Chronic Depression
What is it?
Depression is a strong feeling of sadness. Many people experience depression in response to a loss or sad event. In these cases, an episode of depression usually lasts for six to nine months. However, when depression lasts longer, and the depressive symptoms go away for a short time only to return again, it is termed chronic depression. While everyone experiences sadness at one time or another, these feelings are generally temporary. Chronic depression is long-lasting, interferes with daily activities, and causes a loss of interest in things that were normally pleasurable to the patient.
Who gets it?
People who have a family history of anxiety, depression, or bipolar disorder; are always anxious; or have an alcohol or drug abuse problem are more likely to develop depression. Women are twice as likely as men to experience
depression.
What causes it?
While depression is frequently a response to a sad or traumatic event, the cause of chronic depression is often not known. Factors that are known to contribute to depression are heredity, a chemical imbalance in the brain, and significant levels of stress. Heredity refers to the fact that people who have family members with any type of depressive disorder are more likely to also experience depression. Studies of brain functioning have revealed a complex system of neurotransmitters that produce chemicals that transfer signals from nerve cell to nerve cell. Some of these neurotransmitters, such as serotonin, are responsible for feelings of well-being. Drugs that correct neurotransmitter imbalances are very effective in treating depression, which supports the theory that there is some type of chemical imbalance that triggers depression. Chronic depression can occur when stresses in a person's environment become overwhelming, such as years of childhood abuse and neglect. It can also be caused by chronic illness, such as AIDS, Parkinson's disease, chronic fatigue syndrome, certain chronic cardiac conditions, and hormonal disorders.
What are the symptoms?
The symptoms of chronic depression may come and go, with periods of depression alternating with periods of no symptoms at all. Chronic depression usually begins gradually, with vague feelings of sadness that gradually build in intensity. The individual may begin to have difficulty sleeping, or want to sleep more than usual. He or she may experience changes in eating habits, feelings of hopelessness, low self-esteem, low energy levels, restlessness, loss of interest in normal activities, decreased sex drive, feelings of guilt for no reason, difficulty maintaining relationships, and difficulty concentrating. In severe cases, the individual may have thoughts of death, or may attempt suicide. People with chronic depression have at least two of these symptoms for a period of two years or more. People with chronic depression are generally gloomy and extremely critical of themselves and others. They are usually seen as extremely negative people, who seem to expect failure and take no pleasure in
anything.
How is it diagnosed?
Doctors diagnose chronic depression by common signs and symptoms. If you are seeing your family doctor, he or she will refer you to a psychiatrist or psychologist, who specializes in mental health. This doctor will ask you questions about your physical health, home and work environments, and any experiences that would affect how you feel about yourself and others. The doctor might use a special questionnaire that helps diagnose depression. The doctor will also ask about any drug or alcohol abuse, or physical illness that could cause depression. If you are a woman and your doctor suspects a hormonal disorder, he or she may order blood tests to make a
diagnosis.
What is the treatment?
Chronic depression is commonly treated with a combination of drug and psychotherapy. Drugs are used to treat the symptoms of sadness and to correct any chemical imbalances in the brain that contribute to depression. Therapy helps to resolve any personal issues that may have caused the depression. There are many different types of antidepressants and it is helpful to have a basic understanding of each type. One group of antidepressants is called selective serotonin reuptake inhibitors (SSRIs). Drugs classified as SSRIs include fluoxetine and sertraline. These drugs are very effective in treating chronic depression because they increase serotonin levels, which contributes to a feeling of well-being. Any side effects, such as headache, anxiety, diarrhea, sweating, difficulty concentrating, nausea, reduced sex drive, and difficulty sleeping, are generally milder than with other types of antidepressants.
Another type of drug sometimes used to treat chronic depression is a tricyclic antidepressant (TCA), such as amitriptyline, imipramine, and nortriptyline. However, these are not used quite as often because they have the possibility of more severe side effects, including persistent dry mouth, sedation, dizziness, and irregular heart rhythms. You may also have heard of a class of antidepressants called monoamine oxidase inhibitors (MAOIs). These include anylcypromine and phenelzine. MAOIs are so named because they block, or inhibit, the action of the enzyme monoamine oxidase in the central nervous system. However, they can cause severe and life-threatening side effects if combined with certain other drugs or foods. These include foods that are high in tyramine (such as soy sauce, beer on tap, red wines, and aged cheeses and meats), some over-the-counter cough and cold medicines, and both trycyclic and SSRI antidepressants. The combination of an MAOI and any of these causes a sudden and severe rise in blood pressure. People taking MAOIs must be aware of any food or drug interactions. One final category of antidepressant is the heterocyclics. These include bupropion and trazodone. However, bupropion is not given to patients with a seizure disorder. Tazodone can cause sedation, so it is often effective in treating patients with insomnia.
You and your doctor can decide which medication is best for you by reviewing your medical history and evaluating the risks of negative side effects. It may take anywhere from two to six weeks for you to feel the effects of an antidepressant. Antidepressants are not addictive. And, unless you are severely depressed, at risk for suicide, or unable to take care of yourself, hospitalization is generally not needed during treatment.
Just like there are different types of antidepressants, there are also different types of psychotherapy. Your doctor will help decide which is best for you, but all types focus on exploring what life experiences may have contributed to your current feelings. The therapist will help you develop special skills to cope with your problems. Electroconvulsive therapy (ECT, or shock therapy) is only used in cases of severe or chronic depression where medication and psychotherapy have not worked, the patient is dangerously suicidal, or refusing to eat. While the patient is under general anesthesia, electrodes are placed on the head and an electric current is applied, through the electrodes, to create a small, controlled seizure in the brain. The seizure appears to
"interrupt" the electrochemical processes in the brain that can cause depression and provides immediate relief. This procedure can cause temporary memory loss, headaches, muscle soreness, and confusion right after the
treatment.
Self-care tips
Many people with chronic depression do not seek treatment because they don't want people to know they have a mental illness. However, with proper treatment, people with chronic depression can lead full, productive lives. If you suffer from chronic depression, see a doctor. He or she can help create a treatment plan that will help you feel the way you want to. If your doctor recommends an antidepressant, take the recommended dose at around the same time each day. Even if you are feeling great, do not stop taking your medication or skip a dose without your doctor's permission. Antidepressants need to be reduced gradually to prevent side effects. It is also important to work with a therapist or support group to get help with any problems that are contributing to your depression. They can help you develop a positive attitude and a new way of looking at life and your problems. Recognizing your symptoms and taking control of them is an important step in becoming healthy again. And, never forget that what you eat, the amount of sleep you get, and how much you exercise all contribute to how good you feel. If you or someone you know has thoughts of suicide, call your doctor or therapist immediately. Also call your doctor if you have any negative side effects from an antidepressant.
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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