Major Depression

How FINDcures Can Help

FINDcures specializes in providing help in areas that other foundations often miss or leave unaddressed.  When a family member is diagnosed with Major Depression Disease, a cascade of questions and concerns materialize that can easily overwhelm a family.  Most often the issues of on-going therapy and education on how family members can be effective caregivers when nessesary will be need to be addressed.

Beyond the issues of therapy and caregiver education there are other adjustments that need to be considered.  Specific concerns, that most often arise in a progression of unanswered questions, can have an overwhelming impact on a family’s sense of security and self-worth.  FINDcures has developed a service model (shown at right) called the “Perimeter of Hope” which is designed to provide solutions and answers to the myriad questions that arise when a neurological diagnosis occurs.

The most common questions that come up are these:

  1. Why is this happening?  What caused this?  How difficult is this going to be?  How is this going to impact my family?  Who can we turn to when social stigmas become overwhelming?  How do I deal with all of the emotions I’m feeling?  (Mental Health & Well-Being Services)
  2. How will I be able to provide for my family in the future?  (Financial Planning & Retirement Services)
  3. How can I protect my assets so that they will be available as a resource for my family when I am unable to do so?  (Legal Assistance & Estate Planning Services)
  4. If our family needs to relocate to receive better care or to reduce expenses who can I turn to for help?  (Housing, Relocation & Real Estate Services)
  5. Will I be able to help with my children’s education expenses in the future?  (Education Planning & Tuition Assistance)
  6. When will they find a cure?  What health steps can we take in the meantime?  (Medical Research & Information Services)

When an impacted individual or family is faced with making these decisions on their own and without help from qualified individuals familiar with the impact of neurological diseases, the task list can be overwhelming.  Why make things more difficult by going it alone when you can contact an experienced FINDcures representative and allow them to assist you?  Our services are free of charge.  The consultation costs you nothing and should you choose a service we offer, the cost, if any, is subsidized by the donations we receive.

Major Depression – An Overview

For anyone, like many of us at FINDcures, who have experienced first-hand the debilitating effects of Major Depressive Disorder (MDD), the expressions shared by many well-meaning, but misinformed, people that “It is Just in your Head” or “Just think Happy thoughts” or “This will Pass” or “I understand what you are going through” only makes dealing and living with MDD worse.  While many may really understand or at least honestly think they do, only those who have actually experienced MDD first-hand, personally, or in the lives of close family members, can even begin to understand how difficult MDD is to live and work with.

Although most of us will go through some form of depression in our lives, whether after the loss of a child or job or other traumatic life event, that grief or anger which sometimes turns into depression usually only lasts a few days or months or maybe even a year or so.  MDD may begin to occur because of one, or more like a series, of these events but is much more severe and lasts much longer as it usually results from an actual chemical imbalance in the brain that these significant events can trigger.  MDD may or may not be properly diagnosed or treated with medication as there is no one medication or combination that works for everyone or really even most with MDD.

Living with and trying to function with MDD and learning to live with and help someone who has MDD is like trying to deal with being an alcoholic.  One of the most difficult steps is recognizing and admitting that you or someone you love has MDD, as there are no real outward signs and there is a real social stigma associated with MDD.  Even more difficult, however, is actually being able to do something about it as MDD results in a real lack of not only desire, but actual ability (physically and emotionally) to do something.  The worst feeling about MDD is knowing one has it and what should be done, but not having the desire or will or sometimes even the lack of mental or physical ability to actually get up and do something.  We all need to be more patient and understanding with those who may have MDD and FINDcures is here to provide those as well as Bring Hope through financial, legal and mental health counseling services as well as relocation, education and research services to help FINDcures for MDD.

According to The National Institute of Mental Health (NIMH), a part of the U.S. Department of Health and Human Services, Major Depressive Disorder (a.k.a. Clinical Depression and more commonly, although somewhat inaccurately, known simply as Depression) “is a common but serious mood disorder” which “causes severe symptoms that affect how you feel, think, and handle daily activities, such as sleeping, eating, or working.”

Although The NIMH advises that “the symptoms must be present for at least two weeks … to be diagnosed with depression” and provides information on 5 major forms of depression, including Preinatal (a.k.a. “postpartum”) and Psychotic Depression (a.k.a. “delusions” or “hallucinations”), FINDcures main emphasis is on what NIMH describes as “Persistent Depressive Disorder” (a.k.a. MDD) that is characterized by “a depressed mood that lasts for at least two years”, even if there are “episodes of major depression along with periods of less severe symptoms.”

