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Depression

If you are reading this because you suffer from depression or you know or care for someone who does, or even if you're not sure, then rest assured, you're far from alone.

Everyone has bad days when life no longer seems worthwhile, difficult tasks suddenly seem impossible and problems seem like they will never be solved. Most people are able to shrug off those feelings and go on to have better days. When the bad days outweigh the good and start to stretch into weeks and then months, however, then that can indicate a bigger problem.

This article aims to help people understand what depression is; a recognised, treatable medical illness, and to help people recognise the symptoms in themselves and others.

What is Depression?

Depression is a medical term used to describe symptoms of psychological distress. In its mildest form, depression can cause lowered mood, a reduced enjoyment of life and can make everyday life feel harder and less worthwhile. Severe depression can become life-threatening, people may feel like killing themselves or give up the will to live.

Feeling sad or fed up with life can affect everyone. The difference with depression is that it is an actual illness, which causes intense feelings of sadness or hopelessness and can also cause physical problems, such as loss of energy and sleep disturbance.

Depression is not a sign of personal weakness and people with a depressive illness cannot simply "snap out of it". Depression is, however, a treatable illness and forward progress in the different treatments is being made every day.

There are several different types of illness falling into the category of "depressive disorders"



Major Depression: A combination of symptoms which seriously interfere the ability to work, study, sleep, eat and enjoy life.

Dysthymia: This is a less serious form of depression, which involves less serious symptoms, which make life feel more difficult than usual and keep sufferers from functioning well or feeling good.

Bear in mind that the categories above are simply used to group people together and the root cause of the depression is the same.

Bipolar Disorder: This is also referred to as "Manic Depression" and is less common than other forms of depression. People suffering from bipolar disorder can cycle between intense highs (known as mania) and lows (depression).

Symptoms of Depressive illness

Depression and bipolar disorder can affect different people in different ways, which can make it difficult for others to recognise the illness. Generally, depression and mania result in the following symptoms:

Depression:

Tiredness and lack of energy
Feelings of persistant sadness or hopelessness
Loss of confidence, feelings of low self-esteem
Feelings of guilt, worthlessness
Feelings of numbness or emptyness
Reduced enjoyment of activites that were usually pleasurable
Sleep disturbance, such as not being able to sleep, early-morning awakening, or oversleeping
Difficulty in concentrating, remembering or making decisions
Avoidance of other people, even close friends.
Appetite and/or weight loss or overeating and weight gain
Raised use of tobacco, alcohol or drugs
Loss of sex drive and/or sexual problems
Thoughts or acts of self-harm or suicide
Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain

Mania:

Increased physical and mental energy
Decreased need for sleep
Racing speech, racing thoughts
Increased sexual desire
Grand notions, feelings of self-importance
Increased feelings of irritability and/or agressive behaviour
Impulsive and/or easily distracted
Reckless behaviour, poor judgement
In more severe cases, delusions and/or hallucinations

As a general rule, people who have experienced four or more of these symptoms for most of the day, every day, for over two weeks should seek help.

Some people suffer from Anxiety Disorders, which while different from Depressive Disorders, can disrupt your life and functioning just as badly.

What is Generalized Anxiety Disorder?

The core symptoms of GAD are persistent psychological anxiety, nervousness, or worry that continue over time and that are to some extent uncontrollable—that is, the person cannot put these symptoms out of mind at will.” (R. Kessler, 2002)

Symptoms:
Apprehension (worries about future misfortunes, feeling "on edge", difficulty in concentrating, etc.);
Motor tension (restless fidgeting, tension headaches, trembling, inability to relax); and
Autonomic overactivity (lightheadedness, sweating, tachycardia or tachypnoea, epigastric discomfort, dizziness, dry mouth, etc.). ICD-10)

Common symptoms: (DSM IV)
Restlessness or feeling keyed up or on edge
Being easily fatigued
Difficulty concentrating
Irritability
Muscle tension
Sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep)

The sufferer must have primary symptoms of anxiety most days for at least several weeks at a time, and usually for several months.

Panic Disorder

Panic disorder is a common, chronic illness. Although panic symptoms have been well described for over a century, only in the past decade it has become widely recognized as a distinct psychiatric illness. In panic disorder, brief episodes of intense fear are accompanied by multiple physical symptoms such as heart palpitations and diziness that occur repeatedly and unexpectedly in the absence of any external threat. These "panic attacks" are believed to occur when the brain's normal mechanism for reacting to a threat--the "fight or flight" repsonse--becomes inappropriately aroused.

The intensity of the attack can be extremely severe and many people feel they are having a heart attack an/or are going to die.

