Depression Essay, Research Paper
Each year some thirty thousand Americans die by their own hand, most of them as a result of depression or bipolar. The true figure is probably many times higher. Depression is a disease that afflicts the human psyche in such a way that the afflicted tend to act and react abnormally toward others and themselves. Therefore, it comes to no surprise to discover that adolescent depression is strongly linked to teen suicide. Adolescent suicide is now responsible for more deaths in youth?s aged 15 to 19 than cardiovascular disease or cancer. Despite this increased suicide rate, depression in this age group is greatly under diagnosed and leads to serious difficulties in school, work and personal adjustment, which may often continue into adulthood. (Brown 1996) has said the reason why depression is often over looked in children and adolescents is because “children are not always able to express how they feel.” Sometimes the symptoms of mood disorders take on different forms in children than in adults. Adolescence is a time of emotional turmoil, mood swings, gloomy thoughts, and heightened sensitivity. It is a time of rebellion and experimentation. (Blackman 1996) observed that the “challenge is to identify depressive symptomatology which may be superimposed on the backdrop of a more transient, but expected, developmental storm.”
Depression is a psychiatric disorder characterized by feelings of worthlessness, guilt, sadness, helplessness, and hopelessness. It is different then normal sadness or grief from the loss of a loved one because it is persistent and severe. Clinical depression has many related symptoms trouble sleeping, eating disorders, withdrawal and inactivity, self-punishment, and loss of pleasure. People that are depressed do not like to do things they may usually like to.
Surveys show that approximately 20 in 100 people suffer from depression at any one time. About one in four Americans will suffer from a depression over the course of their lifetime. Depression strikes men and women of all ages, in all races, but most studies indicate that women are more often afflicted.
There are two major forms of depression that people get. One form is called depressive disorder. It is diagnosed only by episodes of depression. Episodes can be short or long but are usually brought about by an incident in a persons life. An example of this is if someone close to them dies. The other kind is called bipolar or manic depressive illness, it is recognized by alternating depressed and manic episodes. This is an actual brain dysfunction. In the major depression or the depressed phase of bipolar illness, a depressed mood predominates, even though the patient may not be aware of feeling sad. Typically, he or she loses all interest in activities. Symptoms include sleep disturbances, not able to concentrate or to make decisions, loss of appetite or greatly increased appetite, slowed thinking , decreased energy feelings of worthlessness, guilt, hopelessness, diminished sexual interest and recurrent thoughts of suicide and death, sometimes leading a person to actually committing suicide. In the manic phase of bipolar disorder the patients behavior is bizarre and sometimes obnoxious. Symptoms of this are the person being hyper and perceiving lots of energy, they talk a lot, racing thoughts and a decreased need for sleep. In this stage it is very hard to recognize. Both depressive and bipolar disorders run in families. Meaning if your father or mother had it you have a high chance of getting it yourself. Most people who are depressed are women. They may be biologically induced depression. Meaning that there is a lack of or too much of a chemical or protein. Or it may be that women learn social roles that favor feelings of helplessness. Because women in trouble are more likely to seek professional assistance than men, statistics report that more people who are depressed are mostly women.
Antidepressant medications are widely used, effective treatments for depression. Existing antidepressant drugs are known to influence the functioning of certain neurotransmitters (chemicals used by brain cells to communicate), primarily serotonin, norepinephrine, and dopamine, known as monoamines. Older medications – tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) – affect the activity of both of these neurotransmitters simultaneously. Their disadvantage is that they can be difficult to tolerate due to side effects or, in the case of MAOIs, dietary and medication restrictions. Newer medications, such as the selective serotonin reuptake inhibitors (SSRIs), have fewer side effects than the older drugs, making it easier for patients to adhere to treatment. Both generations of medications are effective in relieving depression, although some people will respond to one type of drug, but not another. Medications that take entirely different approaches to treating depression are now in development. Electroconvulsive therapy (ECT), although not generally used as a first-line treatment, is one of the effective treatments for severe depression. Psychotherapy is also effective for treating depression. Certain types of psychotherapy, cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT), have been shown to be particularly useful. More than 80 percent of people with depression improve when they receive appropriate treatment with medication, psychotherapy, or the combination. Recently there has been enormous interest in herbal remedies for various medical conditions including depression. One herbal supplement, hypericum or St. John’s Wort, has been promoted as having antidepressant properties. However, no carefully designed studies have determined the antidepressant efficacy of the supplement. NIMH is currently enrolling patients in the first large-scale, multi-site, controlled study of St. John’s wort as a potential treatment for depression.
