Depressive problem is a serious medical problem that impacts the body, feelings, and ideas. It impacts the way one consumes and one rests, your self-concept, and the way one believes about things. A despression signs is not the same as a moving red feelings. It is not a indication of personal weak point or a situation that can be willed or wanted away. Individuals with a depressive sickness cannot merely "pull themselves together" and get better. Without therapy, signs can last for weeks, months, or years. Appropriate therapy, however, often including treatment and/or short-term psychiatric therapy, can help a lot of those who be depressed.
“I can remember it started with a loss of interest in basically
everything that I like doing. I just didn’t feel like doing
anything. I just felt like giving up. Sometimes I didn’t even
want to get out of bed.”
—Rene Ruballo, Police Officer
Despression symptoms can reach anyone regardless of age, cultural qualifications, socioeconomic position, or gender; however, large-scale experiments have discovered that depression is about twice as experienced by females too as in men.1,2 In the Combined Declares, scientists calculate that in any given one-year interval, depressive diseases impact 12 % of females (more than 12 thousand women) and nearly seven % of men (more than six thousand men).3 But essential concerns stay to be responded to about the causes actual this sex change. For example, is depression truly less typical among men, or are men just less likely than females to identify, identify, and search for help for depression?
In focus groups performed by the National Institution of Psychological Wellness (NIMH) to determine despression symptoms attention, men described their own the signs of despression symptoms without acknowledging that they were frustrated. Especially, many were uninformed that “physical” signs, such as complications, digestive complaints, and serious pain, can be associated with despression symptoms. In addition, they indicated concern about seeing a mental medical expert or going to a mental health hospital, thinking that people would discover out and that this might have a negative impact on their job security, promotion potential, or medical insurance benefits. They scary that being marked with a analysis of mental sickness would cost them the respect of their friends and family, or their standing in the community.
Over the past 20 years, biomedical analysis such as genes and neuroimaging has helped to expose despression symptoms and other mental disorders—increasing our understanding of the mind, how its chemistry can go wrong, and how to relieve the suffering that mental diseases can cause. Mind image resolution systems are now allowing researchers to see how effective therapy with medication or psychiatric therapy is demonstrated in changes in brain activity.4 As analysis is constantly expose that despression signs are real and curable, and are no more a sign of weak point than cancer or any other serious sickness, more and more men with despression symptoms may feel motivated to seek therapy and discover improved lifestyle.
Types of Depression
Significant depression comes in different types, just as is the case with other diseases such as center related diseases. This report temporarily explains three of the most common kinds of despression signs. However, within these kinds there are versions in the number of signs, their intensity, and determination.
Major depression (or major depressive disorder) is demonstrated by a variety of signs (see manifestation list below) that inhibits the capability to work, research, sleep, eat, and enjoy once fulfilling actions. An important depressive show may happen only once; but more generally, several times may happen in a life-time. Serious depressive problem may require a person to continue treatment consistently.
A less serious form of depression, dysthymia (or dysthymic disorder), includes long-lasting signs that do not seriously turn off, but keep one from performing well or sensation good. Many people with dysthymia also experience major depressive times at some time in their life.
Another form of depressive sickness is bpd (or manic-depressive illness). As well as problem is recognized by bicycling feelings changes: serious peaks (mania) and levels (depression), often with times of regular feelings in between. Sometimes the feelings changes are extraordinary and fast, but usually they are constant. When in the frustrated pattern, an personal can have any or all of the the signs of depression. When in the manic pattern, the person may be over active, over-talkative, and have a lot of energy. Mania often impacts considering, verdict, and public actions in ways that cause serious problems and discomfort. For example, the person in a manic stage may feel happy, full of huge systems that might range from risky business choices to enchanting sprees and risky sex. Mania, neglected, may intensify to a psychotic state.
Symptoms of Depression and Mania
Not everyone who is depressed or manic experiences every
symptom. Some people experience a few symptoms; some people
suffer many. The severity of symptoms varies among individuals
and also over time.
Depression
- Persistent sad, anxious, or "empty" mood
- Feelings of hopelessness, pessimism
- Feelings of guilt, worthlessness, helplessness
- Loss of interest or pleasure in hobbies and activities that were
once enjoyed, including sex
- Decreased energy, fatigue, being "slowed down"
- Difficulty concentrating, remembering, making decisions
- Trouble sleeping, early-morning awakening, or oversleeping
- Appetite and/or weight changes
- Thoughts of death or suicide, or suicide attempts
- Restlessness, irritability
- Persistent physical symptoms, such as headaches, digestive
disorders, and chronic pain, which do not respond to routine
treatment
“You don’t have any interest in thinking about the future,
because you don’t feel that there is going to be any future.”
—Shawn Colten, National Diving Champion
“I wouldn’t feel rested at all. I’d always feel tired. I could get
from an hour’s sleep to eight hours sleep and I would
always feel tired.”