A panic attack involves the sudden onset of at least four of the following symptoms:
Chest pain or discomfort.
Choking.
Dizziness, unsteady feelings, or faintness.
Fear of dying.
Fear of going crazy or losing control.
Feelings of unreality, strangeness of detachment from ones environment.
Flushes or chills.
Nausea or abdominal distress.
Numbness or tingling sensation.
Palpitations (throbbing) or accelerated heart rate.
Shortness of breath or a smothering sensation.
Sweating, trembling, or shacking.

Symptoms must peak within 10 min and usually dissipate within minutes, leaving little for a physician to observe except the person's fear of another terrifying panic attack.


If you or someone in your life is suffering from any of these disorders, it can be frightening and knowing where to start to get better is daunting. Usually, a trip to your MD is in order, if the symptoms are disrupting your life. Most people feel very hesitant to speak with their doctors about something like this, fearing negative reactions, judgement, or social ostracization. However, it is estimated that up to 10% of the population of most industrialized nations feel the effects of these disorders at some point during their life. Your doctor will not be shocked, nor will he be judgemental! In some instances your doctor may be able to prescribe an anti-depressant medication, or an anti-anxiety medication that will stop your symptoms. If your doctor doesn't feel qualified to deal with it himself, he will be able to refer you to someone who can. Some people find that with just a few months of medical treatment, they are symptom free. Others find they need to continue to take medication for the rest of their lives, but have no symptoms so long as they take their medication as indicated by their doctors. Yet others find that talk therapy or behavioral therapy will help them enormously and don't need medication at all.

Many people find that an online support group is a wonderful way to deal with the way they're feeling. The advantages to an online support group include anonymity, the ability to talk about things that you're not comfortable discussing with immediate family members or friends, and the ability to find someone to talk to 24 hours a day. Any search engine will be able to provide numerous links to depression support groups, using either "Depression Forums" or "Depression Support Online" as your keywords. Important things to remember when looking for online support is that you want a group of people who are supportive and who want to get well too. Also, remember online security! Don't give out personal information that will identify you directly or where you live without getting to know everyone first!

***Numbers to call for more information, or if you're in danger of hurting yourself right now***

In the USA, for adults:

National Hopeline Network
1-800-SUICIDE
1-800-784-2433

Suicide Prevention Hot Line
1-800-827-7571

National Crisis Line
1-866-334-HELP
1-866-334-4357

In the USA, for teens:

Children of the Night
1-800-551-1300
Talk, 24hrs a day about anything. If they cant help, they will refer you to someone who can.

Youth Crisis Hotline
1-800-448-4663

Boys Town USA
Girls & Boys Town
National Hotline
1-800-448-3000
TTY: 1-800-448-1833
Email: Hotline@boystown.org

In Canada:

Kid's Help Phone
1.800.668.6868

Child Abuse Hotline
1.800.387.KIDS (5437)

Northern Alberta only: Distress and Suicide Line
1.800.232.7288

In Australia:

Kids Free Help Line
1.800.551.800

Helpline
Mental illness information and referral
1.800.817.569

Lifeline
131.114

In the UK:

Department of Health, Richmond House, 79 Whitehall, London SW1A 2NL, UK.
Tel: + 44 (0) 20 7210 4850 (10am - 12.30pm and 2pm - 5pm Monday to Friday).
Email: dhmail@doh.gsi.gov.uk Minicom: + 44 (0) 20 7210 5025. Website: www.doh.gov.uk
Responsible for health care services within England including The National Service Framework for Mental Health

Mind, Granta House, 15-19 Broadway, London E15 4BQ, UK.
Mind Information Line: + 44 (0) 20 8522 1728 if you live in Greater London or + 44 (0) 8457 660 163 if you live elsewhere (9.15am-4.45pm Mon, Wed & Thur)
Email: email@mind.org.uk
Website: www.mind.org.uk
Covers all aspects of mental health including legal matters for service users, carers, family and friends, researchers, students, service providers and the public.

NHS Direct
Tel: + 44 (0) 845 4647.
Website: www.nhsdirect.nhs.uk/
A 24 hour nurse-led telephone advice and information service, part of the National Health Service.
Can advise you about local health care services in your area.


If you need someone to talk to urgently and in confidence – the Samaritans are able to offer emotional support 24 hours a day.
Call them on 08457 90 90 90 or visit their website at www.samaritans.org.uk

SANE also offer a helpline, which runs from 12 noon until 2am. The number is: 0845 767 8000 or visit their website at http://www.sane.org.uk

Sources:
MIND - http://www.mind.org.uk
Depression Alliance - http://www.depressionalliance.org
National Institute of Mental Health (USA) - http://www.nimh.nih.gov/publicat/depression.cfm
The Depression and Bipolar Support Alliance (DBSA) - http://www.dbsalliance.org
National Statistics Online - http://www.statistics.gov.uk




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