Depression

There was a time, not so long ago, when people were afraid of talking about depression. People saw depression as a “weakness”, an inability to handle the normal ups and downs of life. Fortunately that time has passed. We now understand that depression is NOT a weakness in one’s personality, but a medical condition that causes an imbalance in the neurotransmitters in the brain. Sure, the stresses of modern life do have an impact on us, and may be part of the trigger that brings on a bout of depression, but ANYONE can get depression, regardless of how “hard” or how “easy” their life is.


Impact

At any given time, about 7% of the population is suffering from depression, and over a lifetime, 20% of people will get at least one bout of depression. The severity of depression can vary greatly, from a brief episode of “the blues,” that may not require any treatment, to a severe bout of Major Depression that may cause problems with work, family, drug use and sometimes suicide.  America has about 45,000 suicides per year, most of which are preventable with proper treatment.


Causes

The brain has dozens of neurotransmitters – small chemicals that pass back and forth between cells in the brain; this is how they communicate with each other to form the complex “neural network” that allows the brain to work.  It is this network of cooperating neurons that give us our intelligence an our personality; it allows us to solve problems, create art and music, and interact with other people. However, with this complexity, errors can sometimes occur. The transmitters can get out of balance and make us too moody, or too sleepy, or too angry. Serotonin is a very important neurotransmitter. Among other things, it give us a sense of calm and contentedness. When it’s levels get to low, we don’t feel right, may not be able to think straight, may not be able to sleep well. This is Depression.


Treatment

Psychotherapy has been a mainstay of depression treatment in the past, and is still very useful, but we also now have medications that are able to address more directly the real root of the problem. They work by adjusting the amount of serotonin and other transmitters in the brain (epinephrine, norepinephrine, dopamine, etc.). The SSRI’s (Selective Serotonin Re-uptake Inhibitors) are a very important class of medications. Examples include Prozac (fluoxetine), Zoloft (sertraline), Celexa (citalopram), Lexapro (escitalopram) and many others. They affect serotonin, and little else. Wellbutrin (bupropion) has some similar effects, but does so in a different way. Effexor (venlafaxine) affects both serotonin and norepinephrine. There are many others, whose names are less familiar – Seroquel, Elavil, Amitriptyline, etc., etc. The SSRI’s are often the first drug tried, but depending on your particular symptoms, your mood, your sleep patterns, a different drug may be right for you. This is where the psychiatrist or the psychiatric nurse practitioner comes in. They are highly trained in understanding the varying effects and side-effects of these drugs, to help decide which one is right for you.