What is Major Depression?

Are you feeling depressed? Do you have a sense of despair? Are you always tired? Are you unable to enjoy things that used to bring pleasure? Going out with a friends might feel like a chore. Your kids share big news with you, such as being accepted to college or finally being pregnant, and you do not feel any joy. You think that you are burden and isolate yourself. Your bed and the covers are your safe place. You barely see the light of the day, and taking a shower is so difficult that you neglect yourself for days or weeks at a time. Your brain is in a fog. You cannot even decide what to have for breakfast.

You no longer bother to call your boss or let anyone know you are not coming in to work. You are helpless, and there seems to be no hope. Thoughts of death and suicide make sense to you and keep your mind busy. But how is this going to affect others? Is this the legacy that you want to leave the generations to come? You used to put on a good show. Nice make-up, large smile, going to work, but nobody could guess how you felt. When you arrived home you were unable to do the bare minimum. Your spouse told you to snap out of it. You were afraid to lose your job if work found out.

• Why does this happen to you?
• What can you do for yourself?
• Where can you start?

Causes of Major Depression

Depression is universal across the history , and continents, affecting all races,and social classes. Everyone from childhood to old age. Philosophers and scientists tried to explain what can bring somebody to such devastating emotions . The causes of depression are still largely unknown.

Biological Causes of Major Depression

Some patients suffering from depression have a family history of mood disorders. Pregnancy and the weeks after delivery are associated with significant changes in hormones.Up to 10-15% of women develop symptoms of postpartum depression. Chronic pain, autoimmune disorders, head injury, medications, recreational use of drugs and many more factors can be associated with depression.

Environmental Causes of Major Depression

People might have experienced loss of a parent in a critical time of their development, or suffered from neglect of a depressed parent. Traumatized by abuse and bullied without having appropriate support. Sometimes even positive life events, like being promoted or a child getting married, can be very stressful and trigger depression. Losing a job, social status, or being burned out, can cause depression. Depression can lead to those events occurring. These factors influence the biochemistry of the brain (the neurotransmitters) and the way that neurons connect with each other.

Symptoms of Major Depression

Depression is like trying to run an engine with empty batteries. The mind is busy with negative thoughts about the self, accompanied by lack of meaning and hope. The feeling is paralyzing, the person will not leave their bedroom, and will not take care of their basic needs. Energy is low, and there can be feelings of exaggerated shame and guilt. Not being able to enjoy activities that used to bring pleasure, the patient will feel so inadequate that they will avoid interaction even with immediate family or friends.

Symptoms of Major Depression

Sleep is disturbed: oversleeping or difficulties falling asleep due to rumination thought or waking up very early and unable to sleep fall asleep again.Appetite and eating habits are affected as well. Feeling depressed almost every and all day for weeks, months, and decades can bring a sense of despair, suicidal thoughts , plans and actions.

Suicide rates have increased by almost 30% in the last 17 years , adding more risk for adolescence and young adult population.Anxiety is associated often with depression . Misuse of alcohol and substance abuse may mask the symptoms of depression.

If you or a love one needs immediate help call 911 or National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or go to www.suicidepreventionlifeline.org

Treatment of Major Depression

Traditionally depression is treated with antidepressants. These agents exert their action on a variety of neurotransmitters that are involved in regulation of mood. The first 2 antidepressants: Imipramine and Iproniazid, were discovered serendipitously in the early 1950s. The First, while looking for a new antipsychotic drug and the second while treating lethargic patients with tuberculosis. These patients became euphoric.

Antidepressants

Prozac was the first designed antidepressant. From the early 1970s and on pharmaceutical companies brought into the marker numerous antidepressant with different mechanism of actions. Antidepressants help of a lot of people suffering from depression. It takes four to six weeks for an antidepressant to start working , but many patients do not respond satisfactory or the relief is only temporary. Many patients stop their prescribed medications due to side effects like:

• Weight gain
• Constipation
• Abdominal discomfort
• Fatigue
• Lack of libido
• Tremors
• Sleep problems

Ketamine

Ketamine is anesthetic agent. Ketamine, in certain dosages is effective in treating severely depressed patients with suicidal thoughts. According to the literature about 70% of cases respond positively to ketamine within hours or days of administration. The effect lasts about 2 weeks, but varies from case to case. Ketamine treatment for depression is not FDA approved, and thorough evaluation will determine if the person is a candidate for treatment.

Psychotherapy

Different forms of talk therapy help depressed patients. Recognizing dysfunctional patterns of thinking and behaviors ,and learning new coping skills.

TMS Treatment of Major Depression

In Transcranial Magnetic Stimulation (TMS) a strong magnetic field is applied on certain areas of the brain that are involved in mood regulation. The current is delivered in pulses that stimulate networks of neurons to communicate more efficiently with each other. This process is evident clinically by slow improvement in energy, motivation, interest in doing things , and quality of sleep. Patients become aware of the changes in their cognitive process.

They do not have automatic negative thoughts, their perception of reality is changing and suicidal thoughts become foreign. Plans for the future take place. Interestingly, significant others notice the change in posture, demeanor, ability to interact, even before the patient reports improvement.

TMS is a safe procedure. The stimulation is noninvasive, and does not involve the use of any pharmacological agents. All this means that TMS is not associated with the systemic side effects of other forms of psychiatric treatments. Side effects like sexual dysfunction, nausea, changes in blood pressure , etc. No anesthesia is required. The stimulation on the scalp can be surprising or painful for the patient for the first few sessions. The most frequent description would be the sensation of a “woodpecker”. It can be associated with twitching of the face or hand during the stimulation. The patient adjusts to the sensation and is able to read and listen to a program during this time.

Earplugs are always used for protection. Tylenol or Ibuprofen can be used before or after session, for headaches if needed. There is a low risk for seizure, which is increased by the use of alcohol. Any change of medication or medical condition needs to be reported to the technician before the session. The use of alcohol is prohibited during the period of treatment. The technician is always present for the duration of the session. The treatment schedule is five time a week, 4-6 weeks for the acute phase of treatment, followed a tapering regimen. The goal of treatment is significant improvement followed by remission.