—Rene Ruballo, Police Officer
Mania
- Abnormal or excessive elation
- Unusual irritability
- Decreased need for sleep
- Grandiose notions
- Increased talking
- Racing thoughts
- Increased sexual desire
- Markedly increased energy
- Poor judgment
- Inappropriate social behavior
Co-Occurrence of Depression with
Other Illnesses
Depression can coexist with other illnesses. In such cases, it is
important that the depression and each co-occurring illness be
appropriately diagnosed and treated.
Research has shown that anxiety disorders, which include
post-traumatic stress disorder (PTSD), obsessive-compulsive
disorder, panic disorder, social phobia, and generalized anxiety
disorder, commonly accompany depression. Depression is
especially prevalent among people with PTSD, a debilitating
condition that can occur after exposure to a terrifying event or ordeal
in which grave physical harm occurred or was threatened.
Traumatic events that can trigger PTSD include violent personal
assaults such as rape or mugging, natural disasters, accidents,
terrorism, and military combat. PTSD symptoms include: reexperiencing
the traumatic event in the form of flashback episodes,
memories, or nightmares; emotional numbness; sleep disturbances;
irritability; outbursts of anger; intense guilt; and avoidance of any
reminders or thoughts of the ordeal. In one NIMH-supported study,
more than 40 percent of people with PTSD also had depression when
evaluated at one month and four months following the traumatic
event.
Substance use disorders (abuse or dependence) also
frequently co-occur with depressive disorders.5,6 Research has
revealed that people with alcoholism are almost twice as likely as
those without alcoholism to also suffer from major depression.6 In
addition, more than half of people with bipolar disorder type I (with
severe mania) have a co-occurring substance use disorder.
Depression has been found to occur at a higher rate among
people who have other serious illnesses such as heart disease,
stroke, cancer, HIV, diabetes, and Parkinson's.6,9 Symptoms of
depression are sometimes mistaken for inevitable accompaniments
to these other illnesses. However, research has shown that the cooccurring
depression can and should be treated, and that in many
cases treating the depression can also improve the outcome of the
other illnesses.
Causes of Depression
Substantial evidence from neuroscience, genetics, and clinical
investigation shows that depressive illnesses are disorders of the
brain. However, the precise causes of these illnesses continue to be
a matter of intense research.
Modern brain-imaging technologies are revealing that in
depression, neural circuits responsible for the regulation of moods,
thinking, sleep, appetite, and behavior fail to function properly, and
that critical neurotransmitters—chemicals used by nerve cells to
communicate—are out of balance. Genetics research indicates that
risk for depression results from the influence of multiple genes
acting together with environmental or other nongenetic factors.
Studies of brain chemistry and the mechanisms of action of
antidepressant medications continue to inform our understanding of
the biochemical processes involved in depression.
Very often, a combination of genetic, cognitive, and
environmental factors is involved in the onset of a depressive
disorder.10 Trauma, loss of a loved one, a difficult relationship, a
financial problem, or any stressful change in life patterns, whether
the change is unwelcome or desired, can trigger a depressive episode
in vulnerable individuals. Later episodes of depression may occur
without an obvious cause.
In some families, depressive disorders seem to occur
generation after generation; however, they can also occur in people
who have no family history of these illnesses.11 Whether inherited
or not, depressive disorders are associated with changes in brain
structures or brain function, which can be seen using modern brain
imaging technologies.
Men and Depression
Researchers estimate that at least six million men in the United
States suffer from a depressive disorder every year.3 Research and
clinical evidence reveal that while both women and men can develop
the standard symptoms of depression, they often experience
depression differently and may have different ways of coping with
the symptoms. Men may be more willing to acknowledge fatigue,
irritability, loss of interest in work or hobbies, and sleep
disturbances rather than feelings of sadness, worthlessness, and
excessive guilt. Some researchers question whether the standard
definition of depression and the diagnostic tests based upon it
adequately capture the condition as it occurs in men.
“I’d drink and I’d just get numb. I’d get numb to try to
numb my head. I mean, we’re talking many, many beers
to get to that state where you could shut your head off, but
then you wake up the next day and it’s still there. Because
you have to deal with it, it doesn’t just go away. It isn’t a
two-hour movie and then at the end it goes ‘The End’ and
you press off. I mean it’s a twenty-four hour a day movie
and you’re thinking there is no end. It’s horrible.”
—Patrick McCathern, First Sergeant, U.S. Air Force, Retired
Men are more likely than women to report alcohol and drug
abuse or dependence in their lifetime;16 however, there is debate
among researchers as to whether substance use is a “symptom” of
underlying depression in men, or a co-occurring condition that more
commonly develops in men. Nevertheless, substance use can mask
depression, making it harder to recognize depression as a separate
illness that needs treatment.
