Sunday, April 22

Depression: Introduction

Today I was waiting in a Medicentres clinic when I found an informative handout: Depression

I found a website has exactly the same information after I got home. I don't know who has the copyright, but I guess the information is well known, and it should be delivered to people as wide as possible. So I copy the information in this blog from the website, and change the formatting as shown in the handout of Medicentres.

Diclaimer: Please ask your doctor for medical advice.


Depression

Depression in a misunderstood illness. Below are several questions many people ask about depression. Please read all of these carefully and share them with others who care about you. After reading this feel free to ask us any of your questions.

1. WHAT IS DEPRESSION? It is an illness affecting the entire mind and body, causing a person to feel miserable in many ways. Imbalances in the chemical of the brain make it happen.

2. WHAT CAUSES DEPRESSION? We don’t know. We used to think it was due to anger held in or something very unhappy in a person’s life. We now know, however, that this illness happens to people who have no reason to be depressed, and who have no psychiatric problems. In other words, this is a disease often affecting normal and healthy people.

3. DOES HAVING A DEPRESSION MEAN THAT A PERSON IS MENTALLY ILL OR GOING CRAZY? No, but it will very often make him think he is.

4. IS IT VERY COMMON TO HAVE DEPRESSION? Yes, it is the most common illness seen in all of medicine. However, it is often confused with other illnesses. For example, many people who are told they have “low blood”, vitamin deficiency, sinus headaches, low sugar, menopause, “the change” “burnout”, and “all run-down and need rest”, actually will have a depression causing their trouble.

5. WHAT TROUBLE DOES A PERSON HAVE WHO HAS A DEPRESSION? A person with a depression will usually feel most of the following things:

  1. He will feel very tired all the time, even when he has not worked or exerted himself very much. He will be just as tired on days when he has rested as on days where he has worked hard.
  2. His sleep will usually be affected in one of two ways: He will either go to sleep and then wake back up during the night and remain awake, or else he will sleep too much, even during the day.
  3. He will feel very irritable. He will get upset very easily over little things that ordinarily would not upset him
  4. He will often feel very sad for no reason, and in fact, will often break into tears without knowing why.
  5. His normal sex drive will be very much decreased. In fact, it will often go away altogether.
  6. He will often have a headache, perhaps not very severe, but present most of the time. Almost any chronic pain elsewhere, such as in the abdomen or back, can be caused by depression. These pains are not imaginary; they are quite real and often severe.
  7. He will find it difficult to enjoy things. He will feel little enthusiasm, even for things he used to look forward to.
  8. He will often be constipated, or have other digestive symptoms such as abdominal pain or diarrhea. He may lose or gain weight.
  9. He will find it difficult to concentrate, to make decisions, to remember things, to get things done.
  10. He will often feel like he is an ineffective, worthless person, even though he knows he has no reason to feel that way.


6. IS THIS REALLY A SERIOUS ILLNESS? Yes. In a mild depression the person will often think he just has a case of spring fever, or that he is just getting a little older, but his efficiency will still be affected. In a more severe depression, it can be quite serious. This is the illness that can cause a very healthy and happy person to decide to kill himself.

7. CAN A PERSON DO ANYTHING TO FIGHT THIS ILLNESS? Not by his own efforts. This is a disease over which a person has no control, and it will do him no good to “try to fight this myself”.

8. IS THERE ANY EFFECTIVE TREATMENT? Very much so! There are several drugs which are usually very effective against depression. They are also very safe.

9. ARE THE MEDICINES TRANQUILIZERS, PEP PILLS, SLEEPING PILLS, PAIN PILLS, HORMONE PILLS, OR NERVE PILLS? No, none of these. They are call antidepressants.

10. ARE THEY ADDICTING? Absolutely not. A person cannot become addicted even though he takes these medications for years.

11. DO THE MEDICATIONS HAVE UNDESIRABLE SIDE EFFECTS? Unfortunately, they do have pesky side effects. They rarely have serious side effects. They will cause a person’s mouth to be dry. Some will cause drowsiness, although this is very temporary. Others cause drowsiness, nausea, headaches and increased nervousness. There are several other minor side effects that affect some people. Most side-effects go away within two weeks.

12. ARE THESE NOT THE SAME AS "PEP PILLS" OR "UPPERS" THAT I HEAR ABOUT? Absolutely not. Pep pills give anybody a sudden boost of energy. They are all dangerous and we do not use them. Antidepressants on the other hand will do nothing to a person without a depression, but will greatly help a person who has depression, by returning his brain chemistry to normal.

13. HOW LONG WILL I HAVE TO TAKE THEM? It varies. I recommend at least six months to a year or longer. Fortunately they can be taken safely for a lifetime, as frequently required.

