EMOTIONAL & MENTAL HEALTH

Depression and other mental conditions: Support groups can help

noreply@blogger.com (Hanza Fridman) — Mon, 10 Dec 2007 19:40:00 +0000

If you have depression or another mental health condition, joining a support group can be a valuable addition to professional treatment. Support groups can help you feel less alone, find new coping skills and motivate you to stick to treatment plans. They can also be a source of hope for recovery and a more enjoyable future.

Depression and mental health support groups abound. Choosing a support group can be challenging but ultimately rewarding. Here's a look at how support groups may help you and how to find one that suits your needs.
Understanding support groups

A support group is a gathering of people who share a common condition or interest. Most mental health support groups focus on specific conditions, whether it's depression, substance abuse or eating disorders, for instance.

Members of the support group share their experiences and practical information about the way they've handled their own situation. They also offer emotional comfort and moral support.

Support groups may be formed by someone with depression or another condition or by someone interested in it, such as a family member. In some cases, they may be formed by nonprofit organizations, mental health clinics or other groups.

In-person support groups may meet in a variety of locations, such as in someone's home, in a church, in a community center or in a clinic. They can also meet electronically, with support shared over the Internet.

Support groups are not the same as group psychotherapy sessions. Group therapy is a formal type of mental health treatment that brings together several people with similar conditions under the guidance of trained mental health professionals.
Gaining benefit from support groups

Good support groups can offer a variety of benefits, from the emotional to the practical. The benefits of support groups include:
Making connections. Meeting others with depression or another mental health condition may make you feel less alone or isolated. A safe and welcoming environment, filled with compassion and understanding, can also reduce any stigma you may feel over having depression or another mental disorder.
Improving your coping skills. Support groups offer the chance to draw on collective experiences. Others who have "been there" may have tips or advice about coping with your condition that hadn't occurred to you. Brainstorming with others may inspire even more ideas. For instance, swapping information about antidepressants for depression can help you see how others handle side effects.
Getting motivated. Support groups can encourage you to seek professional treatment if you haven't yet. They also may encourage you to take a more active role in your treatment or stick to your treatment plan when you feel like giving up. And they may help you tap into community resources, such as housing or transportation assistance.
Finding hope. Sharing experiences and making connections can make you feel better about life in general. Seeing others make strides against depression or another mental illness may give you hope about your own future.

You may be nervous about sharing personal issues with people you don't know. At first, you may reap benefits simply by listening. Over time, contributing your own ideas and experiences can help you get more out of a support group.
Evaluating support groups

Support groups come in many forms. Which one is best for you depends on your needs and wishes.

For instance, perhaps you prefer a structured, moderated group, where you're more likely to find organized discussions and educational information. A moderator or facilitator can help ensure that all participants have equal time and that discussions stay on track.

Here are some questions to consider when evaluating a support group:
Is it geared toward a specific condition?
Is the location convenient for regular attendance?
What is the meeting schedule?
How long has the group existed?
Is there a facilitator or moderator?
What are the confidentiality guarantees?
Does it have established ground rules?
Is it sponsored by a reputable health care facility or organization?
Does it avoid false promises of quick cures?
Does it encourage you to continue your regular medical care and treatment?
What is the mix of participants, such as gender and age?
How many people usually attend?
What is a typical meeting like?
Does it charge reasonable fees, if any?

Plan to attend a few sessions to see how you fit in. If the group makes you uncomfortable or you don't find it useful, try another one.

Remember that even a support group you've come to cherish can change over time as participants come and go. Periodically evaluate the group to make sure it continues to meet your needs.
Finding support groups

You've decided which kind of support group characteristics sound most appealing to you. Now how do you actually find a group to join?

First, ask your doctor, therapist or mental health expert for a suggestion.

Other ways to find a support group include:
Contacting a local, state or national mental health organization
Asking your church, synagogue or other place of worship
Looking in your phone book under mental health, counseling or similar topics
Checking your newspaper for a listing of support resources
Contacting community centers or libraries
Getting recommendations from friends or family
Searching the Internet
Spotting red flags in support groups

Despite all of their benefits, support groups have the potential to interfere with your medical treatment if you're not careful.

Don't abandon treatment with your regular doctor or mental health professional when you join a support group. Support groups are not meant to replace that treatment. They may, however, be a valuable supplement to professional care.

In addition, be wary of information you receive about treatment or medications if it doesn't come from medical professionals. Remember that some information discussed in a support group may not be entirely accurate. If you have depression, for instance, don't be tempted to stop taking antidepressants without consulting your doctor simply because you may hear about a "natural" product to take instead.

Here are some red flags that may indicate the support group isn't in your best interests:
You feel worse after joining the support group
You feel pressure to try a certain kind of treatment
Other members encourage you to stop traditional treatment
Sessions are centered around complaining and negativity
Members insist that you reveal private information
It charges unreasonable fees
It requires you to buy certain products it endorses
It demands your allegiance to a cult-like leader
A few people dominate the discussions

Support groups for depression and mental illness have blossomed on the Internet. And they can be just as valuable as those that meet in person. But keep in mind that while the anonymity can be appealing, it can also be deceiving. The people you're interacting with may not be who they say they are. Also, make sure you don't let extensive Internet use lead to isolation from your in-person social network.

Be sure to talk openly with your doctor or mental health professional about your participation in support groups.
Helping yourself through support groups

Support groups for depression and other mental health conditions can offer a valuable addition to your medical care. They may teach you new coping skills and encourage you to follow through on treatment. They can also broaden your social horizons and make you feel less isolated. Although opening up to others can initially be difficult, you may get more out of a support group than you thought you could.

Depression and anxiety: Exercise eases symptoms

noreply@blogger.com (Hanza Fridman) — Mon, 10 Dec 2007 19:40:00 +0000

If you have depression or anxiety, you might find your doctor prescribing a regular dose of exercise in addition to medication or psychotherapy. Exercise isn't a cure for depression or anxiety. But its psychological and physical benefits can improve your symptoms.

"It's not a magic bullet, but increasing physical activity is a positive and active strategy to help manage depression and anxiety," says Kristin Vickers-Douglas, Ph.D., a psychologist at Mayo Clinic, Rochester, Minn.

When you have depression or anxiety, exercising may be the last thing you think you can do. But you can overcome the inertia. Here's a look at how exercise can ease symptoms of depression and anxiety. Plus, get realistic tips to get started and stick with exercising.
How exercise helps depression and anxiety

Exercise has long been touted as a way to maintain physical fitness and help prevent high blood pressure, diabetes, obesity and other diseases. A growing volume of research shows that exercise also can help improve symptoms of certain mental conditions, such as depression and anxiety. Exercise also may help prevent a relapse after treatment for depression or anxiety.

Research suggests that it may take at least 30 minutes of exercise a day for at least three to five days a week to significantly improve symptoms of depression. However, smaller amounts of activity — as little as 10 to 15 minutes at a time — have been shown to improve mood in the short term. "So, small bouts of exercise may be a great way to get started if it's initially too difficult to do more," Dr. Vickers-Douglas says.

Just how exercise reduces symptoms of depression and anxiety isn't fully understood. Researchers believe that exercise prompts changes in both mind and body.

Some evidence suggests that exercise postively affects the levels of certain mood-enhancing neurotransmitters in the brain. Exercise may also boost feel-good endorphins, release tension in muscles, help you sleep better and reduce levels of the stress hormone cortisol. It also increases body temperature, which may have calming effects. All of these changes in your mind and body can improve such symptoms as sadness, anxiety, irritability, stress, fatigue, anger, self-doubt and hopelessness.

If you exercise regularly but depression or anxiety still impairs your daily functioning, seek professional help. Exercise isn't meant to replace medical treatment of depression or anxiety.
The benefits of exercise for depression and anxiety

Exercise has numerous psychological and emotional benefits when you have depression or anxiety. These include:
Confidence. Engaging in physical activity offers a sense of accomplishment. Meeting goals or challenges, no matter how small, can boost self-confidence at times when you need it most. Exercise also can make you feel better about your appearance and your self-worth.
Distraction. When you have depression or anxiety, it's easy to dwell on how badly you feel. But dwelling interferes with your ability to problem solve and cope in a healthy way. Dwelling also can make depression more severe and longer lasting. Exercise can provide a good distraction. It shifts the focus away from unpleasant thoughts to something more pleasant, such as your surroundings or the music you enjoy listening to while you exercise.
Interactions. Depression and anxiety can lead to isolation. That, in turn, can worsen your condition. Exercising can create opportunities to interact with others, even if it's just exchanging a friendly smile or greeting as you walk around your neighborhood.
Healthy coping. Doing something beneficial to manage depression or anxiety is a positive coping strategy. Trying to feel better by drinking alcohol excessively, dwelling on how badly you feel, or hoping depression and anxiety will go away on their own aren't helpful coping strategies.
Tips to start exercising when you have depression or anxiety

Of course, knowing that something's good for you doesn't make it easier to actually do it. With depression or anxiety, you may have a hard enough time just doing the dishes, showering or going to work. How can you possibly consider getting in some exercise?

Here are some steps that can help you exercise when you have depression or anxiety:
Get your doctor's support. Some, but not all, mental health professionals have adopted exercise as a part of their treatment suggestions. Talk to your doctor or therapist for guidance and support. Discuss concerns about an exercise program and how it fits into your overall treatment plan.
Identify what you enjoy doing. Figure out what type of exercise or activities you're most likely to do. And think about when and how you'd be most likely to follow through. For instance, would you be more likely to do some gardening in the evening or go for a jog in the pre-dawn hours? Go for a walk in the woods or play basketball with your children after school?
Set reasonable goals. Your mission doesn't have to be walking for an hour five days a week. Think about what you may be able to do in reality. Twenty minutes? Ten minutes? Start there and build up. Custom-tailor your plan to your own needs and abilities rather than trying to meet idealistic guidelines that could just add to your pressure.
Don't think of exercise as a burden. If exercise is just another "should" in your life that you don't think you're living up to, you'll associate it with failure. Rather, look at your exercise schedule the same way you look at your therapy sessions or antidepressant medication — as one of the tools to help you get better.
Address your barriers. Identify your individual barriers to exercising. If you feel intimidated by others or are self-conscious, for instance, you may want to exercise in the privacy of your own home. If you stick to goals better with a partner, find a friend to work out with. If you don't have extra money to spend on exercise gear, do something that is virtually cost-free — walk. If you think about what's stopping you from exercising, you can probably find an alternative solution.
Prepare for setbacks and obstacles. Exercise isn't always easy or fun. And it's tempting to blame yourself for that. People with depression are especially likely to feel shame over perceived failures. Don't fall into that trap. Give yourself credit for every step in the right direction, no matter how small. If you skip exercise one day, that doesn't mean you're a failure and may as well quit entirely. Just try again the next day.
Sticking with exercise when you have depression or anxiety

Launching an exercise program is hard. Sticking with it can be even harder. One key is problem solving your way through when it seems like you can't or don't want to exercise.

"What would happen if you went out to your car and it wouldn't start?" Dr. Vickers-Douglas asks. "You'd probably be able to very quickly list several strategies for dealing with that barrier, such as calling an auto service, taking the bus, or calling your spouse or friend for help. You instantly start problem solving."

But most people don't approach exercise that way. What happens if you want to go for a walk but it's raining? Most people decide against the walk and don't even try to explore alternatives. "With exercise, we often hit a barrier and say, 'That's it. I can't do it, forget it,'" Dr. Vickers-Douglas says.

Instead, problem solve your way through the exercise barrier, just as you would other obstacles in your life. Figure out your options — walking in the rain, going to a gym, exercising indoors, for instance.

"Some people have the idea that being physically active is supposed to be easy and natural," Dr. Vickers-Douglas says. "Some think of it as just having enough willpower. But that really oversimplifies it and can make us feel like failures. You can't just rely on willpower. Identify your strengths and skills and apply those to exercise."
From MayoClinic.com

Depression: Supporting loved ones through their battle with depression

noreply@blogger.com (Hanza Fridman) — Sun, 11 Nov 2007 00:52:00 +0000

Depression can rob your loved ones of fully enjoying life or engaging in everyday activities. Instead, they may feel sadness, despair and hopelessness. Not surprisingly, their depression affects you, too, as someone who cares about them, whether it's a family member, friend or even a co-worker facing this serious medical condition.

When a loved one has depression, you can offer support and help in a variety of ways. At the same time, remember to tend to your own physical and emotional needs, too. This way, both of you will be cared for even during the darkest days.
Recognize the symptoms of depression, even if a loved one doesn't

You might think a loved one may have depression even before he or she does. People in the throes of depression sometimes don't recognize the symptoms. Or they may be embarrassed about it or simply think that their situation is hopeless.

Two hallmarks of depression are:
Loss of interest and pleasure in normal daily activities
Feelings of sadness, hopelessness or crying spells

Other signs and symptoms include:
Sleep disturbances
Impaired thinking or concentration
Unintentional weight loss or gain
Agitation or slowing of body movements
Fatigue
Low self-esteem
Less interest in sex
Thoughts of death

If you suspect that a loved one has such symptoms, gently urging him or her to seek medical help may be the best thing you can do. You can also point out that depression is a medical condition that has several effective treatment options. You may also consider discussing how certain other medical conditions, such as thyroid disease, can mimic the symptoms of depression. This may help further persuade your loved one to seek treatment.

