Thursday, April 19, 2012


What is depression?
Only the name of depression comes from the Latin word meaning sadness. When doctors talk about depression, they think of a number of related psychological and physical condition characterized by mood disorders, ie.affective disorders. They are recognized as the reduced mood, negative feelings and dark thoughts. Accompanied by physical symptoms such as fatigue, exhaustion, sleep disturbance and appetite.

It seems that the ignorance of the vast majority of the population that is "beyond medicine", the main culprit as "informal" use of the word depression has become the "in". So every now and then someone at work, in a tram, or even with family in a statement that the "deprivation". Fortunately, it is usually easier to just, transient fall mood.The problem is that the frequent use of the word lightly, and depression "seduce" many healthy people and are often not taken seriously either (right) of the patients in his community, one which should help because the (real) depression.

Who gets depression?
The data indicate that currently suffer from depression 3 to 4 percent of the population of industrialized countries. So far it seems that women are more vulnerable than men because of their depression is diagnosed two to three times more than the "stronger sex". But those figures may be due to the fact that men are less likely because of shame seek medical help.
Currently in Croatia from some form of depressive disorder suffer at least between 100,000 and 200,000 people, one fifth of Croatia will experience at least one depressive episode in their lives.
World Health Organization predicts that by 2010. for 30 percent of people suffer from depressive disorders, and that the 2020th the disease will be the second most common cause of death in the world (due to suicide or secondary diseases caused by depression). According to data from about 15 percent of the toughest depresivaca, who were treated in hospital, you end the life of great suffering. It is believed that more than two-thirds of suicides committed by patients who are in severe depression.

What causes depression?
Although some symptoms related to the psyche, modern medicine considers depression to physical illness. It is a disease of the central nervous system in which the emergence of "critical caught" nervous and physiological factors. The disease occurs when the brain responsible for mood came to the "failure". Here the mood implies a whole range of emotions, on the bottom of a deep depression in the middle of the indifference, takes a peak euphoria. Therefore, depression is not intangible, intangible disease "in the mind" of patients, but visible changes in the nerve cells and chemical processes in the brain.
The most common disease of water external factors, such as suffered stress, improper diet, lack of light, low physical activity, alcohol and some drugs and narcotics. It turned out that some people have an innate tendency (predisposition) depression, which is genetically transmitted. So people with congenital "defect" in the nervous system can suffer from low life hit, and even without it, while those with a naturally strong nervous system can withstand very severe shocks.
Biological psychiatry so depressed about the material, which is written in the genetic code indicates a particular propensity to develop depressive disorders .. Simply put, the brain acts as electro-chemical system consisting of hundreds of billions of nerve cells. These cells are "bathed" in hundreds of chemical substances, each nerve cell and the chemical substance has a specific task. When a substance does not have enough or if they are dead nerve cells, brain areas may remain "out of order."
Depression is associated with decreased activity of certain hormones in the brain substances called neurotransmitters (neurotransmitters). These nerve cells (neurons) use to communicate with each other, or transmission of impulses across the synapses, ie. tiny cracks that separates nerve cells. Some of the neurotransmitters such as serotonin, norepinephrine and dopamine have a natural antidepressant function, which can not be implemented if their levels in the brain decreases.
Another important factor for depression is the mechanism of abnormal stress or excessive secretion of stress hormones like cortisol and CRH-a. It is known that more than half of depressed patients have higher levels of the hormone cortisol, which destroys brain cells and disrupt brain chemistry.

Symptoms of depression
Depression can be identified by a number of symptoms, each patient is the strength and type of symptoms differ from each other. No symptoms of volatility comes into play with the same depresivca, over time, can suffer from different symptoms and who have different strength.

The most common symptoms of depression include:
- Melancholy, gloomy mood, rush black thoughts and memories;
- Intense sadness, pity, fits of crying;
- The sensitivity, vulnerability, irritability ("everything bothers me");
- Fear, anxiety, worry, anxiety ("something terrible will happen");
- Pessimism, hopelessness and helplessness ("I have nothing to hope", "we will never get better");
- A sense of worthlessness, guilt and redundancies ("nobody likes me", "No one should not");
- Loneliness, insecurity and a sense of not belonging ("I am completely alone in the world");
- The inability to enjoy previously pleasurable things or activities ("Nothing makes me happy");
- Apathy, lethargy ("nothing we can not");
- Weakened concentration and impaired memory;
- Fatigue, exhaustion, lack of energy;
- Significantly reduced or increased appetite;
- Insomnia or excessive need for sleep;
- Physical pain with no physical cause;
- The desire for death or planning suicide ("I can not take it anymore", "no better to me").