14. YOU SAY DEPRESSION HAPPENS TO PEOPLE WITHOUT ANYTHING PERSONAL CAUSING IT? In many cases, yes. However, many people will have things in their personal life that are bothering them a great deal, and if the depression happens during this time, then everything gets much worse. For example, if they are having difficulty with their marriage or their job, and unfortunately get a depression also, then the difficulties just get worse, because their ability to cope with those difficulties is impaired.

15. WHAT SHOULD I TELL MY FAMILY ABOUT ALL OF THIS? We strongly recommend that you have them read this paper. A person with depression will almost always find that his husband or wife is very much affected by the way he feels. Very often our family will not realize that your symptoms are due to an illness, and will think that you simply do not love them anymore! They will often think the fault is somehow theirs. It is very important that they know that this is simply an illness, just as diabetes is an illness, and that neither you nor they are responsible for it. We would welcome them to come back with you to discuss this in detail. Even though they do not really cause your depression, it is still a great help to have your loved ones understand what is happening, why you need medication, etc.

16. DOES COUNSELING HELP DEPRESSION? Yes. Research shows that learning new ways to deal with stress, conflict and resolution of past hurts helps in the treatment of depression. The medicine only changes the brain chemistry, counseling helps you develop new patterns of relating to others and your world.


ANTIDEPRESSANT MEDICATIONS

Please read the following directions until you are certain you understand them thoroughly, but call us if there are any questions about your medications.

1. Antidepressants are listed below. The chemical names are capitalized. The brand names are listed in lower case below each one.

FLUOXETINE SERTRALINE CITALOPRAM PAROXETINE VENLAFAXINE BUEROPION TRAZADONE CLOMIPRAMINE
Prozac Zoloft Celexa Paxil Effexor Wellbutrin Desyrel Anafrani








IMIPRAMINE DESIPRAMINE AMITRIPTYLINE FLUVOXAMINE MIRTAZAPINE
NEFAZODONE
MAPROTOLINE DOXEPIN
Tofranil Norpramine Elavil Luvox Remeron Serzone Ludiomil Sinequan

2. Antidepressants must be taken regularly, not just when you feel like you need them. Please don’t stop taking them because you feel better and think you no longer need them. Stop them only when we tell you to.

3. The good effects of this medication will not show themselves for two to four weeks. Some of the medications will help you sleep right away, but all of the other benefits will be delayed. Then, when the medication does begin to work, you should notice: an increase in your energy, sex drive will return to normal, headaches will go away, and the tendency to cry and feel irritable will go away; in other words, you will feel back to normal.

4. When you do begin to feel better, don’t stop taking the medication. You will feel worse again if you do.

5. It is extremely important that we see you after 2 to 4 weeks to evaluate whether our diagnosis and treatment is correct. Whatever you do, do not stop taking the medication until you see us.

6. If anything troublesome happens which you think may be due to the medication, call us and let us know what is happening. Many times the problem will have nothing to do with the medication at all. However, it is true that with a few people there may be reactions such as nausea, diarrhea, headache, dry mouth, insomnia, nervousness, agitation, sweating, dizziness, tremor and sexual dysfunction, constipation, blurred vision, or delay of urination. Such side effects are usually temporary and can be controlled with other medications.

7. You should be able to work, drive, and carry out your usual activities while taking the medicine. When first beginning the antidepressant, you should use some caution about driving or engaging in other hazardous activity until you see how the medicine will affect you. Usually you can anything you wish, especially after the first two or three days. If you are too sleepy after that, or either cannot sleep, it usually means that we need to change the type of antidepressant to one that gives more or less drowsiness, and we can easily do that by phone. So call us if that is a problem.

8. You should be aware that the safety of these medications lies in the fact that you cannot die from troublesome life situations with them[Note 1]. If for example you do not have the true medical disease of depression, but instead are only working too hard, you will receive no “energy” from these pills. If you have no true depression, but instead are simply unhappy with a life situation that would make anybody unhappy, then the pills will give no happiness. If your headache or stomach ache should be due to some other disease, the pills will be of little help. They only work when you are depressed, and then they usually give dramatic and gratifying relief to all of the symptoms. So, you can see the basic difference between these medications and such drugs as alcohol “uppers”, “nerve pills”, sleeping pills, and the like. All of these drugs can be used as an “escape” from life’s problems, and as such can be habituating. The antidepressants cannot be used in that way, and this is their greatest safety feature.

9. The following is a list of new antidepressants which are specific in action and should be taken exactly as prescribed by your doctor:
Prozac, Luvox, Zoloft, Paxil, Serzone, Manerix, Effexor. [Note 2]

Thomas R McFarland, MD
Arlene McFarland, DNS
256-845-5606


[Note 1]
[Note 2]

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