Instead of acknowledging their feelings, asking for help, or
seeking appropriate treatment, men may turn to alcohol or drugs
when they are depressed, or become frustrated, discouraged, angry,
irritable and, sometimes, violently abusive. Some men deal with
depression by throwing themselves compulsively into their work,
attempting to hide their depression from themselves, family, and
friends; other men may respond to depression by engaging in
reckless behavior, taking risks, and putting themselves in harm’s
way
“When I was feeling depressed I was very reckless with my
life. I didn’t care about how I drove, I didn’t care about
walking across the street carefully, I didn’t care about
dangerous parts of the city. I wouldn’t be affected by any
kinds of warnings on travel or places to go. I didn’t care. I
didn’t care whether I lived or died and so I was going to do
whatever I wanted whenever I wanted. And when you take
those kinds of chances, you have a greater likelihood of
dying.”
—Bill Maruyama, Lawyer
Four times as many men as women die by suicide in the
United States, even though women make more suicide attempts
during their lives. In addition to the fact that the methods men
use to attempt suicide are generally more lethal than those methods
used by women, there may be other issues that protect women
against suicide death. In light of research indicating that suicide is
often associated with depression,19 the alarming suicide rate among
men may reflect the fact that men are less likely to seek treatment
for depression. Many men with depression do not obtain adequate
diagnosis and treatment, which may be life saving.
More research is needed to understand all aspects of
depression in men, including how men respond to stress and
feelings associated with depression, how to make them more
comfortable acknowledging these feelings and getting the help they
need, and how to train physicians to better recognize and treat
depression in men. Family members, friends, and employee
assistance professionals in the workplace also can play important
roles in recognizing depressive symptoms in men and helping them
get treatment.
Depression in Elderly Men
Men must cope with several kinds of stress as they age. If they have
been the primary wage earners for their families and have identified
heavily with their jobs, they may feel stress upon retirement—loss
of an important role, loss of self-esteem—that can lead to
depression. Similarly, the loss of friends and family and the onset
of other health problems can trigger depression. Nevertheless, most
elderly people feel satisfied with their lives, and it is not "normal" for
older adults to feel depressed.20 Depression is an illness that can be
effectively treated, thereby decreasing unnecessary suffering,
improving the chances for recovery from other illnesses, and
prolonging productive life.
However, health care professionals may miss depressive symptoms in
older patients, who are often reluctant to discuss
feelings of hopelessness, sadness, loss of interest in normally
pleasurable activities, or extremely prolonged grief after a loss, and
who may complain primarily of physical symptoms.21 Also, it may
be difficult to discern a co-occurring depressive disorder in patients
who present with other illnesses, such as heart disease, stroke, or
cancer, which in themselves may cause depressive symptoms, or
which may be treated with medications that have side effects
resembling depression. If a depressive illness is diagnosed,
treatment with appropriate medication and/or brief psychotherapy
can help older adults manage both diseases, thus enhancing
survival and quality of life.
“As you get sick, as you become drawn in more and more
by depression, you lose that perspective. Events become
more irritating, you get more frustrated about getting things
done. You feel angrier, you feel sadder. Everything’s
magnified in an abnormal way.”
—Paul Gottlieb, Publisher
The importance of identifying and treating depression in older
adults is stressed by the statistics on suicide among the elderly.
There is a common perception that suicide rates are highest among
the young; however, it is the elderly, particularly older white males
that have the highest rates. Over 70 percent of older suicide victims
have been to their primary care physician within the month of their
death, many with a depressive illness that was not detected.22 This
has led to research efforts to determine how to best improve
physicians’ abilities to detect and treat depression in older adults.
Approximately 80 percent of older adults with depression
improve when they receive treatment with antidepressant
medication, psychotherapy, or a combination of both.24 In addition,
research has shown that a combination of psychotherapy and
antidepressant medication is highly effective for reducing
recurrences of depression among older adults.25 Psychotherapy
alone has been shown to prolong periods of good health free from
depression, and is particularly useful for older patients who cannot
or will not take medication.20 Improved recognition and treatment
of depression in late life will make those years more enjoyable and
fulfilling for the depressed elderly person, the family, and caregivers.
Depression in Boys and
Adolescent Males
Adolescent Males
Only in the past two decades has depression in children been taken
very seriously. An NIMH-sponsored study of 9- to 17-year-olds
estimates that the prevalence of any depressive disorder is more
than 6 percent in a 6-month period, with 4.9 percent having major
depression.26 Before puberty, boys and girls are equally likely to
develop depressive disorders. After age 14, however, females are
twice as likely as males to have major depression or dysthymia.27
The risk of developing bipolar disorder remains approximately equal
for males and females throughout adolescence and adulthood.