If your loved one refuses to seek medical treatment, remember that it may simply be out of shame or a sense that things can't get better. Try to be patient and bring up the topic again — but without being pushy or insensitive. However, if your loved one's depression is so severe that it's debilitating or life-threatening, you may need to consider intervening by contacting a doctor, hospital or emergency medical services.
Don't tell someone with depression to snap out of it

If you've never experienced depression yourself, then it's impossible to know how helpless and hopeless a person can feel in the midst of it.

Understand that depression is a serious illness that requires medical attention. It isn't the result of a character flaw or moral weakness. It may result from a chemical imbalance in the brain. When someone with depression can't get out of bed, go to work or play with their children, it's not laziness. Rather, it may be a debilitating sense of fatigue, overwhelming feelings of worthlessness or the inability to make even simple decisions.

People with depression can no more snap out of it than can people with diabetes or arthritis. If a loved one has depression, don't tell them to smile more or just get over it. People don't enjoy having depression, but they can't simply will themselves into wellness.

Try reading more about the condition and treatment to better understand what it's like to have depression.

And even if your loved one begins depression treatment, don't expect immediate results. Treatments, such as therapy and medication, take time to have an effect on depression symptoms. In the meantime, encourage your loved one to continue treatment and remind him or her that things will improve as time goes on.
Offer support and compassion to a loved one with depression

Even if you can't know what depression feels like, you can offer empathy and compassion. Simply being there for the person can make a difference in the course of his or her illness.

To help someone who has depression, you can:
Gently express concern. Acknowledge their pain but avoid using the words "I know how you feel" if you really don't. Although you may think you know what's causing the depression, avoid offering solutions. Listen if he or she wants to talk, but try not to ask too many intrusive questions. People with depression often don't have the energy or inclination to discuss their symptoms, and they may instead just stop talking altogether.
Ask how you can help. Depression may leave your loved one unable to take care of regular chores and tasks. Make yourself as available as possible to help balance the checkbook, keep the home in order, run errands and take care of children or pets, for instance. Keep in mind that your loved one may not be able to offer suggestions. If that's the case, give specific suggestions about what you're willing to do and ask if it's OK if you go ahead and do them, such as mowing the lawn.
Give positive reinforcement. Depression can make people feel worthless. They may judge themselves harshly and find fault with everything about themselves, from their appearance to their job to their thoughts and feelings. You can remind your loved one about his or her positive qualities and how much he or she means to you and others.
Encourage healthy behaviors. Depression steals away motivation, energy and interest. Ask your loved one to join you on a walk, for a movie, or to work on a hobby or other activities he or she previously enjoyed. But don't try to force him or her into doing something. If your loved one is in treatment for depression, help him or her remember to take prescribed medications and to attend therapy appointments.
Watch for depression symptoms that worsen

People with depression are at an increased risk of taking their own life. Stay alert for suicide warning signs such as:
Agitated behavior and sleeplessness
Statements about no longer living, such as "You won't have to worry about me much longer"
Giving away possessions or saying goodbye to friends
Suddenly cheering up after a period of depression, which could actually signal a renewed sense of energy to follow through on suicide plans

If you think a loved one is considering suicide, encourage him or her to call a doctor, mental health clinic or suicide hot line immediately. If your loved one's life is in imminent danger but he or she refuses to seek help, call for emergency help yourself.
Keep depression from taking a toll on you

Supporting someone with depression isn't easy. You may find yourself stressed and you may even begin to think that things won't improve. It can be even more difficult if you have others to care for as well.

Share your feelings with a caregivers' support group or discuss the situation with a therapist, relative or confidante. See your doctor if you develop any problems that you think require medical attention.

And finally, remind yourself that with appropriate treatment, most people with depression do see an improvement in their symptoms. Better days may be on the horizon — for both of you.

Deep brain stimulation: An experimental depression treatment

noreply@blogger.com (Hanza Fridman) — Wed, 07 Nov 2007 09:43:00 +0000

Depression is usually a very treatable condition. Often, standard treatment with antidepressant medications, psychotherapy or electroconvulsive therapy can help improve even severe cases of depression.

But if standard depression treatment doesn't work, you might wonder if experimental treatment can help. One potential option is deep brain stimulation. This procedure hasn't been approved by the Food and Drug Administration (FDA) to treat depression, but it may be available to you through a clinical trial.
How deep brain stimulation works

Deep brain stimulation is a highly experimental treatment for depression in which the brain is stimulated with electrical impulses in an attempt to change mood. The procedure hasn't been FDA approved for depression and is in only the early stages of research. However, deep brain stimulation has become a standard treatment for people with Parkinson's disease.

Deep brain stimulation requires two surgical procedures — surgery on your brain to implant electrodes and surgery on your chest to implant a neurostimulator device. Because the procedure is new and experimental for depression, it may not be performed exactly the same way everywhere.

In general, here's how surgery for deep brain stimulation works. For the brain surgery portion, you're given local anesthetics to numb the area being operated on. You remain awake and alert, however, so that the surgeon can talk to you to make sure the proper areas of your brain are being stimulated. Your head is placed in a special frame to keep it still during surgery. Two holes are drilled in your skull. Guided by imaging techniques, the surgeon implants electrodes on both sides of your brain.

During the second portion of surgery, the surgeon implants the neurostimulator in your chest. Wires from the brain electrodes are placed under your skin and guided down to the battery-operated neurostimulator. The neurostimulator sends electrical signals along the wires to the electrodes, stimulating the brain.

The neurostimulator can be easily programmed from outside your body. Dosage of the electrical impulses is customized to the individual. Stimulation is generally continuous, 24 hours a day.
How deep brain stimulation affects depression

Exactly how deep brain stimulation can affect depression isn't clear. Researchers theorize that certain regions deep within the brain influence mood and depression. They believe that the areas associated with depression may be overactive in certain people. Sending electrical impulses to these areas may "reset" them to normal functioning, researchers speculate.

Little research has been done using deep brain stimulation in people with depression. One clinical trial included just six people, for instance. Follow-up of these people has been short, which means it's not known if any improvements in depression symptoms will last long term. Additional research is needed to learn more about how deep brain stimulation works and how safe and effective it is for depression.
Who may benefit from deep brain stimulation

Because deep brain stimulation is experimental, it's available only through participation in clinical trials. In addition, because of the risks involved, its use is limited to people who have severe, debilitating depression that has not improved with other treatments. Talk to your doctor to see if it may be an option for you.
Side effects of deep brain stimulation

Any surgical procedure carries risks. Because deep brain stimulation involves brain surgery, the procedure may be especially risky. In addition, the neurostimulation itself may cause side effects.

Common side effects and adverse health problems associated with deep brain stimulation include:
Bleeding in the brain
Infection
Delirium
Unwanted mood changes
Movement disorders
Lightheadedness
Insomnia

In addition, people who have undergone deep brain stimulation to treat Parkinson's disease have reported such side effects and adverse events as panic attack, speech difficulty, movement problems and even suicide.

The long-term risks of deep brain stimulation for depression aren't known.

There also are possible inconveniences associated with deep brain stimulation. For instance, the hardware may malfunction, and batteries must be replaced every one to three years.
Weighing the pros and cons of deep brain stimulation

Deep brain stimulation is a serious and potentially risky procedure. Even if you are a candidate for a clinical trial to test deep brain stimulation, you and your doctors must carefully weigh the pros and cons of the procedure. If your depression is incapacitating or life-threatening, you may be more willing to face the risks involved with deep brain stimulation.

Combined reuptake inhibitors and receptor blockers

noreply@blogger.com (Hanza Fridman) — Fri, 02 Nov 2007 21:05:00 +0000

Certain brain chemicals called neurotransmitters are associated with depression, including the neurotransmitters serotonin (ser-oh-TOE-nin) and norepinephrine (nor-ep-ih-NEF-rin). Research suggests that abnormalities in neurotransmitter activity can affect mood and behavior.

Combined reuptake inhibitors and receptor blockers are dual-action antidepressants that act on brain cells both by inhibiting the reabsorption (reuptake) of neurotransmitters into nerve cells and by blocking nerve cell receptors. This leaves more of these neurotransmitters available in the brain, thereby boosting mood.

Here are the combined inhibitors and blockers that have been approved by the Food and Drug Administration specifically to treat depression, with their generic names followed by available brand names in parentheses:
Trazodone (Desyrel)
Nefazodone (Serzone)
Maprotiline
Side effects and safety concerns

Side effects of combined inhibitors and blockers include:
Dry mouth
Dizziness
Drowsiness
Lightheadedness
Nervousness
Nausea
Constipation
Weakness
Vision problems
Confusion
Headache

Trazodone has been associated with priapism — persistent, usually painful erections not associated with sexual arousal. If this occurs, seek medical treatment immediately. Many of those cases have required surgical correction, resulting in permanent impairment of erectile function or impotence.

In rare cases, nefazodone (nef-AY-zoe-done) can cause life-threatening liver failure. Don't take it if you already have liver problems. Know the signs and symptoms of possible liver dysfunction, such as yellowing of your skin or the whites of your eyes, unusually dark urine, loss of appetite, nausea or abdominal pain. Contact your doctor immediately if you experience any of these problems.

Maprotiline has been associated with seizures, so people with a history of seizures usually shouldn't take this medication.

In some cases, antidepressants may be associated with worsening symptoms of depression or suicidal thoughts or behavior, particularly early in treatment or when you change your dosage. Be sure to talk to your doctor about any changes in your symptoms. You may need more careful monitoring at the beginning of treatment or upon a change in treatment, or you may need to stop the medication if your symptoms worsen.
From MayoClinic.com

Anger management: Tips to control your temper

noreply@blogger.com (Hanza Fridman) — Tue, 30 Oct 2007 20:54:00 +0000

If you find that your angry outbursts are negatively affecting your relationships with family, friends, co-workers and even complete strangers, it's probably time to change the way you express your anger.

Here are some tips to get your anger under control:
Take a "time out." Count to 10 before reacting or leave the situation altogether.
Do something physically exerting. Physical activity can provide an outlet for your emotions, especially if you're about to erupt. Go for a walk or a run, swim, lift weights or shoot baskets, for example.
Find ways to calm and soothe yourself. Practice deep-breathing exercises, visualize a relaxing scene, or repeat a calming word or phrase to yourself, such as "take it easy." You can also listen to music, paint, journal or do yoga.
Express your anger as soon as possible so that you aren't left stewing. If you can't express your anger in a controlled manner to the person who angered you, try talking to a family member, friend, counselor or another trusted person.
Think carefully before you say anything so that you don't end up saying something you'll regret.
Work with the person who angered you to identify solutions to the situation.
Use "I" statements when describing the problem to avoid criticizing or placing blame. For instance, say "I'm upset you didn't help with the housework this evening," instead of, "You should have helped with the housework." To do otherwise will likely upset the other person and escalate tensions.
Don't hold a grudge. Forgive the other person. It's unrealistic to expect everyone to behave exactly as you want.
Use humor to defuse your anger, such as imagining yourself or the other person in silly situations. Don't use sarcasm, though — it's just another form of unhealthy expression.
Keep an anger log to identify the kinds of situations that set you off and to monitor your reactions.

You can practice many of these strategies on your own. But if your anger seems out of control, is hurting your relationships or has escalated into violence, you may benefit from seeing a psychotherapist or an anger management professional. Role playing in controlled situations, such as anger management classes, can help you practice your techniques.
Keep at it

It may take some time and intense effort to put these tips into practice when you're facing situations that typically send you into a rage. In the heat of the moment, it can be hard to remember your coping strategies.

You may need to keep something with you that serves as a reminder to step back from the situation and get your anger under control. For instance, you may want to keep a small, smooth stone in your pocket or a scrap of paper with your tips written down. With due diligence, these anger management techniques will come more naturally and you'll no longer need such reminders.

Anger management: Recognize and understand unhealthy behaviors

noreply@blogger.com (Hanza Fridman) — Sat, 20 Oct 2007 16:06:00 +0000

You've probably heard the joke: "I went to a fight and a hockey game broke out." Certainly, it seems like there are more brawls than ever at sporting events these days, that you're lucky if you've never been subjected to road rage, and that you may have to tip-toe around coworkers who seem constantly ready to explode.

But it's not anger itself that's a problem — it's how you handle it. Robert T. Zackery is a licensed independent clinical social worker at Mayo Clinic, Rochester, Minn., who provides counseling and runs anger management classes. Here, he offers insights into the nature of anger, when it can be helpful, how to manage it, and what to do when you're confronted by someone whose anger is out of control.
What is anger?

Anger is a feeling of displeasure or hostility. It's a normal, healthy emotion, just like any other feeling you have.

Anger has several components:
Psychological. This is the emotional component of anger, how you feel, such as sadness, disappointment or frustration.
Physiological. This is how your body responds to anger, such as muscle tension or an increase in heart rate and blood pressure as your body releases adrenaline — the fight-or-flight hormone.
Cognitive. This is what you think as you experience anger, such as acknowledging that it's OK to be frustrated, or, on the other end, thinking that the world is out to get you or that your spouse "never" does what you ask.

In essence, anger is a warning bell that tells you something is wrong in a situation. It's a natural response to perceived threats.
So it's not "bad" to feel angry?

No, being angry isn't a bad or negative thing. Being angry can motivate people to listen to your concerns. It can prevent others from walking all over you. And it can motivate people to change larger societal issues. It's how you handle your anger that can be a problem.
Why, then, do some people think that being angry is unacceptable?