Signs and Symptoms

If you have been experiencing some of the following signs and symptoms most of the day, nearly every day, for at least two weeks, you may be suffering from depression:

  • Persistent sad, anxious, or “empty” mood
  • Feelings of hopelessness, or pessimism
  • Irritability
  • Feelings of guilt, worthlessness, or helplessness
  • Loss of interest or pleasure in hobbies and activities
  • Decreased energy or fatigue
  • Moving or talking more slowly
  • Feeling restless or having trouble sitting still
  • Difficulty concentrating, remembering, or making decisions
  • Difficulty sleeping, early-morning awakening, or oversleeping
  • Appetite and/or weight changes
  • Thoughts of death or suicide, or suicide attempts
  • Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment

Not everyone who is depressed experiences every symptom. Some people experience only a few symptoms while others may experience many. Several persistent symptoms in addition to low mood are required for a diagnosis of major depression, but people with only a few – but distressing – symptoms may benefit from treatment of their “subsyndromal” depression. The severity and frequency of symptoms and how long they last will vary depending on the individual and his or her particular illness. Symptoms may also vary depending on the stage of the illness.

Risk Factors

Depression is one of the most common mental disorders in the U.S.  Current research suggests that depression is caused by a combination of genetic, biological, environmental, and psychological factors.

Depression can happen at any age, but often begins in adulthood. Depression is now recognized as occurring in children and adolescents, although it sometimes presents with more prominent irritability than low mood. Many chronic mood and anxiety disorders in adults begin as high levels of anxiety in children.

Depression, especially in midlife or older adults, can co-occur with other serious medical illnesses, such as diabetes, cancer, heart disease, and Parkinson’s disease. These conditions are often worse when depression is present. Sometimes medications taken for these physical illnesses may cause side effects that contribute to depression. A doctor experienced in treating these complicated illnesses can help work out the best treatment strategy.

Risk factors include:

  • Personal or family history of depression
  • Major life changes, trauma, or stress
  • Certain physical illnesses and medications

Treatment and Therapies

Depression, even the most severe cases, can be treated. The earlier that treatment can begin, the more effective it is. Depression is usually treated with medications, psychotherapy, or a combination of the two. If these treatments do not reduce symptoms, electroconvulsive therapy (ECT) and other brain stimulation therapies may be options to explore.

Quick Tip: No two people are affected the same way by depression and there is no “one-size-fits-all” for treatment. It may take some trial and error to find the treatment that works best for you.

Medications

Antidepressants are medicines that treat depression. They may help improve the way your brain uses certain chemicals that control mood or stress. You may need to try several different antidepressant medicines before finding the one that improves your symptoms and has manageable side effects. A medication that has helped you or a close family member in the past will often be considered.

Antidepressants take time – usually 2 to 4 weeks – to work, and often, symptoms such as sleep, appetite, and concentration problems improve before mood lifts, so it is important to give medication a chance before reaching a conclusion about its effectiveness. If you begin taking antidepressants, do not stop taking them without the help of a doctor. Sometimes people taking antidepressants feel better and then stop taking the medication on their own, and the depression returns. When you and your doctor have decided it is time to stop the medication, usually after a course of 6 to 12 months, the doctor will help you slowly and safely decrease your dose. Stopping them abruptly can cause withdrawal symptoms.

Please Note: In some cases, children, teenagers, and young adults under 25 may experience an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed. This warning from the U.S. Food and Drug Administration (FDA) also says that patients of all ages taking antidepressants should be watched closely, especially during the first few weeks of treatment.

If you are considering taking an antidepressant and you are pregnant, planning to become pregnant, or breastfeeding, talk to your doctor about any increased health risks to you or your unborn or nursing child.

To find the latest information about antidepressants, talk to your doctor and visit www.fda.gov .

You may have heard about an herbal medicine called St. John’s wort. Although it is a top-selling botanical product, the FDA has not approved its use as an over-the-counter or prescription medicine for depression, and there are serious concerns about its safety (it should never be combined with a prescription antidepressant) and effectiveness. Do not use St. John’s wort before talking to your health care provider. Other natural products sold as dietary supplements, including omega-3 fatty acids and S-adenosylmethionine (SAMe), remain under study but have not yet been proven safe and effective for routine use. For more information on herbal and other complementary approaches and current research, please visit the National Center for Complementary and Integrative Health  website.

Psychotherapies

Several types of psychotherapy (also called “talk therapy” or, in a less specific form, counseling) can help people with depression. Examples of evidence-based approaches specific to the treatment of depression include cognitive-behavioral therapy (CBT), interpersonal therapy (IPT), and problem-solving therapy. More information on psychotherapy is available on the NIMH website and in the NIMH publication Depression: What You Need to Know.