Diagnosis should not only lay only in the physician’s hands but be associated with parents, teachers and anyone who interacts with the patient on a daily basis. Unlike adult depression, symptoms of youth depression are often masked. Instead of expressing sadness, teenagers may express boredom and irritability, or may choose to engage in risky behaviors. .
For many teens, symptoms of depression are directly related to low self -esteem stemming from increased emphasis on peer popularity. For other teens, depression arises from poor family relations, which could include decreased family support and perceived rejection by parents. Oster & Montgomery (1996) stated that “when parents are struggling over marital or career problems, or are ill themselves, teens may feel the tension and try to distract their parents.” This “distraction” could include increased disruptive behavior, self-inflicted isolation and even verbal threats of suicide. So how can the physician determine when a patient should be diagnosed as depressed or suicidal? Brown (1996) suggested the best way to diagnose is to “screen out the vulnerable groups of children and adolescents for the risk factors of suicide and then refer them for treatment.” Some of these “risk factors” include verbal signs of suicide within the last three months, prior attempts at suicide, indication of severe mood problems, or excessive alcohol and substance abuse.
Many physicians tend to think of depression as an illness of adulthood. In fact, Brown (1996) stated that “it was only in the 1980’s that mood disorders in children were included in the category of diagnosed psychiatric illnesses.” In actuality, 7-14% of children will experience an episode of major depression before the age of 15. An average of 20-30% of adult bipolar patients report having their first episode before the age of 20. In a sampling of 100,000 adolescents, two to three thousand will have mood disorders out of which 8-10 will commit suicide (Brown, 1996). Blackman (1995) remarked that the suicide rate for adolescents has increased more than 200% over the last decade. Brown (1996) added that an estimated 2,000teenagers per year commit suicide in the United States, making it the leading cause of death after accidents and homicide. Blackman (1995) stated that it is not uncommon for young people to be preoccupied with issues of mortality and to contemplate the effect their death would have on close family and friends. Once it has been determined that the adolescent has the disease of depression, what can be done about it? Blackman (1995) has suggested two main avenues to treatment: “psychotherapy and medication.” The majorities of the cases of adolescent depression are mild and can be dealt with through several psychotherapy sessions with intense listening, advice and encouragement. For the more severe cases of depression, especially those with constant symptoms, medication may be necessary and without pharmaceutical treatment, depressive conditions could escalate and become fatal. Brown (1996) added that regardless of the type of treatment chosen, “it is important for children suffering from mood disorders to receive prompt treatment because early onset places children at a greater risk for multiple episodes of depression throughout their life span.” Until recently, adolescent depression has been largely ignored by health professionals, but now several means of diagnosis and treatment exist. “Although most teenagers can successfully climb the mountain of emotional and psychological obstacles that lie in their paths, there are some who find themselves overwhelmed and full of stress.”(Brown 1996). With the help of teachers, school counselors, mental health professionals, parents, and other caring adults, the severity of a teen’s depression can not only be accurately evaluated, but plans can be made to improve his or her well-being and ability to fully engage life (Blackman, 1995).
Modern brain imaging technologies are revealing that in depression, neural circuits responsible for moods, thinking, sleep, appetite, and behavior fail to function properly, and that the regulation of critical neurotransmitters is impaired. Genetics research indicates that vulnerability to depression results from the influence of multiple genes acting together with environmental factors. Studies of brain chemistry, mechanisms of action of antidepressant medications, and the cognitive distortions and disturbed interpersonal relationships commonly associated with depression, continue to inform the development of new and better treatments. The hormonal system that regulates the body’s response to stress – the hypothalamic-pituitary-adrenal (HPA) axis – is overactive in many patients with depression. The hypothalamus, the brain region responsible for managing hormone release from glands throughout the body, increases production of a substance called corticotrophin releasing factor (CRF) when a threat to physical or psychological well-being is detected. Elevated levels and effects of CRF lead to increased hormone secretion by the pituitary and adrenal glands which prepares the body for defensive action. The body’s responses include reduced appetite, decreased sex drive, and heightened alertness. Research suggests that persistent overactivation of this hormonal system may lay the groundwork for depression. The elevated CRF levels detectable in depressed patients are reduced by treatment with antidepressant drugs, and this reduction corresponds to improvement in depressive symptoms.
Unfortunately, the diagnosis of depression is often delayed, as well meaning friends and family tell the depressed individual to “just snap out of the mood”. Medical treatment is necessary for the treatment of major depression, and will often relieve the symptoms within a few weeks. The treatment of depression is twofold, namely, psycho pharmaco-therapy and psychotherapy. Unlike common belief, antidepressant medicines are non-addictive and safe, if used as prescribed. The antidepressants help to restore the balance of the neurotransmitters in the brain and thereby, relieve the vegetative symptoms of depression.