Some people are uncomfortable with the expression of anger. A lot of it depends on their own personal experiences with anger. For instance, if they were in abusive situations or if they grew up in a household where anger was used to control their family, any sign of anger can make them anxious. They can feel intimidated by anger, even if it's expressed in an appropriate manner. They may think "nice" people don't get angry.
What causes people to become angry?

There's usually an activating event — something in particular that sets you off, such as a disagreement at work, being stuck in traffic or not being able to get through to an actual person on the phone. Some people may be angry about their own personal circumstances, such as financial problems.

Most people don't just walk around feeling mad all the time, though, unless it was a learned behavior. People aren't born angry.
You said it's how people handle their anger that's important. What are the ways of handling anger, and what's the healthiest way?

There are two basic ways to handle anger:
Expression. This is conveying your anger. Expression occurs along a continuum, from having a reasonable, rational discussion to erupting into out-of-control violence. It's the difference between talking to someone or picking up a baseball bat and hitting them.
Suppression. This is trying to hold in or ignore your anger. You may think you shouldn't be angry or that you'll lose control if you let yourself feel any anger. The danger in this passive approach is that you may not protect yourself when the need arises. On the other hand, you may become passive-aggressive, where you don't express your anger assertively or directly but scheme to retaliate because you haven't learned how to express anger constructively. Trying to suppress your anger can lead to such health problems as headaches, stress, depression or high blood pressure.

Expressing yourself in an assertive — not an aggressive — manner is the healthiest approach to handling anger. You state your concerns and needs clearly and directly, without hurting others or trying to exert power over them.
Why do some people snap, exploding into rages even over seemingly minor irritations?

Reactions to anger really aren't instantaneous, even if it may appear that someone suddenly "snaps." When someone explodes with anger, there are actually a lot of feelings behind that prior to reaching that boiling point. What happens, though, is that people don't stop to examine their feelings before they explode.

Your personal history feeds your reactions to anger. That's why some people react so angrily to certain situations, like losing a parking space, while others take it in stride. You may have built up years of feeling unheard, ignored, sad, frustrated or disrespected. From the activating event that initially triggers your anger, you move along a continuum where you feel a number of things, such as intensifying agitation or irritation, and then your personal history comes into play and you may explode, especially if you don't step back to think about where your anger is heading. Also, if you were taught that being angry was negative, you may never have learned how to express anger appropriately.
How can you stop your anger from turning into a violent outburst?

Out-of-control anger is a learned behavior, so you have to unlearn it. Consider, for instance, someone who was in the military and basically taught to kill. Then he leaves the military, but with every confrontation or challenge, he goes back into that military role and responds aggressively — not assertively, but with aggression or hostility. He has to realize that no one is trying to fight with him, and that his reaction is out of proportion to the situation.

Some anger management techniques he can practice include:
Self-talk to remind himself he's not in the military anymore and to keep himself aware of his reactions.
Walking away from the situation until he calms down.
Remembering to treat other people like he'd want to be treated.
Agreeing to disagree, and leaving it at that.

He may also need professional help or a qualified anger management class to help him unlearn these behaviors.
What is an anger management class, and how does it work?

An anger management class is a way to teach people how to express their anger in a controlled, healthy way. We teach people about what anger is, how to recognize their anger triggers, how to become aware of their own feelings of anger, and how to keep their anger under control. We also discuss what other feelings they may have going on, such as depression. We can do this individually, with spouses or families, or in groups.

So, for the person who was in the military, for example, we would work with him on realizing that he doesn't need to yell and scream and get aggressive when he's angry. We'd also work with him on issues he may have with his upbringing, such as being in an abusive household.
How do you know if you might benefit from an anger management class?

Not everyone who gets angry needs an anger management class. You may get ticked that your television remote control doesn't work and throw it across the room. Do you have an anger management issue if you do that? Probably not.

But if you have run-ins with the police, you physically harm someone or you try to intimidate someone with your anger, you could probably benefit from an anger management class.
Some people blame their reactions on others, saying things like, 'You bring out the worst in me.' Is that a valid excuse?

Someone can make you angry, but how you express that anger is your responsibility. In a marriage or family, does your spouse or your kids know which buttons to push that will set you off? Sure they do. They know your vulnerable spots.

This happens to me with my teenage daughter sometimes. She may repeatedly ask to go out with friends I don't want her to be with, and I get mad at her. But what I'm really feeling is afraid for my child. Is her behavior making me angry? Yes, sometimes it is. But you have to remember that we're responsible for our own feelings and reactions to what other people do. Recognize that you have a conflict and see how you can handle it appropriately.
Can anger harm your health?

There is evidence that shows inappropriately expressing anger can be harmful. Whether you're overly passive and keep your anger pent up, whether you're prone to violent outbursts or whether you're quietly seething with rage, you may have headaches, sleep difficulties, high blood pressure or digestive problems. There's even some evidence that stress and hostility related to anger can lead to heart attacks. That's another reason it's important to learn how to express anger constructively and appropriately — it's good for your health.
It seems as if so many people are on edge these days, ready to explode or actually launching into violent rages, like at sporting events. Is society becoming angrier?

Many people today are faced with multiple stressors — bills, drugs, peer pressure, racial conflicts, health care issues, war. There's a lot of stress in society in general. There are so many things to feel threatened about, and some people respond in a negative way. Or maybe they're just not satisfied with life; they're not content. And they haven't learned how to handle their anger constructively.

But it's not entirely unique to modern-day society. I experienced a road-rage situation 25 years ago. I pulled up to a stop sign and so did another person. I felt I was there first so went ahead. Well, she followed me around the block several times, and when I went and parked, she pulled up next to me so close that I couldn't even open my car door. And then she started screaming at me that I'd cut her off. I finally said I'd call the police and she drove away.
What can you do if you're confronted by someone whose anger is out of control?

Usually the most rational thing to do, if possible, is to just walk away. If you stay, you risk it escalating into violence. It's important to take reasonable precautions to protect yourself if leaving the situation is difficult or impossible, and to not engage the other person in a manner that's likely to provoke an escalation in their angry behavior.

That's not to say you should never confront someone. If someone is doing something you don't want them to do, and you confront them about it, you now have a conflict. You have to know how you're going to handle that conflict, though. Size up the person you're confronting, and be ready to protect yourself, especially if it's a stranger.

Anger management: How angry are you?

noreply@blogger.com (Hanza Fridman) — Thu, 11 Oct 2007 16:00:00 +0000

Do you slam down the phone when faced with endless computerized voice prompts? Have you gotten into a shouting match with a stranger over a parking space at the mall? Ever put your fist through the wall after an argument with your spouse?

Although anger is a natural emotion, it may be getting the best of you. Instead of expressing your anger in a healthy and assertive way, you may be expressing it in a hostile, aggressive manner — a manner that could lead to violence.

Here are some points to consider when assessing whether you express your anger in a healthy or unhealthy manner.
Determine your level of anger

Anger itself isn't bad. Expressed appropriately, anger can be healthy. It can help protect you from dangerous situations, energize you to resolve problems or lead to sociocultural reforms, for instance.

Sure, everyday frustrations, impatience and resentment can all cause your temper to flare. For many people, these are fleeting moments. They're able to take these moments in stride and quickly return to a sense of calm without exploding.

But if your blood boils after minor irritations — such as losing that coveted parking space — or you're constantly seething, you may need to get your anger under control. Anger that's out of control can be destructive, leading to problems in your relationships, at work, in your general enjoyment of life and with your health. You may even be arrested or face other legal problems.

Just how angry are you? Study this chart to determine a barometer of your anger. See if the words describe your behavior or thoughts over the past week. Then rate each word on this scale:
0 = Not at all accurate
1 = Somewhat accurate
2 = Moderately accurate
3 = Very accurate
4 = Extremely accurate
Determining your level of anger
Words Your rating
Angry
Bitter
Rebellious
Spiteful
Deceived
Annoyed
Furious
Resentful
Bad-tempered
Ready to fight
Yelling
Frustrated
Disappointed

If you have several 2, 3 and 4 ratings, you may need professional help in learning to handle anger in a healthier way. Talk to your health care providers about resources, such as counseling or anger management classes.
Examine your anger patterns

Anger responses can become habitual. That is, you may respond automatically to a situation that makes you angry, with little pause to think about your reactions. You may even surprise yourself by the intensity of your reactions.

How do you express your anger? Consider these questions to assess your anger responses:

Do you express anger in a way that overwhelms you and others?
Do you get angry more often than most people you know?
Do you get angrier than is necessary?
Do you use threatening language or gestures?
Do you get angry enough to hit, throw or kick things or living beings?
Do you stay angry for hours?
Do you hide angry feelings from others or try to suppress your feelings?
Do you use alcohol or drugs to calm your rage?
Do you experience physical reactions such as muscle tension or a racing heart when you get angry?
Does expressing your anger usually leave you feeling better about yourself and the person who angered you?

Identify the ways you express anger to help you determine if you need to change the ways you respond to upsetting situations. You may react too aggressively or even too passively. In either case, you can learn new anger patterns to replace old, unhealthy habits.
Tips to control your anger

If your level of anger is high or you tend to express anger in an unhealthy way, make plans to deal with your anger.
Aim for constructive expressions of your anger

Anger management is not about stopping you from expressing your anger entirely. It's OK to feel angry. In fact, trying to suppress or deny your anger can lead to a host of physical complaints, such as headaches, depression, stress, and sleeping or eating difficulties. It can also lead you to erupt into violent behavior if your anger has been simmering without an outlet.

The key, though, is to express your anger in an assertive, controlled way. Managing anger effectively can benefit you and those around you. Your health may improve, you'll feel better about yourself, and your relationships with others may improve. So get your anger under control, before it controls you.

Alpha-2 receptor blockers

noreply@blogger.com (Hanza Fridman) — Tue, 02 Oct 2007 14:38:00 +0000

Certain brain chemicals called neurotransmitters are associated with depression, including the neurotransmitters serotonin (ser-oh-TOE-nin) and norepinephrine (nor-ep-ih-NEF-rin). Research suggests that abnormalities in neurotransmitter activity can affect mood and behavior.

Instead of inhibiting the reabsorption of certain neurotransmitters as other antidepressants do, alpha-2 receptor blockers prevent neurotransmitters from binding with nerve cell receptors called alpha-2 receptors. This indirectly increases the levels of norepinephrine and serotonin in the brain, which may improve and elevate mood.

Mirtazapine (Remeron, Remeron Soltab) is the only alpha-2 receptor blocker approved by the Food and Drug Administration specifically to treat depression. Its generic name is followed by available brand names in parentheses. Mirtazapine (mir-TAZ-a-peen) is available as a pill and as a tablet that dissolves on your tongue (Remeron Soltab).
Side effects and safety concerns

Side effects of alpha-2 receptor blockers include:
Sedation
Weight gain
Dry mouth
Dizziness
Lightheadedness
Thirst
Muscle or joint aches
Constipation
Increased appetite
Increased cholesterol

Because of a potential drug interaction, don't take mirtazapine with another type of antidepressant called a monoamine oxidase inhibitor (MAOI). You may have increased drowsiness if you take mirtazapine with other medications or substances that also cause drowsiness, such as antihistamines, sedatives or alcohol.

In addition, in rare circumstances, mirtazapine can cause a potentially dangerous drop in white blood cell counts, which can make you vulnerable to infection. Talk to your doctor if you develop a sore throat, fever, inflammation of the mouth, flu-like symptoms or other signs of infection.

In some cases, antidepressants may be associated with worsening symptoms of depression or suicidal thoughts or behavior, particularly early in treatment or when you change your dosage. Be sure to talk to your doctor about any changes in your symptoms. You may need more careful monitoring at the beginning of treatment or upon a change in treatment, or you may need to stop the medication if your symptoms worsen.

Male depression: Don't ignore the symptoms

noreply@blogger.com (Hanza Fridman) — Tue, 02 Oct 2007 14:37:00 +0000

Are you irritable, isolated and withdrawn? Do you find yourself working all the time, drinking too much alcohol, using street drugs or seeking thrills from risky activities?

If so, perhaps you're being chased by what Winston Churchill called his "black dog" — male depression. Churchill attempted to ward off his black dog with compulsive overwork and large amounts of brandy. For male depression, the coping strategy may be reckless driving, risky sex or shutting yourself off from the world.

But none of these can keep male depression at bay for long. Even worse: Men with depression are at an increased risk of suicide.
Male depression often undiagnosed

Each year, depression affects about 6 million American men and 12 million American women. But these numbers may not tell the whole story. Because men may be reluctant to discuss male depression with a health care professional, many men with depression may go undiagnosed, and consequently untreated.

Some men learn to overvalue independence and self-control during childhood. They're taught that it's "unmanly" to express common feelings and emotions often associated with depression, such as sadness, uncertainty or a sense of hopelessness. They tend to see illness — especially mental illness — as a threat to their masculinity. So men may deny or hide their problems until a partner's insistence or a catastrophic event, such as job loss or arrest, forces them to seek treatment.