Research has revealed that depression is occurring earlier in
life today than in past decades.28 In addition, research has shown
that early-onset depression often persists, recurs, and continues into
adulthood, and that depression in youth may also predict more
severe illness in adult life.29 Depression in young people frequently
co-occurs with other mental disorders, most commonly anxiety,
disruptive behavior, or substance abuse disorders, as well as with
other serious illnesses such as diabetes.30,31 The depressed younger
child may say he is sick, refuse to go to school, cling to a parent, or
worry that the parent may die. The depressed older child may sulk,
get into trouble at school, be negative, grouchy, and feel
misunderstood.
Among both children and adolescents, depressive disorders
confer an increased risk for illness and interpersonal and
psychosocial difficulties that persist long after the depressive
episode is resolved; in adolescents there is also an increased risk for
substance abuse and suicidal behavior. Unfortunately, these
disorders often go unrecognized by families and physicians alike.
Signs of depressive disorders in young people are often viewed as
normal mood swings typical of a particular developmental stage. In
addition, health care professionals may be reluctant to prematurely
"label" a young person with a mental illness diagnosis. However,
early diagnosis and treatment of depressive disorders are critical to
healthy emotional, social, and behavioral development.
Although the scientific literature on treatment of children and
adolescents with depression is far less extensive than that for
adults, a number of recent studies have confirmed the short-term
efficacy and safety of treatments for depression in youth. Larger
research studies on treatments are underway to determine which
ones work best for which youngsters. Additional research is needed
on how to best incorporate these treatments into primary care
practice.
Bipolar disorder, although rare in young children, can appear
in both children and adolescents.34 The unusual shifts in mood,
energy and functioning that are characteristic of bipolar disorder
may begin with manic, depressive, or mixed manic and depressive
symptoms. It is more likely to affect the children of parents who
have the illness. Twenty to 40 percent of adolescents with major
depression go on to reveal bipolar disorder within five years after
the onset of depression.
Depression in children and adolescents is associated with an
increased risk of suicidal behaviors. This risk may rise,
particularly among adolescent males, if the depression is
accompanied by conduct disorder and alcohol or other substance
abuse. In 2000, suicide was the third leading cause of death
among young males, age 10 to 24.38 NIMH-supported researchers
found that among adolescents who develop major depressive
disorder, as many as seven percent may die by suicide in the young
adult years.29 Therefore, it is important for doctors and parents to
take seriously any remarks about suicide.
NIMH researchers are developing and testing various
interventions to prevent suicide in children and adolescents. Early
diagnosis and treatment, accurate evaluation of suicidal thinking,
and limiting young people's access to lethal agents—including
firearms and medications—may hold the greatest suicide prevention
value.
Suicide
“You are pushed to the point of considering suicide, because
living becomes very painful. You are looking for a way out,
you’re looking for a way to eliminate this terrible psychic pain.
And I remember, I never really tried to commit suicide, but I
came awful close, because I used to play matador with buses.
You know, I would walk out into the traffic of New York City,
with no reference to traffic lights, red or green, almost hoping
that I would get knocked down.”
— Paul Gottlieb, Publisher
Sometimes depression can cause people to feel like putting themselves
in harm’s way, or killing themselves. Although the majority
of people with depression do not die by suicide, having depression
does increase suicide risk compared to people without depression.
If you are thinking about suicide, get help immediately:
- Call your doctor’s office.
- Call 911 for emergency services.
- Go to the emergency room of the nearest hospital.
- Ask a family member or friend to take you to the hospital or
call your doctor.
- Call 1-800-SUICIDE (1-800-784-2433), the toll-free, 24-
hour hotline of the National Hopeline Network sponsored by
the Kristin Brooks Hope Center, to be connected to a trained
counselor at a suicide crisis center nearest you.
Diagnostic Evaluation and Treatment
“Your tendency is just to wait it out, you know, let it get
better. You don’t want to go to the doctor. You don’t want to
admit to how bad you’re really feeling.”
—Paul Gottlieb, Publisher
The first step to getting appropriate treatment for depression is a
physical examination by a physician. Certain medications as well as
some medical conditions such as a viral infection, thyroid disorder,
or low testosterone level can cause the same symptoms as
depression, and the physician should rule out these possibilities
through examination, interview, and lab tests. If no such cause of
the depressive symptoms is found, a psychological evaluation for
depression should be done by the physician or by referral to a
mental health professional.
A good diagnostic evaluation will include a complete history
of symptoms, i.e., when they started, how long they have lasted,
how severe they are, whether the patient had them before and, if so,
whether the symptoms were treated and what treatment was given.
The doctor should ask about alcohol and drug use, and if the patient
has thoughts about death or suicide. Further, a history should
include questions about whether other family members have had a
depressive illness and, if treated, what treatments they may have
received and if they were effective. Last, a diagnostic evaluation
should include a mental status examination to determine if speech,
thought patterns, or memory has been affected, as sometimes
happens with depressive disorders.
