Posts Tagged ‘Depressive Illness’

Dealing with the loss of a loved one is not an easy thing. Mourning and grieving are natural processes a person will go through in order to cope with the reality of a major loss. Mourning the loss of a loved one is a very personal affair which may last many months, or even years.

Grieving is the outward expression of your loss. Your grief is likely to be expressed physically, emotionally, and psychologically. For instance, crying is a physical expression, while depression is a psychological expression.

Grief that is complicated by adjustment disorders (especially depressed and anxious mood or disturbed emotions and behavior), major depression and post-traumatic stress disorder are all issues which can arise as a result of grief or loss. Complicated grief can be identified by the length of time of the symptoms, the manner they affect normal function, or by the intensity of the symptoms (for example, intense suicidal thoughts or acts).

Complicated grief may also appear as a complete absence of grief and mourning, or the inability to experience normal grief reactions, delayed grief, conflicted grief, or chronic grief. Factors contributing to the chances one may experience complicated grief include the suddenness of the death, the gender of the person in mourning, and the relationship to the deceased.

Grief reactions that turn into major depression should be treated with both drug and psychological therapy. One who avoids any reminders of the person who died, who constantly thinks or dreams about the person who died, and who gets scared and panics easily at any reminders of the person who died may be suffering from post-traumatic stress disorder.

Depressive illness, not to be confused with situational depression caused by the loved one’s death, occurs in 17%-27% of survivors during the first year after a death. Symptoms of depression typically begin after one to two months of bereavement, last for several months after the loss, and are constant. The help of a mental-health professional is needed.

Mental health professionals tend to approach their subject from one of two quite different perspectives. Some regard mental health problems as a biological disorder or malfunction. This is the approach that is emphasized within medical models of illness, and by psychiatrists. Psychologists are more likely to look at the psychosocial and cognitive factors. So where does that leave the ‘chemical imbalance’ theory of depression?

Mind: Body Relationships and Chemical Imbalance

We are beginning to understand the ways in which the mind and body are interdependent. The consensus today is that stress and emotions can induce the biochemical changes that can be measured in depressive illness. More rarely it can work the other way round, with physical illness resulting in depressed mood.

Often it is hard to separate the two. Stress or poor diet causes us to become run down and renders us more vulnerable to physical illness. Physical illness is itself frequently a cause of stress, and so a feedback situation arises. Most experts agree that depressive illness is a two-way street.

Various diseases and conditions are thought to trigger depression in certain individuals. Depression is associated with various diseases of the nervous system and the endocrine system, for example. It can also be triggered by infections, such as glandular fever.

What Chemicals Are Implicated in Depressive Illness?

Whichever approach is adopted, there is no doubt that biochemistry is a very real factor in depressive illness and that drug treatments that alter body chemistry can be effective. Attention has focussed on hormones and neurotransmitters called monoamines.

The best-known neurotransmitter linked to depression is serotonin. Low serotonin levels are linked to depressed mood, poor appetite and sleep and other bodily functions. The stress hormone norepinephrine is another. Drugs that prevent re-uptake of these neurotransmitters increase their levels in the body and are fundamental to medical management of depression, usually together with psychological therapies.

An alteration in brain chemistry is involved in depression. Returning that imbalance to normal plays an important role in treatment.

Much has been made of ‘happy pills’, with drugs such as Prozac becoming a household name in the 1990s. Antidepressant drugs have been around for half a century, with new types regularly being developed. They are as controversial as they are widely used.

Apart from potentially unpleasant side effects, they have been described as overrated and over-prescribed. A key criticism is that they target the symptoms of depression without addressing the causes. That is certainly true, but antidepressants have their uses in modern medicine and mental health treatments, although many professionals no longer use them as a first line of defense against depressive illness.
Types of Antidepressants

Although there are many classes of antidepressants, three are most commonly used. All work in much the same way, by affecting the chemicals known as neurotransmitters. Those chemicals include serotonin, dopamine and norepinephrine (noradrenalin), which are all implicated in mood regulation.

* Tricyclic antidepressants (TCAs) are the oldest kind, dating back to the 1950s. They have largely been replaced by newer kinds with fewer side effects and lower overdose potential. Imipramine, clomipramine, trimipramine and amitryptiline are all TCAs (brand names include Anafranil, Tofranil, Surmontil). They are still occasionally prescribed when the need arises.

* Monoamine oxidase inhibitors (MAOIs). These are now rarely prescribed because of negative interactions with other drugs and with foods containing tyramine (including red wine, some cheeses, Marmite/Bovril/Vegemite).

* Selective serotonin reuptake inhibitors (SSRIs). The most used these help to build up serotonin levels in the brain. Serotonin is linked to mood as well as appetite, and low levels have been implicated in chronic pain syndromes. Well known SSRIs include fluoxetine (Prozac), paroxetine (Paxil/Seroxat) and sertraline (Zoloft).
Antidepressants are often in the headlines due to real and supposed side effects and questions about their effectiveness. Some argue that they are little better than placebos. Anyone opting for antidepressant drug therapy should discuss the pros and cons with their doctor. Antidepressants alone may not solve the problem and are often taken as one arm of a wider-ranging treatment program that can include counseling and lifestyle changes.