When they visit their health care professional, men are more likely to focus on physical complaints — headaches, digestive problems or chronic pain, for example — than on emotional issues. As a result, the connection between such symptoms and male depression may be overlooked. And even if they're diagnosed with depression, men may resist mental health treatment. They may worry about stigma damaging their careers or about losing the respect of family and friends.
Symptoms of male depression

In both men and women, common signs and symptoms of depression include feeling down in the dumps, sleeping poorly, and feeling sad, guilty and worthless. Men with depression, however, have bouts of crying less often than do women with depression.

Other symptoms of male depression often include:
Anger and frustration
Violent behavior
Losing weight without trying
Taking risks, such as reckless driving and extramarital sex
Loss of concentration
Isolation from family and friends
Avoiding pleasurable activities
Fatigue
Loss of interest in work, hobbies and sex
Alcohol or substance abuse
Misuse of prescription medication
Thoughts of suicide

In addition, men often aren't aware that physical symptoms, such as headaches, digestive disorders and chronic pain, can be symptoms of male depression.
Job stress a common trigger of male depression

Whether in men or in women, the precise cause of depression isn't known. Researchers believe depression is the result of a combination of genetics, your thought processes and your social environment. Everyone, for instance, is susceptible to depression in the wake of a major life stress, such as the end of an important relationship, the death of a loved one, moving or financial problems.

Some research suggests that for men, job-related stress may also play an important role in male depression. Some job characteristics that may be associated with male depression include:
Lack of control over your responsibilities
Unreasonable demands for performance
Conflicts with supervisors or co-workers
Lack of job security
Night-shift work
Excessive overtime
More time than you'd like spent away from home
Wages that don't reflect the level of responsibility
When male depression goes untreated

Like other men, you may feel that your depression symptoms aren't severe. You may believe that you should be able to just get over them or tough them out. You may try to deny them, ignore them or blunt them by drinking too much alcohol or working longer hours. But left untreated, male depression symptoms can disrupt your life in many ways and leave you chronically unhappy and miserable.

Depression can also affect your health. For instance, it can keep your stress response continually activated, a state that can damage many organs, including the heart. Depression may even shorten your life. In a given year, men with depression are more than twice as likely as men without depression to die of any cause. Women with depression also have an increased risk of dying, compared with women without depression, but the difference is not as great as it is in men. Although the reasons for this difference are unclear, men with depression may be more likely to engage in self-destructive behavior — from excessive drinking to reckless driving to suicide — that may contribute to it.

Depression also increases your risk of divorce and your children's risk of developing depression themselves. At work, male depression makes you less productive, limits your earning potential and increases your risk of losing your job.
Suicide and male depression

Although women are twice as likely to have depression, men are four times as likely to suffer its worst consequence: suicide. Starting in adolescence, men are far more likely than women to take their own lives. Older men, particularly white men over age 85, have the highest suicide rate. Although women attempt suicide more often than men do, men are more likely to complete suicide.

Men are more likely to use more lethal means in suicide attempts, such as guns, which partly accounts for their higher rate of suicide. But other factors also are involved. One such factor may be their tendency to move from suicidal thoughts to suicidal actions faster than women. Men take an average of just 12 months to go from contemplating suicide to attempting suicide. In contrast, it takes women about 42 months. During this time, men are less likely than women to show warning signs, such as talk of suicide. Because this window of opportunity is so short, family and mental health professionals may have little chance to recognize a man's depression and intervene.
Treatment and self-care for male depression

If you or someone close to you is considering suicide, seek help immediately from your doctor, the nearest hospital emergency room or emergency services (911).

If you suspect you have depression, schedule a physical examination with your family doctor or primary health care professional. Conditions such as a viral infection, thyroid disorder and low testosterone levels can produce symptoms similar to male depression. If your doctor rules out such conditions as a cause of your symptoms, the next step may be a depression screening. Treatment for male depression may include antidepressant medications, psychotherapy or both.

Self-care strategies also may help. These include:
Setting realistic goals and prioritizing tasks
Spending time with supportive family and friends
Engaging in activities you enjoy, such as exercise, movies, ball games or fishing
Delaying important decisions, such as changing jobs or getting married or divorced, until your depression symptoms improve

Family therapy: Healing family conflicts

noreply@blogger.com (Hanza Fridman) — Mon, 24 Sep 2007 15:58:00 +0000

Your family can be your greatest source of support, comfort and love. But it can also be your greatest source of pain and grief. A health crisis, work problems or teenage rebellion may threaten to tear your family apart.

Family therapy may help your family weather the storm. Family therapy can help patch strained relationships among family members and improve how your family works together. Whether it's yourself, your partner, a child or even a sibling or parent, family therapy can help all of you relate more harmoniously.
What is family therapy?

Family therapy is a type of psychotherapy. It helps families or individuals within a family understand and improve the way family members interact with each other and resolve conflicts.

Family therapy is usually provided by therapists known as marriage and family therapists. These therapists provide the same mental health services as other therapists, simply with a different focus — family relationships.

Family therapy is often short term. You usually attend one session a week, typically for three to five months. In some cases, though, families may need more intensive treatment.
Who can benefit from family therapy?

In general, anyone who wants to improve troubled relationships can benefit from family therapy. Family therapy can help with such issues as:
Marital problems
Divorce
Eating disorders, such as anorexia or bulimia
Substance abuse
Depression or bipolar disorder
Chronic health problems, such as asthma or cancer
Grief, loss and trauma
Work stress
Parenting skills
Emotional abuse or violence
Financial problems

Family therapy may be an addition to other types of treatment, particularly for certain mental disorders that require more in-depth treatment. Family therapy shouldn't substitute for other necessary treatments. For instance, family therapy can help family members cope if a relative has schizophrenia. But the person with schizophrenia should continue with his or her individualized treatment plan, such as medication and possibly hospitalization.

In some cases, family therapy may be ordered by the legal system. Adolescents in trouble with the law may be ordered into family therapy rather than serving jail time, for instance. Violent or abusive parents are sometimes spared jail if they enter family therapy. Divorcing couples may also be required to attend family therapy.
How does family therapy work?

Family therapy often brings entire families together in therapy sessions. However, family members may also see a family therapist individually, and family therapy may include nonfamily members, such as schoolteachers, other health care providers or representatives of social services agencies.

Working with a family therapist, you and your family will examine your family's ability to solve problems and express thoughts and emotions. You may explore family roles, rules and behavior patterns in order to spot issues that contribute to conflict. Family therapy may help you identify your family's strengths, such as caring for one another, and weaknesses, such as an inability to confide in one other.

For example, say that your adult son has depression. Your family may not understand the roots of his depression or how best to offer help. Although you're worried about your son's health, you have such deep-rooted family conflicts that conversations ultimately erupt into arguments. You're left with hurt feelings, decisions go unmade, and the rift grows wider.

Family therapy can help you pinpoint your specific concerns and assess how your family is handling them. Guided by your therapist, you'll learn new ways to interact and overcome old problems. You'll set individual and family goals and work on ways to achieve them. In the end, your son may be better equipped to cope with his depression, you'll understand his needs better, and you, your spouse and your son may all get along better.
How do you choose a family therapist?

Like other psychotherapists, family therapists are licensed mental health professionals. Although different states have different licensing or credentialing requirements, most require advanced training, including a master's or doctoral degree, graduate training in marriage and family therapy, and training under the supervision of other experts. Many marriage and family therapists opt to become credentialed by the American Association for Marriage and Family Therapy (AAMFT), which sets specific eligibility criteria.

Most family therapists work in private practice. They may also work in clinics, mental health centers, hospitals and government agencies.

How do you find a family therapist who's right for you? The same way you'd find a psychiatrist, psychologist or other therapist: Ask lots of questions. Among them:
Are you a clinical member of the AAMFT or licensed by the state, or both?
What is your educational and training background?
What is your experience with my type of problem?
How much do you charge?
Are your services covered by my health insurance?
Where is your office, and what are your hours?
How long is each session?
How often are sessions scheduled?
How many sessions should I expect to have?
What is your policy on canceled sessions?
How can I contact you if I have an emergency?

Ask your primary care doctor for a referral to a marriage or family therapist. Family and friends also may give you recommendations based on their experiences. Your health insurer, employee assistance program, clergy or state or local agencies also may offer recommendations.

Defining mental illness: An interview with a Mayo Clinic specialist

noreply@blogger.com (Hanza Fridman) — Mon, 24 Sep 2007 15:57:00 +0000

Mental illnesses have been recognized for thousands of years. Today, advances in science are helping researchers better understand the origins of mental illness and find more effective treatments. But much remains to be learned. Here, Daniel Hall-Flavin, M.D., a psychiatrist at Mayo Clinic, Rochester, Minn., offers a modern interpretation of mental illness, including a look at how mental disorders are defined, the use of medications, the role of psychotherapy and how stress affects well-being.
What is mental illness?

Mental illness is a term that refers to all the different types of mental disorders, including disorders of thought, mood or behavior. To be classified as a mental illness, the condition must cause distress and result in a reduced ability to function psychologically, socially, occupationally or interpersonally.

This means that someone who has a mental illness may have trouble coping with emotions, stress and anger, for instance, and trouble handling such things as daily activities, family responsibilities, relationships, or work and school responsibilities. You can have trouble, to a greater or lesser degree, with one area or all of them. And you can have more than one type of mental illness at the same time.
How is the classification of mental illness evolving?

Today, we classify mental illness based on the symptoms a person experiences and the clinical features of the illness, such as feeling hopeless or having delusions. But as we continue to gain a clearer understanding of how specific genes interact with illnesses or behaviors, we may be able to develop a much more sophisticated classification system that is directly linked to a biological cause of mental illness, rather than just symptoms. This can help us better tailor treatment to individuals. For instance, some disorders have similar symptoms and clinical features but are actually very different in terms of their underlying biology. To treat them similarly simply because they share the same symptoms may not be appropriate. We suspect, for example, that there are different types of schizophrenia, with different causes, and that they possibly respond differently to different treatments.
What are the classes of mental illness?

Our evolving understanding of genetics and how the brain works may eventually change how we classify mental illnesses. For now, we think of several main classes of mental illness:
Mood disorders. These include disorders that affect how you feel, such as persistent sadness or feelings of euphoria. They include major depression and bipolar disorder.
Anxiety disorders. Anxiety is an emotion characterized by the anticipation of future danger or misfortune accompanied by a feeling of being ill at ease. Examples include panic disorder, obsessive-compulsive disorder, specific phobias and generalized anxiety disorder.
Substance-related disorders. These include problems associated with the misuse of alcohol, nicotine, caffeine and illicit drugs.
Psychotic disorders. These disorders impair your sense of reality. The most notable example of this is schizophrenia, although other classes of disorders can be associated with psychosis at times.
Cognitive disorders. These disorders affect your ability to think and reason. They include delirium, dementia and memory problems. Perhaps the most well-known of these disorders is Alzheimer's disease.
Developmental disorders. This category covers a wide range of problems that usually first begin to make themselves known in infancy, childhood or adolescence. They include autism, attention-deficit/hyperactivity disorder and learning disabilities. But just because they're all grouped in this category doesn't necessarily mean they share a common cause or that there's a relationship among the disorders.
Personality disorders. A personality disorder is an enduring pattern of inner experience and behavior that is dysfunctional and leads to distress or impairment. Examples include borderline personality disorder and antisocial personality disorder.
Other disorders. These include disorders of impulse control, sleep, sexual functioning and eating. Also included are dissociative disorders, in which a person's sense of self is disrupted, and somatoform disorders, in which there are physical symptoms in the absence of a clear physical cause, such as hypochondriasis.
Does all mental illness have a biological basis — a problem with the brain's chemistry?

No, not all of them. We know that many serious mental illnesses do have a strong biological basis. But that's not the entire story.

Some people, for example, might have an inherited, biological tendency to develop depression. They can experience serious depression even though no specific event triggers it. Others, however, have no known inherited tendency for depression. But if something happens, such as the death of a loved one, it can trigger major depression.

We don't yet know if the underlying neurochemical aspects of these two depressive reactions are the same. In other words, one person may have a mental illness because of their nature — their genetic vulnerabilities and, their neurochemical functioning. And another person may have a mental illness because of nurture — an environmental cause that perhaps changes their neurochemistry. Most of the time, however, it's probably a complex interaction of both nature and nurture.
With so many medications available to treat depression and other mental illness, is psychotherapy still a good option?

Yes, there is still a major role for psychotherapy in treating mental illness. Among the many forms of psychotherapy are brief therapy, cognitive-behavioral therapy, psychodynamic therapy, and family or couples therapy. Psychotherapy remains a very important part of treatment for many individuals, couples and families and often is the treatment of choice.

Medication might be all that some people need to restore their brain chemistry to a more normal state. But it's psychotherapy and education that can help change coping behaviors and offer strategies to help understand and modify risk factors for illness. In some cases, medication is entirely ineffective and psychotherapy alone is helpful. In other cases, someone may not be able to take psychiatric medications, for health or other reasons. But very often, a combination of medication and psychotherapy is most effective in treating mental illness.
Is mental illness more common these days?

More people seek help today than in the past. But is that because more people have a mental illness? Or is it because now it's more acceptable to seek help, and help is more readily available? Also, the world is more complicated and fast paced than it once was. Does this change in environment contribute to increased mental illness? We don't know the answers to those questions.
Is mental illness simply whatever a culture or society defines it as?