Which should be kept
Depressive symptoms caused by chemical and nervous disorders in the brain, causing no part in their number of factors:
- Stressful event (trauma) - The death or illness of a loved one, divorce, termination of a love affair or intimate friendships, job loss, moving, serious injury, the diagnosis of serious illness, exposure to violence, arrest, trial, sentence to imprisonment, disasters such as earthquakes or fires and so on.;
- Exposure to chronic stress - stress at work, at school or in the family, poor interpersonal relationships, poor social life;
- Lack of light;
- Some medications - contraceptives, steroids, reserpine, sedative;
- Alcohol or drugs;
- Allergies;
- Unhealthy diet - low in complex carbohydrates and unsaturated fatty acids;
- Last disease - a disorder of the thyroid, diabetes, stroke and so on.;
- A genetic tendency - inherent weakness of the nervous and hormonal systems, irregularities in the structure of the brain.

Treatment for depression

The most common is depression treated with antidepressants. When taken regularly and as directed by your doctor, your mood within one to six weeks
The first question that arises when the depression hits us is what to do. In any case you should seek medical attention. This may be a general practitioner, who will have to rewrite the antidepressant medication or ill will if necessary refer-specialist psychiatrist. One can go a psychiatrist who has a private practice.
Unfortunately, the large number of patients difficult to accept that suffering from a mental disorder is uneasily goes to a psychiatrist. Many were "shocked" when their doctor tells you to suffer from depression and this diagnosis seen as blow to the ego. Others fear it will behave co-workers and acquaintances, if you find out about their illness. It seems not without reason, because some of the "healthy" and indeed sometimes poorly educated noses at depresivce. Fortunately, given the more global awareness of the physical character of the diseases that traditionally and loosely called "psychic" and there is less understanding of the environment and more patients seeking medical attention.

Life problems
Suffer from depression or another mood disorder does not mean "be crazy", "stupid" or "immoral." There is no reason to be ashamed to go to a psychiatrist or someone to explain that his move. Embarrassment is only one consequence of depression, and how treatment is progressing so ashamed fading. On examination it is important to honestly and thoroughly familiar with the symptoms of medical illness. According to symptoms, posture and manner of speech and other external indicators, the doctor will determine the treatment. Will prescribe taking one of the many antidepressants and psychotherapy if needed.

Without improvisation
The treatment of depression are most commonly used drugs, so called. antidepressants. They remove or alleviate the symptoms of the disease within one to six weeks and can be combined with other procedures and counseling.Antidepressants should be taken continuously and accurately by your doctor, without deviation or "improvisations" which are sometimes prone to.
World Health Organization recommends taking antidepressants, and six to ten months after the disappearance of symptoms, and some experts advocate a long-term or even lifelong medication in patients with chronic depression.
It is believed that antidepressants do not cure the basic disorder that causes depression, but also ease or eliminate symptoms. But some recent findings suggest that prolonged intake of antidepressants may have a "profound" effect on the biological "defect" in the brain and even stimulate the growth of new brain cells.

Three rings
On the market there are dozens of anti-depressants that are classified according to their activity in several major groups. In common is that potentiate the action of one or more brain hormones and so "quench hunger" neurons that use the hormone.
The earliest antidepressants called monoamine oxidase inhibitors (MAOIs), stop the degradation process of "antidepressant substance" of serotonin and noradrenaline (monooxidases). Therefore, the result of taking these drugs increased amount of serotonin and norepinephrine between nerve cells.
Tricyclic drugs (so called because "troprstenog" form of the chemical structure) to stop a process called.neurotransmitter reuptake. They inhibit serotonin and norepinephrine to pull the nerve cells that were extracted.The result is an increased amount of neurotransmitter in the brain "circulation".
The medicines are discovered fifties of the 20th century. Although effectively eliminate the symptoms of depression, not acting sufficiently "targeted" and causing a number of adverse events. Some require strict adherence to the prescribed diet, and all are suitable for the abuse because they are lethal if taken in excessive amounts. Additional They emphasized their lack of sedative effect, so long as the patients can take to manage vehicles and machinery.

Targeted and clean
The second group consists of so-called remedies. Selective serotonin reuptake inhibitors (SSRIs), for "targeted" to prevent premature serotonin "resigning" from cerebral circulation, and it remains more available to nerve cells. This group of drugs can cause undesirable effects such as nausea, irritability and reduced sex drive. Nausea usually occurs at the beginning of treatment, but eventually disappears, and it can be said that this group of drugs better tolerated than the so-called. tricyclic antidepressants. It must be added the important fact that these drugs are not suitable for the abuse (for suicide), and interfere with the treatment or management of the car and machinery.
The last decade produced a number of effective medications: reboxetine (which targets the noradrenalinski system), venlafaxine (who like triciklika stronger activity of serotonin and noradrenaline but with far fewer side effects), bupropion (unique in that it acts on norepinephrine and dopamine).

