Wednesday, October 2, 2013

Depression


Treatment of Depression
Everyone, from time to time , we feel a bit ' sad or down in the dumps , but these feelings are usually temporary and disappear after a few days . Depressive disorder , however , interferes with daily life and the performance of normal duties , in addition to causing pain to both the person affected and those who live in close contact with her. Depression is a common disease, but that should not be underestimated and the majority of people who suffer from it must resort to therapy to feel better .



Many patients do not cure but most of them, including those suffering from more severe forms of depression may find relief with treatment . Extensive research led to the development of drugs , psychological therapies and other methods to treat people suffering from this debilitating disease.



Forms of depression

There are different types of depressive disorder . The most common forms are major depressive disorder and dysthymic disorder .

Major depressive disorder , also called major depression, is characterized by a combination of symptoms that interfere with their ability to work , sleep , study, eat, and feel pleasure in activities that first captivated the patient. Major depression is disabling and prevents the person from fulfilling its functions normally . The episode can be unique and occur only once in the life of the patient, or, in most cases , may be used for the whole life .

The dysthymic disorder , also called dysthymia , is characterized by symptoms in the long term (two years or more), but less severe : the symptoms are not disabling but may prevent the patient to carry out its functions normally or feeling well. Distimiche people can also suffer from one or more major depressive episodes over a lifetime .

Some forms of depressive disorder have slightly different characteristics from those described above , or you can develop only in certain circumstances . However, the researchers do not all agree on the definition and characterization of these forms of depression. Among them are:
   



Psychotic depression occurs when a severe depressive disorder is accompanied by some form of psychosis , such as detachment from reality , hallucinations and delusions .
   

 Postpartum depression is diagnosed when the new mother has a severe episode of depression within the month following childbirth . It is estimated that a variable percentage of 10 to 15 percent of women suffer from postpartum depression after giving birth to a son .
    


Seasonal Affective Disorder is characterized by the occurrence of major depressive disorder during the winter months , when there is less sunlight. This form of depression usually fades during the spring and summer months . SAD may be effectively treated with light therapy , but nearly half of patients with this disorder do not improve if the therapy is the only treatment adopted. Antidepressants and psychotherapy may lessen the symptoms of the DAS , or alone or in combination with phototherapy .

Bipolar disorder , also called manic depression , is less common than major depression and dysthymia .
Bipolar disorder is characterized by cyclical mood swings , from a very elated mood (mania ) in a very black mood ( depression).



Causes

The specific causes of depression are still unknown, as in the case of many other mental diseases it is believed that depression is caused by a set of biochemical factors , genetic and environmental .

    
Biochemical factors . Some evidence obtained with advanced imaging techniques show that depressed people have brain changes . The importance of these changes is still uncertain but may eventually help to identify the causes of the disease. Even the neurotransmitters , the chemicals that are found in the brain and are linked to mood , might play a role in depression as , one supposes, the hormonal imbalances.
    
Genetic factors. Some research shows that depression is more common among people with family depressed. Researchers are trying to identify the genes that may be responsible for depression.
    
Environmental factors. The environment may play a causal role . Environmental causes are all situations of life difficult to deal with , such as the disappearance of a loved one , economic problems and high stress .







Risk Factors

Although there are no accurate statistics, depression is considered to be relatively common . Each year in the United States, about 12 million people become ill with depression, which transcends all barriers of race , ethnicity and economic status : no one is immune from the risk of getting sick.

It occurs normally at about thirty years , but can start at any age , affecting virtually anyone from children to seniors . In women is diagnosed twice as likely than men, but this may be partly due to the fact that women do care more easily.

Although the exact cause is still unknown , researchers have identified several factors that appear to increase the risk of development or onset of the disease , among them are:

  •     Presence of family members suffering from depression,
  •     Presence of family members who have taken their lives ,
  •     Stressful events such as the death of a loved one ,
  •     Depressed mood at a young age ,
  •     Concomitant illness, such as cancer , heart disease , Alzheimer 's disease or HIV / AIDS,
  •     Prolonged use of certain medications , such as some medications used to control high blood   pressure, sleeping pills or, in some cases , birth control pills,
  •     Certain personality traits, including low self-esteem , a tendency to be employees , excessive pessimism or self-criticism ,
  •     Abuse of alcohol , nicotine and drugs,
  •     Having recently given birth to a son ( postpartum depression ) ,
  •     Poor economic and social conditions .





Care and Treatment

Fighting against depression can be very difficult , because it is a disease that makes it more difficult to adopt behaviors and engage in activities that may help you to feel better . Ask your doctor or specialist how can we improve the styles of fighting disease , and keep these tips in mind :

  
  • Not complicate in life . Reduce the commitments required , if possible, and give yourself a reasonable timeframe to achieve your goals .
        