Behaviors that are approved of or frowned upon can vary greatly from culture to culture. But research shows a surprising consistency in the prevalence of serious mental illness across all cultures. Schizophrenia, for instance, occurs in about 1 percent of all populations worldwide. Major depression also has a consistent prevalence in countries around the world. This information supports the idea that serious mental illnesses have a biological basis common to all humans.
How does stress affect mental illness?

Going through a stressful event doesn't necessarily mean that you'll develop a mental illness, such as depression or an anxiety disorder. But it can increase your risk of developing a mental illness. Stress runs the gamut, from daily hassles, such as traffic jams and financial worries, to major life events, such as the breakup of a relationship or the death of a loved one. People who have experienced depression in the past are more vulnerable to depression after a major loss. People with an active, problem-solving style are less likely to experience mental illness such as depression than are those with a passive, emotion-focused style.
Many people are hesitant to get treatment for mental illness. How can they take that first step?

People may be hesitant to seek treatment for a number of reasons. They may think that their depression, for instance, will go away on its own. Or they may consider it a sign of weakness. In addition, some people fear the stigma that's sometimes attached to mental illness. But it's important to understand that biological factors play a major role in the development of mental illness, just as they do with other medical disorders. Effective treatment is available that can eliminate or minimize symptoms, improve a person's ability to function and ultimately improve the quality of their life.

Antidepressants: Selecting one that's right for you

noreply@blogger.com (Hanza Fridman) — Wed, 19 Sep 2007 18:05:00 +0000

Medication is often the first treatment choice for adults with moderate or severe depression. Although antidepressant medications don't cure depression, they can help you achieve remission — the disappearance or nearly complete reduction of symptoms. Sadness, anxiety, depression-related sleep and appetite problems, concentration, and energy levels all can improve with antidepressant medications.

For many people, combining medication use with psychotherapy, such as cognitive-behavioral therapy, proves most effective. With scores of antidepressants available, though, finding the right one for your situation can be challenging. Understanding what a treatment plan entails and what goes into determining the right medication for you will help you sort through your options.
How antidepressants work

Precisely how antidepressants work to treat depression remains speculative. Scientists do know that antidepressants can influence brain activity through the effects they have on mood-related brain chemicals called neurotransmitters and certain nerve cell receptors. Nerve cells release neurotransmitters to communicate with other nerve cells in the brain. Neurotransmitters transmit signals across a gap (synapse) between the nerve cells.

Neurotransmitters associated with depression are serotonin (ser-oh-TOE-nin), norepinephrine (nor-ep-ih-NEF-rin) and possibly dopamine (DOE-puh-mene). Research suggests that people with depression have lower levels of one or more of these neurotransmitters.

Nerve cells send a signal and then reabsorb (reuptake) the neurotransmitters after they've communicated with other nerve cells. Antidepressants interfere with this reuptake. This results in a greater quantity of a particular neurotransmitter remaining in the synapse. This can change the activity of certain nerve cells and influence brain activity. Maintaining a higher level of neurotransmitters improves neurotransmission — the sending of those nerve impulses — which, in turn, improves your mood.

In addition, a type of antidepressant called alpha-2 receptor blockers is thought to work by preventing neurotransmitters from binding with the nerve cell receptors called alpha-2 receptors. This indirectly increases the levels of norepinephrine and serotonin in your brain.
Numerous types of antidepressants available

Dozens of antidepressants are available, each affecting neurotransmitters in a different way. Antidepressants are typically grouped into categories, either based on when the medications came into use, their chemical structure or how they affect brain chemistry.

Here are the antidepressants that have been approved by the Food and Drug Administration (FDA) specifically to treat depression, with their generic names followed by available brand names in parentheses, and grouped by how they affect brain chemistry.

Selective serotonin reuptake inhibitors (SSRIs)
Citalopram (Celexa)
Escitalopram (Lexapro)
Fluoxetine (Prozac, Prozac Weekly)
Paroxetine (Paxil, Paxil CR)
Sertraline (Zoloft)

Serotonin and norepinephrine reuptake inhibitors (SNRIs)
Duloxetine (Cymbalta)
Venlafaxine (Effexor, Effexor XR)

Norepinephrine and dopamine reuptake inhibitors (NDRIs)
Bupropion (Wellbutrin, Wellbutrin SR, Wellbutrin XL)

Alpha-2 receptor blockers
Mirtazapine (Remeron, Remeron Soltab)

Combined reuptake inhibitors and receptor blockers
Trazodone (Desyrel)
Nefazodone (Serzone)
Maprotiline

Tricyclic antidepressants (TCAs)
Amitriptyline
Desipramine (Norpramin)
Doxepin (Sinequan)
Imipramine (Tofranil)
Nortriptyline (Aventyl, Pamelor)
Protriptyline (Vivactil)
Trimipramine (Surmontil)

Monoamine oxidase inhibitors (MAOIs)
Phenelzine (Nardil)
Tranylcypromine (Parnate)
Isocarboxazid (Marplan)
Off-label use of drugs

The FDA normally approves a drug to treat a specific condition in a particular population. Many drugs used to treat depression in adults have been FDA approved specifically for that use.

But doctors may also prescribe drugs to treat depression that haven't actually been approved to treat depression — a practice known as off-label use. For instance, doctors often prescribe clomipramine (Anafranil) because it may improve depression even though it's FDA approved for obsessive-compulsive disorder. The same may be true of other psychiatric drugs, as well.
Finding the right medication for you

So among the dozens available, which antidepressant should you take?

Finding the right one might take time. Each medication has its own pros and cons, and until you try one, you won't know how it'll affect you or how well it'll work. You may need to try several antidepressants before finding the one, or the combination, that's most effective for you with the fewest side effects.

Consider your health profile
Your family doctor or psychiatrist will take into account your symptoms and their severity, your health history, other illnesses you have and lifestyle factors when determining which antidepressant to prescribe.

Your doctor will also consider your age, sex, weight and diet, mostly because of concerns about side effects. Older adults, for instance, generally tolerate the side effects of the newer antidepressants better than the side effects of the older tricyclic antidepressants. However, for some people, the older medications are more effective in treating depression.

Pregnancy is also an issue. Some psychiatric medications may pose a risk to the developing baby. Other medications may be excreted in breast milk to infants.

If any close relatives, such as a brother or sister, have taken antidepressants, their experiences could predict how well a medication will work for you or what side effects you may experience. Tell your doctor if any of your close relatives have taken antidepressants.

Make your personal preferences known
How you take an antidepressant may also influence your medication choice. Some medications come in pill form, while others come as solutions or injections. You may not be comfortable taking an antidepressant that must be injected, for instance. Or you may prefer a once-a-week medication, while someone else doesn't mind taking several doses a day.

Cost is also a consideration. Some antidepressants are available in a generic form, which is generally cheaper than a brand-name version. Newer versions of a drug are sometimes more expensive than the original. But watch out — those newer versions aren't necessarily more effective.
Trying the medications

Once you and your doctor have selected an antidepressant for you to try, it may take four to eight weeks to determine its full effectiveness. With some medications, you can take the full dosage immediately. With others, you may need to gradually increase your dose.

If you have no improvement at all in your symptoms after six weeks, it may be time to try a different antidepressant or add a second medication to augment your treatment. You may have to taper off of one medication before starting another, because potentially dangerous drug interactions and withdrawal-like symptoms can occur from an abrupt switch.

In rare cases, antidepressants simply might not work for you. You may need to consider other forms of treatment, such as psychotherapy to help cope with social or other life stressors, or electroconvulsive therapy if your depression is severe or life-threatening.

Finding the right antidepressant and the correct dosage can take time. Talk to your doctor if you're having trouble coping with the wait.
Common side effects of antidepressants

All antidepressants cause some degree of side effects. Most side effects are mild and temporary. In general, the most common are:
Nausea
Sexual dysfunction
Constipation
Bladder problems
Dizziness
Drowsiness
Dry mouth
Changes in sleep patterns
Restlessness

Side effects vary by medication and by person. Your side effects might be more severe or less severe than what someone else taking the same medication experiences.

Side effects often are most pronounced within the first few days of beginning a new medication but then taper off. Side effects can increase or change if you take higher doses or combine antidepressants with other medications, including other antidepressants. Some antidepressants actually have fewer side effects at higher doses rather than lower doses.

Be sure to tell your doctor about your side effects, as some could require medical treatment or changes in your medication.

If an antidepressant is working for you but the side effects seem intolerable, ask your doctor for help dealing with the side effects so that you don't have to discontinue your medication.
New cautions about suicidal thoughts

In some cases, antidepressants may be associated with worsening symptoms of depression or suicidal thoughts or behavior, particularly early in treatment or when you change your dosage.

In October 2004, the FDA began requiring that all antidepressants carry a "black box" warning — the strongest warning it can issue — alerting doctors and the public to a link between antidepressants and suicidal thoughts and behavior in children and adolescents. Each prescription must also provide a medication guide that advises parents and caregivers about risks and precautions.

Although the black box warning itself is directed at pediatric use of antidepressants, the same cautions about suicide also apply to adults who take antidepressants. The FDA has begun reviewing data on whether antidepressants can cause an increased risk of suicide in adults.Antidepressants requiring warnings about a link to suicide
Clomipramine (Anafranil) Tranylcypromine sulfate (Parnate)
Citalopram (Celexa) Paroxetine (Paxil, Paxil CR)
Duloxetine (Cymbalta) Paroxetine mesylate (Pexeva)
Trazodone (Desyrel) Fluoxetine (Prozac, Prozac Weekly, Sarafem)
Venlafaxine (Effexor, Effexor XR) Mirtazapine (Remeron, Remeron Soltab)
Amitriptyline (Elavil) Nefazodone (Serzone)
Escitalopram (Lexapro) Doxepin (Sinequan)
Chlordiazepoxide/amitriptyline (Limbitrol) Trimipramine (Surmontil)
Maprotiline (Ludiomil) Olanzapine/fluoxetine (Symbyax)
Fluvoxamine (Luvox) Imipramine (Tofranil, Tofranil-PM)
Isocarboxazid (Marplan) Perphenazine/amitriptyline (Triavil)
Phenelzine sulfate (Nardil) Protriptyline (Vivactil)
Desipramine (Norpramin) Bupropion (Wellbutrin, Wellbutrin SR, Wellbutrin XL, Zyban)
Nortriptyline (Aventyl, Pamelor) Sertraline (Zoloft)

Note: Some brand-name medications may no longer be on the market.
Source: Food and Drug Administration, October 2004

You may need more careful monitoring at the beginning of treatment with antidepressants or upon a change in dosage, either up or down. It's a good idea to involve family members or friends, who can also watch for signs that your depression is worsening.

Possible signs that depression may be worsening include:
Agitation
Irritability
Anxiety or panic attacks
Insomnia or other sleeping problems
Hostility
Impulsivity
Inability to remain still
Mania or hypomania, such as extreme elation, racing thoughts or rapid talking
Increasing sadness
Mood swings
Decreasing ability to have fun or experience pleasure
Pulling away from relationships
Spending more time alone

If you notice any of these signs, have thoughts of suicide or self-harm, or feel that your depression is getting worse, talk to your doctor right away.
Length of treatment varies by situation

How long will you have to take antidepressants? It can range from several months to a lifetime.

Treatment of depression with medications is often divided into two stages. The initial focus on getting better is called acute therapy. Later, the focus turns to staying well, called maintenance or continuation therapy. In general, your doctor will probably suggest that you continue taking antidepressants for at least six months — and more likely 12 months — even after remission of your symptoms and you feel better. This will help prevent a return of your symptoms.

If your depression is chronic or recurrent, you'll probably have to take medication for years or even for the rest of your life to help control your symptoms and prevent a relapse.

Deciding how long to continue medication treatment includes consideration of:
The length and severity of your depression before treatment started
How difficult the depression was to treat
Whether you've previously had depression
Your family's history of depression
Your stress levels before, during and after treatment

Don't stop taking a medication without consulting your doctor even if you're feeling better. Stopping a medication too soon can make you more vulnerable to a relapse. It can also cause withdrawal-like symptoms if done suddenly.

If you do stop a medication and your symptoms return, talk to your doctor about starting medication again. But be aware that in some cases, if you stop a medication and then restart it, it may no longer be effective.

Although the choices may seem daunting, with some persistence, you have a good chance of finding an antidepressant that works well for you and that has only mild side effects that won't disrupt your lifestyle. The payoff is your ability to enjoy life more fully again.
From MayoClinic.com

Seasonal affective disorder treatment: Choosing a light therapy box

noreply@blogger.com (Hanza Fridman) — Wed, 19 Sep 2007 18:01:00 +0000

A light therapy box is a small, portable device that contains fluorescent bulbs or tubes and is used mainly in the treatment of seasonal affective disorder, a type of depression. You can purchase a light box over-the-counter, without a prescription.