Treatment choice will depend on the patient's diagnosis,
severity of symptoms, and preference. There are a variety of
treatments, including medications and short-term psychotherapies
(i.e., “talking” therapies), that have proven effective for depressive
disorders. In general, severe depressive illnesses, particularly those
that are recurrent, will require a combination of treatments for the
best outcome.
Medications
There are several types of medications used to treat depression.
These include newer antidepressant medications—chiefly the
selective serotonin reuptake inhibitors (SSRIs)—and older ones—the
tricyclics and the monoamine oxidase inhibitors (MAOIs). The
SSRIs, and other newer medications that affect neurotransmitters
such as dopamine or norepinephrine, generally have fewer side
effects than tricyclics. Sometimes the doctor will try a variety of
antidepressants before finding the most effective medication or
combination of medications for the patient. Sometimes the dosage
must be increased to be effective. Although some improvements
may be seen in the first couple of weeks, antidepressant medications
must be taken regularly for three to four weeks (in some cases, as
many as eight weeks) before the full therapeutic effect occurs.
Patients often are tempted to stop medication too soon. They
may feel better and think they no longer need the medication, or
they may think it isn't helping at all. It is important to keep taking
medication until it has a chance to work, though side effects (see
section on Side Effects, pages 19-21) may appear before
antidepressant activity does. Once the person is feeling better, it is
important to continue the medication for at least four to nine
months to prevent a relapse into depression. Some medications
must be stopped gradually to give the body time to adjust, and
many can produce withdrawal symptoms if discontinued abruptly.
Therefore, medication should never be discontinued without
talking to your doctor about it. For individuals with bipolar
disorder and those with chronic or recurrent major depression,
medication may have to be maintained indefinitely.
Research has shown that people with bipolar disorder are at
risk of switching into mania, or of developing rapid cycling
episodes, during treatment with antidepressant medication.39
Therefore, "mood-stabilizing" medications generally are required,
alone or in combination with antidepressants, to protect people with
bipolar disorder from this switch. Lithium and valproate
(Depakote®) are the most commonly used mood-stabilizing drugs
today. However, the potential mood-stabilizing effects of newer
medications continue to be evaluated through research.
Medications for depressive disorders are not habit-forming.
Nevertheless, as is the case with any type of medication prescribed
for more than a few days, these treatments have to be carefully
monitored to see if the most effective dosage is being given. The
doctor will check the dosage of each medicine and its effectiveness
regularly.
For the small number of people for whom MAO inhibitors are
the best treatment, it is necessary to avoid certain foods that contain
high levels of tyramine, including many cheeses, wines, and pickles,
as well as medications such as decongestants. The interaction of
tyramine with MAOIs can bring on a hypertensive crisis, a sharp
increase in blood pressure that can lead to a stroke. The doctor
should furnish a complete list of prohibited foods that the patient
should carry at all times. Other forms of antidepressants require no
food restrictions. Efforts are underway to develop a “skin patch”
system for one of the newer MAOIs, selegiline; if successful, this
may be a more convenient and safer medication option than the
older MAOI tablets.
Medications of any kind—prescribed, over-the-counter,
or borrowed—should never be mixed without consulting a doctor. Other health professionals, such as a dentist or other
medical specialist, who may prescribe a drug should be told of the
medications the patient is taking. Some medications, although safe
when taken alone can, if taken with others, cause severe and
dangerous side effects.
Alcohol, including wine, beer, and hard liquor, or street drugs
may reduce the effectiveness of antidepressants and should be
avoided. However, some people who have not had a problem with
alcohol abuse or dependence may be permitted by their doctor to use
a modest amount of alcohol while taking one of the newer
antidepressants.
Antianxiety drugs or sedatives are not antidepressants. They
are sometimes prescribed along with antidepressants, but they are
not effective when taken alone for a depressive disorder.
Stimulants, such as amphetamines, are also not effective
antidepressants, but they are used occasionally under close
supervision in medically ill depressed patients.
Lithium has for many years been the treatment of choice for
bipolar disorder, as it can be effective in smoothing out the mood
swings common to this illness. Its use must be carefully monitored,
as the range between an effective dose and a toxic one is small. If a
person has preexisting thyroid, kidney, or heart disorders or
epilepsy, lithium may not be recommended. Fortunately, other
medications have been found to be of benefit in controlling mood
swings. Among these are two mood-stabilizing anticonvulsants,
valproate (Depakote®) and carbamazepine (Tegretol®). Both of these
medications have gained wide acceptance in clinical practice, and
valproate has been approved by the Food and Drug Administration
for first-line treatment of acute mania. Other anticonvulsants that
are being used now include lamotrigine (Lamictal®), topiramate
(Topamax®), and gabapentin (Neurontin®); however, their role in the
treatment of bipolar disorder is not yet proven and remains under
study.
Most
Most people who have bipolar disorder take more than one
medication including, along with lithium and/or an anticonvulsant,
a medication for accompanying agitation, anxiety, depression, or
insomnia. Finding the best possible combination of these
medications is of utmost importance to the patient and requires
close monitoring by the physician.