Brain Stimulation Therapies

If medications do not reduce the symptoms of depression, electroconvulsive therapy (ECT) may be an option to explore. Based on the latest research:

  • ECT can provide relief for people with severe depression who have not been able to feel better with other treatments.
  • Electroconvulsive therapy can be an effective treatment for depression. In some severe cases where a rapid response is necessary or medications cannot be used safely, ECT can even be a first-line intervention.
  • Once strictly an inpatient procedure, today ECT is often performed on an outpatient basis. The treatment consists of a series of sessions, typically three times a week, for two to four weeks.
  • ECT may cause some side effects, including confusion, disorientation, and memory loss. Usually these side effects are short-term, but sometimes memory problems can linger, especially for the months around the time of the treatment course. Advances in ECT devices and methods have made modern ECT safe and effective for the vast majority of patients. Talk to your doctor and make sure you understand the potential benefits and risks of the treatment before giving your informed consent to undergoing ECT.
  • ECT is not painful, and you cannot feel the electrical impulses. Before ECT begins, a patient is put under brief anesthesia and given a muscle relaxant. Within one hour after the treatment session, which takes only a few minutes, the patient is awake and alert.

Other more recently introduced types of brain stimulation therapies used to treat medicine-resistant depression include repetitive transcranial magnetic stimulation (rTMS) and vagus nerve stimulation (VNS). Other types of brain stimulation treatments are under study. You can learn more about these therapies on the NIMH Brain Stimulation Therapies webpage.

If you think you may have depression, start by making an appointment to see your doctor or health care provider. This could be your primary care practitioner or a health provider who specializes in diagnosing and treating mental health conditions. Visit the NIMH Find Help for Mental Illnesses if you are unsure of where to start.

Beyond Treatment: Things You Can Do

Here are other tips that may help you or a loved one during treatment for depression:

  • Try to be active and exercise.
  • Set realistic goals for yourself.
  • Try to spend time with other people and confide in a trusted friend or relative.
  • Try not to isolate yourself, and let others help you.
  • Expect your mood to improve gradually, not immediately.
  • Postpone important decisions, such as getting married or divorced, or changing jobs until you feel better. Discuss decisions with others who know you well and have a more objective view of your situation.
  • Continue to educate yourself about depression.

See https://www.nimh.nih.gov/health/topics/depression/index.shtml for more information.

Wikipedia (see https://en.wikipedia.org/wiki/Major_Depressive_Disorder), summarized the effects of MDD by saying that: “Major depressive disorder can negatively affects a person’s family, work or school life, sleeping or eating habits, and general health.[1][2] Between 2–7% of adults with major depression die by suicide,[3] and up to 60% of people who die by suicide had depression or another mood disorder.[4]

The cause is believed to be a combination of genetic, environmental, and psychological factors.[1] Risk factors include a family history of the condition, major life changes, certain medications, chronic health problems, and substance abuse.[1][2] About 40% of the risk appears to be related to genetics.[2] The diagnosis of major depressive disorder is based on the person’s reported experiences and a mental status examination.[5] There is no laboratory test for major depression.[2] Testing, however, may be done to rule out physical conditions that can cause similar symptoms.[5] Major depression should be differentiated from sadness which is a normal part of life and is less severe.[2] The United States Preventive Services Task Force (USPSTF) recommends screening for depression among those over the age 12,[6][7] while a prior Cochrane review found insufficient evidence for screening.[8]

Typically, people are treated with counselling and antidepressant medication.[1] Medication appears to be effective, but the effect may only be significant in the most severely depressed.[9][10] It is unclear whether medications affect the risk of suicide.[11] Types of counselling used include cognitive benavioral therapy (CBT) and interpersonal therapy.[1][12] If other measures are not effective electroconvulsive therapy (ECT) may be tried.[1] Hospitalization may be necessary in cases with a risk of harm to self and may occasionally occur against a person’s wishes.[13]

Major depressive disorder affected approximately 253 million (3.6%) of people in 2013.[14] The percentage of people who are affected at one point in their life varies from 7% in Japan to 21% in France.[15] Lifetime rates are higher in the developed world (15%) compared to the developing world (11%).[15] It causes the second most years lived with disability after low back pain.[16] The most common time of onset is in a person in their 20s and 30s. Females are affected about twice as often as males.[2][15] The American Psychiatric Association added “major depressive disorder” to the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) in 1980.[17] It was a split of the previous derpressive neurosis in the DSM-II which also encompassed the conditions now known as dysthymia and adjustment disorder with depressed mood.[17] Those currently or previously affected may be stigmatized.[18]