Commercial outlets offer a wide variety of light boxes and other light devices for seasonal affective disorder treatment. You can buy light boxes on the Internet and at some drugstores and hardware stores. But not all of these products are safe or effective for seasonal affective disorder treatment, so check with your doctor before buying one. To avoid complications, use light boxes only under your doctor's guidance.
Features to look for in a light therapy box

Here are some considerations when buying a light therapy box for seasonal affective disorder treatment:
Intensity. Look for a light box that allows you the right intensity of light at a comfortable seating distance. Some light boxes offer 10,000 lux only when you're within a few inches of the box, while others can reach a distance of nearly two feet.
Minimal UV exposure. Some light boxes use full-spectrum light bulbs that give off ultraviolet (UV) light, which can cause eye and skin damage. Look for devices that produce as little UV light as possible at high intensity or that carefully shield the UV rays they produce.
Light direction. Light should come from above your line of sight, not at it or below it. Make sure the light box you want can be positioned appropriately.
Blue light. Exposure to the blue light spectrum should be minimal because it may mens sexual health cause vision problems, such as glare or sexual health macular degeneration.
Cost. Prices vary greatly, from about $200 to $500. Health insurance plans don't always cover the cost of light therapy boxes. Check with your insurance company to see if your benefits will cover the cost.
Style. Some light boxes look like upright lamps, while others are small and rectangular. You can even purchase a light therapy device attached to a visor, which would allow you to receive light therapy while remaining active. However, keep in mind that scientific evidence about the effectiveness of light visors is lacking.
Convenience. Some light boxes are bigger than others, which can make them less portable. Find one that you can move health easily and that fits the desired location in your home or office.
From MayoClinic.com

Antidepressants: Test shows which may be your best bet

noreply@blogger.com (Hanza Fridman) — Sat, 15 Sep 2007 17:13:00 +0000

Figuring out which antidepressant may be best for you has been a matter of trial and error to some extent. To be sure, doctors could make a pretty solid choice based on your medical history, your symptoms and even how your relatives may have responded to the same antidepressant.

But they couldn't predict how the antidepressant would affect you — if you'd wind up with nausea, insomnia or some other side effect, for instance. And you might take a certain antidepressant for several weeks, only to realize your symptoms haven't improved. Doctors also couldn't predict that. So you may have been stuck trying out several different medications over a period of months or even years to find one with the fewest side effects and biggest benefits.

Now the process of choosing an antidepressant may be easier. A relatively new genetic test may help end the sometimes frustrating process of trial and error. This test, called the cytochrome P450 (CYP450) genotyping test, may help you find out how an antidepressant will affect you before you ever swallow the pill.
Testing how your body reacts to antidepressants

The CYP450 test is among a handful of tests that can analyze specific genes that play a role in how your body metabolizes certain medications. It's part of an emerging field called pharmacogenomics, or personalized medicine.

Each of your body's cells contains genes. These genes instruct your body to produce enzymes that control how cells process (metabolize) the medications you take. The CYP450 test identifies the genes responsible for producing enzymes that play an important role in processing certain antidepressants and other medications.

Not everyone processes the same medications the same way. This processing difference is what makes you react differently to an antidepressant than does someone else.

Processing antidepressants too slowly
Your genes may produce enzymes that metabolize an antidepressant too slowly. This means that the medication stays in your body longer than it should. As a result, the medication can build up in your body, possibly leading to intolerable side effects or even a toxic reaction. This, of course, may prompt you to stop taking the medication.

Processing antidepressants too quickly
Your genes may produce enzymes that metabolize an antidepressant too quickly. In this case, the medication is eliminated from your body before it has a chance to work fully. This means that you may not see much improvement in your depression symptoms.

Achieving a balance with antidepressants
If your doctor knows in advance how your body is likely to process an antidepressant, he or she can make a better selection for you or adjust your dose appropriately — before you ever start taking the antidepressant. Your medication choice is personalized to your body's genetics. For instance, if you process an antidepressant too slowly, your doctor may suggest taking a lower dose so that it doesn't accumulate in your body and cause severe side effects.
CYP450 test helps predict reactions to antidepressants

This is where the CYP450 test may help. The test checks to see if two specific genes produce normal enzymes or variants of these enzymes. Which ones you have determine how your body processes certain antidepressants.

Figuring out which antidepressant may be best for you has been a matter of trial and error to some extent. To be sure, doctors could make a pretty solid choice based on your medical history, your symptoms and even how your relatives may have responded to the same antidepressant.

But they couldn't predict how the antidepressant would affect you — if you'd wind up with nausea, insomnia or some other side effect, for instance. And you might take a certain antidepressant for several weeks, only to realize your symptoms haven't improved. Doctors also couldn't predict that. So you may have been stuck trying out several different medications over a period of months or even years to find one with the fewest side effects and biggest benefits.

Now the process of choosing an antidepressant may be easier. A relatively new genetic test may help end the sometimes frustrating process of trial and error. This test, called the cytochrome P450 (CYP450) genotyping test, may help you find out how an antidepressant will affect you before you ever swallow the pill.
Testing how your body reacts to antidepressants

The CYP450 test is among a handful of tests that can analyze specific genes that play a role in how your body metabolizes certain medications. It's part of an emerging field called pharmacogenomics, or personalized medicine.

Each of your body's cells contains genes. These genes instruct your body to produce enzymes that control how cells process (metabolize) the medications you take. The CYP450 test identifies the genes responsible for producing enzymes that play an important role in processing certain antidepressants and other medications.

Not everyone processes the same medications the same way. This processing difference is what makes you react differently to an antidepressant than does someone else.

Processing antidepressants too slowly
Your genes may produce enzymes that metabolize an antidepressant too slowly. This means that the medication stays in your body longer than it should. As a result, the medication can build up in your body, possibly leading to intolerable side effects or even a toxic reaction. This, of course, may prompt you to stop taking the medication.

Processing antidepressants too quickly
Your genes may produce enzymes that metabolize an antidepressant too quickly. In this case, the medication is eliminated from your body before it has a chance to work fully. This means that you may not see much improvement in your depression symptoms.

Achieving a balance with antidepressants
If your doctor knows in advance how your body is likely to process an antidepressant, he or she can make a better selection for you or adjust your dose appropriately — before you ever start taking the antidepressant. Your medication choice is personalized to your body's genetics. For instance, if you process an antidepressant too slowly, your doctor may suggest taking a lower dose so that it doesn't accumulate in your body and cause severe side effects.
CYP450 test helps predict reactions to antidepressants

This is where the CYP450 test may help. The test checks to see if two specific genes produce normal enzymes or variants of these enzymes. Which ones you have determine how your body processes certain antidepressants.

Before prescribing an antidepressant, your doctor may discuss with you the option of having the CYP450 test. If you have the test, you and your doctor may know what to expect before you take certain antidepressants. The test helps predict if you're likely to experience harsh side effects or if the antidepressant has little chance of working for you.

The CYP450 test requires only a simple blood draw from a vein in your arm. You don't need to fast before the test or follow other special preparation procedures. You and your doctor will review the results of the test and see how they factor into your choice of antidepressant medication.

Here's how genetic variations can affect processing of an antidepressant and how you and your doctor can decide how to handle them:
Normal metabolizer Slow metabolizer Fast metabolizer
Genetic variation Your genes produce a typical amount of enzyme. Your genes produce too little enzyme. Your genes produce too much enzyme.
Effects on you The antidepressant helps your depression and causes few side effects. The antidepressant builds up in your body, causing intolerable side effects. The antidepressant is eliminated too quickly, providing little or no improvement in depression.
Treatment options Follow the recommended dosage. Switch antidepressants or reduce your dosage. Switch antidepressants or increase your dosage.

Drawbacks of genetic testing for antidepressants

Although it may be a good start in better personalizing treatment to individual situations, the CYP450 genotyping test does have some drawbacks.

One major drawback is that the test can't actually predict if certain antidepressants will improve your depression symptoms. The test can only show which antidepressants probably won't work.

In addition, the test can be used only for certain antidepressants, not all of them. That's because the test is able to check only for two genes that are responsible for metabolizing certain antidepressants. Other genes affect how your body responds to other antidepressants, and the CYP450 test isn't able to check for them.

Here are the antidepressants the CYP450 test can be used for, with their generic names followed by available brand names in parentheses:
Desipramine (Norpramin)
Fluoxetine (Prozac, Prozac Weekly)
Imipramine (Tofranil)
Nortriptyline (Aventyl, Pamelor)
Paroxetine (Paxil, Paxil CR)
Venlafaxine (Effexor, Effexor XR)

These two genes may also influence your reaction to two other medications that haven't been FDA approved for use in depression but that are often used off-label to treat depression. These medications are:
Clomipramine (Anafranil)
Diazepam (Valium, Diazepam Intensol)

Finally, although the cytochrome P450 test has been FDA approved for certain situations, it may not be available in all communities yet. In addition, not all psychiatrists and other doctors routinely use the test.
Other factors also important in selecting antidepressants

If you opt for testing, keep in mind that the cytochrome P450 genotyping test isn't meant to be the only way to determine which antidepressants to try. A thorough medical and psychiatric evaluation, as well as consideration of your preferences and lifestyle, is still important.

Warning strengthened on Paxil birth defect risks

noreply@blogger.com (Hanza Fridman) — Sat, 15 Sep 2007 17:08:00 +0000

What happened: Based on the results of two studies, the Food and Drug Administration (FDA) has strengthened its warning on the antidepressant paroxetine (Paxil). FDA stated in a Dec. 8, 2005, public health advisory that Paxil increases the risk of birth defects in women taking the drug during their first trimester of pregnancy. Women who take Paxil during their first three months of pregnancy are nearly two times more likely to give birth to a child with a birth defect — in particular a heart defect — than are women taking other antidepressants, the FDA stated.

What does this mean to you? If you're taking Paxil and you're in your first trimester or are considering getting pregnant, see your doctor about switching to another antidepressant or discontinuing treatment. Don't stop taking Paxil without contacting your doctor first, as side effects may occur after immediate cessation of the drug. Your doctor may recommend a phased withdrawal from the medication or may determine that for you the benefits of Paxil outweigh the risk.
From MayoClinic.com

Seasonal affective disorder drug Wellbutrin XL wins approval

noreply@blogger.com (Hanza Fridman) — Mon, 10 Sep 2007 18:40:00 +0000

What happened? People who have seasonal affective disorder and experience depression during waning daylight hours may find relief in a medication approved to prevent this potentially debilitating condition.

The Food and Drug Administration (FDA) has approved the antidepressant bupropion hydrochloride extended release (Wellbutrin XL) for prevention of depression in people with seasonal affective disorder (SAD).

With the approval, Wellbutrin XL becomes the first medication approved to prevent SAD, a type of depression characterized by seasonal episodes of depressed mood, loss of energy, social withdrawal, increased sleep and other, sometimes debilitating, symptoms. Wellbutrin XL is already FDA approved to treat depression.

The FDA noted that Wellbutrin XL's effectiveness for preventing SAD episodes was demonstrated in three clinical trials. In the trials, approximately 1,000 people with seasonal affective disorder were randomly chosen to receive either Wellbutrin XL or a placebo beginning in the fall and winter, before the onset of symptoms of depression. Treatment was stopped in the spring.

Pooled results of the three studies showed that 84 percent of people taking Wellbutrin XL were free of depression, compared with 72 percent taking the placebo. All of the studies were funded by Wellbutrin XL's manufacturer, GlaxoSmithKline.

What does this mean to you? Wellbutrin XL is the first antidepressant officially approved by the FDA to prevent seasonal affective disorder. But many other antidepressants are used to treat or prevent SAD.

These other medications are used off-label, a common practice that simply means that a prescription drug is prescribed for a purpose not officially FDA sanctioned. For some people, light therapy is also an effective treatment for seasonal affective disorder.

If you're already being effectively treated for seasonal affective disorder, whether with medication or light therapy, you may not need to change treatments.

As with other antidepressants, Wellbutrin XL poses potential side effects and health risks. Certain antidepressants, including Wellbutrin XL, may be associated with worsening symptoms of depression or suicidal thoughts or behavior.

Before taking an antidepressant to try to prevent symptoms of seasonal affective disorder, carefully weigh the pros and cons with your doctor.
From MayoClinic.com

Mixing migraine, depression drugs poses risk of serotonin syndrome

noreply@blogger.com (Hanza Fridman) — Mon, 10 Sep 2007 18:37:00 +0000

What happened? Mixing certain medications for migraine and depression might be risky, warn Food and Drug Administration (FDA) officials.

Taking triptans — a common class of migraine medications — along with selective serotonin reuptake inhibitors (SSRIs) or serotonin/norepinephrine reuptake inhibitors (SNRIs) can cause serotonin syndrome, a life-threatening condition that occurs when there's too much of the chemical serotonin in your blood.

All three types of medication increase serotonin levels. If a triptan is taken with either an SSRI or SNRI, the drugs may increase serotonin to dangerous levels. Signs and symptoms of serotonin syndrome may include:
Restlessness
Hallucinations
Loss of coordination
Fast heartbeat
Rapid changes in blood pressure
Increased body temperature
Overactive reflexes
Nausea, vomiting and diarrhea

Serotonin syndrome often resolves within 24 hours of stopping any medication that increases serotonin. Severe cases may require additional medications or hospitalization.

Common triptans include:
Almotriptan (Axert)
Naratriptan (Amerge)
Sumatriptan (Imitrex)
Zolmitriptan (Zomig)

Common SSRIs include:
Citalopram (Celexa)
Escitalopram (Lexapro)
Fluoxetine (Prozac)
Paroxetine (Paxil)
Sertraline (Zoloft)

SNRIs include duloxetine (Cymbalta) and venlafaxine (Effexor).

The FDA has asked manufacturers of all three types of medication to include a warning about serotonin syndrome in their prescribing information.

What does this mean to you? If you're taking a triptan with either an SSRI or SNRI, consult your doctor about possible risks. Don't stop taking any of the medications on your own. If your doctor prescribes a new medication, make sure he or she knows about all the other medications you're taking — especially if you receive prescriptions from more than one doctor.