Questions about any medication prescribed, or problems
that may be related to it, should be discussed with your
doctor.
Side Effects
Before starting a new medication, ask the doctor to tell you about
any side effects you may experience. Antidepressants may cause
mild and, usually, temporary side effects (sometimes referred to as
adverse effects) in some people. Typically these are annoying, but
not serious. However, any unusual reactions or side effects, or
those that interfere with functioning, should be reported to the
doctor immediately.
The most common side effects of the newer
antidepressants (SSRIs and others) are:
- Headache — this will usually go away.
- Nausea — this is also temporary, but even when it occurs, it is
transient after each dose.
- Nervousness and insomnia (trouble falling asleep or waking
often during the night) — these may occur during the first few
weeks; dosage reductions or time will usually resolve them.
- Agitation (feeling jittery) — if this happens for the first time
after the drug is taken and is more than transient, the doctor should
be notified.
- Sexual problems — the doctor should be consulted if the
problem is persistent or worrisome. Although depression itself can
lower libido and impair sexual performance, it has been clearly
established that SSRIs and other strongly serotonergic
antidepressants (e.g., the tricyclic antidepressant clomipramine)
provoke new, dose-dependant sexual dysfunction independent of
their therapeutic activity in both men and women. These side
effects can affect more than half of adults taking SSRIs. In men,
common problems include reduced sexual drive, erectile dysfunction, and delayed ejaculation.
In some cases of sexual dysfunction, the symptoms improve
with the development of tolerance or lowering of the dose of
medication; drug "holidays" in anticipation of sexual activity have
proved to be successful for some patients taking shorter-acting
SSRIs but are not feasible in the case of fluoxetine (Prozac®). Data
describing differences among the SSRIs are limited, and there are no
data showing a clinical benefit with respect to sexual dysfunction as
a result of switching medications within this class. If an
antidepressant must be changed, one from a different class should
be substituted; bupropion (Wellbutrin®), mirtazapine (Remeron®),
nefazodone (Serzone®), and venlafaxine (Effexor®) appear to be
good choices on the basis of these side effects. Guided by a limited
number of studies, some clinicians treating men with antidepressant-
associated sexual dysfunction report improvement with
the addition of bupropion (Wellbutrin®), buspirone (BuSpar®), or
sildenafil (Viagra®)40 to ongoing treatment. Be sure to discuss the
various options with your doctor, as there may be other
interventions that can help.
Tricyclic antidepressants have different types of side effects:
- Dry mouth — it is helpful to drink sips of water; chew
sugarless gum; clean teeth daily.
- Constipation — bran cereals, prunes, fruit, and vegetables
should be in the diet.
- Bladder problems — emptying the bladder may be
troublesome, and the urine stream may not be as strong as usual;
the doctor should be notified if there is marked difficulty or pain;
may be particularly problematic in older men with enlarged prostate
conditions.
- Sexual problems — sexual functioning may change; men may
experience some loss of interest in sex, difficulty in maintaining an
erection or achieving orgasm. If worrisome, these side effects
should be discussed with the doctor.
- Blurred vision — this will pass soon and will not usually
necessitate new glasses.
- Dizziness — rising from the bed or chair slowly is helpful.
- Drowsiness as a daytime problem — this usually passes soon.
A person feeling drowsy or sedated should not drive or operate
heavy equipment. The more sedating antidepressants are generally
taken at bedtime to help sleep and minimize daytime drowsiness.
Psychotherapies
Several forms of psychotherapy, including some short-term (10-20
weeks) therapies, can help people with depressive disorders. Two of
the short-term psychotherapies that research has shown to be
effective for depression are cognitive-behavioral therapy (CBT) and
interpersonal therapy (IPT). Cognitive-behavioral therapists help
patients change the negative thinking and behavior patterns that
contribute to or result from depression. Through verbal exchange
with the therapist, as well as “homework” assignments between
therapy sessions, CBT helps patients gain insight into and resolve
problems related to their depression. Interpersonal therapists help
patients work through disturbed personal relationships that may be
contributing to or worsening their depression. Psychotherapy is
offered by a variety of licensed mental health providers, including
psychiatrists, psychologists, social workers, and mental health
counselors.
For many depressed patients, especially those with moderate to
severe depression, a combination of antidepressant medication
and psychotherapy is the preferred approach to treatment. Some
psychiatrists offer both types of intervention. Alternatively, in many
cases two mental health professionals collaborate in the treatment
of a person with depression; for example, a psychiatrist or other
physician, such as a family doctor, may prescribe medication while
a nonmedical therapist provides ongoing psychotherapy.