  1. “Depression”.  May 2016. Retrieved 31 July 2016.
  2. American Psychiatric Association (2013), Diagnostic and Statistical Manual of Mental Disorders (5th ed.), Arlington: American Psychiatric Publishing, pp. 160–168, ISBN 978-0-89042-555-8, retrieved 22 July 2016
  3. Richards, C. Steven; O’Hara, Michael W. (2014).  The Oxford Handbook of Depression and Comorbidity.  Oxford University Press. p. 254. ISBN 9780199797042.
  4. Lynch, Virginia A.; Duval, Janet Barber (2010).  Forensic Nursing Science.  Elsevier Health Sciences. p. 453.  ISBN 0323066380.
  5. Patton, Lauren L. (2015).  The ADA Practical Guide to Patients with Medical Conditions (2 ed.). John Wiley & Sons. p. 339.  ISBN 9781118929285.
  6. Siu, AL; US Preventive Services Task Force, (USPSTF); Bibbins-Domingo, K; Grossman, DC; Baumann, LC; Davidson, KW; Ebell, M; García, FA; Gillman, M; Herzstein, J; Kemper, AR; Krist, AH; Kurth, AE; Owens, DK; Phillips, WR; Phipps, MG; Pignone, MP (26 January 2016). “Screening for Depression in Adults: US Preventive Services Task Force Recommendation Statement”. 315 (4): 380–7.
  7. Siu, AL; U.S. Preventive Services Task, Force (1 March 2016). “Screening for Depression in Children and Adolescents: U.S. Preventive Services Task Force Recommendation Statement.”Annals of Internal Medicine. 164 (5): 360–6.
  8. Gilbody S, House AO, Sheldon TA (2005). Screening and case finding instruments for depression”. Cochrane Database of Systematic Reviews (4): CD002792.
  9. Fournier JC, DeRubeis RJ, Hollon SD, Dimidjian S, Amsterdam JD, Shelton RC, Fawcett J (January 2010). “Antidepressant drug effects and depression severity: a patient-level meta-analysis”.  JAMA. 303 (1): 47–53.
  10. Kirsch I, Deacon BJ, Huedo-Medina TB, Scoboria A, Moore TJ, Johnson BT (February 2008).  Initial severity and antidepressant benefits: a meta-analysis of data submitted to the Food and Drug Administration”.  PLoS Med. 5 (2): e45.
  11. Braun, C; Bschor, T; Franklin, J; Baethge, C (2016). “Suicides and Suicide Attempts during Long-Term Treatment with Antidepressants: A Meta-Analysis of 29 Placebo-Controlled Studies Including 6,934 Patients with Major Depressive Disorder.”.Psychotherapy and psychosomatics.85 (3): 171–9.
  12. Driessen Ellen; Hollon Steven D (2010).  “Cognitive Behavioral Therapy for Mood Disorders: Efficacy, Moderators and Mediators”.  Psychiatric Clinics of North America. 33 (3): 537–55.
  13. Association, American Psychiatric.  American Psychiatric Association Practice Guidelines for the Treatment of Psychiatric Disorders: Compendium 2006. American Psychiatric Pub. p. 780. ISBN 9780890423851.
  14. Global Burden of Disease Study 2013, Collaborators (22 August 2015).  “Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013.”   Lancet (London, England). 386 (9995): 743–800.
  15. Kessler, RC; Bromet, EJ (2013).  The epidemiology of depression across cultures”.  Annual review of public health. 34: 119–38.
  16. Global Burden of Disease Study 2013, Collaborators (22 August 2015).  “Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013”.  Lancet (London, England). 386 (9995): 743–800.
  17. Hersen, Michel; Rosqvist, Johan (2008).  Handbook of Psychological Assessment, Case Conceptualization, and Treatment, Volume 1: Adults.  John Wiley & Sons. p. 32.  ISBN 9780470173565.
  18. Strakowski, Stephen M.; Nelson, Erik. “Introduction”.  Major Depressive Disorder.  Oxford University Press. p. Chapter 1.  ISBN 9780190206185.
  19. (see https://www.nimh.nih.gov/health/topics/depression/index.shtml)

Disclaimer

The information contained in the FINDcures website is provided for informational and educational purposes only, and should not be construed to be a diagnosis, treatment, regimen, or any other health-care advice or instruction.  The reader should seek his or her own medical or other professional advice, which the information contained in the FINDcures website is not intended to replace or supplement.  FINDcures disclaims any responsibility and liability of any kind in connection with the reader’s use of the information contained herein.