If you and your doctor decide the benefits of combining a triptan with an SSRI or SNRI outweigh the risks, be alert to the possibility of serotonin syndrome. If you develop restlessness, hallucinations or any other signs or symptoms of serotonin syndrome, seek medical attention immediately.
From MayoClinic.com

Antidepressant patch Emsam approved by FDA

noreply@blogger.com (Hanza Fridman) — Thu, 06 Sep 2007 19:08:00 +0000

What happened: The Food and Drug Administration (FDA) has approved a skin patch to treat depression in adults. The antidepressant medication, called Emsam, is the first skin (transdermal) patch for depression.

Known generically as selegiline, Emsam belongs to a class of antidepressants called monoamine oxidase inhibitors (MAOIs). At its lowest dose, Emsam may offer a way around the strict dietary requirements needed when using oral MAOIs.

You apply a new Emsam patch to your torso, thigh or upper arm each day, allowing the medication to be absorbed into your bloodstream over a 24-hour period. Precisely how MAOIs such as Emsam work isn't fully known. Researchers believe that MAOIs, including Emsam, relieve depression by maintaining high levels of certain mood-enhancing chemicals in your brain.

Emsam is not approved for use in children ages 17 or younger.

What does this mean to you? For some adults, Emsam provides more depression treatment options because at its lowest dose you can use it without the dietary restrictions needed with all oral MAOIs.

MAOIs can cause potentially life-threatening interactions with foods, even common cheeses and luncheon meats. Because of these problems, doctors typically prescribe MAOIs only after trying other antidepressant medications first.

At the lowest dose of the Emsam antidepressant patch — 6 milligrams (mg) daily — there are no dietary restrictions. That may give some people more flexibility in their depression treatment options.

Higher doses of the patch — 9 mg and 12 mg — do pose the same dietary risks as other MAOIs. If you take either of those higher daily doses of Emsam, you must follow the same dietary restrictions as with oral MAOIs.

Like other MAOIs, Emsam has other side effects, as well. And like all other antidepressants, it must carry a warning that its use may be associated with worsening suicidal thoughts and other depression symptoms.

Because of the numerous side effects and interactions, it's not appropriate for everyone. Talk to your doctor or other health care provider to see if Emsam may be right for you.

Male depression: Don't ignore the symptoms

noreply@blogger.com (Hanza Fridman) — Fri, 31 Aug 2007 17:15:00 +0000

Male depression is a serious medical condition. Many men try to tough it out on their own, but depression symptoms can make them chronically miserable. Effective treatment helps.

Are you irritable, isolated and withdrawn? Do you find yourself working all the time, drinking too much alcohol, using street drugs or seeking thrills from risky activities?

If so, perhaps you're being chased by what Winston Churchill called his "black dog" — male depression. Churchill attempted to ward off his black dog with compulsive overwork and large amounts of brandy. For male depression, the coping strategy may be reckless driving, risky sex or shutting yourself off from the world.

But none of these can keep male depression at bay for long. Even worse: Men with depression are at an increased risk of suicide.
Male depression often undiagnosed

Each year, depression affects about 6 million American men and 12 million American women. But these numbers may not tell the whole story. Because men may be reluctant to discuss male depression with a health care professional, many men with depression may go undiagnosed, and consequently untreated.

Some men learn to overvalue independence and self-control during childhood. They're taught that it's "unmanly" to express common feelings and emotions often associated with depression, such as sadness, uncertainty or a sense of hopelessness. They tend to see illness — especially mental illness — as a threat to their masculinity. So men may deny or hide their problems until a partner's insistence or a catastrophic event, such as job loss or arrest, forces them to seek treatment.

When they visit their health care professional, men are more likely to focus on physical complaints — headaches, digestive problems or chronic pain, for example — than on emotional issues. As a result, the connection between such symptoms and male depression may be overlooked. And even if they're diagnosed with depression, men may resist mental health treatment. They may worry about stigma damaging their careers or about losing the respect of family and friends.
Symptoms of male depression

In both men and women, common signs and symptoms of depression include feeling down in the dumps, sleeping poorly, and feeling sad, guilty and worthless. Men with depression, however, have bouts of crying less often than do women with depression.

Other symptoms of male depression often include:
Anger and frustration
Violent behavior
Losing weight without trying
Taking risks, such as reckless driving and extramarital sex
Loss of concentration
Isolation from family and friends
Avoiding pleasurable activities
Fatigue
Loss of interest in work, hobbies and sex
Alcohol or substance abuse
Misuse of prescription medication
Thoughts of suicide

In addition, men often aren't aware that physical symptoms, such as headaches, digestive disorders and chronic pain, can be symptoms of male depression.
Job stress a common trigger of male depression

Whether in men or in women, the precise cause of depression isn't known. Researchers believe depression is the result of a combination of genetics, your thought processes and your social environment. Everyone, for instance, is susceptible to depression in the wake of a major life stress, such as the end of an important relationship, the death of a loved one, moving or financial problems.

Some research suggests that for men, job-related stress may also play an important role in male depression. Some job characteristics that may be associated with male depression include:
Lack of control over your responsibilities
Unreasonable demands for performance
Conflicts with supervisors or co-workers
Lack of job security
Night-shift work
Excessive overtime
More time than you'd like spent away from home
Wages that don't reflect the level of responsibility
When male depression goes untreated

Like other men, you may feel that your depression symptoms aren't severe. You may believe that you should be able to just get over them or tough them out. You may try to deny them, ignore them or blunt them by drinking too much alcohol or working longer hours. But left untreated, male depression symptoms can disrupt your life in many ways and leave you chronically unhappy and miserable.

Depression can also affect your health. For instance, it can keep your stress response continually activated, a state that can damage many organs, including the heart. Depression may even shorten your life. In a given year, men with depression are more than twice as likely as men without depression to die of any cause. Women with depression also have an increased risk of dying, compared with women without depression, but the difference is not as great as it is in men. Although the reasons for this difference are unclear, men with depression may be more likely to engage in self-destructive behavior — from excessive drinking to reckless driving to suicide — that may contribute to it.

Depression also increases your risk of divorce and your children's risk of developing depression themselves. At work, male depression makes you less productive, limits your earning potential and increases your risk of losing your job.
Suicide and male depression

Although women are twice as likely to have depression, men are four times as likely to suffer its worst consequence: suicide. Starting in adolescence, men are far more likely than women to take their own lives. Older men, particularly white men over age 85, have the highest suicide rate. Although women attempt suicide more often than men do, men are more likely to complete suicide.

Men are more likely to use more lethal means in suicide attempts, such as guns, which partly accounts for their higher rate of suicide. But other factors also are involved. One such factor may be their tendency to move from suicidal thoughts to suicidal actions faster than women. Men take an average of just 12 months to go from contemplating suicide to attempting suicide. In contrast, it takes women about 42 months. During this time, men are less likely than women to show warning signs, such as talk of suicide. Because this window of opportunity is so short, family and mental health professionals may have little chance to recognize a man's depression and intervene.
Treatment and self-care for male depression

If you or someone close to you is considering suicide, seek help immediately from your doctor, the nearest hospital emergency room or emergency services (911).

If you suspect you have depression, schedule a physical examination with your family doctor or primary health care professional. Conditions such as a viral infection, thyroid disorder and low testosterone levels can produce symptoms similar to male depression. If your doctor rules out such conditions as a cause of your symptoms, the next step may be a depression screening. Treatment for male depression may include antidepressant medications, psychotherapy or both.

Self-care strategies also may help. These include:
Setting realistic goals and prioritizing tasks
Spending time with supportive family and friends
Engaging in activities you enjoy, such as exercise, movies, ball games or fishing
Delaying important decisions, such as changing jobs or getting married or divorced, until your depression symptoms improve

By Mayo Clinic Staff

Depression

noreply@blogger.com (Hanza Fridman) — Fri, 31 Aug 2007 17:10:00 +0000

Introduction

Depression is a disorder that affects your thoughts, moods, feelings, behavior and even your physical health. People used to think it was "all in your head" and that if you really tried, you could "snap out of it" or just "get over it." But doctors now know that depression is not a weakness, and it's not something you can treat on your own. Depression is a medical disorder with a biological and chemical basis.

Sometimes a stressful life event triggers depression. Other times depression seems to occur spontaneously with no identifiable specific cause. Depression is much more than grieving or a bout of the blues.

Depression may occur only once in a person's life. Often, however, it occurs as repeated episodes over a lifetime, with periods free of depression in between. Or it may be a chronic condition, requiring ongoing treatment over a lifetime.

People of all ages and races suffer from depression. Medications are available that are generally safe and effective, even for the most severe depression. With proper treatment, most people with serious depression improve, often within weeks, and can return to normal daily activities.
Signs and symptoms

Two hallmarks of depression — symptoms key to establishing a diagnosis — are:
Loss of interest in normal daily activities. You lose interest in or pleasure from activities that you used to enjoy.
Depressed mood. You feel sad, helpless or hopeless, and may have crying spells.

In addition, for a doctor or other health professional to diagnose depression, most of the following signs and symptoms also must be present for at least two weeks.
Sleep disturbances. Sleeping too much or having problems sleeping can be a sign you're depressed. Waking in the middle of the night or early in the morning and not being able to get back to sleep are typical.
Impaired thinking or concentration. You may have trouble concentrating or making decisions and have problems with memory.
Changes in weight. An increased or reduced appetite and unexplained weight gain or loss may indicate depression.
Agitation. You may seem restless, agitated, irritable and easily annoyed.
Fatigue or slowing of body movements. You feel weariness and lack of energy nearly every day. You may feel as tired in the morning as you did when you went to bed the night before. You may feel like you're doing everything in slow motion, or you may speak in a slow, monotonous tone.
Low self-esteem. You feel worthless and have excessive guilt.
Less interest in sex. If you were sexually active before developing depression, you may notice a dramatic decrease in your level of interest in having sexual relations.
Thoughts of death. You have a persistent negative view of yourself, your situation and the future. You may have thoughts of death, dying or suicide.

Depression can also cause a wide variety of physical complaints, such as gastrointestinal problems (indigestion, constipation or diarrhea), headache and backache. Many people with depression also have symptoms of anxiety.

Children, teens and older adults may react differently to depression. In these groups, symptoms may take different forms or may be masked by other conditions. Kids may pretend to be sick, worry that a parent is going to die, perform poorly in school, refuse to go to school, or exhibit behavioral problems. Older people may be more willing to discuss the physical manifestations of depression, instead of their emotional difficulties.

Types of depression
The main types of depression include:
Major depression. This type of mood disturbance lasts more than two weeks. Symptoms may include overwhelming feelings of sadness and grief, loss of interest or pleasure in activities you usually enjoy, and feelings of worthlessness or guilt. This type of depression may result in poor sleep, a change in appetite, severe fatigue and difficulty concentrating. Severe depression may increase the risk of suicide.
Dysthymia. Dysthymia (dis-THI-me-uh) is a less severe but more chronic form of depression. Signs and symptoms usually aren't disabling, and periods of dysthymia can alternate with short periods of feeling normal. Having dysthymia places you at an increased risk of major depression.
Adjustment disorders. If a loved one dies, you lose your job or you receive a diagnosis of cancer, it's perfectly normal to feel tense, sad, overwhelmed or angry. Eventually, most people come to terms with the lasting consequences of life stresses, but some don't. This is what's known as an adjustment disorder — when your response to a stressful event or situation causes signs and symptoms of depression. Some people develop an adjustment disorder in response to a single event. In others, it stems from a combination of stressors. Adjustment disorders can be acute (lasting less than six months) or chronic (lasting longer). Doctors classify adjustment disorders based on the primary signs and symptoms of depression or anxiety.
Bipolar disorder. Having recurrent episodes of depression and elation (mania) is characteristic of bipolar disorder. Because this condition involves emotions at both extremes (poles), it's called bipolar disorder or manic-depressive disorder. Mania affects your judgment, causing you to make unwise decisions. Some people have bursts of increased creativity and productivity during the manic phase. The number of episodes at either extreme may not be equal. Some people may have several episodes of depression before having another manic phase, or vice versa.
Seasonal affective disorder. Seasonal affective disorder (SAD) is a pattern of depression related to changes in seasons and a lack of exposure to sunlight. It may cause headaches, irritability and a low energy level.
Causes

There's no single known cause for depression. The illness often runs in families. Experts believe a genetic vulnerability combined with environmental factors, such as stress or physical illness, may trigger an imbalance in brain chemicals called neurotransmitters, resulting in depression. Imbalances in three neurotransmitters — serotonin, norepinephrine and dopamine — seem to be linked to depression.

Scientists don't fully understand how imbalances in neurotransmitters cause signs and symptoms of depression. It's not certain whether changes in neurotransmitters are a cause or a result of depression.