  • Keep a diary, in which you express pain, anger , fear or other emotions .


  • Read books that offer a reliable method of self -help and talk to your doctor or healthcare professional.
       
  •  Not Isolate . Try to participate in normal activities and to find regularly with family or friends.
        

  • Attend a support group for depressed people : in this way you make contact with other people who are facing problems similar to yours.
        
  • Recovery from depression is a gradual process. Stay motivated , bearing in mind the objectives of healing. Remember that the management of the disease and the achievement of your goals are your responsibility .

  • Learn relaxation techniques and stress management . Try stress reduction techniques such as meditation, yoga or tai chi.







 



Depression : Definition


Among mental illnesses , depression plays a prince, we are talking about a complex disorder that refers , essentially , a significant mood disturbance . In other words, depression can be described as a feeling of sadness, unhappiness and frustration, often associated with anxiety , stress and suicidal thoughts .


Depression : Causes
Depression can be the result of more or less serious diseases (eg, alcoholism, renal impairment , hypothyroidism and hyperparathyroidism, Hashimoto's disease , Alzheimer's disease and Parkinson's disease, premenstrual syndrome , tumors), but it is often a result of psychological distress / emotional originated from disappointments work / emotional , social isolation , stress , neglect of self.


Depression : Symptoms
There are many types of depression, sometimes distinguished on the basis of severity and intensity of the symptoms that characterize them : agitation , anxiety , apathy, appearance of unexplained physical problems ( back pain and headaches) , difficulty concentrating , insomnia / hypersomnia , lack of sexual desire, thoughts of death , loss of interest, tearfulness , sadness .


Depression : Diet and nutrition
Information on Drugs for the treatment of depression are not intended to replace the direct relationship between health professional and patient. Always consult your doctor and / or healthcare professional before taking drugs for the treatment of depression .


Depression drugs
For the treatment of depression are available numerous cures ; generally , to achieve a cure in a shorter time , the patient is subjected to cross- treatments , namely either based on the approach psychotherapeutic , pharmacological and on that . Clearly, to ward off the disease , the patient who is affected must have willpower and work , trying to look at what surrounds it according to a different, better : in doing so, the patient can achieve positive results in shorter time .
As mentioned, the depression constitutes a pathological condition heterogeneous and multifactorial , therefore the choice of a drug instead of another , and a specialist rather than another , essentially depends on the severity of the condition . Some patients complain of a slight depression so you do not need drugs to even complete healing , while others , fall into a depression so deep that I could not re-emerge, nor with psychiatrists or with antipsychotics.


 



The following are classes of drugs most used in therapy against depression , and some examples of pharmacological specialties ; up to the physician to choose the active substance and the dosage most suitable for the patient , based on the severity of the disease , the state of health the patient and his response to treatment :



Tricyclic antidepressants : useful for the treatment of depression of medium and severe , possibly associated with physical ailments . These medications are not indicated to treat mild depression acute grade . Still, the tricyclics are widely used in therapy for depression associated with alteration in appetite , insomnia, hypersomnia , and related disorders. Most often , the first symptom of rehabilitation is to improve the quality of sleep , clearly altered by depression.

     
Amitriptyline ( Elavil eg , Triptizol , Adepril ): Initially , the drug can be taken at a dose of 75 mg daily , in divided doses over 24 hours , the dose may be increased up to 150-200 mg . For teenagers and older people with depression, the initial dose is 30-75 mg . The drug should be taken preferably at bedtime.







Imipramine (eg Imipra C FN , Tofranil ): Initially , the drug should be taken at a dose of 75 mg per day in divided doses . You can increase the doses up to 150-200 mg, in some depressed patients hospitalized , the dose of the drug may increase to 300 mg per day. The maximum dose to be taken before bed is usually 150 mg . This dosage should be reduced when administered to elderly patients .

     
Nortriptyline (eg Dominans , Noritren ) : at the beginning of antidepressant therapy , it is recommended to take a low dose of medication and gradually increase up to 75-100 mg per day , to be split in multiple doses during 24 hours. For teenagers and elderly people with depression, it is recommended that a lower dose (30-50 mg daily) .

These described above are just a few of the many tricyclic drugs , among others, include: clomipramine, dosulepina , doxepin , trazodonelo , fepramina .Currently , the tricyclics are not used in therapy because of their obvious side effects: changes in vision, anorgasmia , weight gain , hypertension, sexual difficulties , fluid retention, tachycardia .


Selective serotonin reuptake inhibitors : These drugs , second-generation antidepressants , tricyclic replaced in a short time due to its lower side effects : These drugs , in fact, are deprived of the cholinergic , instead implicated in the manifestation of the side effects of tricyclic antidepressants . The selective serotonin reuptake inhibitors are not effective for severe forms of depression.


