It may take a few tries, and it can take several weeks for the medicine and therapy to start working. Try to be patient and keep following your treatment plan.
Depression can return (relapse). How likely you are to get depression again increases each time you have a bout of depression. Taking your medicines and continuing some types of therapy after you feel better can help keep that from happening. Some people need to take medicine for the rest of their lives. This doesn't stop them from living full and happy lives.Primary Treatments For Depression Essay Paper
What can you do if a loved one has depression?
If someone you care for is depressed, the best thing you can do is help the person get or stay in treatment. Learn about the disease. Talk to the person, and gently encourage him or her to do things and see people. Don't get upset with the person. The behavior you see is the disease, not the person.Primary Treatments For Depression Essay Paper