Factors that contribute to depression include:
Heredity. Researchers have identified several genes that may be involved in bipolar disorder, and they're looking for genes linked to other types of depression. But not everyone with a family history of depression develops the disorder, and conversely, people with no family history of the disorder can become depressed.
Stress. Stressful life events, particularly a loss or threatened loss of a loved one or a job, can trigger depression.
Medications. Long-term use of certain medications, such as some drugs used to control high blood pressure, sleeping pills or, occasionally, birth control pills, may cause symptoms of depression in some people.
Illnesses. Having a chronic illness, such as heart disease, stroke, diabetes, cancer or Alzheimer's disease, puts you at higher risk of developing depression. Having an underactive thyroid (hypothyroidism), even mildly, also can cause depression.
Personality. Certain personality traits, such as having low self-esteem and being overly dependent, self-critical, pessimistic and easily overwhelmed by stress, can make you more vulnerable to depression.
Postpartum depression. It's common for mothers to feel a mild form of distress that usually occurs a few days to weeks after giving birth. During this time you may have feelings of sadness, anger, anxiety, irritability and incompetence. A more severe form of the baby blues, called postpartum depression, also can affect new mothers.
Hormones. Women experience depression about twice as much as men, which leads researchers to believe hormonal factors may play a role in the development of depression.
Alcohol, nicotine and drug abuse. Experts once thought that people with depression used alcohol, nicotine and mood-altering drugs as a way to ease depression. But using these substances may actually contribute to depression and anxiety disorders.
Risk factors

Depression affects all ages and all races. Twice as many women experience depression as men. While men are less likely to become depressed than women are, depression does affect men as well. Gender differences in depression may be due in part to biological causes, such as hormones and different levels of neurotransmitters.

Other factors that may put you at an increased risk of depression include a family history of the disorder, pregnancy or stressful life events, such as the loss of a loved one or a job.
When to seek medical advice

If you show little interest in once-enjoyable activities, if you feel sad, helpless, tired or worthless, and if your eating and sleeping habits have changed greatly, see your doctor to determine if you have depression. If you know someone who exhibits the characteristics of depression, encourage him or her to seek professional help.
Screening and diagnosis

To diagnose depression, your doctor may perform a physical examination, including tests to rule out conditions that can cause symptoms that mimic depression.

If your doctor sees signs of severe depression or suspects the possibility of suicide, he or she may refer you to a medical doctor who specializes in mental illness (psychiatrist) or even recommend immediate hospitalization.

Your doctor or psychiatrist diagnoses depression based on the hallmark signs and symptoms of the disease, plus the presence of other signs and symptoms that typically accompany depression.
Complications

Depression is a serious illness that can take a terrible toll on individuals and families. Untreated, depression can lead to a downward spiral of disability, dependency and suicide. Women attempt suicide more often than men do, but men are much more likely to succeed in killing themselves. The rate of suicide is four times greater for men. Men over 70 are the most likely to commit suicide.

Certain warning signs may indicate serious depression and the possibility of suicide. Take any threat of suicide seriously, even if the person is already being treated for depression. If you see any of the following danger signs, call a doctor, mental health clinic or suicide hot line immediately:
Pacing, agitated behavior, frequent mood changes and sleeplessness for several nights
Actions or threats of assault, physical harm or violence
Threats or talk of death or suicide, such as "I don't care anymore," or "You won't need to worry about me much longer"
Withdrawal from activities and relationships
Putting affairs in order, such as saying goodbye to friends, giving away prized possessions or writing a will
A sudden brightening of mood after a period of being depressed
Unusually risky behavior, such as buying or handling a gun or driving recklessly
Treatment

The development of newer antidepressant medications and mood-stabilizing drugs has improved the treatment of depression. Medications can relieve symptoms of depression and have become the first line of treatment for most types of the disorder.

Treatment may also include psychotherapy, which may help you cope with ongoing problems that may trigger or contribute to depression. A combination of medications and a brief course of psychotherapy usually is effective if you have mild to moderate depression. If you're severely depressed, initial treatment usually is with medications or electroconvulsive therapy. Once you improve, psychotherapy can be more effective.

Doctors usually treat depression in two stages. Acute treatment with medications helps relieve symptoms until you feel well. Once your symptoms ease, maintenance treatment typically continues for four to nine months to prevent a relapse. It's important to keep taking your medication even though you feel fine and are back to your usual activities. Episodes of depression recur in the majority of people who have one episode, but continuing treatment greatly reduces your risk of a rapid relapse. If you've had two or more previous episodes of depression, your doctor may suggest long-term treatment with antidepressants.

Medications
Selective serotonin reuptake inhibitors (SSRIs). Doctors often consider selective serotonin reuptake inhibitors, such as fluoxetine (Prozac, Sarafem), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa) and escitalopram (Lexapro), as the first-line treatment for depression because they have fewer serious side effects. They seem to work by increasing the availability of the neurotransmitter serotonin in your brain. Drugs similar to SSRIs include serotonin and norepinephrine reuptake inhibitors (SNRIs), such as trazodone (Desyrel) and venlafaxine (Effexor), and dopamine reuptake inhibitors, such as bupropion (Wellbutrin).
Tricyclic and tetracyclic antidepressants. These medications also affect neurotransmitters, but by a different mechanism than SSRIs. They may be used for any type of depression, be it mild or severe. Among tricyclic antidepressants are amitriptyline, desipramine (Norpramin), nortriptyline (Aventyl, Pamelor), protriptyline (Vivactil), trimipramine (Surmontil) and a combination of perphenazine and amitriptyline. Tetracyclics include maprotiline and mirtazapine (Remeron).
Monoamine oxidase inhibitors (MAOIs). These drugs, which include phenelzine (Nardil) and tranylcypromine (Parnate), prevent the breakdown of neurotransmitters. The drugs have potentially serious side effects if combined with certain other medications or food products. Doctors rarely use them unless other options have failed. Your doctor may prescribe them if you have chronic depression and eat or sleep excessively.
Stimulants. Your doctor may initially prescribe a stimulant such as methylphenidate (Ritalin, Concerta), dextroamphetamine (Dexedrine, Dextrostat) or modafinil (Provigil) if you can't take antidepressants because they're contraindicated due to another medical condition. These medications are also sometimes given in conjunction with antidepressants.
Lithium and mood-stabilizing medications. Doctors prescribe lithium (Eskalith, Lithobid), valproic acid (Depakene), divalproex (Depakote) and carbamazepine (Tegretol, Carbatrol) to treat bipolar depression. Medications called atypical antipsychotics such as olanzapine (Zyprexa), risperidone (Risperdal) and quetiapine (Seroquel) were initially developed for treatment of psychotic disorders. Doctors sometimes also use them to treat bipolar disorder.

According to the American Diabetes Association (ADA), certain antipsychotic drugs may increase the risk of diabetes, obesity and high blood pressure. That's why the ADA recommends that doctors screen and monitor anyone taking Risperdal, Seroquel and Zyprexa.

Not everyone responds the same way
Most antidepressants have a similar level of effectiveness. But a medication that works for someone else might not work for you. Doctors choose antidepressants based on your family history and the match between your symptoms and the medication's side effects. For example, if you have insomnia, a sedating antidepressant may help you. But if you're lethargic, then a more energizing antidepressant may be more helpful.

It can take up to eight to 12 weeks before you feel the full effects of an antidepressant, though you may feel some changes earlier. If your response to medication hasn't resulted in satisfactory progress after that time, your doctor may suggest either adding another antidepressant or replacing the first medication with another drug from a different chemical family.

Side effects of medications
As with any medication, side effects are possible. You may notice side effects before you can feel the drug begin to ease your depression. Most of the side effects from antidepressant are temporary and will disappear as your body gets used to the medication. Let your doctor know about any side effects that interfere with daily functioning, or if they're especially bothersome.
SSRIs. Side effects that may occur with SSRIs and other new antidepressants include headache, nausea, insomnia, agitation or a jittery feeling, and sexual difficulties.
Tricyclic antidepressants. Older medications, such as tricyclics, may cause dry mouth, constipation, sexual difficulties, blurred vision, dizziness, bladder problems and daytime drowsiness.
MAOIs. These drugs can cause a significant increase in blood pressure if you eat foods high in tyramine, such as wine, cheese or pickles, or if you take certain drugs, such as decongestants, while taking an MAOI. Ask your doctor or pharmacist for a list of foods and drugs to avoid.

Alcohol can interfere with the way your body absorbs antidepressants. Talk with your doctor before drinking alcohol while you're taking an antidepressant.

Concerns with children and teens
In children and teenagers, there's some concern that the use of antidepressants to treat major depression may lead to an increased risk of suicide — from about 2 percent for children not taking these medications to 4 percent for children taking an antidepressant for major depression. Physicians, parents and children need to weigh the benefits of these medications against the potential risks. Because of the increased risk, the Food and Drug Administration (FDA) directed manufacturers of antidepressants to include a warning on the medication that explains the risk and recommends that children be closely observed by their families, caregivers and physicians while on these medications.

Other treatments
In addition to medications, depression treatment may include:

Psychotherapy. There are several types of psychotherapy. Each type involves a short-term, goal-oriented approach aimed at helping you deal with a specific issue. Prolonged psychotherapy is seldom necessary to treat depression. If an underlying factor contributing to your depression is an inability to get along with others or difficulty finding your place in life, then prolonged psychotherapy could help you.

The success of therapy depends on finding a doctor, psychiatrist or psychologist you're comfortable with. Both medications and psychotherapy can take weeks to have an effect. Specialized and supervised group therapy, such as bereavement groups, stress management classes, marital counseling and family therapy, also may help.
Electroconvulsive therapy. Despite the images that many people conjure up, electroconvulsive therapy is generally safe and effective. Experts aren't sure how this therapy relieves the signs and symptoms of depression. The procedure may affect levels of neurotransmitters in your brain. The most common side effect is confusion that lasts a few minutes to several hours. Some people experience some transient memory loss. This therapy is usually used for people who don't respond to medications and for those at high risk of suicide. It may be the only treatment available for severely depressed older adults who can't take medications because of heart disease.
Light therapy. This therapy may help if you have seasonal affective disorder. This disorder involves periods of depression that recur at the same time each year, usually when days are shorter in the fall and winter. Scientists believe fewer hours of sunlight may increase levels of melatonin, a brain hormone thought to induce sleep and depress mood. Treatment in the morning with a specialized type of bright light, which suppresses production of melatonin, may help if you have this disorder.
Self-care

Once treatment for depression begins, you still have to manage on a day-to-day basis. Here are some guidelines:
See your doctor regularly. Your doctor can monitor your progress, provide support and encouragement, and adjust your medication if necessary.
Take your medications. Finding the best medication for you may take several tries. It may take several weeks for you to start seeing results. Once you feel better, continue to take your medication as prescribed.
Don't become isolated. Try to participate in normal activities.
Take care of yourself. Eat a healthy diet and get the right amount of sleep and exercise. Exercise can help treat some forms of depression, ease stress and help you relax.
Avoid alcohol and recreational drugs. Abuse of alcohol and drugs will slow or prevent your recovery.
Complementary and alternative medicine

Herbal and dietary supplements sold in stores have become increasingly popular. People take them to help prevent or treat a number of health conditions. Some of these alternative therapies are being studied to determine their effectiveness in helping depression. With additional studies, researchers may know more about these products, how effective they are and if they can cause other health problems or interfere with medications.

In the meantime, talk with your doctor before taking any herbal or dietary supplement. A problem with herbal and dietary products is that they aren't regulated. The FDA doesn't test them for safety, purity or effectiveness. That means you can't always be sure of what you're getting or if it's safe. Also, if you're already taking medications, herbal or dietary supplements may interfere with the way they work, or could cause dangerous interactions.

Some popular supplements marketed or taken for treatment of depression include:

St. John's wort. St. John's wort is an herbal preparation from the Hypericum perforatum plant. It has long been used in folk medicine, and today it's widely prescribed in Europe to treat anxiety and depression. In the United States, it's sold in health food stores and pharmacies in the form of tablets or tea.

European studies suggest that St. John's wort may work as well as antidepressants in mild depression and with fewer side effects. However, some studies have found that St. John's wort isn't effective in treating major depression. Adverse reactions include dry mouth, dizziness, digestive problems, fatigue, headache and sexual problems. In most cases, signs and symptoms are mild. Of concern is that St. John's wort can interfere with the effectiveness of prescription medications, including antidepressants, drugs to treat human immunodeficiency virus (HIV) infections and AIDS, and drugs to prevent organ rejection in people who've had transplants.

SAM-e. Pronounced "sammy," short for S-adenosyl-methionine, this chemical substance is available in Europe as a prescription drug to treat depression. In the United States it's sold as an over-the-counter dietary supplement.

SAM-e is a chemical substance found in all human cells and plays a role in many body functions. It's thought to increase levels of serotonin and dopamine. Some studies have found SAM-e to be more effective than a placebo, but no more effective than treatment with antidepressant medications. The pills are expensive, especially considering their effectiveness is unproved. SAM-e can cause nausea and constipation.
5-HTP. One of the raw materials that your body needs to make serotonin is a chemical called 5-HTP, which is short for 5-hydroxytryptophan. In theory, if you boost your body's level of 5-HTP, you should also elevate your levels of serotonin. But there's not enough evidence to determine if 5-HTP is effective and safe. Larger studies than have been conducted to date are needed.

Omega-3 fatty acids. Omega-3 fatty acids are found in fish oil and certain plants. They're being studied as a possible mood stabilizer for people with bipolar depression and other psychiatric disorders.

Fish oil capsules containing omega-3 fatty acids are sold in stores. The capsules are high in fat and calories and may produce gastrointestinal problems. Another way to get more omega-3 fatty acids is simply to eat more fish, tofu, soybeans, walnuts, or canola or flaxseed oil.
From MayoClinic.com