What you should know about taking medicines
First Antidepressants do not act immediately, such as aspirin or tranquilizers. Depending on the form of the disease, it is between one and six weeks that drugs lead to improvements. It is crucial to be taken continuously and in full compliance with instructions.
Second All types of antidepressants as successfully combat symptoms of depression for nearly 80 percent of patients. When one drug proves ineffective, your doctor may increase the dose of the same drug, prescribed another drug (usually with a different mechanism of action), the first drug or add another medicine or thyroid hormone.
Third Antidepressants do not cause addiction. If the patient has to take medication long term, it is because it requires a kind of sickness, not because the drug is addictive.
4th Antidepressants do not interfere ill in solving problems in life, if problems exist. Indeed, enabling them to address them.
5th Antidepressants do not serve to "push" life problems "under the rug", or for their suppression. Depressed patient is just depression and highest life problem which should be solved first.

Conversational therapy
Psychotherapy is a welcome help a depressed patient, especially in the period before beginning the medication to work. When his condition improves, the therapist can learn some practical "antidepressant" skills.
A few decades doctors have treated depressed patients only "conversational therapy" or psychotherapy. It is not surprising, because most of psychotherapeutic techniques designed to detect rather than biological nature of depression, and before they have produced effective medications.
Today, a good therapist to the patient should be primarily to provide company, attention, understanding, comfort and hope, especially in the period before antidepressant drugs act. When the patient "clarify" the situation and is willing to actively participate in therapy, then the therapist can learn some practical "antidepressant" skills: how to better treat people, how to better organize their lives and avoid stressful situations, how to ask for what you want and opposed to what he does not go "into account" in general to be a part of society.
No theory of the development of depression and therapeutic techniques that are based on them, and have major deficiencies.
Psychoanalytic therapy, which laid the foundations for Sigmund Freud, based on the assumption that the depression caused by trauma in infancy. Destructive of them are the absence of parental attention and failure to meet the parents. Thus, psychoanalysts treat depression by the patient to state that "become aware" of trauma suffered in childhood, which was eventually "pushed".
There is no doubt that the stress suffered in childhood is extremely destructive to the nervous system because it can cause physiological sensitivity to stress, and increased activity and chronic stress mechanism. But it is questionable how depressed patient may benefit from the evocation of stressful experiences in consciousness, even when the process of remembering repressed trauma would not have lasted for months or years.

Cognitive-behavioral (cognitive-behavioral) therapy assumes that depression is a consequence of deep-seated wrong (negative) images of the patient himself and his circumstances. The therapist helps the patient to expose the "misconceptions", and replace them with correct ones. It also seeks to uncover wrongdoing and ill conduct, that cause or contribute to depression. Then the patient is trying to learn healthier behaviors.
The problem is that depressed patients do not have a distorted perception of life. For example, believing that a failure or a very difficult situation - and thereby be right! Then, in the world millions of people who have a faulty understanding of themselves and their own lives and in ways that suffer from depression. Finally, many depressed patients are really false knowledge, distorted attitudes and disturbed behavior, but mostly it is a consequence of disease rather than its causes. There is no convincing evidence that abnormal perceptions precede depression, but usually they disappear or be mitigated after treatment with antidepressants.
Interpersonal therapy is considered that the most common cause of depression, disturbed interpersonal relations: within marriage, extended family and in society. Therefore, patients learn "social skills" (establishing, developing and maintaining healthy interpersonal relationships), expectations regarding real and coping with difficult life situations.
Although disturbed interpersonal relationships can be an inexhaustible source of stress, is doubtful how, for example, an unhappy marriage and conflict in the workplace causes, and how the consequences of depressive disorders.

From electric shock therapy to the light
The treatment of depression shown to be effective some actions that affect the biochemical-electrical processes in the brain. One of these procedures and electroconvulsive therapy or electroconvulsive therapy (ECT).
Electroconvulsive therapy is still the best method of treatment of major depression and manic phases of bipolar disorder. It is conducted in a hospital and is completely harmless. Ill be given the means to relax the muscles and introduces him to the full anesthesia. Then it is on one or both sides of the head is placed electrodes in the brain that plays a weak current to induce convulsion (seizure). This spasm of the key therapeutic element ECT. The procedure is repeated 6 to 12 times at intervals of two to three days.
Transkranealna magnetic stimulation (TMS) is a new therapy whose effectiveness is still being investigated. The first results are promising. In this case, the doctor passes a magnet in front of the left frontal lobe of the brain of the patient, which activates nerve cells in that part of the brain and leads to a similar effect as with electroshock therapy.
Light therapy is used primarily for winter depression, or those caused by lack of light. Sick looking at a lamp power of 2500 to 10,000 lux between 30 and 120 minutes (which is weaker lamp treatment takes longer). The effect is achieved after 3 to 4 days.
Sleep deprivation therapy helps depressed patients who are significantly relieve symptoms of illness after a sleepless night or after 3 to 4 hours of waking up early. It can be combined with light therapy, so that immediately after waking the patient incurring any bright light. It appears that the electro-chemical brain processes disturbing during sleep, especially during the REM phase (phase of dreaming), while prolonged wakefulness "returns" broken processes in normal function.

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