Fluoxetine (eg, Prozac , Azur , Flotina , Fluoxeren ) : Depending on the severity of depression , it is recommended to take the drug at a dose of 20-40 mg per day. Typically, during the first week of treatment, the drug causes nausea, provided that , however, tends to disappear in a short time. Continue therapy for at least 3 weeks , unless otherwise directed by their doctor


Citalopram (eg Seropram ) : a dose of 20-40 mg per day. The dose Puu be increased after a few weeks of therapy. Do not exceed 60 mg per day for adults and 40 mg daily for the elderly.
   

Sertraline ( eg, Zoloft, sertraline , Tralisen ) : it is recommended to start treatment with a dose of active equal to 50 mg / day. If necessary, increase the dose of 50 mg every 2-3 weeks. Do not exceed 200 mg per day. The maintenance dose is 50 mg per day .






Reuptake inhibitors of norepinephrine and dopamine

Bupropion (eg Elontril , Wellbutrin , Zyban ) is a drug used in therapy to treat mild and moderate forms of depression , the active ingredient , unlike the older drugs , drowsiness and does not interfere less on sexual desire . It is recommended to start treatment with 100 mg of active , to be taken by mouth twice a day. Maintenance dose : Take 75-100 mg of the drug per day , increasing the dose , if necessary, every 3 days (100 mg orally , three times a day ) . Do not exceed 450 mg per day , divided into 4 doses . Therapy should be continued until remission of symptoms or as determined by your doctor. The drug is widely used in therapy for smoking cessation .



Reuptake inhibitors of serotonin and norepinephrine
   
Duloxetine (eg Xeristar , Yentreve , Ariclaim , Cymbalta ) : indicated for the treatment of major depression (in which the patient complains of severe depressed mood for at least two consecutive weeks ) . It is recommended that a dose of 40 mg , divided in two doses of 20 mg in 24 hours. In some cases, you can take two doses of 30 mg each , without food.
  
 Venlafaxine ( Efexor eg ) : indicats to treat depression and generalized anxiety. Compared to the tricyclic antidepressants , venlafaxine does not produce the typical side effects antimuscarinic and sedative effects . At the beginning of the treatment, it is recommended to take 75 mg of active per day, preferably divided into two doses , continue for 3-4 weeks. If necessary, in the first period , you can increase the dose up to 150 mg ( divided into two doses). In case of severe depression, increase the dosage of 75 mg every 2-3 days . Do not exceed 375 mg per day.

Monoamine oxidase inhibitors ( MAOIs): these drugs represent a last resort , ie when the treatment of depression with tricyclics or SSRIs did not bring any benefit really evident in the depressed patient . These are second choice drugs for the side effects they generate. MAOIs are often available as a combination of drugs , in order to improve the final effect and restrict the timing of treatment, therefore the probability of the occurrence of the side effects decrease.


   
Phenelzine (eg. Margyl ) : initiating therapy with 15 mg of the drug , three times a day . Maintenance dose : If necessary, increase the dose to 60-90 mg per day. After you get the maximum benefit from your medication, it is recommended to gradually decrease the dose (15 mg a day and every other day ) until it terminates administration.


   
Isocarboxazide (eg. Marplan) : start therapy for depression taking 10 mg of active , twice a day . You can increase the dose of 10 mg every 2-4 days , up to 40 mg per day during the first week of therapy. Subsequently , increasing, if necessary, to 20 mg every week (not to exceed 60 mg / day). Always divide the dose into 2-4 doses . Even in this case , after having obtained the highest response terapica , gradually decrease the drug administration , to avoid the rebound effect . The maintenance dose is 40 mg a day, divided into several doses . Check with your doctor .

   
Tranylcypromine ( Parnate eg. ) : compared to phenelzine and all'isocarboxazide , this drug is the most dangerous in terms of side effects , in addition to being the most exciting . In fact, the recommended dose for the treatment of depression (10 mg , 2 times a day in the first week , 30 mg per day in the second week , 10 mg daily maintenance dose ) should not be administered after 15.00 ( gives insomnia due to hyper- excitability ) . This medication is contraindicated for the treatment of depression of the child.







 Therapy of Depression

Depression is an abrupt onset of symptoms varied, which mostly takes the form of a psychomotor retardation associated with the absence of feelings, loss of sense of hope and possibility in the future, lack of energy and fatigue, symptoms associated with the reduction / loss of sleep (typical is the early morning awakening, around 4-5 am), appetite, sexual desire, and, in general, the desire to do things that previously gave you pleasure. Sometimes, however, instead of psychomotor slowing, there is a prevailing state of agitation, anxiety, often associated with somatic symptoms, such as pain, excessive complaints have on your physical condition, until concerns about their physical health, so similar to what happens hypochondria.


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