“You start to have these little thoughts, ‘Wait, maybe I can
get through this. Maybe these things that are happening to
me aren’t so bad.’ And you start thinking to yourself,
‘Maybe I can deal with things for now.’ And it’s just little tiny
throughts until you realize that it’s gone and then you go,
‘Oh my God, thank you, I don’t feel sad anymore.’ And
then when it was finally gone, when I felt happy, I was back
to the usual things that I was doing in my life. You get so
happy because you think to yourself, ‘I never thought it
would leave.’ ”
—Shawn Colten, National Diving Champion
Electroconvulsive Therapy
Electroconvulsive therapy (ECT) is another treatment option that
may be particularly useful for individuals whose depression is
severe or life threatening, or who cannot take antidepressant
medication. ECT often is effective in cases where antidepressant
medications do not provide sufficient relief of symptoms. The exact
mechanisms by which ECT exerts its therapeutic effect are not yet
known.
In recent years, ECT has been much improved. A muscle
relaxant is given before treatment, which is done under brief
anesthesia. Electrodes are placed at precise locations on the head to
deliver electrical impulses. The stimulation causes a brief (about 30
seconds) generalized seizure within the brain, which is necessary for
therapeutic efficacy. The person receiving ECT does not consciously
experience the electrical stimulus.
A typical course of ECT entails 6 to 12 treatments,
administered at a rate of three times per week, on either an inpatient
or outpatient basis. To sustain the response to ECT, continuation
treatment, often in the form of antidepressant and/or mood stabilizer
medication, must be instituted. Some individuals may require
maintenance ECT, which is delivered on an outpatient basis at a rate
of one treatment weekly to as infrequently as monthly. The most
common side effects of ECT are confusion and memory loss for
events surrounding the period of ECT treatment. The confusion and
disorientation experienced upon awakening after ECT typically clear
within an hour. More persistent memory problems are variable and
can be minimized with the use of modern treatment techniques,
such as application of both stimulus electrodes to the right side of
the head (unilateral ECT).
Herbal Therapy
In the past several years, there has been an increase in public
interest in the use of herbs for the treatment of both depression and
anxiety. The extract from St. John's wort (Hypericum perforatum), a
wild-growing plant with yellow flowers, has been used extensively
in Europe as a treatment for mild to moderate depression, and it
now ranks among the top-selling botanical products in the United
States. Because of the increase in Americans' use of St. John's wort
and the need to answer important remaining questions about the
herb's efficacy and long-term use for depression, the National
Institutes of Health (NIH) conducted a four-year, $6 million clinical
trial to determine whether a well-standardized extract of St. John's
wort is effective in the treatment of adults suffering from major
depression of moderate severity. The trial found that St. John's wort
was no more effective for treating major depression of moderate
severity than placebo.43 More research is needed to confirm the role of
the herb in managing less severe forms of depression.
The Food and Drug Administration issued a Public Health
Advisory on February 10, 2000 about the use of St. John’s wort. It
stated that the herb appears to affect an important metabolic
pathway that is used by many drugs prescribed to treat conditions
such as heart disease, depression, seizures, certain cancers, and
rejection of organ transplants. Also, St. John’s wort reduces blood
levels of some HIV medications. If taken together, the combination
could allow the AIDS virus to rebound, perhaps in a drug-resistant
form. (See the alert on the NIMH Web site: http://www.nimh.nih.
gov/events/stjohnwort.cfm). Health care providers should alert their
patients about these potential drug interactions, and patients should
always consult their health care provider before taking any herbal
supplement.
How to Help Yourself if You Are
Depressed
“It affects the way you think. It affects the way you feel.
It just simply invades every pore of your skin. It’s a blanket
that covers everything. The act of pretending to be well was so
exhausting. All I could do was shut down. At times you just say
‘It’s enough already.’ ”
—Steve Lappen, Writer
Depressive disorders make one feel exhausted, worthless, helpless,
and hopeless. Such negative thoughts and feelings make some
people feel like giving up. It is important to realize that these
negative views are part of the depression and typically do not
accurately reflect the actual circumstances. Negative thinking fades
as treatment begins to take effect. In the meantime:
- Mild exercise, going to a movie, a ballgame, or participating
in religious, social, or other activities may help.
- Set realistic goals in light of the depression and assume a
reasonable amount of responsibility.
- Break large tasks into small ones, set some priorities, and do
what you can as you can.
- Try to be with other people and to confide in someone; it is
usually better than being alone and secretive.
- Participate in activities that may make you feel better.
- Expect your mood to improve gradually, not immediately.
Feeling better takes time. Often during treatment of
depression, sleep and appetite will begin to improve before
depressed mood lifts.
- It is advisable to postpone important decisions until the
depression has lifted. Before deciding to make a significant
transition—change jobs, get married or divorced—discuss it
with others who know you well and have a more objective
view of your situation.
- People rarely "snap out of" a depression. But they can feel a
little better day-by-day.
- Remember, positive thinking will replace the negative
thinking that is part of the depression and will disappear as
your depression responds to treatment.
- Let your family and friends help you.
How Family and Friends Can Help
The most important thing anyone can do for a man who may have
depression is to help him get to a doctor for a diagnostic evaluation
and treatment. First, try to talk to him about depression—help him
understand that depression is a common illness among men and is
nothing to be ashamed about. Perhaps share this booklet with him.
Then encourage him to see a doctor to determine the cause of his
symptoms and obtain appropriate treatment.
Occasionally, you may need to make an appointment for the
depressed person and accompany him to the doctor. Once he is in
treatment, you may continue to help by encouraging him to stay
with treatment until symptoms begin to lift (several weeks), or to
seek different treatment if no improvement occurs. This may also
mean monitoring whether he is taking prescribed medication and/or
attending therapy sessions. Encourage him to be honest with the
doctor about his use of alcohol and prescription or recreational
drugs, and to follow the doctor's orders about the use of these
substances while on antidepressant medication.
The second most important thing is to offer emotional support
to the depressed person. This involves understanding, patience,
affection, and encouragement. Engage him in conversation and
listen carefully. Do not disparage the feelings he may express, but
point out realities and offer hope. Do not ignore remarks about
suicide. Report them to the depressed person's doctor. In an
emergency, call 911. Invite him 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 him 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 "to snap out of it." Eventually, with
treatment, most people do get better. Keep that in mind, and keep
reassuring him that, with time and help, he will feel better.
Where to Get Help
If unsure where to go for help, talk to someone you trust who has
experience in mental health—for example, a doctor, nurse, social
worker, or religious counselor. Ask their advice on where to seek
treatment. If there is a university nearby, its departments of
psychiatry or psychology may offer private and/or sliding-scale fee
clinic treatment options. Otherwise, check the Yellow Pages under
"mental health," "health," "social services," "suicide prevention,"
"crisis intervention services," "hotlines," "hospitals," or "physicians"
for phone numbers and addresses. In times of crisis, the emergency
room doctor at a hospital may be able to provide temporary help for
a mental health problem, and will be able to tell you where and how
to get further help.
Listed below are the types of people and places that will make
a referral to, or provide, diagnostic and treatment services.
- Family doctors
- Mental health specialists, such as psychiatrists,
psychologists, social workers, or mental health counselors
- Religious leaders/counselors
- Health maintenance organizations
- Community mental health centers
- Hospital psychiatry departments and outpatient clinics
- University- or medical school-affiliated programs
- State hospital outpatient clinics
- Social service agencies
- Private clinics and facilities
- Employee assistance programs
- Local medical and/or psychiatric societies
Within the Federal government, the Substance Abuse and
Mental Health Services Administration (SAMHSA) offers a “Services
Locator” for mental health and substance abuse treatment programs and
resources nationwide. Visit their Web site at
http://www.mentalhealth.samhsa.gov/databases/ or call toll-free,
1-800-789-2647.
Conclusion
Have you known a man who is grumpy, irritable, and has no sense
of humor? Maybe he drinks too much or abuses drugs. Maybe he
physically or verbally abuses his wife and his kids. Maybe he works
all the time, or compulsively seeks thrills in high-risk behavior. Or
maybe he seems isolated, withdrawn, and no longer interested in
the people or activities he used to enjoy.
Perhaps this man is you. If so, it is important to understand
that there is a disease of the brain called depression that may be
underlying these feelings and behaviors. It's real: scientists have
developed sensitive imaging devices that enable us to see it in the
brain. And it's treatable: more than 80 percent of those suffering
from depression respond to existing treatments, and new ones are
continually becoming available and helping more people. Talk to a
healthcare provider about how you are feeling, and ask for help.
Perhaps this man is you. If so, it is important to understand
that there is a disease of the brain called depression that may be
underlying these feelings and behaviors. It's real: scientists have
developed sensitive imaging devices that enable us to see it in the
brain. And it's treatable: more than 80 percent of those suffering
from depression respond to existing treatments, and new ones are
continually becoming available and helping more people. Talk to a
healthcare provider about how you are feeling, and ask for help.
For most men with depression, life doesn't have to be so dark
and hopeless. Life is hard enough as it is; and treating depression
can free up vital resources to cope with life’s challenges effectively.
When a man is depressed, he's not the only one who suffers. His
depression also darkens the lives of his family, his friends, virtually
everyone close to him. Getting him into treatment can send ripples
of healing and hope into all of those lives.
Depression is a real illness; it is treatable; and men can have
it. It takes courage to ask for help, but help can make all the
difference.
“And pretty soon you start having good thoughts about
yourself and that you’re not worthless and you kind of turn
your head over your shoulder and look back at that, that
rutted, muddy, dirt road that you just traveled and now
you’re on some smooth asphalt and go, ‘Wow, what a trip.
Still got a ways to go, but I wouldn’t want to go down that
road again.’ ”
—Patrick McCathern, First Sergeant, U.S. Air Force, Retired
